Foreign Investments
Although some hospitals view international recruitment as a band-aid
to staff shortages, others support the benefits of hiring foreign nurses
By
Heather Stringer
June 6, 2002
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."