Bill would lift cap on foreign nurses


As the United States runs short of nurses, senators are looking abroad, including a little-noticed provision in their immigration bill that would throw open the gate and, some fear, drain nurses from the world's developing countries.

The legislation is expected to pass this week, and the Senate provision, which removes the limit on the number of nurses who can enter, has been largely overlooked in the emotional debate over illegal immigration.

Sen. Sam Brownback, a Kansas Republican who sponsored the proposal, said it is needed to help the United States cope with a growing nursing shortage.

He said he doubted the measure would greatly increase the small number of African nurses coming to the United States but acknowledged that it could have an impact on the Philippines and India, which are already sending thousands of nurses here each year.

The exodus of nurses from poor to rich countries has strained health systems in the developing world, which already face severe shortages. Many African countries have begun to demand compensation for the training and loss of nurses and other health professionals who move away.

The Senate provision, which would be in effect until 2014, contains no provision for compensation and has not stirred serious opposition in Congress. But it is not part of the House immigration bill. So if the full Congress approves the legislation, a committee from both houses would have to decide the issue.

Public health experts in poor countries, told about the proposal in recent days, reacted with dismay and outrage, coupled with doubts that their nurses would resist the magnetic pull of the United States, which sits at the pinnacle of the global labor market for nurses.

Removing the immigration cap, they said, would particularly hit the Philippines, which sends more nurses to the United States than any other country, several thousand a year.

Health care has deteriorated there in recent years as tens of thousands of nurses have moved abroad. Thousands of ill-paid doctors have abandoned their profession to become migrant nurses, Filipino researchers say.

"The Filipino people will suffer because the U.S. will get all our trained nurses," said George Cordero, president of the Philippine Nurse Association. "But what can we do?"

The nurse proposal has strong backing from the American Hospital Association, which reported last month that U.S. hospitals have 118,000 vacancies for registered nurses. The federal government predicts that the accelerating shortfall of nurses in the United States will swell to more than 800,000 by 2020.

"There is no reason to cap the number of nurses coming in when there's a nationwide shortage, because you need people immediately," said Bruce Morrison, a lobbyist for the hospital group and a Democratic former congressman.

The American Nurses Association, which represents 155,000 registered nurses, opposes the measure. Erin McKeon, the ANA associate director of government affairs, said Congress should focus on strengthening the U.S. nursing education system rather than what she called "an ethically questionable" strategy of relying on nurses from developing countries.

There are now many more Americans seeking to be nurses than places to educate them. Last year, U.S. nursing schools rejected almost 150,000 qualified people, according to the National League for Nursing, a nonprofit group that counts more than 1,100 nursing schools among its members.

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