Legislation on Foreign Nurses Practicing in the United States

Legislation Pertaining to Foreign Nurses Practicing in the United States

Discuss the process that this legislation will go through, referencing the steps to the legislative and administrative process

The Rural and Urban Health Care Act of 2001 (S 1259 and HR 2705) dramatically expanded the existing H-1C temporary nursing visa program established in 1999. Before, there were only three ways that foreign-educated nurses could get permission to enter the United States to practice their profession. The first was by obtaining a permanent visa, which was solely for those nurses who want to become residents of the United States. The second was by obtaining a temporary visa, for those nurses who only desired to work in the United States for specified, usually limited periods of time. (Trossman, 2002) The last method was under negotiated trade agreements, such as the North American Free Trade Agreement. During NAFTA,

Discuss the history or similar types of legislation.

The American Nursing Association worked closely with Representative Bobby Rush (D-IL) and Senator Richard J. Durbin (D-IL), who introduced the NAFTA-era legislation (HR 2759) designed to allow for limited, temporary immigration of foreign nurses to work at hospitals that were having difficulty recruiting domestic RNs. (Stewart, 1998) Legislation pertaining to loosening immigration restrictions, however, when not in an international trade context of such scope as NAFTA is usually first proposed by a member of congress, goes through congressional hearing and review, and if passed, then is administered through the immigration, international, and health care bodies that allow foreign workers to work in the United States, negotiate labor arrangements between nations, and also make sure that the special needs of the health care industry are met in terms of nursing credentials.

For example, Congress responded to the nation's last major nursing shortage -- in the late '80s -- by passing the Immigration Nursing Relief Act of 1989 to create a special temporary H-1A visa category for RNs. According to Ruth Samardick, a statistician with the U.S. Department of Labor, 6,000 to 7,000 foreign-trained nurses were granted H-1A visas in each of the four fiscal years from 1992 to 1995. (Flaherty, 1997)

The method of credential validation has remained fairly constant. Foreign-educated nurses entering on temporary or permanent employment-based visas must go through a screening process, which includes a predictor examination that forecasts their likely performance on the National Council of State Boards of Nursing licensure examination (NCLEX), English proficiency testing, a review of the nurse's educational preparation comparing it with the standard U.S. curriculum, and a check of the nurse's license in her home country to ensure that it's valid and unencumbered.( Trossman, 2002)

The 2001 The Rural and Urban Health Care Act of 2001 was designed to increase the pool of foreign nurses in a greater number of critical urban and rural environments that lacked quality health care. (Trossman, 2002) "It's no secret that there's a nurse-staffing crisis in the United States. An American Hospital Association (AHA) survey of 715 hospitals conducted in spring 2001 revealed that there were as many as 126,000 unfilled registered nurse positions nationwide. U.S. health care facilities -- individually and in coalition -- continue to urge state and federal lawmakers to ease restrictions in both state regulations and U.S. immigration law to allow a greater influx of foreign-educated nurses into this country to ease this critical shortage." (Trossman, 2002) It was feared, however, that resorting to looser immigration restrictions and a more free dispensing of visas, even for needy rural and urban areas, will open the floodgates as never before to foreign nurses.

Discuss the stand that various health organizations have taken on this issue

While hospital organizations and local authorities in the regions targeted by the legislative act supported more aggressive strategies to recruit foreign nurses to deal with immediate difficulties of staffing, nursing organizations have stressed the need to find long-term solutions to improve working conditions and job placement strategies in areas where recruitment of U.S. nurses have failed. (Morgan, 1997) "If we constantly pass legislation that provides short-term fixes to cycles of workforce demands, we never address the real problems." (Flaherty, 1998) Education and recruitment of a new pool of nurses, rather than bolstering current reserves with 'imported' nurses does not provide a network of long-lasting community support in the needy areas, nor address why certain regions and rural and urban districts remain critically understaffed.

This is why the American Nurses Association and other nursing associations oppose the proposed loosing of current immigration law as and more aggressive recruitment of foreign-trained nurses in general, even for hard-pressed areas such as targeted in The Rural Nursing Act of 2001. The organizations do so on both ethical and practical grounds. "When we have a nursing shortage and ease our immigration laws, what we're doing is stealing nurses from other countries," protested the Virginia Nurses Association (VNA). The ANA, however, and its subsidiary organizations are designed to represent American nurses. They are mainly concerned in their manifestos, not about the exploitation of foreign-educated nurses once they begin working in health care facilities that have sub-standard working conditions, although that is a legitimate concern, as "many employers know that foreign-educated nurses will not speak up about poor working conditions or unfair treatment." (Trossman, 2002) Rather, these organizations were formed to protect the rights of domestic nurses; rights they believe are being violated.

The U.S. registered nurses the ANA represents will have to be prepared to be more competitive against an international pool of nurses who are likely to be "baccalaureate-prepared and willing to work at a wage below the prevailing U.S. rate," (Stewart, 1998) Also, there is not always a free and fair exchange of opportunities between countries. "U.S. nurses wanting a license to practice in these two provinces must be a permanent resident, or obtain Canadian citizenship," but no similar barrier faces Canadian nurses wishing to work in the U.S. "For Canadian nurses...the process of getting a TN visa is easy." (Stewart, 1998)