Legislation on Foreign Nursing Practicing in U.S.

Legislation on Foreign Nurses Practicing in the United States

Acute shortage of registered nurses is a grave problem faced by most hospitals in the United States. This problem is aggravated by the increasing demand for healthcare caused by a nation with an aging population. Around 1/3rd of the registered nurses in the country are over fifty. Estimates show that most hospitals are struggling with an average 15% vacancy for RN being left unfilled. Projections indicate that the situation is slated to worsen further resulting in around 20% deficit of nurses by 2020. [Gorenberg]. To solve this crisis, many health care centers in the country aggressively recruited nurses from foreign countries. The result was a surge in migration of nurses from many countries like Philippines, Canada, India, Nigeria, etc. Pressed by concerns regarding quality standards of these foreign nurses, the Department of Homeland security implemented new regulations by adding section 343 to the Illegal Immigration Reform and Immigrant Responsibility Act of 1996. Let us now have a brief overview of the implications of this important regulation and also touch upon the new developments.

IIRIRA of 1996 (Section 343)

The illegal immigration reform and immigration responsibility act of 1996 was passed to check illegal immigration. Over the last few years, thousands of nursing staff were recruited from foreign nations under temporary and permanent visa schemes. Many nurses from developing countries such as India, Philippines, china, etc., found the opportunity of working in American hospitals and getting citizenship an attractive proposition. However, the implementation of section 343 to the IIRIRA by the DHS in July 2003 bought a new situation to the nursing crisis. The new regulation requires that nurses from foreign countries coming under temporary nonimmigrant visas obtain a visa certificate. The DHS also recognized the CGFNS (Commission on Graduates of Foreign Nursing Schools) as a designated certifying authority. The CGFNS certification, which ascertains whether a foreign nurse is eligible to serve in the U.S., is a three-step process involving 'Credentials review', CGFNS qualification exam and TOEFL. [CGFNS]

The immediate impact of this new regulation is that it has made obtaining permanent resident status a tedious and cumbersome process. Also new aspiring nurses who are applying for temporary work visas have to wait for months together to satisfy the visa screening certificate requirement. As immigration attorney Carl Shusterman says, "something is clearly wrong when, despite the severe nationwide shortage of nurses, it is far easier to obtain a working visa for a fashion model than for a registered nurse."[Immigration Specialties]. It must be borne in mind that the CGFNS conducts the visa screening exams only four times a year, which creates a delay of at least 3 months for the certification to be obtained. The absence of a non-immigrant visa category for nurses also implies severe processing delays and induction time typically takes more than a year. A widely expressed concern is that the Visa Screen program is widely applied for all nurses working on temporary visas in the U.S., irrespective of the years of service they have already rendered. As Donna Dorsey, the president of National Council of the State Boards of Nursing (NCSBN) put it, "10,000 to 15,000 nurses who have been licensed and practicing in the U.S. since 1997 will be unable to provide health care because of the retroactive implementation of the rule.." [Lorraine Steefel]. Canadian nurses, who mainly serve the border states, are also affected by this new regulation.

The impact of this regulation is that it forces hospitals with nurse deficit to wait an unacceptably long time to fill in the staff from foreign countries. The result is an overburdened nursing force. Several studies have documented the negative impact of nurses working overtime to cover up for the lack of staff. As per 'The international council of Nurses', "the increasing amount of overtime threatens nurses' ability to provide safe and individualized care for patients." [MNA] Thus, there is significant concern that the quality of medical care would be seriously affected if the current shortage of nursing staff is not met with an intake from foreign countries. Though it has to be admitted that the purpose of section 343 of the IIRIRA is to make sure that nursing standards are not compromised, the truth is that the acute shortage of nurses presents a more pressing and real problem.