Filipinos packing up 4
April 10, 2003 - Fourth of a series
U.S. nursing shortage
If you are currently taking up Nursing in the Philippines, migrating and working in the United States should be your foremost, if not your only option after graduating. If you tell me you have other options, I would guess it's to London, Canada, Kuwait or other places in the map. If you are still unaware of this reality by now, where have you been all this time? Tora Bora?
Fact No. 1: There's no more room for employment for nurses in the Philippines, now and in the future. The best you can do is volunteer at a hospital to gain some experience and to avoid being in the unemployment statistics, while processing your employment papers to go abroad. A family friend had volunteered for three years in a government hospital, she deserves a Red Cross medal for volunteerism, if there is such a thing. Yet, nursing schools turn out thousands of graduates each year.
Fact No. 2: The shortage of nurses in the United States has reached alarming proportions, predicated on the fact that there are many more positions available than there are workers to fill them. There have been solutions implemented and proposed to solve this shortage, but the most successful so far is to allow foreign nurses (read: Filipino nurses) into U.S. soil.
|
"By spending millions of dollars promoting nursing, U.S. Congress hopes (with emphasis on the word "hope") to convince American students to choose nursing as a profession. But will they? The odds are, according to my crystal ball, they won't."
|
Fact No. 1 and Fact No. 2 are as compatible as any twosome you could find. Like Starsky and Hutch. Tango and Cash. Simon and Garfunkel. Or even Jake and the Fat Man.
But it is not always that easy.
It used to be that the only way to work as a nurse in the United States is through direct immigration, one that would fall under "aliens of exceptional talent". No temporary working visas, you go straight to the airport carrying a green card (it's actually colored pink now but you wouldn't want to confuse it with the ones they give away at Social Hygiene in Tanza). But the approval process usually took months to years that shortages could not be filled up easily. Alarmed by the diminishing supply of new talent entering the profession and by a growing demand for health care, the U.S. Congress, in 1989, passed a law entitled the Immigration Relief Act of 1989 (INRA). INRA created a special temporary work category known as H-1A for foreign born nurses. Being it a pilot project, the law expired on September 1, 1995.
The H-1A visa has undoubtedly benefitted a lot of Filipino nurses. Hundreds, probably thousands left for the U.S. during the visa's life span. Recruiters and review centers were having a heyday too. The failure of the U.S. Congress to act on extending the law is a question that was never answered. Nursing positions were not adequately filled as nursing homes continue to appear everywhere. A special commission established by Congress to study INRA recommended in March 1995 that the law be extended with certain modifications. As I have mentioned, U.S. Congress has not acted to extend the law, nor to make any provision for the thousands of nurses with H-1A status still employed when the law expired.
As a result, health care facilities in the U.S. could no longer petition for H-1A status for new registered nurses, or to even petition nurses who were on H-1A status but were already employed by another facility. However, if a facility was in possession of an attestation approved by the U.S. Department of Labor (DOL) (this is the form that nurses present to the U.S. Embassy for an H-1A visa), an H-1A visa could be extended until the DOL attestations expired. Unfortunately, since the expiration of the INRA, facilities with expired attestations could no longer apply for an extension of an H-1A nurse. Most H-1A nurses were smart enough to ask their employers to petition them for green cards before the INRA expired.
Based on hearsays and some anecdotal evidence, many Filipino nurses were terminated since September 1, 1995 with H-1A status because failure to do so constituted a violation and could result in civil fines for the employer. According to the grapevine, there were a few who were eventually sent home, but most stayed and found employment elsewhere. It was good for Filipino nurses who were not able to secure green cards because there was no program or law that enforced their departure from the U.S. Many have adjusted their status (secured green cards) through other employers or other means for that matter.
It is of course futile to discuss H-1A now because it no longer exists. My only purpose was to illustrate why it was relatively easy for nurses to come to the U.S. before than it is now. There was a specific law for it. That law is now gone. Although there are a couple of options left, the process has increasingly become more and more difficult. If it was like pedicure before, now it's triple-bypass surgery.
An Immigration and Naturalization Service (INS) memorandum dated August 1995, described by one website as "poorly-worded", raised the hopes of many nurses and health care facilities that nurses would be able to qualify for temporary (H-1B) visas after September 1, 1995. H-1B is the visa category which includes all professionals from accountants to zoologists. Nurses should easily qualify as professionals in this category but I could not find any evidence nor literature to support such. How many Filipino nurses actually went to the U.S. through H-1B, I really have no idea. It is said that it has stricter rules for the nurses as well as for the employers that they don't bother to process petitions anymore.
Which brings us to the next option - immigration. Which means you have to have an approved petition for permanent residency (green card) filed on your behalf by your employer. You just have to wait months to even years to be approved for permanent residency since the number of green cards which are granted every year are limited both by category and by country of birth. Herein lies the rub both for Filipino nurses and for their waiting employers in the U.S. It is no secret that majority (maybe more than 90% but I'm guessing) of the so-called foreign-born nurses are from the Philippines. The backlog for Filipino nurses applying for immigration, according to an immigration lawyer site, is now 20 months and rising. Because of restrictions I mentioned earlier, they can only approve a certain number per year. To illustrate this further, if you are a nurse from a country other than the Philippines, for example, you don't have to wait as long as your Filipino counterpart.
