Discontent growing in the nursing ranks


As the pandemic grinds on, overworked nurses 
are beginning to strike over inadequate pay and shortages of personal protective equipment.

The ongoing PPE shortage is especially galling. Even though hundreds of nurses have died from COVID-19, N95 masks, designed for a single use, remain in short supply at many hospitals and nursing homes.

Front-line nurses in some areas are being asked to wear a single mask for an entire shift. Centers for Disease Control and Prevention guidance on reuse notes N95 mask performance “will decrease as the number of hours and the number of donnings and doffings increase.”

Given the added risks and the relatively low pay for full-time, college-educated registered nurses (the median salary was $73,300 in 2019), no one should be surprised that we’re once again facing a nurse shortage, even though hospital admissions and elective surgeries remain below normal. Demand for temporary nurses is surging.

“We’re seeing an all-time high in demand for nurses,” said Kelly Rakowski, group president for AMN Healthcare, a top player in the staffing industry. “It’s even higher than what we saw during the initial surge in April and May.”

Finding nurses to fill those slots is getting tougher. It’s not just burnout. Women make up 80% of the profession. Many are taking time off this fall because their children must attend school remotely.

One solution, being pushed by the subset of the staffing industry represented by American Association of International Healthcare Recruitment, is lifting visa restrictions on foreign nurses seeking entry into the U.S. 

Healthcare organizations should tread very carefully when stepping onto this minefield. First off, raiding other countries’ healthcare workforce in the midst of a global pandemic is unethical, even when the countries involved have low infection rates. That may not be true six months from now.

Moreover, some members of the international nurse recruitment industry take advantage of migrating nurses. A year ago, a federal judge in New York ruled a nurse-staffing company engaged in human trafficking when it attempted to collect $25,000 in “liquidating damages” from foreign nurses who changed jobs for higher wages after coming to the U.S.

Such contract clauses are common in the industry. A New England Journal of Medicine Perspective essay last January noted that exorbitant contract-breach fees have been used “to hold immigrant nurses captive for three or more years.”

Two temp agencies, MedPro and Health Carousel, filed at least 120 lawsuits in Florida and Ohio seeking damages from immigrant nurses who violated their employment contracts. “It is unconscionable that a staffing agency would use the threat of a financial penalty, or debt bondage, to force nurse retention,” the essay concluded. 

This isn’t new. Healthcare providers facing shortages have turned to foreign nurses in the past. Foreign nurses now make up 5% to 7% of the total workforce of about 4 million. A majority are from the Philippines, a major recruiting ground. No one can blame foreign nurses for wanting to come to the U.S. Wages are higher than in their home countries, and the prospects for their children are greater. 

But the long-term solution for the healthcare system lies elsewhere. Even before the pandemic, nursing educators warned of a looming shortage. They cite Bureau of Labor Statistics projections on nurse retirements and the greater demand for nursing services from a growing elderly population. 

But a 2017 study by the Health Resources and Services Administration suggested the existing education pipeline was capable of filling those slots through 2030. The real problem, the report noted, was a spatial mismatch. Some aging states like California will need more nurses, while states growing younger like Florida will need fewer.

The solution to that problem lies in basic economics. If systems raise wages and improve working conditions, qualified Americans will join the nursing ranks and move to where the jobs are.

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