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Importing Nurses:  A Solution to Shortage at US Hospitals? - 2003-01-08


There is a growing nursing shortage in the United States. The situation is especially serious in Tennessee, where it's predicted that by the year 2020, the state will employ 10,000 to 30,000 fewer registered nurses than it needs. One local entrepreneur wants to provide some short-term relief for this long-term problem.

It's time for morning rounds at the Vanderbilt Hospital burn unit, on what nurse Michelle Wise calls a slow day.

"This place is really sedate today, which is nice," she said. "I love having days like this because sometimes you don't even get to go to the bathroom, much less eat lunch or anything."

Although the nurses' station on her floor is fully staffed, Ms. Wise says she often feels shorthanded and overworked. And that's the kind of feeling that's led many nurses to leave the profession. There have been nursing shortages before, but health care experts say this one is different. It's bigger, and it's long-term.

"The real crisis hasn't hit yet, but it's going to," said Ann Duncan, who directs the Tennessee Center for Nursing, a research center that did its own study on the shortage.

"The best-case scenario, based on the Tennessee study, would be that we would need over 9,000 nurses more than what we will have," said Ms. Duncan. "The worst-case scenario would be if the national sampling study that was done is actually accurate, that we would need in excess of 30,000 nurses more than we will actually have. When you think about spreading that out in our hospitals across the state and in other areas that employ nurses, that's a severe crisis that we will face."

It's a crisis that Nashville businessman Ron Marston says he can help resolve, not just in Tennessee, but at chronically understaffed hospitals across the country. His company, HCCA, has managed health care facilities in the Persian Gulf for over 30 years. He says his experience staffing those hospitals uniquely qualifies him to address medical personnel problems in this country.

"Always before we've taken people out of England and the United States and Canada and the Philippines and so forth and sent them to the Middle East. So we took that expertise that we had built over these 30 years with the knowledge, and the infrastructure, and the talent that we have and decided that we could bring nurses into the United States," said Mr. Marston.

HCCA plans to pay trained registered nurses from Britain, Canada, India, and the Philippines to immigrate and fill two-year contracts at hospitals in this country. The company has contracts with facilities in Arizona, North Carolina, and Kentucky, but none yet in Tennessee. Within five years, Mr. Marston hopes to bring in 2,500 to 3,000 nurses to work at academic centers, hospital chains, and independent facilities.

But some experts see international recruitment as a quick fix that may do more harm than good.

"Ultimately, importing nurses from other countries is not going to be the long-term solution," said Colleen Conway-Welch, dean of Vanderbilt's School of Nursing. She calls the nursing shortage a worldwide crisis.

"The problem now is that there's a global shortage of nurses and that we don't want to be in a position where we are raiding other countries of their nurses," she explains.

In her opinion, the international recruitment amounts to nothing more than a reshuffling of a meager resource and it won't address the real issue of fewer and fewer nurses entering the profession. "Ultimately, we're going to have to grow our own through workplace and workforce systems redesign," she said.

HCCA's Ron Marston agrees, and notes that international recruitment was never meant to solve the problem.

"It will not make a tremendous impact," he said. "You have about 126,000 vacancies today for nurses. Three thousand nurses doesn't really make a dent. But it is a move toward trying to enlarge that pool of nurses that we have here."

And what it will also do, he adds, is decrease health care's dependence on travel nurses, temporary employees who fill positions for a few weeks or months. Because they are usually paid a higher hourly wage than staff nurses, they can cause resentment, and skyrocketing labor costs for hospitals.

Balancing those costs with trying to keep an often overworked nursing staff satisfied is a tough job, according to Becky Keck, an administrator at Vanderbilt Hospital. But even with a tenth of their nursing positions unfilled, Ms. Keck says Vanderbilt isn't ready to hire nurses from abroad.

"You have to really screen very heavily for the language barrier, particularly because a lot of the language in medications and so forth, the orders that are written, are pretty complicated," she said.

Ms. Keck prefers to hire nurses from the many Nashville nursing schools and focus her efforts on holding on to the staff she's got. But with declining enrollments in those programs and the constant exodus of young nurses from the profession, she admits she may have no choice but to eventually look overseas for help.

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