Now, the U.S. Nursing Profession Is Facing Foreign Competition

[Natalie Kopple]

"Indian nurses flock to the US"
http://in.rediff.com/money/2004/feb/13nurses.htm
"Nursing as a Route to the Green Card"
http://www.murthy.com/uknurse.html
[ March 04, 2004: Message edited by: Natalie Kopple ]

[Arjun Shastry]

and this is again a cheap labor or some fraud, right?

[Jeroen Wenting]

cheap labour in part, lack of locals in part, fraud in part maybe.
In Europe we've been importing nurses from eastern Europe for a few years because there's a huge shortage. Due to cutbacks in healthcare leaving the profession in a bad light as underpaid, overworked and no job security the number of people entering training is too low to cover the number of new nurses needed each year.
In part because of this hospitals have entire floors standing empty due to lack of staff (in parts it's also because of the cuts leaving hospitals without money to staff them all) while patients have to wait sometimes for years to get treatment!
Some of them are now bringing in nurses from Poland and Czechoslovakia (and even from African countries like Nigeria) to compensate.
These are however hired strictly on shortterm contracts (3 years for example) to cover the slack while people here are in training (and are in part paid for out of foreign aid in programs to train nurses from developing nations to return to their homecountries to improve healthcare over there).

[Ashok Mash]

Originally posted by Capablanca Kepler:
and this is again a cheap labor or some fraud, right?

How did you guess?
I bet this is going to be more interesting to watch than the IT jobs, I would imagine, because there will be two groups with in the American coderanch, a group representing nurses and medical staff, and the other group - patients and general public who are worried about the massive delays in treatments and increasingly prohibitive expenses). This time around this may not between American public versus greedy corporations � or is it? Well, in both cases, there�s one group who are being blamed, hated and everything � the Indians. Well, I wonder whom should they point a finger at?

[Don Kiddick]

Well, in both cases, there�s one group who are being blamed, hated and everything � the Indians

Maybe by a small minority, but please don't tar us all with the same brush, I find that quite offensive.
D.

[Ashok Mash]

Originally posted by Don Kiddick:

Maybe by a small minority, but please don't tar us all with the same brush, I find that quite offensive.
D.

No offence meant, Don. That was a generalization ("sexed up", ). Please let me rephrase it.
"In both cases, there is one common unfortunate group that are being blamed, hated and everything else by some Americans � The Indians."

[Arjun Shastry]

Few Indians.

[Rufus BugleWeed]

How come I do not see any government programs to re-train IT workers to be nurses?

[Stephen Pride]

This was actually reported on 60 Minutes (or one of those news shows) last year, although, the reprt was specific to South African nurses coming to the US and the subsequent nursing shortage it is causing in South Africa (which has one of the highest rates of AIDS cases).

[Jon McDonald]

Importing nurses has been going on for probably 20+ years now. From what I've heard, a large portion of them have been filipina. However, one difference between nursing and IT is that foreign nurses have to take 1 or 2 tests to become licensed here. One is the NCLEX, and another is a test specific to foriegn nurses applying for licensure. They also may be required to take additional coursework if their previous education does not fill the requirements of licensure.
Also, there actually is a shortage of nurses, as opposed to IT personel. I know several IT people with proper credentials that are unemployed. I can't say the same for nurses. As a general rule, the one thing most nurses won't have trouble with is finding jobs.
Jon

[Paul McKenna]

Originally posted by Jon McDonald:
From what I've heard, a large portion of them have been filipina.

Yep.. you are right. I recollect reading an article that said Indian nurses were being turned away because they are usually grumpier when compared to Filipino nurses. The funnier part is, I agree.. The one time I spent a night in the hospital in India, the nurse was absolutely inconsiderate and inattentive.
Well, I'll surely want to get out of the hospital if some Indian nurse was attending to me. Ummm... maybe we should staff those hospitals where illegal immigrants seek treatment with nurses from India

[Thomas Paul]

My wife is an RN so I can tell you that there is a huge nursing shortage. Every hospital in our area is on constant recruitment. Salaries are steadily going up and there is no decrease in demand in sight. Hospitals had tried to switch to LPNs about 15 years ago for much of the care RNs were providing but since RNs have much more training and can recognize problems with patients much better it was found that patient outcomes were much better with more RNs on the floors. Combine that with the ageing US population and the demand for nurses is through the ceiling.

