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RUBENSTEIN: Discounting the legacy of Florence Nightingale
A painful pinch for native-born nurses
For more than a decade the U.S. health care industry has warned that the nursing shortage will get worse unless more foreign nurses are admitted into the country. Those warnings have been heeded: In 1994, 9 percent of the total registered nurse workforce was composed of foreign-born RNs; by 2010 that percentage had risen to 16.3 percent, or about 400,000 RNs, according to academic research. Over the past decade foreign nurses have accounted for about one-third of the total increase in employed nurses.
Yet 100,000 nursing positions remain vacant, prompting hospital and nursing home associations to warn of a dangerous shortage. Some congressional Democrats want higher foreign nurse quotas to be included in President Obama's comprehensive immigration reform package.
It's time for a reality check: There is no nursing shortage -- not now, anyway.
Health care is a bright spot in an otherwise dismal U.S. employment picture, with nurses gaining jobs faster than other health care practitioners. The number of full-time nurses grew by about 386,000 from 2005 to 2010. This was the largest increase in the nursing workforce during the past 40 years, according to the American Hospital Association.
For the first time in memory, there are actually reports of nurses having difficulty finding jobs, and hospitals report almost a glut of nurses.
More foreign nurses could, in fact, exacerbate the nursing shortage. The vast bulk of imported nurses are from poor countries where long hours, abysmal working conditions and a lack of advanced medical technology are the norm. To them the United States is the land of milk and honey. They are easily exploited by a health care industry eager to cut costs -- and corners -- whenever possible. Not only are they paid less than U.S.-born nurses of comparable education and experience, but understaffing, mandatory overtime and physically demanding work are increasingly shifted their way.
Easy access to imported nurses has removed incentives for U.S. hospitals and nursing homes to improve wages and working conditions. That explains why up to 500,000 registered nurses -- fully one-fifth of the current RN workforce of 2.5 million -- have left the profession for other fields. Many of these experienced men and women would re-enter nursing if conditions improved.
At a health care summit at the start of his administration, Mr. Obama said, "The notion that we would have to import nurses makes absolutely no sense." He added, "There are a lot of people [in the U.S.] who would love to be in that helping profession, and yet we just aren't providing the resources to get them trained -- that's something we've got to fix."
This is one promise Mr. Obama made good on. About $100 million of the economic stimulus bill was set aside for promoting nursing and increasing capacity at U.S. nursing schools. As a result, nursing school enrollments have exploded. In the 2010-2011 school year, 169,000 people were enrolled in entry-level nursing baccalaureate programs. That's more than double the 78,000 students training to be RNs a decade ago, according to the American Association of Colleges of Nursing.
Unfortunately, these newly minted RNs are encountering thousands of job postings with an impossible requirement: "no new grads." About 43 percent of newly licensed RNs still do not have jobs within 18 months of graduation, according to a survey conducted by the American Society of Registered Nurses.
Hospitals simply do not want to train young, native-born RNs when cheaper, experienced, foreign nurses are so plentiful. When confronted with this scandal, hospital officials insist the need for foreign nurses is only "temporary." While it is true that most foreign nurses come here on temporary work visas, most end up qualifying for green cards. Census data indicate that 63 percent of foreign-born RNs residing in the United States in 2000 had become naturalized U.S. citizens.
As someone familiar with U.S. immigration policy once said, there is nothing more permanent than a temporary worker.
Perhaps the biggest outrage: While shunning newly minted nursing school graduates, hospitals warn of an impending shortage caused by a rapidly aging nursing workforce -- a shortage they insist requires more foreign nurses.
Things could change quickly, of course. Obamacare and the aging Baby Boom population will increase the demand for RNs. A real nursing shortage could develop. But more foreign nurses? That would only detract from efforts to bring more native-born workers into the nursing profession.
Immigration policy should not be used as a cheap employee procurement system for American hospitals.
Edwin S. Rubenstein is president of ESR Research Institute.
By Donald Lambro
Growth spikes are little more than trend-free anomalies
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