Importing care

As the nurse shortage balloons, leaders in Washington are pushing competing philosophies on whether the problem is best addressed by training larger numbers of American nurses or granting more visas to foreign-born nurses. At least two bills on the issue are pending in Congress, and a third is expected in coming weeks.

Employers and their advocates want to ramp up the use of visas for immigrant nurses to fill the thousands of nursing jobs already vacant across the country, particularly in California, Florida and Texas. Labor and nursing officials would rather see more energy spent on training nurses domestically. President Barack Obama has left little doubt on where he stands on the question.

“The notion that we would have to import nurses makes absolutely no sense,” Obama said March 5. “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 that we’ve got to fix. That should be a no-brainer.”

The next day, the U.S. State Department announced that the wait time for the type of work visa that includes nurses had lengthened from four to six years. The “retrogression” of the wait time was enacted “to help ensure that the amount of future demand is significantly reduced,” according to the State Department. Officials from the White House and the State Department who spoke on condition of anonymity said last week that the timing was a coincidence. The State Department official said the change was prompted by unexpectedly high demand, and he noted that the longer waiting time limited only the volume of applications, not the number.

Not so, said Los Angeles immigration lawyer Carl Shusterman. Lengthening the delay does effectively decrease the number of professionals who immigrate because the applicants often take on new spouses and children during the years they wait. “It’s very disappointing. I’m all for training American nurses, but even if Obama made it his first priority, it would take several years,” he said.

Rep. John Shadegg (R-Ariz.) proposed the Nursing Relief Act of 2009, which would allow up to 50,000 new visas per year. Meanwhile the Nurses’ Higher Education and Loan Repayment Act of 2009, introduced by Rep. Tom Latham (R-Iowa), would establish a graduate degree loan-repayment program for nurses who agree to become school faculty.

Rep. Robert Wexler (D-Fla.) plans to reintroduce the Emergency Nursing Supply Relief Act in coming weeks, Wexler’s spokeswoman Ashley Mushnick said. Last year’s failed version would have allowed 20,000 more visas for healthcare, and forced the sponsoring employers to pay for domestic nurse education.

Estimates vary widely about the true depth of the current shortage of nurses from as low as 126,000 to more than 200,000. Figures are similarly murky on how many nurse visas are granted each year. Del Garbanzos, director of human resources at 156-bed Delano (Calif.) Regional Medical Center, would like to see the visa numbers increase for healthcare. Garbanzos said importing nurses appears to be the only way to meet her hospital’s staffing needs because opportunities to sponsor students at nursing schools are so limited.

Labor groups like the Service Employees International Union oppose the visas as a “Band-Aid, not a cure.” The American Hospital Association and the American Nurses Association agree on compromises that recognize that nurse visas are a short-term but necessary solution, and both associations supported Wexler’s legislation last year. But the AHA wants to expand the visa allotment, while the ANA would rather see as few nursing visas granted as possible.

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