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Foreign nurses often fight an uphill battle to find work in the United States, despite the country's nursing shortage. Nearly 10 years after she started the immigration process, Fritzi De La Cueva, RN, finally landed a job in the brain injury unit of Sinai Health System's Schwab Rehabilitation Hospital in Chicago.

Fritzi De La Cueva, RN, earned so little during her first nursing job in the Philippines that she had to borrow food and rent money from her mother. Nonetheless, she paid more than a month's salary for a review course to help her pass the NCLEX predictor exam, the first step for foreign nurses who want to immigrate to the United States.

"It was expensive for that time," the 30-year-old rehabilitation nurse said.

Nurses will pay for such classes because 70 percent of those who take the exam do not pass the first time, and most U.S. hospitals will not sponsor them for a visa until they do. De La Cueva passed. Her mother and her aunt then helped her to pay a placement agency $4,500-more than 30 times the average monthly salary of a nurse in the Philippines-to find her a job in the United States.

De La Cueva landed a contract with a nursing home, which petitioned the Immigration and Naturalization Service (now known as the Bureau of Citizenship and Immigration Services) for a visa. But the INS held up her visa and she was unable to leave. She recouped all but $800, but the experience left a bitter taste in her mouth.

"After that, I didn't have any interest in applying here," she said.

Instead, De La Cueva went to work in the Middle East. After two years, she was ready to make a second attempt to work in the United States. She took a placement agency referral from colleagues who were leaving to work in Florida. Her next step was to pass tests showing her English proficiency. She paid airfare from Abu Dhabi, where she worked, to Oman, where English exams are given more frequently, and paid yet another placement fee.

Nearly 10 years after she started the immigration process, De La Cueva finally landed a job in the brain injury unit of Sinai Health System's Schwab Rehabilitation Hospital in Chicago.

"It's difficult," De La Cueva said of immigrating to the United States. "It means a lot of time and money."

Obstacle course

Foreign nurses often fight an uphill battle to find work in the United States, despite the country's nursing shortage. They have to try to not only avoid unscrupulous recruiters, but also pass tests and qualification clearance procedures that can mean significant out-of-pocket expenses. Even if they clear these hurdles, they still must find a hospital willing to sponsor them.

Securing work in the United States is difficult in part because the American government and nursing organizations have historically tried to restrict foreign nurse immigration, said Catherine Ceniza Choy, assistant professor of American studies at the University of Minnesota. Choy has written a book about the relationship between Filipino nurses and the United States-a relationship that reaches back to the beginning of the 20th century, when the Philippines was a U.S. colony.

"One of the gripes of some U.S. nurses is that the recruitment of foreign nurses has a detrimental effect on their wages," Choy said. "Whether or not that's true is debatable, but I understand where they're coming from."

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