One option some nurses took was to accept employment in other places while waiting for their U.S. immigrant visa to be approved. My brother's brother-in-law worked in London for over a year. A friend worked in Singapore for about the same time. They are now both working at a nursing home in downtown Chicago.
It is widely acknowledged that the nurses most affected by the expiration of the INRA are those born in the Philippines. Last year figures show the backlog for permanent resident visas for Filipino nurses exceeds 18 months. This is not only bad news for the nurses but also for the employers who have been waiting all this time for their nursing positions to be filled.
I am not here to discourage anyone so take heart. In fact, you should be encouraged considering the demand for Filipino nurses is not winding down. With the current situation of stricter regulations, the demand is going way up. It could be just a matter of time before the geniuses of the U.S. Congress come up with another law similar to the INRA.
So far, they have been trying. There have been solutions proposed to solve the shortage. But the general consensus is, these solutions so far, do not appear to have much of a chance of making a serious dent in the shortage.
One solution is the H-1C visa established in 1999, but this category has such rigorous restrictions, not one H-1C visa has been issued until last year. This visa category was established by the Nursing Relief for Disadvantaged Areas Act of 1999 (NRDAA) and is designed for registered nurses working in health professional shortage areas (HPSAs). H-1C is based on the former H-1A visa category but the classification is more restrictive due to its numerical cap on the number of visas issued annually and its application only to underserved areas - an area within the continental U.S. with a facility approved as a designated health professional shortage area as defined by the Department of Labor. From the grapevine again, only about 5 hospitals in the U.S. have been approved last year. You are lucky if your recruiter happens to be in contact with these hospitals. One recruiter in the Chicago area told me recently the number of hospitals approved to recruit via H-1C is increasing. "How do you know which ones they are?", I asked him. "I should", he proudly proclaimed, "I earn about $9,000.00 for every Filipino nurse I give them."
He was not lying. About two months ago, a former classmate of my wife on an H-1C visa stayed for a few days at our place before going to an "underserved area" in Texas. She boasted she didn't have to pay a single cent to her recruiter. "That is not possible," I told her, "who is your recruiter? Bill Gates?" Upon further research, however, she is supposed to receive a $9,000.00 signing bonus upon signing a contract at the Texas hospital. The pre-arrangement was, she didn't have to spend for anything (except her plane ticket), the recruiter gets the signing bonus. I did not ask my wife's classmate, however, if she knew how much the signing bonus was.
The U.S. Congress' latest proposals to solve the shortage issue, H.R. 3487 and its companion bill S. 1864 both known as the "Nurse Reinvestment Act" don't include recruiting foreign nurses, that's why they are already destined to fail. HR 3487 does not propose to take any direct action but rather to issue a series of grants that would pay for public service announcements to promote the profession of nursing and to promote nurse education programs. A similar bill in the U.S. Senate, S. 1894, includes money for a nursing corps loan repayment program, for hospitals to develop and evaluate models for retaining nurses, for a student loan fund and for multimedia nurse recruitment campaigns and community outreach programs to recruit and retain nurses. "Both of these bills are noble in intent," says a commentary at a web site of immigration lawyers, "but inadequate in practice."
It is not hard to conclude from these 2 bills that the U.S. government wants to give jobs to its citizens first before opening it up to foreign workers which, to me, is fair enough. The problem is, by merely increasing public knowledge and granting scholarships, the most Congress could hope for is probably slight increase in the number of students who choose nursing as a profession. The bill does not, in any way, portrays nursing as an attractive position to Americans. One would rather take computer programming, get the same pay, and avoid the pressure and the hard work that nurses are usually stereotyped for. It doesn't matter if computer programming positions are hard to come by. By spending millions of dollars promoting nursing, U.S. Congress hopes (with emphasis on the word "hope") to convince American students to choose nursing as a profession.
But will they? The odds are, according to my crystal ball, they won't. But let's just say, for the sake of discussion, that they answer the call. Still, the bills do nothing to address the nursing shortage in the present time. While today’s high school students attend nursing colleges, today’s American citizens experience the debilitated state of the American health care system due to a lack of qualified nurses. And who could guarantee that the public message service will take hold? Would they advertise it on MTV where most high school students are tuned in to today. Would they use Cristina Aguilera as their spokesperson? So while there is potential for a success, there is also potential for complete failure.
I don't want to sound like an immigration lawyer or a nurse recruiter but does this response from the U.S. Congress have the potential to remedy the problem in the future? Does this even warrant the patience of the American people now? Unfortunately, the answer is no, and that's only my right thumb thinking. The nursing shortage today is so bad, the Chicago Sun-Times had to run a cover story on it. Cook County Hospital in Chicago in the article complained about how they always have to pay some nurses more than 60 hours of overtime per week (an overtime is paid "time and a half"), way above their budget. The question most people are asking nowadays is - does Congress realize the gravity of the current situation? It is bad, and without significant and immediate action, it will only get worse.
