Legislation of Foreign Nurses Practicing in the United States The United States Health Care system is undergoing a major crisis of nurse-staffing shortage. A survey conducted by the American Hospital Association -- AHA of 715 hospitals performed during spring 2001 showed that a vacancy of 126,000 positions of registered nurses prevails through out the nation. The International Council of Nurses -- ICN, a federation of 125 nursing organizations indicated it to be a global problem. In order to meet the staff requirements, the U.S. health care facilities, both individually and in collaboration are persistently demanding the state and federal law makers to smoothen the restrictions in both the state regulations and U.S. immigration law to permit an increased influx of foreign-educated nurses. (Trossman, 2002)

Cheryl Peterson, MSN, Registered Nurse, a senior policy fellow in the practice department of ANA reveals that there are three primary modes that foreign educated nurses can have permission to enter into the U.S. To practice such as firstly, permanent visas for those who desire to become residents of the U.S.; secondly, temporary visas, for those who have reached the nation to work only for a specified period of time; and finally, under negotiated trade agreements, like the North American Free Trade Agreement. H-1C visa, to illustrate, is a temporary visa that is unique to nursing; but, the number of these visas which are made being available each year is confined to 500 and those individuals who come to United States with such a visa are allowed to practice only with the specifically designated health professional-shortage areas. All over the nation only 14 hospitals presently fulfills the conditionality which is prescribed by the Department of Labor for such visas. Largest number of foreign-educated nurses comes from Philippines and Canada and considerable number of them also come from United Kingdom, Ireland, and India. Peterson reiterates that presently the INS do not have the system to correctly record and evaluate the number of nurses who come into the country, therefore, it is very hard to receive accurate data regarding the number of foreign educated nurses who are practicing in the U.S.

The foreign-educated nurses are required to undergo a screening process that incorporates a predictor examination in order to be qualified for practice in United States that sheds light on their future potential performances on the National Council of State Boards of Nursing licensure examination --NCLEX, English Proficiency testing, an assessment of the nurse's license in he home country to make it certain that it is legitimate and tangential. The advent of Rural and Urban Health Care Act of 2001 dramatically expands the prevailing H-1C temporary nursing visa program instituted in 1999 and tide away workplace safeguards for foreign-educated nurses. In South Carolina a bill has been introduced that would permit Canadian nurses to practice in the state without getting through the NCLEX. Efforts are continuing in Virginia to permit the nurses from Canada to become licensed in the state just by endorsement. Legislative measures earlier permitted the foreign educated nurses to work in nursing homes without the help of a license for 180 days; presently it has been reduced to only 90 days. (Trossman, 2002)

The Bureau of Citizenship and Immigration Services -- BCIS brought out the final rules necessitated under section 343 of the illegal Immigration Reform and Immigration Responsibility Act -- IIRIRA of 1996 on July 23, 2003. Such rules require that the foreign-educated healthcare professionals, like nurses, occupational therapists, physical therapists, medical technicians, physician assistants, speech language pathologists, medical laboratory technologists and audiologists who are striving for a temporary or permanent occupational visa and also those who are striving for NAFTA status are necessitated to first attain a CGFNS/ICHP Visa Screen certificate as part of the visa process. Early such requirements were applicable only to those seeking permanent occupational visas. This rule will also require some non-immigrant foreign health care workers other than physicians to present a certificate granted by an approved independent credentialing organization prior to entering the U.S. (All Foreign Healthcare Workers Must Re-certify)

Taking into consideration the shortage of staff nurses in U.S., the role of foreign nurses in are viewed quite significant, particularly with regard to multicultural awareness and bilingual and multilingual ability. Amidst the widespread diversity that America exhibits presently, the significance of such roles need not be minimized particularly amidst the growing trend of diversity of the U.S. patient population. Irrespective of such positive contributions the foreign nurses are confronting several challenges in entering U.S. In order to practice. The...

The foreign-educated nurses are required to show the nursing school transcripts and their high school diplomas. They are also required to satisfy that their secondary education is equal to the high schooling of a U.S. nurse, which is not always very easy amidst various educational systems. They are required to pay substantially for having these documents translated into English. They are to incur costs to travel to a location to take the Commission of Graduates of Foreign Nursing Schools --CGFNS tests. (Stewart, 1998)
In such manner the financial and personal costs of preparing to work in the U.S., specifically for nurses from the developing nations are considered to be very high. Foreign nurses who are already placed in the U.S. also confront several challenges. Nothing ensures that foreign nurse is able to understand U.S. And state law. In accordance with the NAFTA conditions, a foreign nurse is expected to be treated like any other Registered Nurse but she is not like any RN as the foreign nurses are not able to know the wage and hour laws and thereby placed at a disadvantage. Even the American nurses indicating abuse of wage and hour laws impacting foreign nurses are also considered to be at a disadvantage.

Some of the foreign nurses even do not understand about the American Democratic Process and their right to involve themselves in concerted actions in the middle of the abuse. The international mobility of nurses will continue to be a vital concern as a result of global trade in professional services affecting the economic value of the services of registered nurses, not withstanding whether they work in the U.S. Or abroad. The ANA is committed to improve the causes of quality nursing and patient care safeguarding all nurses domestic and foreign. This has been targeted to be attained through close watch and influence upon the complex patchwork of trade agreements, labor issues, immigration legislation, and private market forces that in combination exert the challenges of global nursing. (Stewart, 1998)

The nurses who have emigrated from other nations contribute substantially to the nursing profession in U.S. In terms of tremendous advocacy for their patients and their profession. However, some employers exploit and abuse the foreign health care professionals who are sometimes not able to challenge or make formal complaints. It is evidenced that nurse smuggling rings are active in U.S. that fraudulently attain visas for the nurses, compel the nurses to work and live in awful conditions paying them substandard salaries. There is a striking balance between the necessity of human resources in developed countries like United States and the rights of the individual nurses to improve themselves economically and contribute to the financial prosperity of their families. (Position Statement on Recruitment and Rights of Foreign Nurses)

State laws controlling nursing practices have progressively been acknowledged the incidents in which nurses are made legally liable for exercising judgment independent of the physicians, acknowledging that nurses are progressively coming to school to attain advanced degrees, specialize in the specific field of practice, enabling themselves are assuming more of a leadership role in healthcare delivery. This is optimistic for the profession, but it is required to be aware that along with enhanced liability and acknowledgement entails enhanced exposure to liability. The American Nurse's Association has chalked out a curriculum for the managed care that emphasizes the roles for nurses amidst the managed care environments. The major liabilities and skills incorporate providing of health promotion, health screening, prevention and educational programs and services. Additionally, nurses are called upon to involve in referral, triage and case management actions. Nurses assist patients to learn and adopt self-care techniques and personal health management efficacies. The gradual transition from focusing on the individual patients to concentrate on patient collectives or specific populations necessitates nurses to think in wider terms. (Shinn; Cipriano; Britt; Reckling; Welsh; Sattler, 2001)

The roles and responsibilities for the enhanced role of nurses have been identified in the study of Graff et al., during 1995 as: identifying of at risk population, developing interventions to lessen risk factors; establishing care coordination system; resource networks and important links for patients and staff to promote accessibility to required services; data collection, assessing and evaluation; detection of approaches to minimize hospital duration of stay; a concentration on results and an assessment of variances from that of the standards of care. The ethical questions…