Editor’s Notebook

In a year when the Philippine Nurses Association of America is proudly celebrating its 30th anniversary as an important and highly respected presence in our nation’s nursing landscape (see Directing Our Destiny), it might seem strange that the immigration of Philippine nurses to the U.S. could still— after all these years—continue to be a source of controversy. But consider this email I recently received from a reader named Janet Christian:

“I have one important question on behalf of all nurses who graduated from American nursing schools by taking out lots of loans and making a significant difference in the U.S. economy,” she writes. “Why should they do so when hospitals want to hire or import nurses from [outside the U.S.]? Hospitals in the state of New York are filled with Philippine nurses. [People] who are stakeholders for NCSBN (the National Council of State Boards of Nursing) and CGFNS (the Commission on Graduates of Foreign Nursing Schools) have special interests, and hospitals have their own interests, but what about the future of our children, who want to be nurses but [can’t find jobs] because hospitals are looking for cheap labor from overseas?”

It would be easy to dismiss this as just the grumbling of one disgruntled nurse who may be having a tougher than usual time trying to compete in a recessionary job market. But some remarkably similar comments surfaced this past August during the National Black Nurses Association’s 2009 annual conference in Toronto, Canada—the first-ever NBNA convention to be held outside the U.S. After a presentation on international nurse migration and global health by CGFNS chief executive officer Barbara Nichols, someone in the audience who introduced herself as a faculty member at a nursing school in California complained that “foreign nurses are being hired for jobs that should be going to my BSN graduates.” Someone else pointed out that even President Obama has said he wants to reduce America’s dependence on foreign-educated nurses.

Nichols’ response to these comments was—as they say on the public radio quiz show “Whad’Ya Know?”—well-reasoned and insightful. (As the barrier-breaking first African American president of the American Nurses Association, Nichols knows a thing or two about territorial prejudices in nursing.) And since Janet Christian, as well as other nurses who share her sentiments, were presumably not there to hear it, Minority Nurse is happy to pass it along. First of all, Nichols argued compassionately, nurses in the U.S. must be careful not to scapegoat nurses from the Philippines, Africa, India and elsewhere who come to our country in search of a better way of life for themselves and their families. These nurses have every right to arrive here in pursuit of the American dream, just as so many previous generations of immigrants have done. The foreign nurses themselves are not the problem, Nichols emphasized; the real problem is that certain U.S. health care employers must stop hiring nurses from overseas simply because they can pay them less than American nurses.

There are other reasons why some hospitals in this country prefer to fill their staffing needs with foreign-educated nurses rather than U.S. nursing graduates, Nichols continued. Nurses from overseas are more likely to have BSN-level education than American nurses, as well as more work experience. Secondly, many of today’s newly graduated U.S. nurses are reluctant to pick up and move to where the jobs are—such as rural and underserved areas. And some hospitals have learned the hard way that many of these new grads— unlike “imported” nurses—tend to not stick around for more than a year or so once they’re hired.

These are all issues that nurses can work toward addressing, both collectively and individually. Through nursing unions, professional associations and political activism, nurses can try to influence health care employers to adopt fairer hiring practices. And some individual nurses may need to take an honest look at how they can increase their marketability to employers—e.g., by advancing their education. Together, nurses can find some viable answers to Ms. Christian’s “one important question.” But blaming foreign-educated nurses shouldn’t be one of them.