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Cynthia Garcia, RN, remembers the potent mix of thrill
and trepidation that coursed through her the moment
she learned she'd landed a job in the United States.
The Filipino nurse knew she'd have to endure a difficult
separation from her tight-knit family, but soon she'd
be earning $1,600 per month instead of $50. She'd have
a chance to pursue a better life and regularly send
money to her family.
That was almost 20 years ago. Today, Garcia is working
to give other nurses from the Philippines the same opportunity
at her hospital, Methodist Medical Center in Dallas.
The 60 nurses she has helped recruit will have the
chance to drastically increase their income and will
fill positions that have been difficult to fill during
the nation's nursing shortage.
But critics of foreign nurse recruitment point to a
darker side to the practice of hiring international
nurses for positions in American hospitals. They suggest
that recruiting foreign nurses is a short-term solution
to the shortage and argue that hospitals shouldn't be
doling out thousands of dollars to recruit each foreign
nurse, but instead should direct that money to strategies
that will attract Americans to those jobs. Opponents
also question the morality of taking nurses from countries
struggling with shortages of their own.
Cheryl Peterson, MSN, RN, senior policy fellow at the
American Nurses Association, said that U.S. hospitals
cannot recruit internationally with integrity until
they start "tending to their own business."
"The drawbacks are related to the fact that we
are using immigration as a way to deal with our nursing
shortage without addressing the root causes as to why
we have a shortage," she said.
"Hospitals need to look at their work environments
and cultures. From the ANA perspective, we believe we
should be investing in our own and building a strong
profession here."
Even if it means closing units because there are no
American nurses to fill those positions, Peterson said
this may be a cost necessary to establish long-term
solutions to the shortage.
Worldwide shortage
Peterson and organizations such as the International
Council of Nurses also question whether it's ethical
to recruit nurses from countries that are just as desperate
to find nurses for their own hospitals.
"Recently, aggressive international recruitment
is on the increase," according to the council's
position statement on ethical nurse recruitment. "This
type of recruitment focuses on large numbers of recruits,
sometimes significantly depleting a given health facility
or contracting an important number of newly graduated
nurses from a given educational institute."
Peterson also wonders whether hospitals are providing
adequate transition programs for the foreign nurses.
According to a recent study by the Commission on Graduates
of Foreign Nursing Schools, almost 20 percent of the
foreign nurse respondents indicated that they had difficulty
with communication and said a better understanding of
both the English language and U.S. health care terminology
would have eased their transition to the United States.
While several nurse executives agree that seeking nurses
abroad is a short-term solution, they also argue that
there is no alternative.
Chief Nurse Executive Linda Daum, MBA, RN, at McAllen
Medical Center acknowledges that her hospital is hiring
foreign nurses, but at the same time, the facility is
investing in the American nursing system. The hospital
subsidizes faculty salaries at local colleges with nursing
programs, pays relocation costs for instructors and
provides money for scholarships for nursing students.
"Foreign recruitment is a short-term solution,
and I'd rather hire an American nurse," Daum said.
"But when I had 130 openings in my system, I couldn't
wait two years to get new faculty hired and new people
graduated [in the United States]."
Supply and demand
But Paula Bradney, RN, director of staffing and recruitment
at Mesa Lutheran Medical Center and Valley Lutheran
Medical Center in Arizona, contends that foreign nurses
may not necessarily be a short-term solution to the
shortage.
"It's a supply-and-demand issue, and we don't
have the supply in the United States," she said.
"To do nursing, you have to be passionate about
patients because nursing is a tough profession. The
work is hard and you have to have a service mind.
"Young Americans today are not so interested in
service professions. What's wrong with offering other
people the opportunity to experience the benefits of
living in the United States? A lot of people come from
very poor countries," Bradney said.
Even though foreign nurses are an appealing option
for many hospital executives, Beth Mancini, MSN, RN,
FAAN, of Parkland Health & Hospital System in Dallas
is channeling her efforts toward recruiting in the United
States. Mancini said the costs of hiring foreign nurses
have substantially increased. Several nurse executives
said it costs about $10,000 to recruit an international
nurse today and can take between 18 and 24 months for
the nurse to arrive.
Mancini said her hospital needs nurses who speak Spanish
and, as a result, the hospital is focusing on finding
nurses who were licensed in Mexico but live in Dallas.
If these nurses moved to Dallas within the last two
years, the hospital provides preparatory courses to
help them take the nursing license exam. If they haven't
worked in the last two years, then the hospital offers
programs to help them pay for re-entering school.
We recognize that it's a worldwide shortage,"
Mancini said. "When you do international recruiting,
you aren't doing anything to increase the global net
population of nurses. That's why reaching populations
that are typically underrepresented, such as Hispanics
or men, is ideal because then you aren't taking from
Peter to pay Paul."
But Carl Shusterman, JD, chairman of the health care
professionals committee of the American Immigration
Lawyers Association, takes a different stance on the
recruitment of foreign nurses. "I figure those
nurses are going to leave their countries and come to
Western countries one way or another," Shusterman
said.
"At least if nurses are in U.S. hospitals, they
will be valuable to the health of Americans."
Nurse executives also point out that one of the most
popular countries for recruiting, the Philippines, trains
more nurses than it can use. The nurses are essentially
one of the country's exports and many send money back
to their families in the Philippines.
Judy Pendergast, JD, RN, director of planning, marketing
and communication at the Commission on Graduates of
Foreign Nursing Schools, said she recognizes that it's
ethically complicated to recruit nurses from countries
facing their own shortages, but it's also a nurse's
right to decide where he or she wants to practice.
"Migration and movement is a human right, and
it should be the right of the nurse to decide where
he or she lives," Pendergast said.
Time of transition
Advocates of foreign nurse recruitment also cite evidence
to show that international nurses are well taken care
of when it comes to making the transition to the United
States.
Now, facilities such as St. Mark's Hospital in Salt
Lake City work hard to help international nurses make
a smooth entrance into their new jobs and communities,
said Pauli Marr, vice president for patient care services
at St. Mark's Hospital. She's trying to negotiate a
deal to have local residents house foreign nurses who
are scheduled to arrive in the fall.
"It's very important to have a community for the
nurses to live in," she said. "They need to
have a place where they feel safe."
The hospital also initially provides meal tickets for
the nurses and helps them set up bank accounts. Preceptors
also accompany the nurses during their first six months
to help them adjust to working in American hospitals.
For some foreign nurses, especially from countries
such as the Philippines, one of these transitions is
learning to be more assertive, several nurse executives
said. In the Philippines, nurses often have a more technical
role in which they follow a physician's instructions,
while in the United States, nurses are encouraged to
be more autonomous.
"We are very timid as [a] people because that's
how we are raised," Garcia said. "Here in
America, you have to be assertive."
Although foreign nurses may require time to adjust
and, in the eyes of some, provide only a short-term
solution to the nursing shortage, hospital staffing
executives such as Bradney can't ignore the benefits
of these international recruits.
"My personal experience has been very rewarding
in working with international nurses," she said.
"We've had very good success, and they are delighted
to be here. They are an absolute pleasure."
Contact
Heather Stringer at heathers@nurseweek.com.
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