Code Aims to Aid Nurses
Group Says Foreign Hires Need Protection

By Lori Aratani
Washington Post Staff Writer
Tuesday, September 16, 2008

A coalition of health-care groups this month unveiled a code of ethics it hopes will protect nurses from other countries from abusive employment practices when they take jobs in the United States.

"It's our feeling that if we're going to recruit foreign-educated nurses, we need to do so responsibly and ethically," said Cheryl Peterson, director of the department of nursing practice and policy for the American Nurses Association, one of the groups that helped write the guidelines. She called the code a first step.

Since the late 1990s, the United States has struggled to recruit enough nurses to serve its rapidly aging population. The Department of Health and Human Services calculates that by 2020 the country will need about 2.9 million nurses, and will only have about 1.8 million -- a 36 percent shortfall. The shortage has prompted many hospitals, nursing homes and other medical facilities to look overseas for qualified candidates. A 2004 survey found that about 4 percent of all registered nurses in the United States had been educated abroad.

But not all who arrive in this country find what they expect. The coalition that prepared the ethics guidelines says that some are given jobs beneath their skill level -- jobs that American nurses are reluctant to do -- or are not placed in the hospitals or medical facilities they were promised. Others may not be paid fairly compared with their American counterparts.

"We've heard anecdotal stories of nurses who are abused -- there are pay issues, working-condition issues," Peterson said.

The four-page code of ethics lays out guidelines on those issues as well as summaries of relevant employment laws. The document offers examples of ways in which hospitals and other employers can train and support nurses from overseas. The code is designed to be used by employers and recruitment agencies and as a primer for nurses who'd like to work in the United States but aren't clear on what rights they might have.

The code will be voluntary, but medical institutions that subscribe must agree to independent monitoring. The coalition, which included industry representatives as well as unions, will begin work on how to monitor aspects of the code later this year, according to Patricia Pittman, executive vice president of AcademyHealth. Her organization, which serves researchers, policy analysts and practitioners, helped bring the interest groups together to write the standards.

Archiel Buagas, 28, who trained as a nurse in the Philippines, said such guidelines will be invaluable for foreign nurses hoping to work in the United States.

"Even before they start the process, they know what to expect,'' said Buagas, a supporter of the ethics code. "[The nurses] know that there are laws that protect them before they even come here. There is someone pointing them in the right direction."

That was not the case when Buagas came to the United States three years ago. She said her recruitment agency did not follow through on promises to have the proper paperwork in place when she arrived to work. It also placed her with a different employer than the one with whom she had signed a contract.

Only after she sought help from a lawyer, she said, did she find that at least a dozen other Filipino nurses who worked with the same recruitment agency had similar complaints.

Today, she works at a hospital in New York that offers training programs and support for foreign nurses like herself.

According to the American Hospital Association, about 17 percent of U.S. hospitals recruit staff from overseas. As of 2007, there were more than 300 specialized nurse recruiting agencies, a nearly tenfold increase over the past decade. Officials at a handful of Washington area employers including Adventist HealthCare and Georgetown Medical Center have recruited nurses from overseas and say they have extensive programs in place to support them.

Not everyone in the health-care industry thinks that recruitment abroad is the best way for Americans to address the nursing shortage. Others have said the best solution is to expand domestic training programs and to improve working conditions for nurses.

And the new ethics code encourages U.S. companies to refrain from recruiting in countries already facing severe shortages of medical personnel, coalition members said. While most foreign-trained nurses come from the Philippines, India, the United Kingdom and Canada, others come from countries that have been identified by the World Health Organization as experiencing a "health-care workforce crisis." Most seriously threatened is sub-Saharan Africa; for example, 34 percent of nurses trained in Zimbabwe were working in richer countries in 2006, according to WHO.

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