[Joe Pluta]

Ashok: Well, in both cases, there�s one group who are being blamed, hated and everything � the Indians. Well, I wonder whom should they point a finger at?
Ashok, I'm one of the most vocal critics of the visa programs in IT. But since as Thomas points out there is a real shortage of nurses at this time, I have no problem with supplementing the work force with temporary workers.
The issue comes into play when there are enough nurses, and hospitals begin to lay off American workers in favor of visa workers. Then it's a problem.
And even them I would not blame the Indian nurses, I would target the American medical community, Congress and the visa body shops (whateevr their nationality).
Joe

[Rufus BugleWeed]

When there exists a shortage in any given market this is when the invisible hand is to go to work. I do not think the shortage of nurses is because bubonic plague came along and wiped out nurses by the score. I do not think that this shortage was not anticipate.
In these United States the cost of a college education continues to outstrip the cost of living. The rising cost far exceed the bogus cost of living numbers the US goverment calculates so as not to have to pay social security retirees. IMO, it is getting to the point where nursing students have to go deep in debt to finish colllege. Or, they have to originate in what John Edwards calls The Other America. Or they have to make excellant grades all their acedemic careers to be in the scholarship crowd.
IMO, the scholarship crowd has no life and is subject to health threatening stress.
People hailing from The Other America for some reason avoid the nursing profession.
So we come back to my main point, that the cost and the rewards of getting a job as an RN in the US of A are not viewed by the labor pool as being worth the risk or do not pay well enough. Those people from the US labor market that make the sacrifices to become a registered nurse should enjoy lush benefits.
Importing scores of Indian nurses certainly alleviates the nursing shortage in the US. Should not the Indian taxpayers be rewarding for growing this crop of nurses with better health care?
I know that not allowing the importation of nurses means that people in the US will suffer and die from poorer healthcare. Is this outcome not what the free market demands? IMO, professionals in the US get shorted and the only way to overcome this is to let the market work. I think forcing people to die from poor health care is a fair trade for diminishing the entire life of a person who made the sacrifices to bring the in short supply skill of nursing to the market.
I am always delighted to hear why I am crazy, always delighted to hear why you do not agree with me, always delighted to be reminded that I have an opinion you do not like and therefore am not nice.

[Matt Cao]

Originally posted by Rufus BugleWeed:
How come I do not see any government programs to re-train IT workers to be nurses?

Hi,
Have you tried?
What I know is that some of my family members after the 9/11 a lot of them unemployed and the EDD gave them Nursing career manuals.
Regards,
MCao

[Rufus BugleWeed]

If the government is going to open the floodgates and allow a zillion foreign nationals into the country won't the pay scales really deflate?
IIRC, nursing salaries are not too high to begin with. Will they allow enough nurses in the country to get the salaries down to the 12 to 15K range? Being that the government buys a lot of healthcare, don't they have a huge incentive to flood that market too?
Why should I expect that the nursing profession is going to be any better about age discrimination than the IT profession? I can tell you from first hand experience the EEOC looks like a cruel joke to protect The Other America.

[Matt Cao]

Hi,
Why on earth do you expect nursing have high compensation? It is equivalent to technician in a manufacture.
I can see the reason why there is a shortage, if a nurse have the brain with discipline, could evolves into a doctor. The same analogy goes for technician and engineer.
For the issue of age discrimination, of course there is an age discrimination in every professions, it is why we have law prohibit such action. But in the case of nursing profession in the present time, if the hospital have the difficulty to staffing qualify nurses, are they going to bitching about the nursing age? Unless that particular nurse is so out of shape.
Based on my observation when I was babysitting my dad in the hospitals when no one else in my family had the time/clout to have time off more than a year. The reason government stepped up recruiting foreign nurses so the hospitals selected the best quality from the bunch instead just relied on native nurse only. Native nurses picked the time, picked which area that they want to work, the list went on. The hospitals yielded because demand over supply. As we know, it would not last because a trench worker, one did not have the power to challenge the system. It's OK by me, if he/she had the brain. The situation I witness was a garbage collection. I would not trust my life nor anyone I known with the current nurses. Ironically, the lousy ones were the one likely to complain about overworks and underpaid. What I saw in them mostly severely lacking in time management, lacking in self-priortization, and lacking in flexibility. I tried to point out the weakness to several of them, but met with fiercing resistants; therefore, I went the other way that was letting the doctors know.
Regards,
MCao
[ March 06, 2004: Message edited by: Matt Cao ]
[ March 06, 2004: Message edited by: Matt Cao ]

