With the passage of health care reform, an estimated 32 million more Americans are expected to regularly access medical services. That’s one more reason – on top of the aging population and the graying nursing pool — for an increase in the demand for nurses.
Yet, Filipino nurses are no longer confident about their chances of finding jobs in the U.S. In New York, where there is a heavy concentration of Filipino nurses working in hospitals and nursing homes, three areas of concern weigh heavily: the long-running recession, a shortage of visas, and a testing scandal.
Cheryl Peterson, director of nursing practice and policy for the American Nurses Association, said nurses across the country are having trouble finding jobs.
“Because of the economic downturn, we’re seeing fewer hiring, or hiring that’s taking longer,” she said.
Filipino nurses have acutely felt the belt-tightening. At Mount Sinai Hospital in Manhattan, RN Angeline Foronda-Friedman remembers the 1980s and 1990s, the so called gold rush of nursing recruitment, when a Filipino nurse would be seduced with free housing, free air fare, and a thousand-dollar signing bonus to work at a U.S. hospital. The mother of all perks – a green card for the nurse and her family – would follow in a matter of months.
“We were given free housing for a month and free ticket,” said the dusky, long-haired Foronda-Friedman, now married to a Jewish doctor and with two children. “We never paid, they gave us money to come here. Now, the nurses have to pay.”
Foronda-Friedman arrived in 1990 with very little pocket money, but her anxiety was short-lived because a Brooklyn hospital was waiting for her services.
“There was a shortage then,” she said.
There’s still a shortage today, but Filipino nurses don’t find the same generous welcome from U.S. hospitals.
The demand is projected to grow – one million new and replacement nurses will be needed by 2016, according to the U.S. Bureau of Labor Statistics. And Peterson stresses that the factors leading to the nursing shortage in the 1980s and 90s, such as the aging population and nurses looking to retire remain. “It’s still a challenge,” she said.
For decades, the Philippines has been a top supplier of nurses to the U.S., accounting for about 30 percent of foreign-educated nurses in the country. But this trend now appears to be reversing due to the economic slowdown. The recession has forced the closure of many hospitals in the New York-Tri State area and around the country, leaving many Filipino nurses to downshift or look for other jobs, like caregiving, or go back to school for higher education.
But even before the recession, the “Berger Commission” meant the loss of many nursing jobs for Filipinos in New York. In 2005, the New York State Commission on Health Care Facilities in the 21st Century was created to review the state’s bloated health care system and propose ways to make it lean and efficient. The commission, headed by former New York State Social Services Commissioner Stephen Berger, recommended the closure of nine hospitals – including five in New York City – and the downsizing and consolidation of 48 other hospitals and about 3,000 nursing homes. Most of the recommendations were carried out, according to NY State Health Department spokesman Jeffrey Hammond. The nine hospitals were closed, others were merged with existing hospitals, and the nursing homes were either closed or the beds considerably reduced.
The Cabrini Medical Center in Manhattan, one of the padlocked hospitals, had a nursing staff that was almost 80 percent Filipino.
“We were the majority, and the Americans were the minority,” recalls Lolita Compas, who was a nursing educator for critical care and emergency services at Cabrini until its closure in 2008. Many of the Filipino nurses were absorbed by hospitals around the city; a few decided to go into retirement.
To this day, in some New York hospitals, competent, patient, and friendly Filipino nurses remain visible at almost every floor and in every department – from the ICU to the ER. At Mt. Sinai Hospital, where Foronda-Friedman works in the research department, she said “about 50 percent of all nurses are Filipinos.” In her department alone, there are two American and eight Filipino nurses.
But Compas, past president of the New York State Nurses Association, says the landscape is changing. “Now, there are so many layoffs, and a lot of people entered nursing as a second career. Even the American grads don’t have jobs.”
On top of increased competition, availability of visas for foreign nurses is at an all-time low.
“There are no visas,” declared New York immigration lawyer Reuben Seguritan, a Filipino American.
Foreign nurses, professionals and other skilled workers compete for 140,000 employment-based visas (EB) each year. With the nursing category assigned a 28.6 percent allocation out of 140,000 available visas, and the Philippines given only 7 percent of that 28.6 percent, the country is currently allotted just 2,800 visas per year, according to Seguritan.
As of September 2009, “there were 56,896 Filipinos waiting for EB-3 visa numbers,” he said.
Back in the 80s and 90s the quota was much higher. Filipino nurses were coming to the U.S. in numbers of anywhere from 7,000 to 8,000 a year.
Simply put, these days the list of applicants far exceeds the limited number of visas.
The View From The Philippines – Quality Control
The Philippines turns out thousands of licensed nurses every year – 65,000 in 2007; 95,000 in 2009 – prompting one education official to joke that nursing schools have become like “boarding areas for nurses.”
But many officials and industry leaders in the Philippines claim the quality of Filipino nurses has declined due to substandard nursing schools, and that’s what’s affecting Filipino employment rates. Currently, there are 456 nursing schools in the Philippines. Yet the Filipino Commission on Higher Education says only 20 of those schools would be considered “best-performing” or offering quality education comparable to international standards. The CHED has warned more than 150 schools to improve their passing rate for licensing exams or face closure.
Many students are admitted to nursing programs, but few graduate, said Dr. Fely Marlyn Lorenzo of the Philippines’ National Institutes of Health under the state-owned University of the Philippines. Of those who graduate, fewer-still pass the licensing exams.
“Quality is the problem,” Lorenzo said.
A 2006 testing scandal may also make Filipino nurses less attractive to U.S. hospitals. Review questions in two sections of the nursing board exams were leaked out, and the 17,000 who passed were not allowed to apply for jobs overseas. While the cheating is believed to have affected only 10 percent of the 45,000 test takers, everyone in Batch 2006 was tainted.
But Cheryl Peterson at the American Nursing Association, doesn’t agree that the perception of Filipino nurses in the U.S. was affected by the scandal. She dismissed the idea that the quality of Filipino nurses is the reason behind the hiring decline.
“I don’t think so,” said Peterson. She said whatever harm, if any, was caused by the cheating scandal, it reflects more on the conduct of the board examination, and not on the nurses themselves. Peterson asserts there is still a demand for Filipino nurses, but because of the decline in available visas the shortfall is being filled by American nursing graduates.
Compas agrees. “Many of us enjoy a high reputation professionally.”