As top human resources officer for Valley Presbyterian Hospital in Van Nuys, Gregg Yost is something of an expert on the fervent demand for nurses in California hospitals and the perks some hospitals use to recruit caregivers to their facilities. It’s been true for years, Yost said, but there’s one type of nurse that Valley hospitals aren’t clamoring for this time of year: foreign nurses. “Although we will sponsor individuals that present themselves at Valley Pres., our problem is it is extremely time consuming,” he said. “It’s not an easy process.” While that may seem counterintuitive given the state’s dearth of nurses, Valley Presbyterian is far from alone. New immigration standards imposed after 9/11 have made sponsoring nurses far costlier and trickier than in previous years. Some hospitals are shying away, saying sponsoring nurses once seen as a reasonable solution to the state’s nursing shortage is simply too risky. “You’re going to invest in that amount of time and it won’t work,” reasoned Yost, but admitting later: “It completely flies in the face of a nursing shortage.” Those familiar with the immigration system contend the worries are based on misunderstandings. “I find an abysmal amount of ignorance in the healthcare community about how this all works,” said Carl Shusterman, an L.A. immigration attorney who specializes in helping nurses enter the country. Hot button ratios The resistance to sponsoring abroad is an odd reversal for the health care industry, which has used foreign nurses to fill its ranks for decades. After World War II, nurses came primarily from the United Kingdom and Canada. In the 1960s, the trend shifted to the Philippines, India, Nigeria, the Pacific Islands and China; by the 1990s, 10 percent of American nursing licenses were going to non-natives. That continued through 1999, when Gov. Gray Davis made California the first state in the union to have minimum staffing levels at its hospitals. The mandate, which went into effect in 2004, required hospitals to employ a certain number of nurses for each patient depending on the ward; from one nurse for every two patients in intensive care to one nurse for every six in psychiatric. While heralded by nurses and patient rights groups, over the past two years the ratios have effectively tapped the local pool of nursing candidates dry. The current shortage is pegged as high as 21,000, a number expected to double by 2010, according the Center for California Health Workforce. To address the shortage, hospitals have lured local nurses and recent graduates to their facilities through perks and signing bonuses while others pay overtime and hire temporary nurses through staffing firms; expensive options given that traveling nurses can make up to $100,000 a year. Others have also taken the most complex option: look overseas. The long route The primary method most immigrants become permanent American citizens is through sponsorship by a U.S. citizen or prospective employer. The U.S. approves a minimum of 140,000 employment-based visas a year and gives preferential treatment to immigrants with advanced training and those that already have a job in the U.S. Consequently, some hospitals send recruiters abroad to seek out nurses, pay for them to come to the United States and make sure they take tests. Shusterman said the process costs around $11,000, although Yost said it’s closer to $20,000. Hospitals also agree to pay the prevailing wage, around $50,000 in L.A. While that may seem efficient compared to signing bonuses or traveling nurses, some hospitals are wary of the cost of sponsoring foreign nurses. That’s one of the reasons the largest healthcare provider in the Valley Providence Health System, which runs Providence St. Joseph Medical Center in Burbank and Providence Holy Cross Medical Center in Mission Hills does not look abroad, said spokesman Dan Boyle. “Sponsoring foreign-born nurses for visas is expensive, and we have not put a policy in place to provide sponsorship, especially since our employee vacancy rate is below the state average for both Providence Saint Joseph and Providence Holy Cross medical centers,” he said. West Hills Hospital and Medical Center also has an informal rule to staff locally and not overseas, said Director of Human Resources Marty Alpert. Encino-Tarzana Regional Medical Center also doesn’t use foreign nurses either and opts to fund about 30 scholarships for the nursing program at Pierce College, said spokesman Mitch Zevin. A matter of trust He said that by putting more nursing students in school, Encino-Tarzana can entice them into permanent positions at the hospital once they graduate. “We want some quality assurance we’re getting a nurse we can trust on the floor,” he said. “An internationally-trained nurse is a bigger unknown.” Caroline Esparza, senior vice president of patient care services for Simi Valley Hospital, said time is also a big factor, since the green card approval process can drag on for months, if not years. She said that when Simi Valley has a staff opening, they can’t wait that long to fill the spot and they usually hire temporary help and look locally for a permanent nurse, even though traveling nurses are expensive and registered nurses are scarce, she said. “I’m sure (sponsoring foreign nurses) could be an option, but between our local recruitment and our ability to fill spots pretty quickly, it works,” she said. “In our situation, we can’t really wait a year down the road to get somebody.” A risky situation More than costs, the more pressing aspect of sponsoring nurses for many hospital execs is the finite number of visas available, a product of tougher post-9/11 immigration standards and caps on how many green cards are issued. That’s because every year, the U.S. sets certain limits on the number of immigrants from each country allowed into America. Once a country exceeds that number, visas are generally capped for the year. Accordingly, the wait to enter the states from countries like the Philippines, China and India have ballooned to three years. And hospitals aren’t willing to start the process only to find out there aren’t any visas. “With the number of visas pretty much exhausted at this time, it makes it very difficult for a healthcare facility to go into an agreement with someone,” said Wes Schmidt, head of human resources for Simi Valley Hospital. “It make take a year, two years, it may take five years for that person to come back working for you.” He said the hospital has sponsored in the past, but is resistant these days because of the restrictions. “It’s a market situation. It’s not that we’re making a stand,” he said. “There’s just nothing available.” Shusterman, however, notes that the backlogs have been largely eliminated since President Bush last year signed a bill providing 50,000 additional green cards for registered nurses. He said nurses could be on the job within a few months. “That’s really helped,” Shusterman said. Yost, however, said the openings still run out quickly. His hospital sponsors about 20 nurses early in the year. By October, the openings have run out. “This is the time of year that we really can’t do anything,” he said. “They are tapping out really fast.” Where it works In all, 1,693 foreign nurses were added in the Los Angeles area in 2003 to 2004, according to the most recent estimates by the Center for California Health Workforce Studies. One of those was Lancaster Community Hospital, which regularly brings in nurses from abroad for around $8,000. The cost and time are well worth it, according to CEO Robert Trautman. “The return on that comes pretty quick,” he said. “It’s a lot less expensive than relying on temporary employees hired through agency and you pay a premium dollar.” Glendale Adventist Medical Center and Henry Mayo Newhall Memorial Hospital in Valencia also sponsor, officials from those hospitals said. Trautman thinks he knows why there are so few hospitals that sponsor. “Some of it could be a cultural thing. Just acclimating the foreign nurses to your community could be an issue,” he said. Additionally, neither the California Nurses Association nor Service Employees International Union have a formal position against foreign nurses, officials from those unions said. In the end, the most logical solution to the nursing shortage is to boost funding for local nursing education programs, said Sue Albert, the director of the nursing program at College of the Canyons in Valencia. “So they’re grown at home,” she said. That way, more nurses can be entering the system here; hospitals won’t have to tap other countries for talent; and foreign nurses could use their skills in their native lands, she said. “We’re pulling nurses out of countries that need them,” she said. “They’re a natural resource.”