[Paul McKenna]

Rufus..
I am NOT going to engage in a debate about visas or labor importation or all those things. But I'm strictly going to debate the validity of your view on economics..
Have you ever been to Germany? I happened to make a transit halt there once and what I noticed in the airport left me thinking that their form of socialism, the one that you like the most.. is the worst economics in the world.
I bought a small, really small bottle of water for ..... USD 4.00. Mein Gott!!! Why is it $4? So that wage deflation does not occur for the person who operates the bottle stand. Is that what you want?

[Axel Janssen]

Originally posted by Paul McKenna:

Have you ever been to Germany? I happened to make a transit halt there once and what I noticed in the airport left me thinking that their form of socialism, the one that you like the most.. is the worst economics in the world.

Have you ever been in a cafe in Paris? A Cafe does cost 10 Euro minimum or so.
The thing you reported does more show that Germany is a capitalistic country (under all this high subvention/high taxes crap, we are going to clean up in the next 5 years. I promise).
They have set the price so high, because they know that at that place a lot of inexperienced tourists pass by. This is more capitalism/greed. The guy who runs the shop is good entrepeneur.
Fundamentally Germany is no socialistic country. The problem with Germany is that we created lots of nice niches for more or less elocuent no-goods who work like in socialism and get paid like in capitalism. And it appears extremly difficult to fight those created interests.
Axel

[Paul McKenna]

Originally posted by Axel Janssen:
They have set the price so high, because they know that at that place a lot of inexperienced tourists pass by. This is more capitalism/greed. The guy who runs the shop is good entrepeneur.

Yep, I'll conceed I never thought about that. But I then asked somone who lived in Germany for some time and he told me it was not much better outside. Perhaps things have changed significantly since he moved out of there.. could you shed some light Axel.
[ March 06, 2004: Message edited by: Paul McKenna ]

[Axel Janssen]

Originally posted by Paul McKenna:

Yep, I'll conceed I never thought about that. But I then asked somone who lived in Germany for some time and he told me it was not much better outside. Perhaps things have changed significantly since he moved out of there.. could you shed some light Axel.

That's because we lean a little towards complaining.
The opposite is true.
In reality our retailing (?) industry is really strong. Our very cheap discount shops chains like Aldi and Lidl are heavily expanding towards Europe and other parts of the world based on their knowledge about selling things cheap.
Whole business is based on low profit margins/high rate of turnover in such a systematic way, I haven't seen in other countries. I think one of the founders of Aldi (Albrecht) is second richtest man of the world (after Bill Gates).
Wall-Mart tried to manage to make inroads in german markte, but they had failed twice because of fierce competition.
I don't know if in other countries people use outlets so much as high percentage do here. I never buy clothes in shop, but in huge storehouses called outlets. They offer high discounts there.
Fierce competition means low trade margins, which is good for the customer.
I consider buying quality stuff cheap a national sport.
People who visited US in last 3 years considered it expensive.
"Midlife crisis" of Federal Republic of Germany is due to other factors (over-regulations, those many niches I mentioned above, costs of reunification). The typical arrogance of this country is in free fall and I am quite confident that finally we are going to enter in a phase where lots of reforms are implemented, like in UK in early 80ties, Netherlands in early 90ties and Sweden in mid-90ties.
[ March 07, 2004: Message edited by: Axel Janssen ]

[Jeroen Wenting]

A major problem in Germany is that quality goods are getting impossible to get by as ever more stores specialising in them (and having to charge higher prices because those goods are simply more expensive to make) are driven out by the Aldis and Liddls.
Decent vegetables and meat are impossible to get in most German cities for example, except that the German legal minimum standards are a bit higher than most countries.

