Faced with a crippling nursing shortage, U.S. hospitals are increasingly recruiting nurses from Canada and England and as far away as the Philippines. By the end of the year, Tenet Healthcare Corp. hopes to recruit at least 100 registered nurses from Northern Ireland to hospitals in the Southeast through a special visa program passed last year by Congress.

But foreign countries such as Ireland and Canada are dealing with their own spiraling health-care labor shortages. Global talent pools that were once plentiful are now drying up, strained by high demand, immigration issues and spreading competition.

Some health-care officials, meanwhile, say foreign recruiting is a deceptive quick fix and could actually detract from solving the real problem: an overwhelming lack of decent wages for nurses and a startling dip in the number of students choosing nursing as a profession worldwide.

"It's really a short-term focus that may not benefit us in the long run," said Debbie Hatmaker, president of the Georgia Nurses Association. Recruiting foreign nurses may be creating problems for other countries and worsening the shortage overall, she said.

Last month, Canada sponsored a job fair in Texas, hoping to lure back some of the nurses it lost to the United States during health-care cutbacks leaders in Canada levied during the 1990s. That's a far cry from a few years ago, when Canadian job fairs were mostly set up for nurses who were being recruited to the United States, said Sandee Phillips, president of Global Nurse Force, an Atlanta-based international nurse recruiting agency.

Canada was a hot spot for recruiting. Now they have closed their job fairs and have begun looking at foreign recruiting themselves, Phillips said.
Other countries, such as England and Ireland, are jumping on the bandwagon with their own new efforts to shore up nursing shortages, shelling out better pay and providing more educational opportunities for nurses they hope will stay.
Fifteen years ago, Ireland was inviting U.S. hospitals over, setting up job fairs for their abundant pool of nurses, said Lorna Martin, vice president of nursing for Piedmont Hospital. Now they are competing for business.

Canada, while it lobbies for a loosening of nurse migration restrictions, also is raising ethical concerns about recruiting in impoverished nations such as South Africa, where medical personnel are desperately needed. Buckling under a massive HIV/AIDS epidemic, the country is desperate to retain nurses and doctors that are easily seduced by the promise of better pay and better living and working conditions.

Worldwide problem

Several countries are scheduled to meet through the World Health Organization to discuss the state of nursing resources and the gaps that have been identified across the globe, said Lucille Auffrey, executive director of the Canadian Nurses Association. "The shortage of nurses, the manpower issues are universal," Auffrey said. "They are not limited to the United States or Canada."
It has gotten so bad that hospitals in England and Ireland are recruiting from South Africa and South Africa is going to Jamaica and the Caribbean to find nurses, said Piedmont's Martin. "Everybody is kind of taking from each other," she said.

But nurses can't be blamed, say officials. In Third World countries, nurses are paid peanuts and working conditions can be deplorable. In Canada, cutbacks have sent most nurses into part-time positions. "We went from about 75 percent to 80 percent of nurses working full time to 50 percent of nurses working part time," Auffrey said.

As in the United States, the number of nursing students also has dropped dramatically. In 1980 Canada was graduating 10,000 nurses a year, today that number has dropped to 4,000, she said. So Canada, like the United States, has turned to foreign recruiting.

So have England, Ireland and even Saudi Arabia, which now gets most of its nurses from the Philippines -- the very same place where most countries, including the United States, now are doing the majority of their recruiting.
In the last few years, the Philippines has become the global hot spot for recruiting, a seemingly bottomless well of talent. Nurses there are actually groomed to migrate, said Phillips of Global Nurse Force, which has an office in the Philippines and does most of its recruiting there.

Almost all of the graduating nurses in the Philippines want to move to foreign countries, especially the United States, said Anabelle Espinoza, a registered nurse who was recruited from the Philippines to Piedmont Hospital 13 years ago. "Money is the No. 1 reason," Espinoza said. "It means something to be in the United States."

Last year, Promina Health System sponsored a trip to the Philippines for recruiters from DeKalb Medical Center who would also be recruiting for Piedmont Hospital. From that trip the hospitals actually only have gotten five or six new nurses so far, Martin said.

The immigration process for foreign nurses can take months, even years. Hospitals, hoping to ease immigration restrictions, are lobbying Congress to increase the number of health-care professionals that can be recruited into the United States each year. Canada is lobbying for similar immigration concessions for their own hospitals.

Win-win or short-sighted?

This year, Tenet is one of the first U.S. hospital systems to take advantage of the Walsh Visa Program, sponsored by U.S. Rep. James Walsh and passed last year by Congress. The program allows 4,000 residents from Northern Ireland between the ages of 18 and 35 to enter the United States each year to work for up to three years.

It is a win-win situation for both countries, said veteran nurse Diane Kriegal, a director of services development for Tenet who is helping with the Irish nurse recruiting efforts. "This program allows nurses to come over here and upgrade their skills so when they come home they are better educated and more skilled nurses," Kriegal said. Tenet probably will only be able to take about 100 nurses a year from Ireland because of their shortage, she added.

Growing competition for the world's available nurses could eventually jack up the costs of foreign recruiting. A shrinking pool of talent also may force countries, such as Canada, to more adequately deal with the root cause of their shortage, Auffrey said. "Foreign recruitment is short-sighted. That kind of thinking is going out with the aardvark," she said. Georgia's Hatmaker agrees. Hospitals need to focus on retention as well as recruiting, she said.

The Canadian Nurses Association is working to compile a national report that will show exactly how many nurses Canada needs versus how many they have, she said. Similarly, U.S. Institute of Medicine President Kenneth Shine, who spoke recently at Emory University, said the institute plans to tackle the nursing shortage issue, particularly how quality of care has been affected.

The Georgia Hospital Association is supporting federal legislation that would provide more dollars for nursing education and make it easier for nurses to pay back school loans, said Karen Waters, the hospital association's vice president of professional services. This year the hospital association lobbied successfully for more state dollars for its nurse scholarship program and is upping its efforts to get more nurses through school.

This nursing shortage isn't going away, Phillips said. "In the past, [nursing] shortages have been cyclical," she said. "They would end and the labor pool would build back up, but this time there are a lot of reasons why this one will continue far into the future."