The newest U.S. import: nurses
The newest U.S. import: nurses
Date: Sunday, June 01, 2003 7:30 PM
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According to this article, the nursing shortage is so severe that the
Philippines, Canada and Australia can't send us enough of them to meet
the demand. Texas probably depleted the world's supply of foreign
nurses faster than the rest of us sucked Texas crude oil out of the
ground because since the 1970s about 30,000 foreign nurses were
imported into Texas hospitals. A 30 year shortage is for all intents
and purposes a permanent shortage.
Note: In 1976 the Eilberg Ammendment declared a permanent shortage of
college professors. Let's just say that the timing of these two events
is rather fishy.
Some of this "shortage" is blamed on the fact that more stringent
testing has been imposed on foreign nurses. It used to be (in Texas
especially) that anybody that could change a bedpan could come to the
U.S. to be a nurse. Hospitals now assure us that they screen nurses
with tests like English proficiency. How much you wanna bet that the
Bush family designed the English test? (See
http://politicalhumor.about.com/library/weekly/aa102400a.htm for
information about Bushisms.)
Now foreign nurses are required to be able to utter some English words.
Not surprisingly hospitals are applying for Green Cards so they don't
have to meet H-1B regulations that require foreign nurses to be RNs -
or to have fake diplomas.
Next time you see a nurse you may want to ask her whether she is a H-1B
or a Green Card holder - that is if she can understand you! According
to this article most foreign nurses are women so if you have a male
nurse don't worry about it.
Soon H-1C will open the door for a flood of foreign nurses and then
none of these issues will matter anyway, except that self-proclaimed
nurses will still be required to pass a basic English test. It will
back to business for hospitals that want to bring in cheap nurse
imitations from overseas to cut costs.
http://www.dallasnews.com/sharedcontent/dallas/business/stories/060103dnbusNursesanytime.4c15.html
The newest U.S. import: nurses
Strapped for staff, hospitals are looking overseas
06/01/2003
By ROGER YU / The Dallas Morning News
At the end of May, Deepa Kurup reined in her travel anxiety, hopped on
a plane and left India for the first time in her life.
The 26-year-old's five-day trip to Saipan was the beginning of what she
hoped would be a long and rewarding career as a nurse in the United
States. At the island, a U.S. territory, she took the second of two
demanding exams that are required to work in this country.
"I'm very excited," she said in anticipation of her trip. "I've never
been outside of India, so I don't know what to expect. And I think I
won't be able to fully explain my experience until I return from the
exam. Hopefully, it will be good."
Ms. Kurup's odyssey puts her in the vanguard of an urgent trend in
American health care: The ever-widening global search for nurses.
Traditional overseas sources for nurses the Philippines, Canada and
Australia, among them have been heavily tapped, experts say. Now
recruiters are turning to India as the chronic U.S. nursing shortage
only threatens to get worse.
"With the shortage of nurses, health care companies are turning to
international countries to hire qualified people to fill vacancies,"
said Mary Prascher, human resource manager at Plano-based Triad
Hospitals Inc. "India now is being recognized as one of those areas
that offers bachelor-degree nurses, and a good health care system with
an abundance of nurses."
A recent federal report projected that the U.S. health care workforce
now at 2 million people must triple by 2050 to meet the needs of the
large, aging baby boom generation. Nursing is one of the most critical
areas, with many hospitals already battling double-digit vacancy rates.
Rushing into the breach are recruiters from companies as diverse as big
hospital chains and small start-up firms. Ms. Kurup, for example, owes
her prospective U.S. career to Nurses Anytime, a small Dallas-based
firm started by technology entrepreneur Shiek Shah to target the Indian
market.
Triad, which owns 49 hospitals, began to seriously recruit
internationally in 2001 and so far has 250 foreign applicants in
testing or obtaining visas. None are from India, but the hospital may
initiate an India recruiting project next year, Ms. Prascher said.
Texas Health Resources, one of the area's largest hospital chains with
13 facilities, began to recruit internationally two years ago until the
events of Sept. 11 put that effort on hold.
But with the nursing shortage still unsolved, the hospital has revived
the effort. The Arlington-based company should have a dozen or two
overseas recruits by year's end, according to Mark Morales, vice
president of planning and development.
Grueling process
The process of getting Ms. Kurup and others like her to the United
States is filled with red tape, nerve-wracking interviews with
immigration officials and hours of training to prepare for mandatory
exams.
The tight regulations were born out of concerns about the exploitation
and quality of nurses imported from other countries.
The influx of foreign nurses to Texas hit its peak in the 1970s, when
about 30,000 signed on to work in the state, said Clair Jordan, Texas
Nurses Association executive director.
Nurses then were typically brought in under temporary H-1 work visas.
But following a series of investigations of labor exploitation charges
in the late 1990s, the screening and visa process for foreign nurses
was tightened.
