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A note to the global nursing
community on the recent publication by the
California Nurses Associations "Code To Promote
Ethical Practices for the International
Recruitment of RN's."
The California Nurses Association is
a collective bargaining organization that
represents nurses in California and is expanding
to other states. In the distant past, they were
previously part of the larger, American Nurses
Association. There was a vote to form a separate
organization in the 1980's and now the CNA is no
longer part of the professional organization
called the American Nurses Association. The CNA
is politically active within the state of
California and represents nurses as a union in
some hospitals in California. A portion of their
current membership surely consists of nurses who
are foreign nurse graduates and have been
recruited as far back as the 1970's to the
present.
This CNA Code on international
recruitment, is provided to NIUSA readers.
http://www.calnurse.org/?Action=Content&id=608
It has a laudable purpose, that is to protect the
global nursing community from those who would seek
to exploit the nurses by charging them exorbitant
fees with little to no service and false promises
and those agencies that collect the passports and
other original documents of the nurse in the hopes
to "locking in the nurse to their company only."
Such strategies are really "scare tactics", in
that any nurse can apply for a duplicate passport
and the nurse can also apply to the CGFNS for a
duplicate document or Nursing Board for a
duplicate license . NIUSA provides our nurses
with all original documents, even those paid for
by the employer, after they are copied and a copy
supplied to the employer and the attorney for
processing. NIUSA has a no-fee policy for our
current positions for those employers who have
agreed to shoulder many of the expenses in behalf
of their nurse hires. After all, a nurse who is
making the equivalent of US $150 per month, may
not be able to pay all the expenses of the CGFNS,
English exams, Visa Screen, State license, NCLEX
test fee, medical exams, airfare to US etc etc.
If these fees are not paid by the employer, there
is often a loan plan and the nurse can pay this
back when in the US and earning US dollars. Those
nurses who must pay for their own expenses usually
tell NIUSA that their family has gone to money
lenders in their country with outrageously high
interest, or the family has pledged the deeds to
the ancestral lands and sold the farm animals.
CNA Codes states that "too often the
profit motive is the sole concern for the
recruiter and with the hospital with inadequate
regard for the rights of nurse or patient
safety." NIUSA employers are very concerned about
the rights of nurses and patient safety. Patient
safety is the prime reason the employers are
seeking to hire the foreign nurse graduate and
sponsor them for the US work authorization. These
nurses are filling open nurses position that have
been long vacant and in many cases are being
filled by expensive travel nurses and registry
nurses. NIUSA believes that many of our nurses
who are initially on a two year or three year
contract with the employer, will provide a
improvement in continuity of patient care and
these nurses will become highly valued clinical
experts for the hiring hospital. Patient safety
during the initial orientation and assimilation
phase is insured by oversight by the clinical
nurse educator, the preceptor and the nurse
manager and a periodic evaluation process that is
more intensive in the first few weeks. The core
nursing staff on the nursing wards where these new
foreign nurse graduates work, have been happy to
have the nurses as coworkers during this severe
nursing shortage. In California, in particular,
these nurse hires may prevent the mandatory
closing of beds and services to the community at
large.
CNA Code suggests that the employers
and recruiters assess the nurses proficiency in
English. NIUSA has one to one interviews with
all applicants and the nurses ability to speak
fluent and coherent English is a critical
screening tool. For those nurses that pass the
first screening, the employer, will also assess
the nurse applicants English speaking skills.
However, there are some dialects that do persist
even with the most fluent of English
speakers...i.e., been to London and used a cab?
Even within the English language...there can be
dialects that represent wide variation within the
same language. My personal experience with nurses
educated in the Philippines, is that they have an
excellent proficiency in English, which does get
"rusty" the longer they are out of nursing
school. The BS Education is entirely in English.
Those nurse from the Philippines, who are now
working in UK, do take on somewhat of a "British"
dialect over time. They talk about the "Med
Trolley" and the "handover" which we call change
of shift report.
With the requirements of the CGFNS
Visa Screen, those nurses who are seeking to
obtain a work authorization for US employment as
an immigrant or with most work visas....will
require the Visa Screen certificate and the most
rigorous English testing. There are a few
international nurses who are on Diversity Lottery
or or Family based visas...that may not have any
Visa Screen requirements. Then, the requirement
of the Nursing State Board is the only set of
standards to work as an RN. In the case of the CA
BRN, the nurse can obtain licensure without any
English testing. Only when applying for an
interim permit in CA, would the RN need to submit
the English testing results. If a hospital were
to be presented with a licensed nurse applicant
with a US work authorization and social security
number, and that nurses English speaking skills
were inadequate, I believe the hospital could
refer that nurse to local ESL classes and have the
nurse return to them for future consideration
after improvement in the English speaking
abilities.
NIUSA matches the nurses educational
preparation, employment history and skills with
the requirements of the US employer. In addition,
NIUSA provides pre departure preparation for the
nurse who will start to work in USA and education
for the employer on the need for a planned
orientation and assimilation process.
International nurse hires, who are assessed by the
nursing educator on the learning needs and
assigned to a clinical preceptor have a recipe for
success. NIUSA also recommends some review of the
educational and practice environment of the nurses
home country and a specific plan to meet known
known deficiencies. One such deficiency...really
globally ,as compared to US, will be in the
patient assessment responsibilities of the US
nurse and the skill with respiratory and cardiac
auscultation and charting. I would also include
computerized patient record. There may be
significant technology gaps. One example would be
the use of electronic fetal monitors in labor and
delivery here in US and the use of the fetal scope
only in many other countries.
The one area of concern in the CNA
Code is in the last paragraph. CNA comments on
the problem that "poaching" of nurses from
developing countries and the drain on the
countries as a loss of those workers. They use
the example of the recent Tsunami disaster in
South Asia as an example. NIUSA knows of few
nurses that are recruited from the countries
affected by the Tsunami...although who can predict
where any disaster may strike in the future. I
would also suggest that the government of the
Philippines would be the first to identify the
benefit to their country due to the remittances of
overseas workers, including the nurses, of
billions of dollars in foreign currency. This
money sent by nurses working in US and other
countries, is spent by the family members of these
nurses in the home country economy. In fact, the
Philippines may have about 40% of the national
GDP, from these remittances. Most nurses are
making a "sacrifice" of being the one in their
family to go abroad and work and send money home
to the family. The Philippines does have an
excess of nurses..and plans to continue such
excess for export to other countries. NIUSA
would find the motives of the CNA to "protect" the
country of the Philippines from recruiters and
employers, somewhat suspect. NIUSA hopes that the
PNAA-Northern and Southern CA branches may have
some comments on this CNA Code.
The International Council of
Nursing ( ICN)-headquartered in Geneva Switzerland
has also taken some positions on international
recruitment of nurses from the poor countries to
the rich countries. Although this organization
has concerns regarding this trend, they do respect
the individual right of each nurse to make a
self-determination regarding migration and
employment. http://www.icn.ch/psrecruit01.htm
The importance of both the CNA Code
and the ICN is that these documents can become
the basis for possible global or US governmental
regulation or hospital policy. Some of the
provisions of the CNA Code are important problems
and should be brought to the attention of
employers and policy makers. However, there is a
trend within the some of our nursing community to
"throw the baby out with the bathwater" and they
would support further restrictions on foreign
nurse recruitment as protecting the countries from
a loss of their nurse resources. NIUSA supports
all implementation of ethical standards for those
who are in the business of foreign nurse
recruitment. NIUSA strongly supports the
international nurses right to chose their
employment setting to include migration.
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