Sad state of nursing in the USA and how it affects the Philippines

By BRUCE WHEATLEY, gynae@aol.com
January 24, 2011

So, you got into nursing school, passed all the requirements, took and passed the NCLEX and now, here you are wanting to go abroad and work as a nurse. But…. You can’t find an opportunity available. Why? …. Well here may be some answers for you.

As it pertains to the US, nursing is in a sad state of affairs. We are told that there is a shortage of nurses in the US. But in reality, there is no actual shortage. There IS a shortage of nurses willing to WORK as a nurse! Every year, more ‘good’ nurses leave the field of nursing because of the standards in which they are forced to work under have gotten worse over the years they have been a nurse. It is a slow downward spiral.

We here in the US have created a monster with a life of its own called HIGHER EDUCATION. Nurses are now made to think more of themselves than they are actually worth. Why be a ‘nurse’ when you can be a clinical nurse specialist or a clinical educator or a nurse practitioner? School and more school and more school is the way to go, or so say the professors of nursing in those universities. The more students enrolled, the more income to the school the higher the salaries to those same nursing professors who are pushing unqualified and under qualified applicants into these advanced programs just because the applicant can qualify for a student loan or a grant.

There are long waiting lists to get into these already full programs. And of course, there is a shortage of nurses willing to be ‘just’ a bedside nurse and actually (gasp) do basic nursing functions with their patients. Since most of these nurses think they are too good to do basic care, the hospitals have hired aides and simple care givers to take care of those dreaded basic nursing tasks.

Since we now have a shortage of bedside nurses, a shortage that is actually a false shortage, a made up shortage, but still there are not enough nurses willing to work AS A NURSE. So, in past years, there have been at least 2 approaches to fix the situation. One was, as you know, to allow foreign nurses the opportunity to come to the US on a special visa to work as a nurse. The other was to ‘dumb down’ the requirements to actually get into and pass nursing school. Let’s talk about the dumbing down part first.

Prior to say the 1980s, nursing schools had entrance requirements and personal standards that must be met. Those standards have been ‘relaxed’ many times. I have a relative who was a professor of nursing at the associate degree level school for maybe 25+ years. In her last couple of years of teaching, she was ORDERED not to fail anyone. The demographics of the nursing classes had changed (read racial make up) and it was not politically correct for a nursing school to have a failure rate of certain groups of students, which may effect the school’s ability to get more students and tuition income. If an instructor tried to fail a bad student, the instructor would be called a racist for not making special accommodations for that student……

Basically unless you as a student dropped out, if you showed up every day, you were allowed to pass and this was rationalized by the nursing professors in that the ‘really bad’ students would not be able to pass the NCLEX exam. It ended up with that ONE EXAM being the gate keeper between the patient and a nursing disaster being able to work as a nurse.

The end result is that in the US, we now have several generations of people working as a nurse, which are only working because the standards were lowered to allow them into the field of nursing. It is reasonable to say that there have been thousands of felons working as nurses, and many more thousands in or have been in ‘impaired nurse programs’ that are set up for drug addicted nurses to allow them to continue to work while going through some drug program. As long as the student nurse properly disclosed their criminal record on their application to the state Nursing Board, there was a good chance the Board would allow that person a license. Get arrested as a nurse for drug charges? Same standards apply.

Business as usual.

Still with me? Good. We will be getting to the Philippines part soon.

Faced with the growing number of marginally qualified nurses coming into the workforce, the older, qualified nurses started to retire or get out of nursing and into a different profession. This increased the shortage of bed side nurses. The older nurse who went to nursing school to be a NURSE found these new grads were thinking they were too good to do basic nursing care… “Isn’t there a nurses aide to give him a bath? I did not go to nursing school to give some old man a bath….” And the downward spiral continues.

Ah! Now the Philippines……

So, while you may have heard about special visa for Pinoy / Pinay nurses to come to the US and work, actually that special visa is for “foreigners” not just Philippine nurses. And THAT my friends is the problem!

The US today is trying to be a friend to the world and trying to be all inclusive. It is not politically correct to leave anyone out. At least officially that is. I mentioned earlier about the 2 ways the US was addressing the shortage of nursing. Well now we talk about the importation of foreign nurses into the US workforce.

