Nursing a problem

Will the recruitment of health-care workers from overseas ease the shortages at U.S. hospitals?

Published November 3, 1999 5:00PM (EST)

Some hospitals in desperate need of registered nurses will be able to recruit these health professionals from overseas, under a measure passed by the House Tuesday and expected to be signed by the president.

Despite vigorous recruiting drives, many inner-city hospitals are having a difficult time attracting nurses. Even the nursing association agrees that the shortage that eased after the 1980s may be creeping back into the profession. But no one can figure out just why this is happening. In the meantime, advocates say, this legislation can fill the gap.

"What a great day,'' says Steve Nemerovski, a lawyer for St. Bernard Hospital in Chicago. The hospital has had to shut down beds and is on the verge of using contract nurses in order to maintain its standard of patient care ever since the federal law allowing foreign nurses to come to the U.S. expired in 1997. The program was allowed to expire after an advisory committee found the shortage had eased.

Under this bill, 500 foreign nurses will be able to come to the U.S. each year, but they will only be eligible to work in underserved areas. The bill was narrowly drafted to avoid opposition from American nurses. In addition, there is currently no evidence that there is a widespread nursing shortage beyond these inner-city pockets.

These foreign nurses not only have to have nursing certificates from their home country, but they must also have a nursing license from the state they are going to work in. And hospitals must pay them the prevailing wages and cannot use them to replace nurses that have been laid off. These safeguards were negotiated between lawmakers and the nursing associations. (The bill expires in four years.)

"The state of health care is a grave concern in my district,'' said Rep. Bobby Rush, D-Ill., sponsor of the bill, Tuesday on the House floor. The Senate passed the measure last week. "The legislation we must pass today is aimed at helping hospitals, like St. Bernard, keep their doors open to the communities they serve.''

St. Bernard is the only hospital in Englewood, a high-crime area on Chicago's south side. Without this bill, the hospital would have to again use contract nurses, a practice that almost forced the institution to close in 1992, Rush said, because the labor costs for those nurses added $2 million to the community institution's budget. American hospitals turned to foreign nurses in the 1980s as a way to cope with a massive nationwide nursing shortage. The vast majority of these nurses -- about 80 percent -- came from the Philippines.

The shortage abated in the early part of the decade as more nurses graduated from nursing schools and came on board. In recent years, the advent of managed care, which has led to shorter hospitals stays, led hospitals to re-evaluate their staffing patterns. Many began downsizing their nursing ranks. Many of the nurses who lost their hospital jobs began working for managed care organizations, home health organizations and other growth areas in the health field.

Now, said Cheryl Peterson, a policy analyst for the American Nurses Association, hospitals are again rethinking those staffing cutbacks and beginning to hire more nurses.

Only three weeks ago, Calif. Gov. Gray Davis signed a bill that provides for nurse staffing requirements for all hospitals. This is the first-time any mandate has been made; standards will be set by the state Department of Health Services and take effect in 2002.

The ANA has historically been leery of foreign nurse programs and campaigned against them because they believe they cost American nurses jobs. In this instance, Peterson said, the organization has remained neutral. "The reality is we have a shortage of experienced specialty nurses,'' Peterson said. The average age of nurses today is 44. Something has to be done to replenish the ranks.

"We're an aging workforce. Ten years down the road, when we're in our mid-50s and our backs are hurting and there's an environment less conducive to good nursing, we're going to see a lot of nurses jumping ship,'' Peterson added.

The ANA also stayed neutral on this bill because it recognized there is a problem in some areas where nurses just don't want to work. This bill was narrowly drawn to apply just to such areas. Before a facility can apply for these special visas, they have to meet certain requirements. For example, the hospital must: be located in a Health Professional Shortage Area, as defined by the Department of Health and Human Services; have at least 190 acute care beds; and have a Medicare population of 35 percent and a Medicaid population of at least 28 percent.

At St. Bernard's, they have done all they can to recruit nurses, Nemerovski said. But even when they are successful in recruiting nurses, they face another challenge: retaining them. Nemerovski said that is the hardest part.

"As sister Elizabeth, St. Bernard's administrator says, 'Englewood is a place that people want to be from,'" Nemerovski said. So often, the hospital will train young nurses and once they get six months or a year of experience, they leave St. Bernard for a more desirable job. The Illinois Nurses Association has been working with the hospital to try and find out what can be done to better attract nurses to St. Bernard. In the meantime, the hospital will wait impatiently for President Clinton to sign the bill and the U.S.. Labor Department to write the regulations so they can begin importing nurses to the bed sides at St. Bernard's.

By Dena Bunis

Dena Bunis is Washington bureau chief of the Orange County Register.

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