America's hospitals are so critically short of nurses that they are raiding foreign countries to help solve the problem.
Seventy nurses from South Korea, for example, are expected in February but will bring little relief to the potential long-term nursing shortage in the United States.
Nevertheless, recruiters representing hospitals and other medical institutions are mushrooming all over the country, waging what one recruiter calls a "bidding war" in search of nurses around the globe.
Many recruiters, who traditionally sought nurses trained in Europe or Canada, are increasingly looking to Asia and to Caribbean countries for candidates.
The Korean Overseas Development Corp. (KODCO), a government agency, recently set up its first U.S. office in Miami to provide overseas employers with "well-qualified" workers to meet worldwide demands. Its director, Jae Hwan Hyun, noted that last year alone three U.S. recruiting agencies asked for 115 nurses from South Korea.
These requests came at a time when the South Korean government is eager to boost its prestige as a new industrial power with technical know-how. More than 900 South Korean nurses and medical technicians are now working in Saudi Arabia, and the number of nations requesting South Korean workers continues to rise.
South Korean nurses planning to come to the U.S. are registered nurses with four-year college degrees. KODCO in Seoul provides an English studies program to help them pass examinations given by the U.S. Commission on Graduates of Foreign Nursing Schools (CGFNS), which are required by the U.S. Immigration and Naturalization Service. The examinations are given twice annually at 35 locations throughout the world, including seven in the United States.
The number of nurses taking the CGFNS test jumped from 14,000 in 1986 to 18,000 last year. The first 1988 exam in April is expected to draw 10,000 nurses who wish to practice in the U.S.
For the past eight years, CGFNS has administered 76,425 examinations or reexaminations to 47,420 graduates of schools in 104 countries. Of the 47,420 graduates who have taken or retaken the CGFNS exams, 19,849, or 41.8 percent, have achieved a CGFNS certificate and are eligible for jobs in the U.S.
One recruiter, Burt Cutler, executive director of Rank International Agency in West Hempstead, N.Y., said that 10 nurses from South Korea will work at New York's Bronx Municipal Hospital Center and in New Jersey at the Christian Health Care Center. Cutler, who represents major hospitals in Illinois, Massachusetts, New York and New Jersey, said that 1,000 nurses are needed right away in these areas. He added that without foreign nurses, some hospitals and nursing homes may be unable to meet state staffing requirements and will have to close. The hardest-hit areas, according to Cutler, include the Northeast, South Florida and the West Coast.
Jeong Wha Lee of Seoul, who signed a contract with the Bronx Municipal Hospital, said she looks forward to acquiring all the advanced nursing technology offered in the United States. Lee said she worked five years side by side with American and British nurses at Central Hospital in Riyadh, Saudi Arabia.
"Of all the nurses," said Lee, "I was most impressed with up-to-date skills and medical knowledge U.S. nurses demonstrated there, and it made me think about furthering my nursing career in the U.S." With her interest in hospice care for the terminally ill, Lee said she plans to open a hospice when she returns to Korea.
Kyung Ah Park, also waiting for her visa since December, said she loves her profession and wants to learn all she can about surgical nursing. The unlimited educational opportunity, career advancement and monetary reward motivated her to sign a contract with the Bronx Municipal Hospital.
"I love nursing. There are so many hospitals and educational opportunities in the United States. I think I can learn more about surgical nursing over there and hopefully will earn more money," Park said.
But the U.S. Embassy is said to be reluctant to grant working visas, citing the fact that many nurses fail to return to Korea.
Ai-Sil Sohn, coordinator of clinical nursing care at Brookdale Hospital Medical Center in Brooklyn, N.Y., who knows many nurses who had previously arrived from South Korea, said that American hospitals with acute nursing shortages ask most foreign nurses to stay on the job and help them acquire permanent residency. Sohn, who has been in the U.S. 12 years, estimates that at least 2,500 Korean-born nurses work in the Northeast. Recruiting of foreign nurses now has become so intensified that, said Cutler, "it's like a bidding war out there. Some even offer free housing and a trip to Disneyland."
