The shortage of nurses in the United States is a serious and growing problem. According to information in the New England Journal of Medicine (Oct. 27, 2005) the nursing shortage has grave implications. For instance, there are presently126,000 unfilled nursing positions in United States hospitals. The problem is complex. The baby boom generation, 35 million strong, the oldest of whom were born in 1945, will be entering their seventh decade. As we all know, aging brings on numerous health risks and health conditions that require an increase in visits to the doctor and the hospital. That, with declining enrollments in nursing schools, is creating an even worse crisis. Because they are fewer in numbers, increasing demands are often made on nurses. This often leads to early career burnout and early retirement for many nurses. The Department of Health and Human Services projects that by 2020, the shortage of registered nurses in relation to demand will reach 29 percent, with more than one million nursing positions left vacant. Andrea Coombes, in Market Watch (Oct. 27, 2005), reports that job openings for registered nursing jobs will number 110,119 annually. The median salary for registered nurses amounts to $48,090 annually. If you break that down to five days a week for 52 weeks, nurses earn roughly $25 per hour. Compare this to a $90 fee for a plumber who visits your home. This does not seem equitable considering the difficult work nurses must perform. Not only is the work difficult, but also the preparation is intense. Many nurses attend four-year collegiate programs and earn bachelor degrees, which often require full-time study requiring strong math and science skills. This is in addition to sitting for the National Board of Nurse Registration examinations following completion of the program. Some nurses are educated in two-year junior college programs. These nurses are required to have many college-level prerequisites prior to entering a two-year nursing program. They also must sit for the national registration examinations. Other reasons, in addition to the rigorous academic programs required to educate nurses, are cultural. Many Americans do not choose to go into a profession that they perceive as having inadequate input into health care decision-making, public policy and research. These functions can be attained by nurses, but only after more study in one of these given fields. A master s degree or a doctorate either in nursing, or a related area such as public health, is required for advancement, increased responsibility and a higher salary. Many nurses conduct clinical research, but as you may imagine, this can require additional time and money. The median salary mentioned above would certainly be somewhat higher for advanced-degree nurses. However, salaries of those with advanced degrees in other areas such as business, medicine, law and engineering would most likely be higher than advanced-degree nurses receive. Nurses, though seemingly highly valued in our society as caregivers, are not valued enough to be adequately compensated for what they do. Health care costs are rising at an alarming rate, but nurses are not recipients of such excess. Increasingly, the solution to the nursing shortage in this country is to increase the flow of nurses from foreign countries. In the past decade, Indian, Filipino, and Canadian nurses, among others, have been actively recruited to meet the nursing demands here at home. Obviously, there are problems with this solution. The United Kingdom has, for years, relied heavily on the direct recruitment of nurses from African countries such as Botswana, Ghana, Malawi, Nigeria, Kenya, South Africa, Zambia and Zimbabwe. All of these countries were formerly British Colonies. Unfortunately, these countries have been hit by the prevalence of HIV infections in 30 to 40 percent of the population. Understandably, nurses in these countries are needed but are in short supply. This is partly because of the mass migrations to the United Kingdom. These nurses are sorely needed to address health care issues in their own countries. Because of this, resentment may occur as nurses are drained away from their native countries to work in the United Kingdom, the U.S. and other affluent countries. In addition to African nurses, the English National Health Service is recruiting nurses form India, the Philippines and Spain. It is interesting that one in two of these nurses who work in England ultimately choose to immigrate to another country, many ending up in the U.S. The option to move to the United States is now easier than before. This is because of a law passed earlier this year (The Emergency Supplemental Appropriations for Defense), the Global War on Terrorism and Tsunami Relief. The law, which mainly funds military operations and reconstruction, includes approval for 50,000 new visas for nurses and their family members. It was passed a year after the Department of Labor abolished the time-consuming process of labor certification for foreign nurses migrating to the U.S. This requires assurances that wages and working conditions of U.S. workers would not be adversely affected by hiring foreign workers for these positions. The new law facilitates the immigration of foreign nurses who are already certified by the Commission on Graduates in Foreign Nursing schools, who have passed the National Council Licensure Examination for Registered Nurses, or who hold a full and unrestricted license to practice nursing in the state where these nurses might be employed (the New England Journal of Medicine, Oct. 27, 2005). Perhaps we in the U.S. need to address our problem so that we will not need to import so many foreign nurses. Importing foreign nurses may meet our short-term needs. Visas will be issued for the nurses and their families. There may be cultural and language problems when these nurses and their families arrive until they acclimate to their new country. These nurses must pass the rigorous nursing certification examinations, and must have adequate language skills in order to pass the exams. Language problems may make it difficult for physicians and other hospital personnel to communicate with these foreign-born nurses. This may result in issues of safety regarding medication orders and other treatments. When communication is difficult, it can lead to frustration for patients and staff. It is true that many of these nurses come from former English colonies, or English-speaking countries, but sometimes their English is difficult to understand. We in this country need to resolve our acute nursing shortage. The importation of foreign nurses will not solve the crisis in the long term. California is one state that is making a commitment to increase the capacity of its nursing schools to admit more students. This strategy must also include increasing the salaries of faculty who are in possession of a master s degree for teaching at the undergraduate level, and doctorate for teaching at the graduate level. This would not only increase the capacity of nursing education, but will increase the numbers of nurses in the workforce. In addition, salaries must be raised and working conditions should be improved in order to retain our own American nurses. Nurses must be given key roles in decision-making about health care delivery and health policy. Research funding for nurse scholars must also be enhanced. Finally, all health care providers, doctors, physical therapists, pharmacists and nurses should interact with each other with mutual respect and collegiality to improve the care of all of their patients. Teamwork will lead to a higher level of health care for all Americans. In the long run it will result in a higher level of satisfaction and lead to retention of our valuable professional American nurses. All of us will benefit. Park City resident Joan Jacobson, PhD, RN, is an adjunct professor for the University of Utah College of Nursing. She is the author of Midlife Women.
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