People like Kate Zajdel are desperately needed to fill a worldwide shortage of nurses. Yet she was among tens of thousands of qualified applicants turned away last year by nursing programs in the United States because of a lack of teachers and places.
The dilemma brought the 22-year-old New Yorker to a new international nursing school in the Caribbean country of St. Kitts and Nevis.
"I got put on a waiting list at four community colleges," Zajdel said. "I decided that instead of waiting, I would come here. . . . I will actually be able to save lives."
Robert Ross, an American entrepreneur, inaugurated the International University of Nursing last month, inspired by staffing shortages that are forcing nurses to work overtime in hospitals from the United States to Japan.
The $10 million institution, surrounded by sugar cane fields and overlooking the sea, accepted 200 students for the fall semester and aims to enroll 3,000 by 2008. Tuition for the program, which runs about 79 weeks, is $41,505, and students have to make their own living arrangements. After about 45 weeks here, the students will do approximately 34 weeks of clinical work at affiliated U.S. colleges.
Zajdel joined a class of 24 that includes a Filipino soap opera writer looking for a new career and an engaged Egyptian couple desperate to work in the United States.
The school prepares students to take licensing exams to work as registered nurses in the United States, hoping to lure foreign students eager to fill a shortage that the American Nurses Association expects to reach 275,000 by 2010.
U.S. nursing programs rejected more than 125,000 qualified applicants last year because they did not have enough slots, according to the New York-based National League for Nursing, which estimates the United States needs three times the 20,000 nursing teachers it has.
"Every day nurses are making decisions about which patients to go and see first," said Cheryl Peterson, an analyst for the American Nurses Association. "Who is the sickest? Do I have the time to sit and talk them?"
The story echoes around the globe.
In Ireland in 2003, a 2-year-old girl died after her heart operation was canceled because no nurses were available. Our Lady's Hospital for Sick Children in Dublin, where the girl died, apologized last October for canceling two other operations.
Yet Ireland has one of the best nurse-to-population ratios in the world -- almost 14,000 nurses per 1 million people, according to a 2000 study by the Organization for Economic Cooperation and Development (OECD). France, by comparison, had fewer than 7,000 per 1 million. The United States had just over 9,000.
The OECD said studies had found that higher staffing ratios correlate with reduced patient mortality, fewer medical complications and improved health for nurses.
In California, the nursing shortage has sparked a bitter fight between nursing unions and Gov. Arnold Schwarzenegger, who has been delaying implementation of a law requiring the state's hospitals to have one nurse for every five patients at all times.
The feud boiled over in December when Schwarzenegger labeled the 60,000-member California Nurses Association a special interest and said he was "kicking their butts." Nurses have protested at his public appearances ever since.
The shortage of nurses in wealthy countries, where people are drawn to higher-paying professions, is also creating problems in poor regions that see trained nurses lured away by rich nations.
An article in the medical journal the Lancet criticized Britain for importing thousands of nurses from Africa, saying almost half the 16,000 medical workers hired for a recent expansion of the National Health Service came from outside Europe.
"The health systems of developing countries have been badly damaged by the emigration of their doctors and nurses to developed countries," John Eastwood of the University of London and several colleagues said in the article.
Ireland has more than 3,500 nurses from the Philippines. Japan, with shortages in rural communities and one of the world's fastest-graying populations, could start hiring Filipino nurses under a new trade pact. In 2002, more than 7,200 foreign nurses took U.S. licensing exams, a big jump from 5,500 the previous year, according to the National Council of State Boards of Nursing.
Alarmed by the exodus, two lawmakers in the Philippines have introduced legislation to require Filipinos who receive training as nurses to do mandatory stints in their home country.
Nurses in the Caribbean have long been leaving for higher pay in the United States. Trinidad and Tobago, with a population of just over 1 million, reports a shortage of 10,000 nurses. St. Kitts and Nevis, with 40,000 people, has 67 nurses and needs about 24 more, said Jean Condor, the director of health institutions here.
Critics say offshore medical programs such as the International University of Nursing aren't likely to help and could worsen the problem by giving people in poor nations more routes for finding jobs in wealthy countries.
The chance to work in the United States was definitely an incentive for Mohamed Omar, the Egyptian who enrolled at the new school with his fiance.
"It's my biggest dream to work and to study in America," Omar said. "In Egypt, being a nurse is not a good job. They don't care about nurses. The salaries are very weak."