In December, Cutler headed for the Philippines and South Korea. He carried with him English books to help potential candidates pass CGFNS examinations. "Korean and Philippine nurses are very good. Eventually, we are going to bring every nurse who passes her CGFNS examination," said Cutler. Since 1972, he has recruited 10,000 nurses, mostly from the Philippines, where English is widely spoken.
Florida hospitals, many of which are heavily dependent on foreign nurses, now "have about 2,500 vacancies for registered nurses in 150 hospitals," said Mike Willis, director of human resources for the Florida Hospital Association.
A 1986 U.S. Department of Health and Human Services report shows that in 1990 the supply of registered nurses with bachelor's degrees will be 413,000. At the same time, the demand will be 803,000, said Carol Grimaldi, public relations director for the American Nurses Association based in St. Louis, Mo.
"There has been a 23 percent decline in nursing school enrollment since 1983, said Grimaldi. "We are talking about thousands of people when the U.S. is turning into a health-care focused society -- spending more than $1 billion a day in health care."
According to the American Hospital Association's Division of Nursing, the vacancy rate for registered nurses in hospitals more than doubled between 1985 and 1986, going from 6.3 to 13.7 percent, while enrollments in nursing schools have been decreasing at a rate of 10 percent a year for the past three years. Moreover, as many as 40 percent of all registered nurses may have left the field to pursue other careers. Meanwhile, nursing experts project the decline in nursing school enrollments to worsen through the mid-1990s.
The high 13.7 percent rate reflects a large number of vacancies in positions dealing with acutely ill patients, said Bill Losaw, statistician in the Division of Nursing at the U.S. Public Health Service.
"There are nurses out there, but why they are not working is all speculation -- you don't know the real causes," said Losaw. HHS Secretary Otis Bowen is looking at the nursing shortage issue and is setting up a committee for a conference on the nursing shortage early this year.
The most frequently cited reasons for the nursing shortage are low pay, long hours and the negative image of nursing, as well as the declining enrollment in nursing schools at a time when the aging -- who tend to be sicker and require longer care -- are the fastest-growing segment of the U.S. population.
Barbara Lumpkin, director of governmental relations for the Florida Nurse Association, said that today's one-on-one care is just "exploding," as nursing shortages are most acute in such specialty areas as gerontology, geriatric centers and high-tech-related intensive-care units. "Right now, we could use 5,000 to 7,000 nurses in Florida. Five years ago, two nurses with support personnel could care for 25 beds; today you need four nurses," Lumpkin said.
Grimaldi said that of the nation's 1.9 million registered and licensed nurses, 1.5 million are active in nursing, a higher participation rate than in the last 20 years. But the demand for registered nurses outside the hospital has grown, with many new opportunities to work in nontraditional, ambulatory care settings, such as day surgery clinics, home care agencies and others competing for the shrinking pool of nurses.
In response to the acute shortage of registered nurses, the American Organization of Nurse Executives, the American Association of Critical-Care Nurses, the American Hospital Association and other advocacy groups have launched a campaign to recruit more young people into nursing.
Others are lobbying for legislative action on the state and federal level.Foreign graduate nurses will not permanently solve the U.S. nursing shortage, said Lumpkin. "They burn out, just as American nurses do. They return home or go on to find other areas of work, like American nurses, and move out of nursing."
With the advent of the women's movement, women today have career choices they did not have 25 years ago. Currently, 97 percent of nurses are women and their starting salaries average $22,000 a year.
"What these bright young women are saying," said Lumpkin, "is -- after 20 years of practice, nurses will be still making $33,000, whereas engineers, lawyers and women in other professions will triple their salaries."
Sue Hong is editor of Ameri-Asia News, a national newspaper for Asian Americans based in Altamonte Springs, Fla.