Nursing shortages fuel debate on foreign workers

LOS ANGELES -- Nicole Oswell was a straight-A student passionately interested, since first grade, in following in her mother's footsteps as a registered nurse. But she had to wait two years to enter Los Angeles Trade Tech's nursing program, she said, her frustration mounting as national nursing shortages worsened.

Lizbeth Gutierrez got lucky. Her wait was only six months. But that's because she won a lottery for a space at East Los Angeles Community College, one way that nursing schools overwhelmed with applicants now select students.

As nationwide nursing shortages threaten to balloon to more than 1 million over the next several years, health care organizations are grappling with a range of problems, including how many foreign nurses to import, how to increase spaces at overcrowded nursing schools, and how to make sure that students allowed in the programs complete them.

"Just the waiting list alone tells you there are tons of people here who want to be nurses," said Oswell, a 25-year-old Minnesota native. "We should give the people who live here the opportunities for those jobs."

With growing urgency, policymakers are aiming to do just that with a flurry of initiatives to accommodate more California nursing students. Last week, the Los Angeles County Board of Supervisors was set to accept a $3 million grant from L.A. Care Health Plan to open a new nursing program.

Earlier this month, the California Wellness Foundation sponsored a media tour of an East Los Angeles medical clinic and two educational institutions to highlight the shortage of health care workers and encourage more young people, particularly minorities, to consider the profession. The foundation said 51 of California's 58 counties are facing shortages of workers in nearly 200 allied health professions.

The University of California, Los Angeles, reopened its undergraduate nursing program last year after a 10-year hiatus, and several medical centers are partnering with other colleges to increase nursing school spots.

California Governor Arnold Schwarzenegger, meanwhile, launched a three-year, $90 million initiative in 2005 with public and private partners to expand nursing schools.

The debate over nursing highlights the perennial question of whether to import foreign workers or take steps to better train and attract Americans to fill the demand. That debate is heightened now with two major immigration bills pending in Congress that would take dramatically different approaches to the nursing question.

The recently sidelined Senate bipartisan immigration bill would make it "nearly impossible for foreign nurses to immigrate to the US," said Los Angeles immigration attorney Carl Shusterman.

The bill's proposed point system for selecting immigrants favors those with advanced education and skills, he said, but relatively few nurses have graduate degrees. Only a two-year associate's degree is required for registered nurses, and community colleges graduate nearly two-thirds of California's nurses. And the US Labor Department does not consider the nursing profession a "specialty" occupation that wins extra points, Shusterman said.

In contrast, the House immigration bill by Arizona Republican Jeff Flake and Illinois Democrat Luis V. Gutierrez, would allow the unlimited entry of foreign nurses for 10 years.

Many experts say, however, that both foreign and American nurses are badly needed amid a shortage that demographers and labor experts predict will worsen over time as baby boomers retire and the nursing workforce ages.

"It's not either/or," said Shusterman, whose law firm has helped 6,500 foreign nurses immigrate here, mostly from the Philippines, over the last two decades. "The nursing shortage is so bad that you really have to have both."

The nursing profession was battered during the 1990s by the advent of managed care and cost-cutting, which prompted many hospitals to reduce registered nursing staffs and increase workloads.

But as nursing shortages developed, the tide began to turn in the late 1990s and early 2000. Employers began raising pay. Average annual salaries for full-time registered nurses increased to about $69,000 in 2006 from $52,000 in 2000, a 32 percent gain, according to a May study by the state legislative analyst's office.

The rising pay and improved working conditions have attracted thousands of students to the nursing field. But a bottleneck has developed. The average wait to enter nursing school is now two to three years, primarily because of a shortage of classroom space and nursing educators, who can make more money in hospitals than schools. Worsening the problem, 25 percent of those who are admitted to community college nursing programs drop out and another 25 percent do not graduate on schedule, the legislative analyst's office found. Gutierrez, for example, said half or more of her entering class of 70 students have struggled academically and been held back or dropped out of the program entirely. Several organizations are mobilizing to improve those numbers, as research shows that a community's health improves when those who deliver the medical care reflect its demographics .