1. Lim, Fidelindo MA, RN


Thoughts of an immigrant nurse.


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It was 1990. I had just arrived at JFK from the Philippines. Examining my passport with clinical ferocity, the immigration officer asked, "What job are you going to do?" I replied, "I'm going to work as a nurse." He said, "Taking jobs away from Americans, huh?"


What do foreign nurses feel when they are made to think they are stealing jobs from Americans-jobs that are considered undesirable by those who are already in the country? In the early '90s, a professor of mine remarked that foreign nurses will always be needed, as long as there is night shift. I've often wondered whether he's right. I've been on nights for almost 17 years.

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Nurses harvested from abroad-and made to grow very fast in a new environment-risk rejection, like transplanted organs. Is it all right for the immigrant nurse to endure some indignities? After all, no one forced us to come. Should we just grin and bear it, at least in the early years?


During my hospital orientation there were seven foreign nurses. The clinical instructor talked to us-or should I say talked down to us-as if we were sixth graders, her voice rising and falling in a sing-song cadence; her condescension clearly revealed her assumption that we knew nothing about nursing. It was winter, and America felt like a very cold country.


Some nursing supervisors assume that foreign nurses are greedy for overtime because we have to support our families. They bank on the notion that because we are poor, we're more obliging and obsequious-and susceptible to the lure of money. Foreign staff are sometimes not treated with dignity.


There will always be "brain drain," even within a country. The young nursing graduate from rural America will be lured away to the big cities, the land of Health Care Oz. Who will replace him? Does the new graduate benefitting from the Nurse Education Loan Repayment Program remain where understaffing is stark after her two years of obligatory service are completed? New nursing instructors will always be less likely to teach in the small-town nursing school because big-city schools attract more researchers and offer more money.


Although I have no statistical evidence to support this, my observation is that foreign-trained nurses tend to stay in the jobs they were originally hired to do. The Centers for Disease Control and Prevention points out that although foreign nurses constitute only about 4% of the nurses in the United States, that's still 90,000 nurses. So why do some "experts" think we are not part of the solution?


We need no special consideration, only understanding and guidance. When a few of my classmates started working in Milan, Italy, their employer gave them free afternoons for three months to learn the language and public transportation system and took them on field trips to the countryside so they could get acclimated to their host nation. Wouldn't it be nice if someone had explained to me the convoluted design of the New York City subway all those years ago? To the clinical instructors, I say don't treat your foreign nurses as children just because they ask childlike questions. Give them time to learn new technologies, and don't condescend.


Foreign-trained nurses are part of the solution, no matter how imperfect it might be. Nursing shortages are as old as the profession itself. As with any chronic health problem, there will be relapse and remission. With more research and meaningful use of our tax money, a lasting cure may be found. Foreign nurses will keep coming, for better or for worse, and no amount of scholarly writing will stem the tide. Night shift, anyone? Anyone?