The nursing shortage, now back in the news

Let’s review where we are with the nursing shortage in the U.S. and immigrant nurses, about which I have posted in the past. A recent Business Week article includes some passages I have inserted below, prefaced by comments by me. Then I cite from an earlier posting by me which includes an estimate that the supply of nurses from the Philippines, by far the largest source of foreign nurses, may be capping out.
The stimulus package included $100 million to enlarge the number of nursing school slots.
First, a new proposal to increase the number of work visas for foreign nurses (which idea Obama has criticized):
“In May, Representative Robert Wexler (D-Fla.) introduced a bill that would allow 20,000 additional nurses to enter the U.S. each year for the next three years as a temporary measure to fill the gap. If the bill doesn’t pass on its own, lawmakers may include it in a comprehensive immigration reform package. Obama is slated to meet with congressional leaders on June 25 to discuss reforming U.S. immigration laws.”
And, nursing slots are increasingly being filled by foreigners, in particular from the Philippines:
“As openings have become more difficult to fill domestically, more foreign-born nurses have entered the workforce, most commonly through green cards that lead to permanent residency. In 1994, 9% of the total registered nurse workforce was composed of foreign-born RNs; by 2008 that percentage had risen to 16.3%, or about 400,000 RNs, according to Buerhaus’ research. Of those 400,000 nurses, about 10% had immigrated to the U.S. within the previous five years. About one-third of the increase in RNs from 2001 to 2008 was composed of foreign-born RNs.”
Also, nursing union leaders point to poor employment conditions to explain why one fifth of nurses in the U.S. don’t work as nurses. (I wonder about this: aren’t nurses well paid, especially in an economic environment in which households are concerned about income?)
“Understaffing, mandatory overtime, and physically demanding work, such as lifting and bathing patients, take their toll. And while pay has risen in some regions to attract more nurses, in recent years it has flattened at the national level. That’s why up to 500,000 registered nurses are choosing not to practice their profession—fully one-fifth of the current RN workforce of 2.5 million.”
And, there are no enough slots in nursing schools to meet the demand. (That assumes that the turned away students are qualified.)
“One point everyone seems to agree on is that the U.S. needs more capacity to train nurses. Since 2002, enrollments at nursing schools have increased so much that up to 50,000 qualified applicants are turned away each year from training programs. The main problem is a lack of teaching staff at these schools. Dan Stultz, president of the Texas Hospital Assn., which represents more than 500 Texas hospitals, helped form the Texas Nursing Workforce Shortage Coalition to push for funding from the state legislature to boost capacity at Texas nursing schools. Stultz says the state has about 22,000 nurse vacancies now, and that the number could rise to 70,000 by 2020. Meanwhile, for the last five years, 8,000 to 12,000 nursing-student applicants have been denied places at training programs for lack of space. ‘We have qualified people that get accepted and can’t attend,’ says Stultz. ‘We don’t need more immigration; we need to increase capacity and grow our own workforce.’ “
From a prior posting on the global nursing shortage:
The Philippines is the leading primary source country for nurses internationally by design and with the support of the government. The 2001–2004 Medium Term Philippines Development plan views overseas employment as a key source of economic growth.16 Filipino nurses are in great demand because they are primarily educated in college-degree programs and communicate well in English, and because governments have deemed the Philippines to be an ethical source of nurses. A motivator for the Philippines to produce nurses for export is remittance income sent home by nurses working in other countries. In 1993 Bruce Lindquist reported that Filipinos working abroad sent home more than $800 million in remittance income.17 No other country produces many more nurses than are needed in their own health care systems at a level of education that meets the requirements of developed countries.
However, the Philippines may be reaching a natural limit in its ability to provide enough nurses for escalating worldwide demand. An estimated 85 percent of employed Filipino nurses (more than 150,000) are working internationally. About one-fourth of the total number of nurses employed in Philippine hospitals (some 13,500) reportedly left for work elsewhere in 2001.18 There has been recent debate that the growing global demand for Filipino nurses is so great that emigration of nurses could be threatening the country’s health care quality.19 It is estimated there are more than 30,000 unfilled nursing positions in the Philippines.20 In 2001 the United Kingdom, Saudi Arabia, Ireland, Singapore, and United States were the most common destinations for Filipino nurses.21

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