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Issues Update
American Journal of Nursing -
November, 2003 - Volume 103, Issue 11
Protecting the Public
A final federal rule increases the number of
foreign-educated nurses screened.
The U.S. government recently took a positive step forward for patients across the
country when it required that the majority of foreign-educated
nurses who want to practice in this country go through a stringent
screening certification process.
“The ANA believes that to protect people seeking
health care in this country, all foreign-educated nurses need to meet
the basic screening requirements spelled out in the rule,”
explained Cheryl Peterson, MSN, RN, senior policy fellow in the ANA’s
practice department. “We need to ensure that they have a legitimate
license, that their educational background is comparable to ours, and that
they are proficient in English.
“Further, the ANA doesn’t view this as a
barrier to foreign-educated nurses practicing in this country. This is a
matter of public protection.”
Congress passed legislation requiring the
certification process in 1996, but it wasn’t until this summer that
the Bureau of Citizenship and Immigration Services —formerly
known as the Immigration and Naturalization Service and now
a part of the Department of Homeland Security—issued its final
rule for Certificates for Certain Health Care
Workers. This final rule applies to
foreign-educated nurses, as well as workers in six other health care
fields.
Stephanie Tabone, MSN, RN, director of practice for
the Texas Nurses Association (TNA), sees the final rule as potentially
having another benefit in addition to promoting a qualified workforce:
reduced exploitation of foreign-educated nurses. Less than a decade
ago, Tabone found herself in the midst of international intrigue when she
and other TNA nurses helped uncover a scam in which foreign-educated
nurses were brought into the United States illegally under special work
visas.
“Nurses who immigrate here and meet our standard
for an RN should not be treated as less,” Tabone said. “The
screening process helps assure that the nurses we are bringing in are
qualified. And more stringent rules help prevent conditions that allow
immigrants to be exploited.”
The visas and the rule
Although nurse immigration experts say it’s
impossible to precisely determine the number of foreign-educated,
state-licensed nurses working in this country, the 2000 RN Sample Survey of Registered Nurses
placed the number at close to 100,000, with 72% employed in
hospitals. Most nurses applying for RN licensure during the latter part of
the 1990s came from the Philippines, Canada, and Africa (mainly Nigeria and
South Africa), according to International
Nurse Mobility—Trends and Policy Implications.
The 2003 report is a collaborative effort by the World
Health Organization, the International Council of Nurses, and the Royal
College of Nursing.
Foreign-educated nurses are permitted to enter this
country to practice mainly through three mechanisms: permanent visas, for
those who want to become U.S. residents; temporary visas, for those who are
here for a specified time; and under negotiated trade agreements, such as
the North American Free Trade Agreement, which also are time limited.
Under the final rule, nurses entering the United
States on temporary visas, on permanent, employment-based visas, or through
trade agreements must submit to a screening certification process.
Previously, only those seeking permanent visas had to obtain such
certification. The new rule does not apply to nurses entering under certain
training visas or family-sponsored petitions, according to Peterson.
Components of the screening process
include a predictor examination that forecasts a
nurse’s likely performance on the National Council of State
Boards of Nursing’s licensure examination; English proficiency
testing; a review of the applicant’s educational preparation,
comparing it with U.S. curriculae; and a check of the nurse’s license
in her home country to ensure that it’s valid and unencumbered.
Although the rule took effect in September, nurses
already here on temporary visas or under trade agreements have until July
26, 2004, to obtain certificates, which are valid for five years and, for
those entering on a temporary basis, must be presented every time they seek
admission to the United States.
Peterson said the ANA mostly is pleased with the
ruling, because it addresses several issues raised by ANA president Barbara
Blakeney, MS, APRN,BC, ANP, in comments sent to the immigration agency. One
involved the importance of having a federal rule in place.
“While some may argue that the state boards of
nursing already have a review process, this is not standardized across
the country, and if they’re relied on as the sole mechanism for
review, this could affect patient and public safety,” Blakeney wrote.
The ANA still views the rule as having some loopholes.
For example, if a high-tech worker comes into this country with a
spouse who is a nurse, the spouse does not have to obtain a screening
certificate unless it’s required by a state board of nursing. Once
again, Peterson said, by not applying the rule equally, patient safety
could be compromised.
Although the Commission on Graduates of Foreign
Nursing Schools (CGFNS) “is immigration neutral” in its
position on the final rule, CGFNS spokesperson Judy Pendergast, JD,
RN, said the commission has always been concerned with protecting the
public by ensuring that nurses immigrating to this country meet the
required professional standards. The CGFNS is independent but federally
sanctioned and evaluates the education and credentials of foreign nurses
seeking to practice in this country.
She urges foreign-educated nurses previously exempt
from obtaining a certificate to start the screening process with the CGFNS
immediately so they will meet the 2004 deadline.
On a final note, the ANA recognizes the fundamental
right of nurses to migrate. However, it does not consider the recruitment
of foreign-educated nurses to be the primary solution to the U.S. staffing
shortage. The ANA believes it is time for the federal government, the
nursing profession, and the health care industry to devote the necessary
resources to ensure an adequate supply of RNs and a work environment
conducive to safe, high-quality nursing practice.
For more information on the ANA’s efforts
on global nursing issues, contact Cheryl Peterson at cpeterso@ana.org.
Susan Trossman is senior reporter for the American Nurse at the ANA.
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