Posted on 05/30/2006 6:42:24 PM PDT by neverdem
It's become a stock image in the immigration debates: the flooded emergency room, halls packed with sick illegals seeking subsidized care. But now that image's negative is at the heart of a far smaller battle—not over the immigrants awaiting care in the E.R., but the immigrants providing it.
The immigration bill passed by the Senate last week includes a provision that would allow unlimited entry to foreign-trained nurses until 2014, and as a committee attempts to reconcile that bill with the less permissive House version, an open door policy for foreign nurses has a shot at becoming law. A free flow of RNs may seem like sound policy for a country in the midst of a severe nursing shortage, but opponents claim it's parasitic, emblematic of a ruinous American practice of stealing skilled labor from poor countries that can ill afford to export their most educated workers. The Philippines, in particular, seems to be hemorrhaging nurses, while the U.S. soaks up thousands of Filipino-trained RNs annually. Last week, a New York Times article, headlined "U.S. Plan to Lure Nurses May Hurt Poor Nations," implied that the Philippines' health system risks collapse if the U.S. keeps it up. Talking Points Memo Blogger Nathan Newman excoriated supporters of the Senate provision, complaining that " The U.S. refuses to invest in training and education of our own population, then instead leeches off the tiny investments in education done by developing countries."
The vision of American hospital administrators prowling the streets of Manila poaching nurses from Filipino hospitals presupposes that the number of Filipino RNs is fixed, completely independent of U.S. demand. But that hasn't been true for at least half a century. According to Catherine Ceniza Choy's 2003 book Empire of Care, Americans began training Filipino nurses in 1907, and the first wave of Filipino-trained nurses arrived in the United States between 1956 and 1969 as part of an Exchange Visitor Program. The Philippines has since become the world's largest exporter of trained nurses according to the World Health Organization. Filipino nurses trained in Americanized schools in English have been showing up in the U.S. for decades and in droves, and a nursing education has long been seen as a ticket out.
The government of the Philippines clearly thinks it gains something when America "leeches" off its investment. The government has consistently lobbied for more, not fewer, nursing visas in the United States and United Kingdom, with an eye on the massive remittances nurses send back to families still at home. The Philippines is heavily dependent on money sent from abroad; the government is famous for encouraging its citizens to leave, and eight percent of its population resides abroad as domestic workers in Malaysia, English teachers in China, and nurses all over the developed world. According to the Philippines Central Bank, large scale labor migration brought home remittances totaling $9.7 billion last year, and nurses have historically been among the most stable earners.
If the United States agreed to take in fewer nurses, would Filipino hospitals suddenly be flush with staff? Not likely. According to a 2005 report by the International Council of Nurses, new Filipino graduates "report that they can't find jobs in nursing." It's true that the Philippines suffers from a nursing shortage, but it doesn't suffer from a lack of trained nurses. Its hospitals are simply too poor to employ adequate numbers of them. That's a tragedy, but it won't be solved by slamming the gates at the U.S. border. Underfunded health care programs are a symptom of poverty, not of poaching. If the United States were to turn away nurses seeking placement, they would simply fill vacancies in every other developed country—the current nurse dearth is a global phenomenon affecting every region on Earth. U.S. demand has created supply in the Philippines: The medical professionals leaving now—at least some of whom will eventually return—would have been far less likely to invest years in study and training without the prospect of high pay abroad.
The Philippines won't suffer for the opportunities America offers its citizens. But it's not for well-meaning Westerners to decide where a health care worker would be "better off" anyway. Workers are not the property of countries that train them, and any policy that seeks to limit their options will prove cruelly restrictive. After all, stemming the flow of skilled labor doesn't just mean locking workers out of wealthy nations. It means locking them into poor ones.
Kerry Howley is an assistant editor of Reason.
FYI...
Heavy Metals May Be Implicated In Autism
Heart may be home to its own stem cells
If you do an author search at the PNAS website, you do it this way: Leri, A
Leri has nine complete, linked articles there on the heart and regeneration at PNAS. If you find the biology interesting, check the titles and abstracts. My guess is that all of PNAS's articles are free except the newest which require a subscription.
The article of the last thread that I linked had not been posted by PNAS at the time I looked. I've noticed that sometimes they are discussed in the popular press before they are listed here. Please note that those in blue at the last link are freebies.
FReepmail me if you want on or off my health and science ping list.
Totally wrong. The US baby boomers are getting old and want top shelf medical care. Visit an extended care facility and you will see old caucasians there.
