US plan to lure nurses may hurt poor nations

The exodus of nurses from poor countries has strained health systems in the developing world, facing severe shortages of their own. Many African countries have begun to demand compensation for the training and loss of nurses and doctors who move away. The Senate provision, which would remain in force until 2014, contains no such compensation and has not stirred serious opposition in the Congress. A committee from both houses would have to decide whether to include the provision on nurses if the full Congress approves the legislation.

Health experts in poor countries reacted with dismay and outrage, coupled with doubts that their nurses would resist the magnetic pull of the US. Removing the immigration cap, they said, would particularly hit the Philippines, which sends more nurses to the US than any other country.

Researchers say health care has deteriorated in recent years as nurses have moved abroad and thousands of ill-paid doctors have abandoned their profession to become migrant-ready nurses themselves.

The proposal has strong backing from the American Hospitals’ Association, which reported in April that American hospitals had 118,000 vacancies for registered nurses. The federal government predicted in 2002 that the accelerating shortfall of nurses in the US would swell to over 8,00,000 by 2020.

‘‘There is no reason to cap the number of nurses coming in when there’s a nationwide shortage,’’ said Bruce Morrison, a lobbyist for the hospital association and a former Democratic congressman.

The American Nurses’ Association, a professional trade association that represents 1,55,000 registered nurses, opposes the measure. The group said it was concerned the provision would lead to a flood of immigrant nurses and would damage both the domestic work force and the home countries of the immigrants.

‘‘We’re disappointed that Congress, instead of providing appropriations for domestic nursing programmes, is outsourcing the education of nurses,’’ said Erin McKeon, the group’s associate director of government affairs.

Holly Burkhalter, with Physicians for Human Rights, an advocacy group, said the proposal could undermine the US’s multibillion-dollar effort to combat AIDS and malaria by potentially worsening the shortage of health workers in poor countries. ‘‘We’re pouring water in a bucket with a hole in it, and we drilled the hole,’’ she said.

Under the current immigration system, experts estimate that 12,000 to 14,000 nurses have immigrated to the US annually on employment visas that entitle them to bring their immediate family members and obtain green cards. They must pass English and US nursing exams to qualify for visas.

Morrison said the numbers would grow 5 to 10 per cent a year over recent levels. Recruiters would focus on countries with large numbers of well-trained nurses, mainly the Philippines, India and China.

Senator Brownback, who has been an advocate for programmes to combat AIDS and malaria in Africa, said he did not think lifting the cap on nurse migration would have much effect on Africa because the infrastructure of companies that did recruiting for the US market was not set up there, nor did African nurses have a big community there to plug into.

While the Philippines could see an increase in nurse immigration, such flows could also bring benefits, he said, pointing at the nurses’ voluntary efforts to improve health care in their home countries.

The flight of nurses from the Philippines, a former American colony, has provided a huge boost to a weak economy, through remittances. Some government agencies there have encouraged the export of nurses, who send home billions of dollars each year to their families.

A nurse in the Philippines would earn a starting salary of less than $2,000 a year compared with at least $36,000 a year in the US, said Dr Jaime Galvez Tan, a medical professor at the University of the Philippines who led the country’s National Institutes of Health.

–CELIA W DUGGER