[Axel Janssen]

Originally posted by Jeroen Wenting:
A major problem in Germany is that quality goods are getting impossible to get by as ever more stores specialising in them (and having to charge higher prices because those goods are simply more expensive to make) are driven out by the Aldis and Liddls.
Decent vegetables and meat are impossible to get in most German cities for example, except that the German legal minimum standards are a bit higher than most countries.

Come on. Situation isn't that bad. Would be even better, if we hadn't always to watch for those sleeping dutchmen with camper on our highways.
We still have enough people who care about quality. So there are other supermarkets, too. Also there are now lots of farmers who buy their quality stuff directly to customer. Though this is more for people with lots of time like my mother.
We would immediatedly better quality, if we somehow manage to keep those ridiculous EU agricultural policy in check. Found vegetables and especially meat much better in Chile.
Lots of stuff from both is not necesarely of low quality, though I mix my food shoping.
[ March 07, 2004: Message edited by: Axel Janssen ]
[ March 07, 2004: Message edited by: Axel Janssen ]

[Rufus BugleWeed]

Come on. Situation isn't that bad. Would be even better, if we hadn't always to watch for those sleeping dutchmen with camper on our highways.

Could you translate for those of us on the other side of the pond?

[Jon McDonald]

First a little background on me to put my opinion in perspective. I come from a family of nurses. My mother is the Chairperson of a nursing department. I currently work for a university as a technology coordinator, and one of the schools that I am responsible for in the university is its school of nursing, so I have frequent contact and discussions with both faculty and students. This is not to say that my opnion is expert, rather that it maybe somewhat informed.
My personal opinion is that the single biggest reason for the shortage of nurses has to do with the women's liberation movement. 30 years ago, a young, intelligent, women had basicly 3 prospects out of college, become a teacher, become a nurse, or find a husband who is (or will be) successful. Sure, there were exceptions, but by in large, these were a college educated woman's best prospects.
Once the women's liberation movement kicked in, two things happened:
1) Many new opportunities opened up for college educated women.
2) A stigma was attached to nursing as being a demeaning position in which a woman (the nurse) would always be subbordinate to a man (the doctor).
Thus, some of the best and brightest women who would have gone into nursing earlier, now actively avoided it.
Now couple this with the (still present, but diminishing) stigma of a man who choses nursing as a profession as being effeminate, or even homosexual, and we can see why there are shortages. In fact, back in the late '80s several nursing schools closed due to lack of enrollment. In addition to all of this, in my opinion, nursing is one of the most demanding undergraduate majors a person can chose.
One thing that we are seeing is more people entering the nursing field now. At the university I work at, enrollments are going up, and more men are chosing to major in it. Also, nurses are being given much more power than they were even 10 years ago. Some nurses can prescribe medication. Nurse Practitioners now have private practices similar to a General Practictioner Physician (Although they still must consult with Physicians). Nurse Anestisiologist(sp?) can now command salaries of well over $100K per year. Add to that the natural mobility of a nurses skills and it is becoming the career of choice for a growing number of men and women.
Now, we are seeing more people who already have bachelors degrees going back to school to become nurses. For example, I was working on a web app in my office a few weeks ago, and one of the male nursing students stopped by with a question about some educational software we have on our system. While we were talking, he looked at my computer screen and asked "Are you implimenting the Singleton Pattern for that class?". Turns out he has a BSCS and was a programmer for several years before he decided to switch to nursing.
Jon
[ March 08, 2004: Message edited by: Jon McDonald ]

[Steven Broadbent]

As far as nurses being technicians, let me say one thing. I know nurses working in specialist areas like neurology or special baby care who are experienced yet earn less than 20k, while some tit with an oxbridge degree can start with a big 5 company for 25k+. There are many foreign nurses in the uk too, the profession has had problems for a long time in recruitment and staff retention.

[Axel Janssen]

Originally posted by Rufus BugleWeed:

Could you translate for those of us on the other side of the pond?

