Organized nurses are celebrating the defeat in Congress of an attempt to revive a program that allowed foreign nurses to work in the United States.
The House late last month voted 262 to 154 against extending the controversial program.
But supporters haven't given up yet and may try again to renew it.
The program, enacted in 1989 during the nursing shortage, allowed registered nurses who did not intend to become permanent U.S. residents to take temporary jobs in this country. Many of those nurses are from the Philippines and work in New York City.
The H-1A visa program was allowed to expire in September 1995 by the Clinton administration.
But with support from the hospital and nursing home industries, members of Congress have tried to keep H-1A alive for six months until a congressional committee could hold hearings.
"Our country's nursing homes and senior healthcare providers will face a dire situation," Rep. Richard Burr (R-N.C.) said. "These nurses are not taking American jobs because they fill needed positions in rural areas."
"We need more foreign nurses coming into the United States for longer periods of time like Hershey needs candy bars," replied Rep. John Conyers Jr. (D-Mich.). "The current supply of nurses is adequate and may even increase in the coming years due to the downsizing of the American health industry."
That's the position of the American Nurses Association and other nursing unions. "Employers who provide good wages and working conditions have no trouble recruiting and retaining well-educated nurses," said ANA President Virginia Trotter Betts. "Continuing the H-1A visa program is unnecessary and misguided in today's environment."
A commission was set up that recommended continuing H-1A with some changes, but nurses' unions dissented from its conclusions. "We didn't feel like there is still a shortage," said Cheryl Peterson, ANA associate director, federal relations.
In fact the supply of domestic nurses has grown much faster recently than at the time H-1A was enacted. In 1992 there were 80,839 nursing graduates, and in 1993 there were 88,149. In 1990 there were only 66,000.
NAFTA also has allowed nurses from Mexico and Canada free access to the U.S. job market. In 1994 6,000 nurses entered from those countries alone.
"We dissented for those reasons," Peterson said. "We were hearing a lot of anecdotal information of abuses, where nurses were being brought in under H-1A, and instead of being used as nurses they were used as aides."
The Department of Labor has investigated some of those claims. In March the Catholic Archdiocese of Chicago agreed to pay a $50,000 fine and $384,700 in back wages to 99 Filipino nurses who worked at the Villa Scalabrini nursing home. The nurses, who entered the United States in 1993, were supposed to be paid $12 an hour. Instead, they were employed as assistant nurses for $8 an hour.
Carla Luggiero, a lobbyist for the American Hospital Association, said H-1A is important to rural hospitals.
"It happens in geographic pockets. Even if hospitals have made an effort to recruit, you can't lure them away from the glamour spots," Luggiero said. "We feel they shouldn't be foreclosed from getting the qualified personnel they need simply because they are in rural or medically underserved areas." The American Health Care Association, the lobby for nursing homes, also says H-1A is necessary primarily to staff homes in rural areas.
Urban interests also testified in favor of the program. Rep. Bobby Rush, a Democrat from Chicago's South Side, said Sister Elizabeth Von Straten, chief executive officer of Saint Bernard Hospital in his district, asked him to try to keep H-1A.
"Saint Bernard Hospital has employed nurses solely from the H-1A program since 1991 when it was determined that they could save over $3 million a year in nursing salaries," Rush said.
Without the foreign nurses, he said, the hospital has to hire registry nurses. "Registry nurses require a salary that is double that of the H-1A nurse or they will not work in the Englewood area," a low-income community. Continuation of the program "is truly a matter of life and death" for local residents, Rush contended.
Pamela Towne, spokeswoman for the Illinois Nurses Association, said: "Any hospital having trouble recruiting and retaining RNs is probably not paying the prevailing RN rate. There are other inner-city hospitals that are not experiencing difficulty recruiting RNs.
"If they are employing foreign RNs and paying less than the prevailing rate, that is exploitation and abuse and it's a violation of the law," Towne said.
The AHCA is still trying to work out a compromise to continue the H-1A program. It is meeting with other concerned parties this week to find a way to allow H-1A nurses whose visas have expired to stay in the country under H-1B visas, which employers use to sponsor other professionals with nonimmigrant status.