Imagine No More Nurses

Recruiting foreign nurses to cover staffing shortfalls is local hospitals' latest healthcare Band-Aid. But the crisis only grows.

 You might not know it to look at them, but Michael and Elizabeth deVera are sought-after commodities: a picture-perfect example of the latest solution to the nursing shortage.

In Minnesota right now there is a shortfall of upward of 3,000 nurses, and that number is expected to more than double in the next five years. Across the country, the figures are terrifying. This year demand for registered nurses is expected to outpace supply by more than 130,000. At present rates that number will be 800,000 by the year 2020.

The deVeras are nurses, well-educated, well-trained, recruited from their home in the Philippines to work in the Twin Cities--to plug the expanding cracks in the crumbling pipeline of registered nurses here. They work the overnight shift on the telemetry floor (a cardiac care unit) at St. John's Hospital in Maplewood.

Pamela Valfer

They have been here a year now and, aside from occasional bouts of homesickness, have only the best things to say about their new lives. They have only good things to say about their employers, their co-workers, and the patients they treat. They are eager for opportunities to advance professionally. They are happy to earn in two months here the equivalent of a year's salary back home.

"I couldn't speak highly enough about them," says Patrice Dailey, the deVeras' boss and clinical director of the telemetry unit. "We've had nothing but positive comments from our patients. They have such a positive attitude because they're so thankful to be here."

The deVeras are two of some 50 nurses recruited by HealthEast Care System to work in its hospitals and healthcare facilities in the Twin Cities. Other recruiters have also brought Filipino nurses to Minnesota to work in hospitals and nursing homes. It's hard to know exactly how many are here, but the Minnesota Board of Nursing says it issued permits to 39 Filipino nurses in the 2002 fiscal year, compared with 29 from Nigeria and just 4 from India. Overall, 436 licenses were issued to foreign-educated nurses in 2002, up from 292 the previous year and the highest number in five years.

Recruiting nurses from the Philippines is a seductive solution to a growing problem. After all, what could be better? They're trained in a curriculum modeled on that of American nursing schools. They speak English, often with only the scarcest accent. And, of course, as members of a "model minority," they are readily accepted as quiet, smart, and hardworking. In short, it is not hard for them to fit in.

It's no wonder that in the midst of this crisis American hospitals are looking overseas for bodies to beef up their staffs. But it's precisely because the solution is so appealing that it's so dangerous. Recruiting nurses from the Philippines is just one more in a series of Band-Aids for a massive nursing shortage that's been brewing for a long time. It doesn't address the reasons behind the shortage--the deliberate cost-cutting practices of hospitals and HMOs, the entrenched balkanization of nurses--and it doesn't do anything to fix those problems in the future.

"We go to Mexico to get our orange tree workers, India to get our software designers, the Philippines to get our nurses," says Steven H. Miles, M.D., a professor at the University of Minnesota's Center for Bioethics. "But it's a stopgap measure. We've blown an opportunity to make the structural repairs at home by patching over with the Philippine solution."


According to a July 2002 report from the U.S. Department of Health and Human Services, nursing in the United States has a bleak future. For starters, the report takes a look at nurses' salaries. The comparison of choice--with elementary school teachers--is revealing; if you thought the people who shape young minds are underpaid, wait until you see how we compensate the folks who hold your life in their hands. "In 1983, the average elementary school teacher earned about $4,400 more than the average RN; by 2000 this had grown to the point where elementary school teachers earned about $13,600 more," the report states. (In 2000, the average nurse's salary was $41,080.)

But there are other telling statistics. From 1995 to 2000, the number of registered nurses graduating from nursing schools fell by more than a quarter. And nurses are getting older: In 1980 25 percent of nurses were under age 30; in 2000 it was a mere nine percent. Today the average age of a nurse is in the mid-40s. In addition, the number of nurses who are losing or simply giving up their licenses is skyrocketing. The loss of nurses from the license pool grew sevenfold from 1996 to 2000, and by 2020 more nurses will be leaving that pool than entering it.

Cynthia Barnes is 61 years old. She's been a nurse since 1965. She has delivered babies, sat beside patients as they died, treated countless sick people, helped their families cope. She decided, at age three, that she wanted to be a nurse, and she's never swayed from that determination. She loves what she does. The wages, she contends, are decent, and the schedule is fairly flexible. But on more and more days, Barnes's job seems not just difficult, but near impossible.

"It's crazy. It's frenzied," says Barnes, a nurse in the intensive care unit at United Hospital in St. Paul. Though staffing levels, which in the ICU are one or two patients per nurse, have been adequate of late, Barnes has had her share of moments when the nursing shortage hit home.

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