Sorry, I hijack a little, because Rufus asked me.
[OUT_OF_TOPIC]
In german highway mytology dutchman with camping trailer plays an achetypical role of the element of danger, which plays by his own rules.

Is a little bit exagerated, but in part true. I have seen. Lots of dutch have camping trailer, when drinving in Germany and their style doesn't fit very well.

The highway system of the Netherlands is very different from the german one. Dutch highway is like broad, slow, steady river. German highway is like a bit narrower, chaotic and often very fast river.
In Netherlands they have speed limit and nearly all people accept it. In Germany in lots of highways there is no speed limit.
In the Netherlands there are no hills. You can overview trafic for next 40 kilometers. In Germany there are hills and many highways do have lots of curves. Especially the old ones constructed by nazis, who seems to had more a Wagner oper in mind but the nearest connection between 2 cities when planing the track.
So dutch drivers often drive in a way difficult to predict for german system. On german highway when you are with car which does not make more than 150 km/h like me on left track most important thing to watch is driving mirror. Because there is very often some mad german salesman who just got some flashy BMW which can make 230 km/h.
Now dutchman is driving with the 120 km/h he is used to. In front of him is Lithunian truck which does only make 70 km/h uphill. Dutch looks in driving mirror, there is no car, he thinks some seconds about switching to left track, he doesn't watch again in driving mirror (mistake) and switches. Exactly in the very moment when mad german salesmen in suicidal tempo flush is going to pass by both.
So if you ever drive in Germany with fast car, watch out for those yellow plates.
I prefer train this days. Much better for relaxing, reading, laptop and some rare times a good talk.
[/OUT_OF_TOPIC]
Axel
[ March 08, 2004: Message edited by: Axel Janssen ]

[Thomas Paul]

Why on earth do you expect nursing have high compensation? It is equivalent to technician in a manufacture.
I can see the reason why there is a shortage, if a nurse have the brain with discipline, could evolves into a doctor. The same analogy goes for technician and engineer.
This is perhaps the most ill-informed comment about nursing that I have read. It is a lot harder and requires a lot more educaion to become a nurse as compared to becoming a programmer. Nurses aren't just less-educated doctors. The nursing specialty requires a lot of expertise that doctors do not have. Nurses don't simply carry out a doctors orders. A nurse could lose his/her license for carrying out a doctor's orders if those orders are wrong. Nurses must know as much as doctors do in many cases and know it across many more disciplines. A nurse must be a generalist while a doctor can be a specialist.

[Thomas Paul]

Originally posted by Steven Broadbent:
As far as nurses being technicians, let me say one thing. I know nurses working in specialist areas like neurology or special baby care who are experienced yet earn less than 20k, while some tit with an oxbridge degree can start with a big 5 company for 25k+. There are many foreign nurses in the uk too, the profession has had problems for a long time in recruitment and staff retention.

I assume this is in pounds. The typical starting salary for a nurse in the NYC area is in the USD 50-60k area.

[Robin Davies]

To Natalie Kopple
As far as i am concerned, they ahave every right to be there.
In years to come the economy of China and Indai will overtake the U.S.
As well as fill shortages, the U.S needs every body it can get hold of to remain a super power. Anyway, they can't win even if they tried they havn't got the numbers. No matter how many people they let in. China and India, how many years??? 10 -15 ???

[Paul McKenna]

Originally posted by Axel Janssen:
[OUT_OF_TOPIC]
...
[/OUT_OF_TOPIC]
Axel

The Aryan Invasion theory of India has been validated.. I think a lot of Indians have the "mad german salesman" streak in them. I enjoyed your description of the dutch, german and lithuanian drivers Thanks.. it gave me a very good laugh.

[Paul McKenna]

[out of topic]
Actually, come to think of it.. Axel, Germans seem to adapt to Indian traffic also very well. Since my father worked for a German company, we used to have a lot of German friends over in India and they used to insist on driving in India. We used to worry if they would be able to handle the extremely chaotic traffic pattern in India.. but the fascinating thing is they did adapt and very quickly.
The Germans always "behaved like the locals". They cut lanes like me, honked the hell out of the car and yelled and screamed at everyone else on the road.. just like me!
[/out of topic]

[Matt Cao]

Originally posted by Thomas Paul:

This is perhaps the most ill-informed comment about nursing that I have read. It is a lot harder and requires a lot more educaion to become a nurse as compared to becoming a programmer. Nurses aren't just less-educated doctors. The nursing specialty requires a lot of expertise that doctors do not have. Nurses don't simply carry out a doctors orders. A nurse could lose his/her license for carrying out a doctor's orders if those orders are wrong. Nurses must know as much as doctors do in many cases and know it across many more disciplines. A nurse must be a generalist while a doctor can be a specialist.

