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Chris Musillo on Nurse and Allied Health Immigration

Fewer Nurses Means Greater Risk of Death

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by*Chris Musillo

Sometime in 2011, Congress may wish to revisit the*US' immigration policy. MU has consistently called on Congress to raise the artificial limits on true shortage occupations, such as Registered Nursing. At present, it takes a fully-qualified foreign-trained Registered Nurse about six years to obtain an immigrant visa. These nurses pass identical licensing exams to US nurses. They also must pass English fluency exams.

The Department of Labor continues to point to nursing as one of the*occupations in the shortest supply.

Now, comes a*March 17, 2011*New England Journal of Medicine*research paper confirming that*Fewer Nurses Means a Higher Risk of Death. The study, authored by well known researchers such as Dr. Peter Buerhaus, cites hundreds of thousands of admissions and nurse work shifts. The researchers found that*a patient's risk of death increased by about two percent for each work shift that was what the researchers categorized as understaffed.

The study was also subject of a recent*Scientific American*podcast, which is freely available for download.

The*US' immigration policy is woeful on so many fronts, but liberalized nurse visa rules should be a simple one to fix because the benefits to Americans would be enormous.


Read the full Healthcare and Immigration Law Blog at**or*



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  1. USA NURSE's Avatar
    I couldn't agree with you more, nurses save lives. But the issue is hospitals are cutting back on staffing and many US and Perm Status unemployed. I vote hire more nurses, hire US and Perm status, then call for immigration reform/
  2. Chris Musillo's Avatar

    @USA NURSE - I agree. Keep in mind that since 2006-7, virtually zero internationally trained nurses have entered the US workforce under the employment-based visa. The only internationally trained nurses to enter the workforce have been spouses (e.g. an American citizen marries an internationally trained nurse).

    My complaint is that if, tomorrow, US nurse-unemployment rates went back to 0%, like they were from 2000-2008, it would still take 5+ years for a fully-qualified international nurse to legally enter the US and work. That isn't fair to the US nurses who would again be overworked, the foreign nurses who work hard to pass US licensing exams, the hospitals who need the nurses. And most importantly, as this research proves, very risky for American patients.

  3. USA NURSE's Avatar
    I know of many unemployed nurses at this time, if the economy picks up which I know it will, there a legion of US and permanent resident, licensed RNs who can and will pick up the slack. Many RNs who have graduated are working in skilled nursing facilities, their positions can be replaced by practical nurses. So I am not concerned that any nurse will be overworked in many many years due to the lack of unfilled positions. And when the Economy picks up it won't be over night so there will be plenty of time to pass a bill and educate more Americans to work as nurses. The demand that happened in previous decades did not happen over night and the next cycle won't either.

    I am glad you have pointed out that virtually no nurses have entered the USA legally, since many feel they can cheat their way in with an H1B visa. Good to hear this from a lawyer that H1B is not for nurses ( of course there are a very very small minority of nurses who qualify- but not a nurse with no experience. Also to encourage more foreign nurses to enter nursing to gain their "American Dream" is cruel in my experience. Many IEN are paying money they don't have to come to the USA. You are doing a public service pointing this out.

    I read how many foreign nurses who graduated 5 years ago, no nursing experience, are scrambling to renew their license and keep their visa current. Five years is long time in the nursing world, and all these international nurses will need an extensive re entry program and orientation. I question how they are going to be able to help when the economy recovers since they will not have any nursing experience and not have current nursing knowledge, scary to me.

  4. Rajani's Avatar
    @USA Nurse, Are you not aware that various US State Boards Of Nursing have their own way to check the credentials and current nursing knowledge before allowing an RN to renew the license. None of the RNs who have applied for Green Card will sit idle. By and large all of them are working in 500 plus bedded hospitals since they are aware that this will be a requirement by healthcare facility.

    Majority of the International Nurses who passed out NCLEX RN from USA and holding visa screen certificate through CGFNS have already moved to countries like New Zeland, UK, Australia, Ireland etc. and there is no guarantee that they will be available to work in USA when the economy improves.

    It is not an easy task for an International RN to become eligible for Green Card. Apart from various examinations like CGFNS, NCLEX, IELTS etc. the RNs need to undergo interviews at various stages. prior to filing I 140 by Staffing Companies, re interview again when the visa Numbers are available and final interview by the healthcare facility once the visa is stamped and another personal interview on arrival in USA. Unless the RN proves that she is capable working like any other RNs within 2 months of joining the facility in USA, she will out of the job.
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