I don't know about nursing, but for software engineering this does not seem to be the case. It seems that cheaper engineers like those from India make more ambitious software projects financially feasible. Such projects need to involve engineers who understand the target culture and business practices...which means us more expensive engineers from the U.S. have more opportunities which tend to offset those that are lost.
On balance I can't say if there are more or fewer opportunities then there would be without such interference, but I can definitely tell you that the software consumer is a big winner.
I live in the Philippines.
Many people here study nursing BECAUSE they know it will allow them to work overseas...if not in the US then in Canada or Saudi Arabia.
You simply can't work here and make enough money as a nurse (or even as a doctor in many cases) to support your family.
Our family is nearly all doctors and nurses. One doctor got a government public health job and stayed here.
The rest of the cousins are in Chicago or London...or take shorter (2 year) stints in Saudi Arabia or Kuwait to make money...
Thanks for the info.
Ignorance is bliss, in your case.
The nursing shortage is due to three things. Ageing nurses who are retiring. Working conditions that are crazy and dangerous to patients and nurses alike. And, nursing schools can't find teachers while at the same time making the curriculum so difficult that only about 60% of the students can make it through.
It's a serious problem. Just throwing money at it won't solve it.
Saving.
When I reached adulthood mmost women did not work.
There were only three choices for women, nurse, teacher, or secretary. I chose teaching where there is a lot of turnover. As I read this thread, I think nursing may be the same. It is probably run on the assumption that women will work a few years and then go have babies.
As with any job, why spend years and $$$ getting a nursing degree, when the jobs will be taken by immigrants?
Gay men?
"The hospitals can't afford to pay nurses more b/c of all the insurance premiums it pays for possible malpractice "
That's only half of the problem. It costs hospitals millions of dollars every year for uncompensated care..ie illegals. The hospital I work at was cited for trying to bribe a state senator to pass legislation beneficial to the hospital, so as a penalty , they had to increase their amount of uncompensated care by $4,000,000. I think as a 125 bed facility we are spending $8,000,000 a year on uncompensated care.
I was in the hospital for one week last fall. The nurses were from Africa and the doctor was from Russia. The doc was pretty good but the nurses were way below standard.
Nurses do the work other Americans won't do. Do you hear a familiar immigration ring in your ears?
Otherwise, it's a tough education curriculum, hard work physically and intellectually, with crazy hours because the human body breaks down 24/7. Sick people are typically a miserable group of clients with lots of moving parts that can't be opened with a screwdriver.
I wouldn't trade my nursing education and experience for anything. Parlayed it into a very successful career.
Amen!
Reading the comments on this thread make me feel like I'm working in another world. I am in a small community hospital. We have hardly noticed the nursing shortage and receive pay comparable to other hospitals in the region. The docs are human beings, not raving abusive monsters and the nurses do not, with some exceptions ;o), "eat their own". Sheesh!
I agree with you entirely. I would make one addition: a large component in improvement in healthcare in the last 35 years is the tremendous improvement in nursing education. It is much more difficult to get a diploma/license than in the past. The more difficult, the less the pool of qualified applicants and the less graduates. I, of course, applaud the educational trend, but there are consequences.
It's wonderful that you have a postive experience going in your small hospital. That's how it's supposed to be. Unfortunately, it isn't always the case and in 25+ years of nursing I have indeed seen nurses "eat their own". I've also seen out of control doctors on abusive ego trips. It's very ugly because that behavior usually eventually transfers itself down to the patient and patient's family level. It's those complaints that can sometimes lead to the rebuke of an abusive physician, but not often from staff complaints, in my observation.
In my years of administration, it was frustrating to hear the cries of "we need help!" (which was entirely the case) only to have subsequently seen new people I hired, isolated and ostracized simply because they were new. Very much a shoot yourself in the foot scenario and all the counseling I could do didn't change it much in the long run.
Acuity levels have played a large part in driving nurses away from the profession IMO. The patients are sicker than before, yet frequently without additional staffing appropriated by the hospital. Couple that with the other demands of the profession, hours, physical demands, pay scales etc. many very good nurses have decided it just isn't worth the stress.
gay men
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So you think all nurses who aren't women are gay men? Speaking as a man who, though untrained, has had to serve as a nurse for my first wife through cancer, my mother through cancer and my father through cancer, I resent that remark. What does the Z stand for Johnny, Zero?
People have been brainwashed about sending their kids to college and not trade schools. Last time I heard, my plumber was making pretty well $$$$$
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The trades only pay well if you run your own business, except for a few plumb jobs. Most construction people in my area make a lot less than the nurses make, and the nurses in the hospitals have benefits that are worth what the construction worker earns.
Call yourself an extraordinary physician, I don't care. If you're taking this personally you need psychological help.
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