Here's one ominous sign all those geniuses should consider - according to the American Association of Colleges of Nursing, the enrollments in a five-year baccalaureate nursing schools dropped 16.6 percent during the past five years, from 72,452 in 1996 to 60,443 in 2000. Within 10 years, 40 percent of working nurses will be 50 or older. As those RN's eventually retire, the supply of working RN's is projected to be 20 percent below the requirements by 2020.
A nursing magazine, NurseWeek, says today’s shortage also occurs at a time when nursing has lost some of its luster as a career opportunity, partly because nursing is a traditionally female profession and today’s women have more options than they did before. Women graduating from high school in the latter part of the 1980s and during the 1990s were 35 percent less likely to become RNs compared to women in the 1970s, according to the Texas Hospital Association, as quoted by NurseWeek. American men rarely take nursing as a profession. To show how male nurses are sterotyped, you should watch (if you haven't) Ben Stiller's character, Greg (Gaylord) Focker (I hope I spelled that right), in "Meet the Parents".
NurseWeek adds that changes in the delivery of health care in a managed care environment have caused some nurses to become frustrated. Their complaints have discouraged newcomers from joining the profession. In a survey released in early 2001 by the American Nurses Association (ANA), 54 percent said they would not recommend their profession to their children or their friends. The ANA survey found that 75 percent felt the quality of nursing care where they worked had declined during the past two years. A majority, or 56 percent of the 7,299 nurses surveyed, said they had less time to care for patients. Moreover, 40 percent said they would worry about sending a family member or someone close to them to be cared for at the facility where they work. The shortage, NurseWeek qualified, is far from universal at this stage, at least. It tends to be felt hardest in isolated rural areas, depressed urban environments and key specialty areas.
It is amazing why I know this and the U.S. Congress doesn't. Public service announcements and even the hard-to-understand, hard-to-implement H-1C, won't do the job, period. It's not that there is no solution, it is just the wrong solution. "This is not just another cyclical shortage of nurses that can be rapidly cured by paying nurses higher wages and enrolling more students in nursing schools," said Edward O’Neil, Ph.D., MPA, director of the Center for the Health Professions at the University of California, San Francisco. "The aging of the nursing workforce, the upheaval in the health care system and the expansion of career opportunities for women are combining to produce a chronic shortage of nurses. That shortage can only be resolved by improving the work environment for nurses and redefining nursing practice."
No, sir, I respectfully disagree. Immigration is the only key, at least, for now. Bring back H-1A (or approve similar laws). Legislate something that would increase considerably the number of Filipino immigrant nurses entering the U.S. each year. They won't, for sure, take any job away from Americans. By allowing more Filipino nurses the opportunity to work in the U.S. (and thereby decreasing the unemployment rate in the Philippines), there would be a drastic reduction and an immediate solution to the U.S. nursing shortage, not only for the present but for the future. You can always cut the number of foreign nurses later, if, and that's a big if, the remedies the U.S. Congress proposed will work.
The simple solution, therefore, is - bring more Filipino nurses over.
* * *
My heartfelt thanks to the following:
- to Manang Elna Sollano and the rest of the staff at the Registrar's Office for entertaining my brother who secured a certified true copy of my diploma. He brought the copy to me last month, and also your regards and best wishes. You see, I need to remind myself sometimes that I'm a doctor.
- to the group of students doing a study on medical malpractice at the Fatima College of Medicine for your e-mail. Unfortunately, I cannot help you with your research. The last time I did a research paper was 10 years ago. I'm now clueless as to statistical processes, etc.
- to the one who sent me copies of FHM (Philippine edition) magazine, glossy and all, their calendar, their top 100 list. I don't know what you were thinking but thanks anyway. It's very informative, to say the least.
* * *
This week's FINAL WORD comes from Anonymous:
"....i was a nurse once at UH...i really didn't like the way
doctors treated the nurses...i had a lot of bad experiences....right
now, whenever i remember those times...it makes me feel like
saying...."hey doc, wanna ride my LEXUS or maybe my EXPLORER?"...or..."wanna borrow
money?..i have a spare P1,000,000.00 ($20,000.00) in my savings
account"...how's that!...but this is only to those who i had an unforgettable
experience....those who feel like they are GOD!!...current situations
might open their eyes and make them nice to their co-partner in health
care....the lowly NURSES....."co-partner"- the word that filipino
doctors will definitely understand only here in the states..."
On the contrary, I treated nurses very well. In fact, I treated one nurse very, very well, she agreed to be my wife. I'd like to ride in your Lexus and your Explorer but she might not like it. (Oh, by the way, just be thankful of your good fortune.)
* * *
Comments regarding this week's column are welcome. Please fill up the fields below and click Send to Author. Suggestions for future column topics are also encouraged.
* * *
The author's e-mail address is at drgarcia@wvsumedaa.com
* * *
| e-mail this page to a friend | print this page | read author's profile |
Views expressed on this column and any other by-lined articles on this site are the authors' own and do not necessarily reflect the views of the organization or its members. For comments, please e-mail the author.
