Hospital leaders are concerned that the Senate’s immigration reform bill – a measure that is on the sidelines for now – could shut down the overseas pipeline for foreign nurses.
The AHA, hospital workforce officials and health care immigration experts fear the legislation’s new system of admitting visa applicants could make it far more difficult to recruit these nurses, who are critical to providing care in hundreds of U.S. communities with shortages of health care workers.
After intense debate, Senate Majority Leader Harry Reid, D-NV, last Thursday put aside consideration of the bill. But he can bring it up again at any time. The bill, S. 1348, replaces the current employment-based system – known as the “green card” – with a point-based system. The points would be weighted heavily towards visa seekers with higher levels of education, such as a master’s degree or a doctorate. Rather than employers sponsoring applicants, foreign workers would file for their own visas and receive them if they amass enough points.
The point system’s emphasis on higher levels of education would benefit visa applicants with an advanced degree in, say, engineering or computer science, but wouldn’t help foreign RNs who hold undergraduate degrees. “Nurses are disadvantaged under the point system” and might not make the point cut-off for admission, the AHA said in a letter sent last week to every senator on Capitol Hill.
That’s troubling news when many hospitals across the country confront double-digit nurse vacancy rates. The Department of Health and Human Services estimates that by 2020, the U.S. will need 2.8 million nurses – 1 million more than the projected supply. A recent AHA survey reported 116,000 nurse vacancies as of last December.
The AHA recommended that lawmakers reinstate employer sponsorship, and said the bill should give increased points to health care workers, particularly nurses who are in a shortage occupation. Unless it is revised, the bill “could exacerbate an already serious health care workforce shortage in America’s communities,” the AHA told senators.
Experts on immigration policy agree. “Any immigration reform proposal falls short if it fails to account for the need for foreign nurses,” said Stuart Anderson, executive director of the National Foundation for Immigration Policy. “This bill doesn’t work well for hospitals.”
About 12,000 to 15,000 nurses each year are accepted into the U.S. through the current immigration system. Most of them come under permanent green card status from the Philippines, with nurses from India ranking second in number, and are sponsored by their U.S. employer. The employment-based system is slow, expensive and cumbersome, with hospitals sometimes waiting two to three years for overseas RNs to arrive.
“Today the problem is that there are an inadequate number of visas and [hospitals don’t always know] when the visas will be available,” Anderson said. “But at least you know that the person you want will qualify. We don’t know who would qualify” under the Senate bill.
The loss of control in finding nurses worries Janice Kishner, chief operating officer and nurse executive at East Jefferson General Hospital in Metaire, LA, and Wendy Willis, employment director for New Orleans-based Ochsner Health System. Like other New Orleans-area hospitals, their organizations seek foreign RNs to help plug the nursing outflow that has hobbled the region’s medical community since Hurricane Katrina in 2005. The Louisiana State Board of Nursing reported that 4,800 nurses changed the address on their license in the 10 months following Katrina, and nearly half of them moved out of state.
“It is vital for hospitals to be able to continue to recruit from overseas,” said Kishner, who traveled to the Philippines last September and has hired more than 60 Filipino RNs. The hospital needs to hire another 40. Before Katrina, the hospital had a 2% nurse vacancy rate. Today the vacancy rate is 12% – a loss of between 100 to 120 nurses. The hospital has used agency or traveling nurses to help plug the gaps as well.
Kishner said U.S. immigration legislation “needs to consider real job demands in health care. The system has to reflect the needs of the employer.”
While Ochsner Health System was one of only three hospitals in the New Orleans area to remain open during and after Katrina, it still lost 65% of its nursing staff. The health system recently hired 100 Filipino RNs, with the first group expected to arrive later this year. Before those nurses arrive, they must submit to background checks and pass a credentialing exam required by the Commission on Graduates of Foreign Nursing; achieve a bachelor of science degree with an English curriculum and pass the U.S. board certification exam.
“Legislation should not disrupt the overseas pipeline,” said Ochsner employment director Willis. “We want to expand our beds and services to help rebuild the city. International recruitment is part of the way to get there.”