Door closes on direly needed foreign nurses
BY BRIAN BASKIN

Posted on Sunday, January 2, 2005

URL: http://www.nwanews.com/story/adg/103706

Until recently, U.S. hospitals saw Filipino nurses like Stephen Frani, who immigrated in October 2003 to work at St. Vincent Infirmary Medical Center in Little Rock, as a promising way to counter the nationwide nursing shortage.

On Saturday, the gates closed.

On Jan. 1, the U.S. State Department stopped granting fasttrack work permits to immigrants from the Philippines, India and China. Those countries had filled their employment-related visa quotas for the first time in many years, after the State Department began processing labor-certification applications more rapidly.

The fast-track permits allowed thousands of nurses to work in the United States during what area hospital officials say can be a three-year wait for permanent residency.

Limited visa availability likely will add at least two years to what is already a nine- to 24-month process, said Meladee Stankus, founder of Scottsdale, Ariz.-based Nurse Immigration USA, which recruits internationally to find nurses for American hospitals.

The soon-to-be dwindling supply of international nurses comes at a time when hospitals are preparing for a nursing shortage to deepen into a crisis.

State Sen. Brenda Gullett, DPine Bluff, said in a recent report to the Arkansas Legislative Commission on Nursing that 12 percent of nursing positions at the state’s hospitals are vacant.

Nursing schools aren’t keeping up with the demand. In 2004, 793 nurses graduated and were licensed in Arkansas, compared to 1,925 that will be needed each year to solve the shortage, Gullett said. "We’ve been through many shortages, but this is going to be by far the deepest and the longest," said Margaret Nixon, a human resources manager for St. Vincent.

Arkansas hospitals apparently bolstered international recruiting in 2004 as a potential solution to the shortage, said Faith Fields, director of the Arkansas Board of Nursing.

But St. Vincent already is scaling back, well short of a 2000 goal to bring 35 nurses over from the Philippines. So far it has received eight, and it could now be 2007 or later before any more arrive, Nixon said. "The Philippines project was a long-range project to help us cope with what we expected to be a fairly long-term shortage situation," she said. "It’s become a lesser solution."

Hospitals nationwide face the same uncertainty, abruptly reversing a hiring frenzy that drove up the number of internationally educated applicants for American nursing licenses every year between 1999 and 2004.

More than 28,000 foreign-educated nurses applied for nursing licenses in the United States between January 2004 and September. That amounted to 27 percent of all applicants taking the test, and nearly double the number who applied in all of 1999, according to the National Council of State Boards of Nursing.

The increases came partly because nurses have an easier path to immigration than almost any other profession.

Because nurses were in such high demand, they were allowed to bypass the federal government’s labor-certification process with its two-year backlog and apply directly for an employment-related visa, or green card, Stankus said.

The U.S. government assigns each country an employment visa quota, but because of a backlog in the labor-certification process created by inadequate staffing and red tape, those limits were never reached, said Stankus of Nurse Immigration USA.

But in 2004, the State Department began devoting more resources to labor certification, speeding up the process. Thousands of newly cleared potential immigrants lined up for visas, causing the Philippines, China and India to reach their quotas. "They dumped all these thousands of people into visas, and now they’re used," Stankus said.

A spokesman for the U.S. Bureau of Consular Affairs, which oversees the visa process, did not return calls last week.

A new batch of visas won’t be released until Oct. 1. But those almost certainly will go to applicants who had waited the longest for labor certification, few of them nurses, Stankus said. "We’re really just cut off at the knees by this," she said.

Thousands of Filipino nursing school graduates are feeling much the same way, Frani said.

The Philippines long have been the biggest source of foreign nurses for the United States. More Filipinos applied for licenses in 2004 than those from the next four countries combined, according to the National Council of State Boards of Nursing. "It’s common. Most people want to go to the [United States]," said Frani, who took up nursing so he could join the rest of his family, who came to the United States in the early 1990s. "Doctors are taking up nursing, just to get to the United States."

Family and finances drive many to come to the United States, Frani said.

Frani’s starting annual salary as a nurse in his hometown hospital, an hour outside Manila, was $2,400. A nurse typically earns $36,000 to $39,000 starting at St. Vincent, said Margaret Preston, a spokesman for the hospital.

Frani described a feeding frenzy in Manila by representatives of U.S. hospitals and recruiting agencies who came to the Pacific nation in search of nurses. Many offered signing bonuses, paid travel expenses to the United States, and helped Filipinos prepare for English and nursing exams.

He said he had heard from a friend in the Philippines who recently had received a visa that American hospitals had stopped recruiting there.

Stankus said she wasn’t sure what would happen with hospitals’ requests for about 50 nurses from the Philippines that she had expected to fill in 2005. "We have to try and keep those nurses lined up and ready to come. That’s going to be a challenge," she said. "They’re being recruited heavily by Saudi Arabia, Kuwait, Australia, Singapore, the United Kingdom and Japan now."

Stankus said several solutions have been floated by recruitingindustry leaders and immigration lawyers, including creating a special visa class for nurses or adding unused quota space from previous years to the 2005 quota.

Immigration problems couldn’t have come at a worse time, Stankus said. "This is very devastating news for [hospitals]," Stankus said. "They were planning on them arriving. Expansion plans were taking place, a lot of money was invested... to pay for nurses’ expenses."

At least 30 nurses from India who are scheduled to work in hospitals across Arkansas also might become caught in the immigration process, said Calvina Thomas, assistant director for nursing education for the Arkansas Board of Nursing.

Washington Regional Medical Center in Fayetteville had planned on adding 11 Filipino nurses next spring to help staff a new 24-bed unit. Now it could be spring 2007 before any of those nurses arrive, said Steve Percival, human resources director for the hospital.

The fate of another 14 nurses recruited by the hospital is up in the air, he said.

The delay won’t leave Washington Regional short-staffed, as the 25 nurses represented a fraction of the 600 nurses employed by the hospital, Percival said. "We’re going to need nurses in two or three years, too," he said. "Even if the pipeline gets longer to come here, it still could be an effective strategy down the road."

But the tight quotas have eliminated one of the most successful and widely used means of alleviating the shortage.

American nursing schools do not graduate enough nurses to meet the demands of the healthcare system, Nixon of St. Vincent said.

Larger classes have been outpaced by expanding hospitals, increased patient visits and the looming retirements. "Next year, the first of the boomers are eligible for retirement," Nixon said. "The average age of nurses is in the late 40s. That’s beginning to worry us."

With international nurses out of the picture for now, and competition fierce for Arkansas nursing graduates, Washington Regional is looking elsewhere, Percival said. "We’re just going to have to expand our reaches in the United States and see what we can do to supplement positions we had targeted for Filipino nurses," he said.

St. Vincent is focusing on building partnerships with nursing schools, helping institutions grow in the hopes that graduates will start their careers at the hospital, Nixon said.

Baptist Health in Little Rock, Jefferson Regional Medical Center in Pine Bluff, Washington Regional in Fayetteville and Northwest Health System in Springdale all maintain nursing schools.

Frani, who waited three years for a visa, said that hospitals would find just as many Filipinos willing to immigrate as ever, despite the quotas. "Time flies by. You just have to bear with it, because you don’t have much choice," he said. "You cannot tell immigration to just hurry up."

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