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Chicago Hospital Paves the Way for Foreign RNs

Monday January 10, 2000
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For some hospitals, recruitment strategies such as sign on bonuses and flexible work schedules have helped to fill vacant positions during this most recent nursing shortage. However, for other hospitals, especially those in inner-city and rural locations, vacant positions remain unfilled, despite active recruitment efforts.
But help is on the way. The Nursing Relief for Disadvantaged Areas Act of 1999, passed last November, allows for the hiring of foreign nurses for the first time since 1997. The new measure is limited in scope, permitting only 500 foreign nurses to be hired each year in the entire country, with an expiration date of four years. There are also specific conditions that must be met by facilities wishing to hire foreign nurses. But at least the act will be a temporary bandage for hospitals most in need - such as St. Bernard Hospital and Health Care Center in Chicago.
"The bill will enable us to fill open positions; however, it is only a temporary measure and it is not a long-term solution to staffing needs," says Ron Campbell, RN, BA, vice president for patient care services.
In fact, it was at St. Bernard, a 226-bed community hospital located in the Englewood neighborhood, where the seed for the national legislation was first planted. St. Bernard was near closure because it could not recruit enough nurses willing to work in the high-crime neighborhood. The hospital also had foreign nurses working on its staff who were hired several years ago and whose visas obtained under a previous program were about to expire.
"We had closed beds in the hospital and we didn't know if we would have to close any more," Campbell says. The hospital spent $2 million a year hiring contract nurses at about $55 an hour. Campbell, in a desperate effort to keep the facility open, went to see US Rep. Bobby Rush (D-IL) and explained to him the hospital's plight. The Congressman, recognizing the area's healthcare needs, agreed to sponsor an immigration bill to assist medically underserved areas - including rural as well as inner-city hospitals.
But before a proposed bill could be formed, Campbell and Rush met with a variety of local and national nursing organizations concerned about the displacement of American nurses if foreign nurses were allowed to be hired. Campbell eventually went to Washington, DC, to testify in favor of the bill before the House Judiciary Committee.
"We had tried different ways of creative staffing, such as using inhouse registry," says Campbell. "Some of our nurses are working overtime to fill our staffing needs, but we had to come up with something else. Now we will be petitioning to participate in the recruitment of foreign nurses under this bill to help meet our immediate needs."
In addition, paperwork that had been filed with the Immigration and Naturalization Services by previously hired nurses to remain in the country is beginning to be processed, Campbell says. St. Bernard currently has 35 nursing positions open.
Future foreign nurses who are recruited by St. Bernard will enter an orientation program, just as other nurses do, says Campbell. They temporarily will live in housing on the facility's grounds and will receive assistance from the hospital to find permanent housing elsewhere, if desired.
Campbell is also working with local nursing organizations and schools to establish programs that will encourage American youth to enter nursing.
"We are working with schools of nursing to set up mentoring programs for students who are already in a nursing program, in hopes that when they graduate they will be interested in working at community hospitals," says Campbell. "We will also be working with local nursing organizations to establish nursing scholarship programs at the high school level to attract young people to nursing."
Hospitals were unable to recruit foreign nurses when the 1989 Immigration Nursing Relief Act expired two years ago.
Facilities must petition to participate in the recruitment of foreign nurses under the new legislation, as well as provide evidence that -
n similarly employed nurses' wages and working conditions (including work hours) will not be adversely affected
n wages will be the same as other similarly employed nurses
n steps are being taken to recruit US nurses
n no labor dispute is involved
n no more than one-third of a facility's registered nurses will be H-1C nurses
n the employee will not work at a facility other than the petitioning facility
To be eligible for the act, a facility must be a hospital in a health shortage area with at least 190 acute care beds and at least 35% and 28% of its patients being Medicare and Medicaid patients, respectively. Petitioning facilities must have demonstrated that they have undertaken significant steps designed to recruit and retain RNs. Such steps include paying RNs at a rate higher than currently being paid to nurses similarly employed in the geographic area, providing opportunities for salary advancement, providing career development programs to facilitate healthcare workers to become RNs, and operating or participating in a training program for registered nurses.
The number of visas granted to an individual state is dependent on the total population. For states with populations of less than 9,000,000, based on the 1990 census, 25 visas will be granted. For states with populations of 9,000,000 or more, 50 visas will be granted.
While offering a temporary ease to the nursing shortage, the legislation also directs the Secretary of Labor and the Secretary of Health and Human Services to recommend an alternative to the program as a permanent remedy to the RN shortage.
For now, the Nursing Relief for Dis-
advantaged Areas Act proves that "even a small community hospital has a voice," says Campbell. "That says a lot for the democratic system in this country."