First, the Philippines. In reality, since the Philippines is mostly a Catholic country and English is taught in schools, it is easy for a Philippine nurse to blend into the US work force and learn how to adapt. No special handling needed! With the limited number of visas available and the screening process for the nurse applicants, the US benefited from quality as a person and qualified-ness as a nurse of the Pinay.

But, in an effort to be all inclusive, those special visas were also available to ‘other nations’. Where the training, personal hygiene, language, and ethics were not the same as the Philippine nurse imports. Hospitals were confronted with foreign nurses who were easily offended, lacked training standards, who brought strange religions with them, demanded special holidays off and were not as easily accepted by the patients.

These same foreign nurses once here, demanded more accommodations and if the hospital said no, then the hospital could face discrimination charges and legal issues and costs. At the same time, many of these foreign nurses came from countries in which if lets say a patient has a broken leg, that patient may wait 2-5 days to see a doctor. So that foreign nurse did not understand that in the US, patients expect minimal delays. There were many issues of patients or their families having ‘problem’ in the various aspects of patient care / interaction with these foreign nurses.

Over time, our politicians were made aware of these problems and every once in a while these same politicians were patients or their family members were patients and they saw first hand what was happening in America’s hospitals. Also, it should be noted that the majority of Pinay nurses work in California, New York or in some smaller areas and the vast majority or Americans outside these areas see foreign nurses from countries other than the Philippines!

The special visas used to bring foreign nurses here to the US expired as a matter of law and they were not renewed in a timely manner or in the same numbers as past cycles.

Which brings us up to today and of course… you! You are ready to travel, trained, affairs in order and then you find no job visa available.

Now, lets talk about cause and effect and how it relates to time and the Philippines.

Remember, there is a period of time to pass between any action and a reaction. Sometimes it is years before there is a correction.

In past years, it was easy to get a special work visa to go to the US and work as a nurse. In the US, you can work and make between $25 to $45 an hour (P1,100 to P2,000 an HOUR). An entire industry came to be in nursing schools. Selling the students on the idea of going to nursing school, getting the NCLEX certification and then going to the US and making enough money live and send money home for your family. Maybe save and build a big house for your retirement. A good life / dream come true for anyone. 

And then the Philippine hospitals realized that the US hospitals wanted any foreign nurses to have a certain number of years working as a nurse before the US hospitals would accept them as a candidate for a position.

Hospitals in any country work on money! Private or public makes no matter. Without money, there is no budget to pay for supplies and of course salaries. Local governments who must use a certain amount of tax money to support hospitals also like to save money.

When hospitals realized that the number of nursing programs had grown by leaps and bounds, and then there was competition between nursing schools for clinical time for their students. In a few years, there were far more nurses graduating then there were hospital jobs available. From a purely business point of view, why PAY nurses, when there was a huge supply of recently graduated nurses who would work for free just to get the job experience needed to qualify for that special visa to work abroad and make some ‘real money’. Suddenly, hospitals did not have to budget so much money for nurses salaries! And there also the bad stories in Philippine media of hospitals requiring some recent grads to pay to get that free job in order to get that required experience.

So here we are. What is next? Can a special appeal be made to the new US Ambassador to the Philippines to request congressional approval for special work visas of JUST the Philippines?  Doubtful. Is it fair that the Pinay nurse is losing out on a good job opportunity because of the ‘issues’ caused by foreign nurses of other countries? NO!

But with the US trying to show that we are supporting the world and everyone is equal in the world…. It does not look like anything will change anytime soon.

What is needed in my opinion? What will benefit both the US and the Philippines? Well that is easy. The US needs to come to terms with the fact that not all people are equal or able to get along with other cultures. It is OK to not like some people or to give preference to some people that will benefit the host country. It is time to stop being a friend to the world and start doing things that benefit the US.

A good start would be to allow a 5 year visa for Philippine nurses, with 2 renewal periods allowed before that nurse must return to the Philippines. This allows the individual nurse to work for up to 15 years and save enough money to retire to in the Philippines. That nursing job is then opened to another Philippine nurse and the 5-10-15 yr cycle starts for that new nurse. The retiring nurse brings back to the Philippines up to 15 years of quality nursing experience where she / he can retire and work for the government as a nursing instructor or as a community outreach nurse. This benefits the US, helps to reduce the shortage of nurses for us, brings money back into the Philippines and ends up with a well qualified nurse then retiring and giving back into the Philippine community…. And the cycle starts again!

But in the short order… I see no real changes coming soon. And that, is bad for both the USA and the Philippines.