By Cathryn Domrose
December 9, 1999
Photo: Photodisc

Thanks to a new law, some hospitals will be allowed to hire foreign-trained RNs to temporarily alleviate severe staff shortages. But the new short-term visa program, H-1C, will be much stricter than the similar H-1A program, which was subject to abuse, according to the American Nurses Association (ANA).

The Nursing Relief for Disadvantaged Areas Act, signed by President Clinton last month, allows temporary visas for up to 500 foreign nurses each year. But the visas come with several requirements. The nurses must have passed all necessary licensing exams and be ready to work, they must work in underserved areas at hospitals with at least 190 beds, and they must be paid prevailing wages. Furthermore, the foreign-trained nurses cannot replace nurses who have been laid off. The program automatically expires after four years.

“A very limited number of hospitals can use it,” said Cheryl Peterson, RN, a senior policy fellow for the ANA, which stayed neutral on the bill. “The reality is that we should not be solving our workforce problems by bringing in foreign nurses.”

Crisis at two hospitals

The legislation was drafted in response to critical nursing shortages in two hospitals, St. Bernard Hospital and Healthcare Center in Chicago and Mercy Regional Medical Center in Laredo, Texas. Administrators said they could not attract U.S. nurses, because their hospitals are in areas considered undesirable or remote.

“Laredo has always had difficulty recruiting,” said Stephanie Tabone, RN, director of practice for the Texas Nurses Association (TNA). “It’s just way down south, there’s not much around, it’s not a real popular area.”

Avoiding abuses

Under the H-1A visa program, which expired in 1996, 6,000 to 7,000 foreign-trained nurses a year entered the country, according to the U.S. Department of Labor and the Immigration and Naturalization Service (INS). Most came from English-speaking countries and the Philippines—nations with training and education programs similar to those in the United States, Peterson said.

The ANA opposed extending that program because a nursing shortage in the mid-1980s had ended and some hospitals were laying off nurses. Peterson also cited cases of recruiters who fraudulently brought in nurses from abroad, then put them in lower-paying positions or did not pay prevailing wages. In many cases, the foreign nurses did not complain, she said, because they were afraid of losing their green cards.

In the most notorious case, more than 500 nurses from the Philippines and South Korea were smuggled into the country on fraudulent visas to work mostly at nursing homes in Texas and Oklahoma. According to the TNA, the illegally hired foreign nurses caused prevailing wages in Texas to drop from $14 an hour to about $11 an hour. Some of the foreign nurses, who had paid $7,500 for their visas, were given jobs as nurses aides at $5 an hour.

“There was a lot of open-ended language in that bill that allowed people to do almost anything,” Tabone said. “It was a terrible situation. There were so many ways to bring people over here who weren’t qualified.”

Shortage is spotty

The ANA does not document a general nationwide nursing shortage now, Peterson said, but recognizes that hospitals in rural and poor areas are having trouble finding nurses, especially in specialties like OR and ER. She blames this in part on a lack of orientation and mentoring programs, which were cut by many healthcare facilities to save money. To complicate matters, older nurses in specialty areas are retiring and younger ones are not taking their places, she said.

“Hospitals need to take another look at the type of environment that they’re putting people in to work,” she said. “We have a lot to clean up if we’re going be able to recruit the number of nurses we need.”

Nursing and agriculture are the only fields with special temporary visa programs, said Eyleen Schmidt, a spokesperson for the INS. Employers may hire temporary foreign workers under a general visa program called H-1B. But the H-1B program is restricted to bachelor’s-degree jobs and workers, said Patrick Stange, a branch chief for the Department of Labor. Since many hospitals and nursing homes do not require bachelor’s degrees for all their RNs, they are often not allowed to hire nurses under the H-1B program, Stange said.

Hospitals can hire foreign-trained nurses with permanent visas, which allow the nurses to stay in the country and work where they wish. Because the Department of Labor considers nursing a shortage profession, Stange said, employers do not need an employment-based visa for qualified foreign-trained nurses. It usually takes the INS six months to a year to process a permanent nursing visa, Schmidt said.