The more rigorous screening raised the quality of the nurses migrating
to U.S. hospitals, proponents of the regulations say.
"Many were brought in as registered nurses, but they weren't qualified
to be RNs," said Stephanie Tabone, the nurse association's director of
practice. "And many stayed even if they couldn't pass the RN test, and
many got passed around to [long-term] care homes. A lot of them were
horribly exploited."
The federal government no longer issues nurse H-1 visas, except for
special cases. Applicants instead undergo interviews for permanent
residency status.
The recruitment process takes up to 18 months to complete. It has
become so grueling that many hospitals employ international recruitment
firms rather than commit the time and resources to do the job
themselves.
Mr. Shah, the recruiter, wasn't in the health care business but
recognized the growing demand for nurses while running a tech services
company that recruited low-cost software designers from India and
Russia.
Mr. Shah, a former EDS executive, and business partner Andrew Thorby
founded Nurses Anytime nine months ago. The company maintains six
recruiting-training offices in India and two others in the Middle East.
Its business prospects and credibility got a big lift when it signed
with Arlington-based Nursefinders Inc., one of the region's largest
nurse placement firms.
Nurses Anytime will see no revenue until later this year, when it hopes
to place its first group of 19 nurses. It expects to raise that figure
to 200 by the end of 2004.
The company plans to retain its recruits technically as employees even
as they work at client sites nationwide. Nurses typically sign
three-year contracts with the company.
The arrangement in which the company gets a fee based on hourly wage
rates minimizes client hospital commitments and renders better control
to Nurses Anytime over benefits and retention, Mr. Shah said.
"If I have 1,000 nurses, I have leverage," Mr. Shah said. "If one nurse
is being treated unfairly, I can pull her from the hospital."
Given the industry's history, Mr. Shah said that his recruiters closely
scrutinize the competence of incoming nurses.
Nurses Anytime estimates it will spend about $2.6 million for
training, visa paperwork and temporary living expenses for the 200
nurses in its program until they land permanent jobs in the United
States.
Tough competition
Even with a surplus of nurses in India, competition for qualified
candidates is stiff.
Ads from competitors promising high pay, luxury living styles and
professional opPORT 66,69,254,99,132,95
It's so front-loaded."
Even after the visa process, nurses have to pass another test,
administered by the National Council of State Boards of Nursing and
issued only in the United States or its territories.
To qualify to work in the U.S., nurses also have to get a passing score
on the Test of English as a Foreign Language, or TOEFL.
No amount of preparation, however, can prepare nurses for the life they
will face in the United States. Foreign nurses must adjust to the
cultural changes in their professional and personal lives.
Nurses Anytime recruit Melody D'sa, 37, puts on a brave face, knowing
that under U.S. immigration policies she will have to be away from her
husband and 7-year-old son in India for a year. When asked about her
outlook on moving abroad, she replied that she makes friends easily and
that she "can just fit into any community."
Still, ensuring a smooth cultural transition remains a concern for
hospitals and recruiters.
Nurses Anytime, as well as Triad and Texas Health Resources, have
programs to help with temporary housing and basic tasks, such as
getting a driver's license and finding the nearest grocer.
There are professional issues to contend with as well.
More advanced medical technology and different clinical approaches in
the United States pose a daunting learning curve.
Randall Turnbull, vice president of the international group for
Nursefinders, and many hospital executives largely dismiss such
concerns. They say nurses' fundamental knowledge of the field allows
them to eventually adapt to professional differences.
"These nurses are coming from countries whose schools changed
curriculum to match the U.S.," he said. "So these nurses are trained
just as well as they are here."
Ms. Jordan of the Texas Nurses Association isn't convinced, and says
she sees American nurses at times "concerned about the quality of care"
resulting from international recruiting.
"They're not as comfortable when turning over the patients to them, and
I see that reservation," she said.
Nursing officials also express concern that foreign nurses, due to
different cultural practices, may not be as assertive in dealing with
doctors.
Mr. Shah said nurses will need to learn to be more assertive in the
United States, just as his information technology recruits were forced
to do. That, too, will come with time, he said.
"As in IT, they will learn to say no," he said.
E-mail ryu@dallasnews.com
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essional differences.
"These nurses are coming from countries whose schools changed
curriculum to match the U.S.," he said. "So these nurses are trained
just as well as they are here."
Ms. Jordan of the Texas Nurses Association isn't convinced, and says
she sees American nurses at times "concerned about the quality of care"
resulting from international recruiting.
"They're not as comfortable when turning over the patients to them, and
I see that reservation," she said.
Nursing officials also express concern that foreign nurses, due to
different cultural practices, may not be as assertive in dealing with
doctors.
Mr. Shah said nurses will need to learn to be more assertive in the
United States, just as his information technology recruits were forced
to do. That, too, will come with time, he said.
"As in IT, they will learn to say no," he said.
E-mail ryu@dallasnews.com
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