Sept. 17, 2002
Page 8D

Nursing crisis at crossroads
Foreign hires aren't cure-all for U.S. ills

By Steve Friess
Special for USA TODAY

LOUISVILLE -- There's not a lot that's familiar to Perla Riccardo about this city, but the Filipino woman spent more than a decade pining for it.

Certainly, she was entranced by the pictures her sister, Myrna King, mailed home since she landed her job here in 1990.

What impressed Riccardo more, though, was the money for the family sent along with those snapshots. She decided to follow in King's footsteps and enroll in nursing school, with an eye toward employment abroad as thousands of young men and women do in poor nations such as the Philippines, India and Nigeria.

Yet for much of the 1990s, U.S. hospitals cut back on international recruitment, so Riccardo, 32, toiled for nine years in a squalid Filipino hospital. Then, with the American health care system sliding into its worst nursing shortage, Riccardo's time came.

Norton Health Care, Kentucky's largest hospital chain, became so desperate for nurses that officials finally followed King's advice and raced to the Philippines to recruit. Riccardo, who arrived six weeks ago, is one of 200 Filipinos hired by Norton in the past year, filling a $17-an-hour job that pays more by the day than she used to make in a month.

The USA's growing shortage -- about 126,000 vacancies -- is forcing several hospital companies to look abroad for relief. About 69,000 Americans became nurses in 2001, far below the 96,000 in 1995 and reflective of the growing inability of U.S. nursing schools to provide enough workers.

Experts expect the shortage to rise, possibly to as many as 800,000 vacancies by 2020, because baby boomers will require more health care than prior, smaller generations.

Into this lurch springs an aggressive new push by health care companies to hire foreigners. The National Council of State Boards of Nursing, which administers the licensing exam for registered nurses, voted tentatively last month to start offering the test overseas by 2004 for the convenience of foreign job candidates.

The U.S. government does not keep statistics on how many foreign-educated nurses are employed in the country, but more than 23,000 foreigners took the licensing exam last year. More than half were from the Philippines, which for decades has produced more nurses and other professionals than it needs.

"This is an effective way to soothe the nursing shortage," says Ian Blackmoore, finance director for London-based Stateside Nursing, a recruitment firm that recently placed 165 foreign-educated nurses with the Tucson Medical Center in Arizona. "These nurses are highly skilled and become very loyal employees."

Few in the industry view overseas recruitment as a cure-all, and some argue these efforts let hospitals sidestep the problems in American nursing and harm the quality of care. While foreign-educated nurses are competent enough to pass the license and two English proficiency exams, they often are unfamiliar with the high-tech machinery of U.S. hospitals.

Riccardo, for example, cited encounters with new equipment as her biggest shock.

Former nurse Peter O'Reilly of Seattle sees the effort to recruit abroad as "such an American solution to a such an American problem."

Hospitals have run American nurses out of the field with shabby and demeaning treatment, little respect and large amounts of mandatory overtime, he says, and then they want to "buy their way out of the problem" by exploiting the willingness of foreigners to work for less than Americans.

Foreign nurses make, on average, 7% less than their domestic-born colleagues, according to a recent survey by the Commission on Graduates of Foreign Nursing Schools. That alarms nursing unions, who fear immigrant nurses are unaware of their workers' rights and are afraid to demand more money or better conditions for fear of deportation.

"Rather than deal with the problems here, they'll just spend thousands of dollars to bring in people who, in many cases, just don't have the same skills when they arrive as I did when I came out of nursing school," says O'Reilly, who left the field in 1999 to open a flower shop. "The hospitals make this out as a benevolent gesture -- they're bringing people out of a worse lifestyle -- but since when did big business in America ever really care about being altruistic?"

Rebecca Shields, a recruiter for Norton Health Care, says that nobody thinks hiring foreign nurses is the total solution to the problem but adds that these are very good nurses who are ready to do the work. But others also are calling on the health care industry to "fix the job," as University of Pennsylvania researcher Julie Sochalski puts it. Sochalski released a study earlier this month showing that new nurses are leaving the field faster than ever before because of job dissatisfaction.

"I don't have a problem with anybody coming over here and working to send money home to their families, but it's not going to solve our problem," Sochalski says. "We're fooling ourselves to think we can solve it that way." Sochalski's boss, however, thinks that foreign recruitment can be a solution for both American and foreign hospitals.

Afaf Meleis, dean of the University of Pennsylvania School of Nursing, suggests the United States should throw open its doors to more foreign nurses but limit their stay and encourage them to return to their home countries with the advanced new skills they've learned here. Most foreign nurses work here on permanent immigrant visas.

"This is a fantastic way to empower women from other countries where they might be oppressed and help out their country as well," Meleis says.

But Riccardo, who plans to put her siblings through college in the Philippines with part of her salary, already feels empowered.

"I can work with my sister, have a good living and this opportunity to help my family at home," Riccardo says.

"I will stay here the rest of my life, I do hope."

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