1. Kingma, Mireille PhD, RN


Answer to the U.S. nursing shortage?


Article Content

The U.S. Bureau of Labor Statistics predicts that there will be more than a million job openings for new and replacement nurses by 2012. But will that target be met? Last year, educational institutions stretched to their limits were forced to turn away almost 150,000 qualified students because of inadequate numbers of nursing faculty, student places, and clinical placements.


The Senate recently passed a new immigration bill (S 2611) that removes the limit on the number of nurses who can immigrate. Defenders of the bill claim that it's the only way to respond immediately and positively to the national nursing shortage. Will opening the borders effectively address the shortage? It seems highly unlikely.


Significant salary differentials attract nurses to the United States, guaranteeing a steady stream of recruits from abroad. For instance, Ghanaian nurses immigrating to the United States can expect to earn the equivalent of 14 times more than they do at home. A registered nurse in the Philippines earns less than a house painter. Many developing countries are unable to finance enough posts to employ nurses willing to work. Health sector budget cuts and policies imposed by international monetary institutions have resulted in drastic downsizing of workforces.


If managed correctly, this could be a win-win situation. Foreign-educated nurses contribute valuable skills and knowledge to the U.S. health system, providing care in an increasingly multicultural and multilingual society. Many nurses see employment in the United States as a chance for personal and professional development.


But the right to work is distinct from the right to practice. To ensure patient safety, rigorous screening is imposed on foreign-educated applicants, a costly and time-consuming process. The complete accreditation process tends to take a minimum of two years, and often three-ironically, almost the same amount of time needed to educate a nurse in the United States. And recruiting foreign nurses can be even more expensive than recruiting domestic ones. The costs often include travel, work permit or immigration fees, orientation to new health systems, and tutoring.


While developing countries are themselves faced with dramatic nursing shortages, denying their unemployed nurses access to the international labor market is a waste of global resources and can be devastating for the nurses involved, as well as for their families. Until the health care systems in developing countries improve, emigration may be the only option for many nurses.


There are good reasons to remove the cap on nurse visas-to improve the exchange of ideas and experiences among professionals at the unit level, advance medical practice, support the economic independence of women entering the international labor market, and increase the flow of money that strengthens national economies and provides financial support for families left behind.


But lifting the cap will not solve the U.S. nursing shortage. The same factors that cause U.S. nurses to flee the profession will discourage foreign-educated nurses from remaining in active practice. Until there's support from employers and politicians for improving pay and working conditions for nurses, the shortage will not disappear. Cases of discrimination against and exploitation of the migrant nurse continue to be registered (such as missed promotions, abusive postings, sexual and racial harassment, and excessive accommodation charges), often the treatment reserved for U.S.-educated nurses from ethnic minority groups.

Figure. No caption a... - Click to enlarge in new windowFigure. No caption available.

The major supply of nurses must continue to be domestic, and that pool must be carefully nurtured. This means further investment in nursing's education sector-increasing the number of institutions, faculty, student scholarships, and clinical placements. Effective workplace retention strategies that enhance the image of nursing as a viable long-term career choice must be in place. Introducing foreign recruits before repairing the existing fundamental systemic flaws is like using a cosmetic cream to cure a disease.