Hi,
What I have seen demonstrated otherwise. One of the hospitals I have been through was Cedars-Sinai. It supposes to be the best qualified nursing staffs.
Technicians are also many levels not just some clowns with an Associated degree in Electronics/Electrical or whatever could be a well qualify technician. I have known BS in electronic also working as technician.
Regards,
MCao

[Thomas Paul]

Originally posted by Matt Cao:
What I have seen demonstrated otherwise. One of the hospitals I have been through was Cedars-Sinai. It supposes to be the best qualified nursing staffs.

Were you dealing with RN's or LPN's?

[Matt Cao]

Originally posted by Jon McDonald:
First a little background on me to put my opinion in perspective. I come from a family of nurses. My mother is the Chairperson of a nursing department. I currently work for a university as a technology coordinator, and one of the schools that I am responsible for in the university is its school of nursing, so I have frequent contact and discussions with both faculty and students. This is not to say that my opnion is expert, rather that it maybe somewhat informed.
My personal opinion is that the single biggest reason for the shortage of nurses has to do with the women's liberation movement. 30 years ago, a young, intelligent, women had basicly 3 prospects out of college, become a teacher, become a nurse, or find a husband who is (or will be) successful. Sure, there were exceptions, but by in large, these were a college educated woman's best prospects.
Once the women's liberation movement kicked in, two things happened:
1) Many new opportunities opened up for college educated women.
2) A stigma was attached to nursing as being a demeaning position in which a woman (the nurse) would always be subbordinate to a man (the doctor).
Thus, some of the best and brightest women who would have gone into nursing earlier, now actively avoided it.
Now couple this with the (still present, but diminishing) stigma of a man who choses nursing as a profession as being effeminate, or even homosexual, and we can see why there are shortages. In fact, back in the late '80s several nursing schools closed due to lack of enrollment. In addition to all of this, in my opinion, nursing is one of the most demanding undergraduate majors a person can chose.
One thing that we are seeing is more people entering the nursing field now. At the university I work at, enrollments are going up, and more men are chosing to major in it. Also, nurses are being given much more power than they were even 10 years ago. Some nurses can prescribe medication. Nurse Practitioners now have private practices similar to a General Practictioner Physician (Although they still must consult with Physicians). Nurse Anestisiologist(sp?) can now command salaries of well over $100K per year. Add to that the natural mobility of a nurses skills and it is becoming the career of choice for a growing number of men and women.
Now, we are seeing more people who already have bachelors degrees going back to school to become nurses. For example, I was working on a web app in my office a few weeks ago, and one of the male nursing students stopped by with a question about some educational software we have on our system. While we were talking, he looked at my computer screen and asked "Are you implimenting the Singleton Pattern for that class?". Turns out he has a BSCS and was a programmer for several years before he decided to switch to nursing.
Jon
[ March 08, 2004: Message edited by: Jon McDonald ]

Hi,
This is good. I've missed your post earlier.
Regards,
MCao

[Matt Cao]

Originally posted by Thomas Paul:
Were you dealing with RN's or LPN's?

Hi,
Some were RN and others LPN. They also have the so-called associate nurse too which handling bed changing and other mundance tasks. They are all referred doctors as "mom/dad". For instance, they used to give me hard time for using satellite phone in the hospital and my dad room, even I specifically told them I used digital phone. I went to the top to the head doctors. Morning after, no one give me any hard time and one of the RN (very nice gal from Ireland) told me when the "mom/dad" order they had to follow.
Regards,
MCao

[Mark Herschberg]

Let's try to keep this thread on topic, going forward. You can start a new one if your thoughts don't quite fit here.
--Mark