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More recently, an anti-immigration backlash that swept through Congress in the mid-1990s resulted in additional hurdles for immigrating nurses, immigration lawyer Carl Shusterman said. "I'm not wildly optimistic we'll see a bill for nurses in the next two years," he said.

Cheryl Peterson, senior policy fellow at the American Nurses Association, said the United States has never addressed its recurring nursing shortage, relying instead on the market to ensure that the supply of health care workers is in balance.

"In the United States, we have failed to maintain a work environment that is conducive to safe, quality nursing practice that retains experienced U.S. nurses within patient care," she said.

Domestic demand

Rather than poach nurses from other countries-many of which report nursing shortages, too-the government, nursing associations and the health care industry should start long-term planning and re-allocating resources in the nursing profession, Peterson said.

While the ANA has criticized foreign recruitment as a shortsighted solution to ending the nursing shortage, hospitals often see foreign nurses as one of many tools they can use to staff wards.

Looking outside the country for nurses does not preclude making nursing a more attractive career to Americans, said Jennifer Dickman Hermann, MS, RN, assistant director of human resources at the University of California, San Francisco Medical Center. Hermann recently recruited about 75 nurses from the United Kingdom, Australia, New Zealand, Singapore and the Philippines who will arrive at UCSF throughout the next two years.

At the same time, she has become involved in the Coalition for Nursing Careers in California, which sends nurses into schools to encourage young people to think about a career in the field.

"We feel we're spending way too much money on temporary nursing," she said. "We have a steady pipeline of new graduates, but what we wanted to do is think long term and keep the experienced pipeline just as full."

Just as hospitals want nurses, foreign nurses want work in the United States. Nurses once entered the country using temporary work visas, but those expired in 1995. In 1996, Congress passed a law requiring foreign nurses to have their credentials screened by an independent agency.

The Commission on Graduates of Foreign Nursing Schools performs most of the screening for nurses looking to immigrate and administers the test that predicts NCLEX outcomes. The nonprofit group has seen its applications triple in the past two years, said Judy Pendergast, JD, RN, director of planning, marketing and communications. To meet this demand, the company recently made its application available online.

Additionally, the company opened two offices in India and will open another in Beijing in time for the July exam. The three locations met the commission's criteria for new sites, including a significant population of nurses potentially qualified to work in the United States.

In the past, the company has offered its predictor test three times a year, but this year the commission added a fourth test date in September to give people more access to the tests, Pendergast said. Four of the seven sites with the additional test date are outside the United States.

Even the National Council of State Boards of Nursing, which administers the NCLEX exam, is looking into offering the test at various sites around the world. None has been decided upon yet. Nurses who have taken the NCLEX can skip the commission's predictor exam. The test is offered only in the United States and its territories, which include American Samoa, Guam, Saipan and the Northern Mariana Islands.

Foreign investments

The need for nurses in the United States, coupled with the stringent federal requirements to bring them here and the thicket of varying state licensing procedures, has fueled the growth of professional nurse recruiters. Meladee Stankus, MSN, RN, helps bring nurses to the United States through her company, Nurse Immigration USA. She personally answers questions on its detailed Web site, which gets 10,000 hits a month, she said.

"I can't keep up with the questions," Stankus said.