It’s not a question of “is the nursing shortage real or why is it happening”.  The real question is what you do about it for your hospital and your patients, NOW.

  When you get through all of the hand wringing about why:

• 68.3 % of the nurses in the USA are over 40 and many are leaving before reaching the retirement age.

• Enrollments in Nursing Schools is down 16.6% in last five years

• Questions regarding dwindling interest of Americans in the “caring professions”

• Insurance Companies and Administrators squeezing too much out of each nursing dollar, which may lead to nurse “burn-out”.

We have to deal with it now and it is not going away.  The USA will be facing a shortage of over 400,000 nurses by 2010.  Old constructs of stealing from each other is not going to work.  There are just too many demands on today’s nurse from the traditional ways of providing patient care to the administrative demands placed on their time by new systems, policies and of course HIPPA. 

The hospitals in the USA have to turn to another resource and that is nurses graduating from foreign nursing schools.  Currently this is going on but it is going to become a more significant source of nurse staffing as we go forward.  This presents two major dilemmas for hospitals:

• How do you address the moral issue of recruiting from 3^rd World Countries who are facing shortages themselves?

• In the face of the changes 9/11 has brought to our view of immigration patterns and the tougher restrictions now in place or contemplated, will we still have access and will our communities accept them.

The first issue can be easily handled because in today’s world with our access to information, we know where the excess nurses are.  You don’t have to recruit in the typical 3^rd World environs.  There are a few primary locales such as India and the UAE where there is an excess of Nurses and most importantly their quality of care is akin to the level of services one would expect in a major metropolitan area such as New York City.  Historically, many of the foreign nurses already in the states have come from the Philippines however, when analyzing this country we find that their pool of nurses, though not depleted, is coming to the end of their ability to generate significant excess staff.

When you speak to the Indian Nursing community the only resistance you find is to our thinking that they are a 3^rd World nation.  India has a tradition of Medicine that is well respected around the world in the medical communities.  As for the UAE, one only has to visit Dubai to see the quality of care available to their residents and begins to analyze their supply of nurses and you suddenly realize that they are also a great source for nurses; surprisingly many of their nurses traditionally come from Eastern Europe, India and the United Kingdom rather than from the resident population.

The second issue which revolves around the impact of 9/11 on immigration perhaps provides the greatest dilemma for recruiting.  It is not that we are not welcoming immigrants we are just being more cautious.  We have expanded the processes and screening of likely candidates.  Before 9/11 a hospital by themselves or even using agencies were experiencing delays which expanded the immigration process so that the national average for bringing a nurse to the states ran from 18 to 24 months and it seems that this timeframe now could be longer.

Returning to our original question what do you do now to provide adequate patient care when you do not have enough caregivers?  A new service called the Global Supply Methodology (GSM) has been introduced by a new player in the Nursing Marketplace Innovative HealthCare Group, Inc. (IHGi).  GSM is very similar to the “Just in Time” inventory method very much in vogue today.

Essentially, what IHGi purports that they can do is deliver completely certified and vetted experienced nurses to any hospital in the United States.  The process includes handling all of the various steps that a nurse immigrating to the USA has to go through.  As you might imagine this is not a simple task.  For example there is the certification process which includes CGFNS, TSE, TWE, TOEFL, IHCP visa screen and the state specific NCLEX-RN tests which a nurse has to complete before they can even apply for a green card which takes 7 – 8 months via IHGi.

In order to ensure that the nurses pass these tests IHGi operates 7 Training Centers through out the South East Asia where the nurses study for these tests.  Upon successfully completing these tests they then are trained to handle the differences regarding pharmaceuticals, HIPPA and hospital specific credential verification based upon their area of nursing.  During all of this processing (3 – 4 months), the hospital recruiting staff is taken to the countries of residence to interview and select their future nurses.

IHGi doesn’t stop here, they also deal with initial problems that all immigrants face when entering the states; things such as initial housing, transportation, Social Security Cards and Drivers Licenses.  As stated previously, the IHGi method is very much like the “Just in Time” inventory approach many of our businesses are taking today.  IHGi is preparing nurses today for placement tomorrow. 

The end result is a “win/win” situation for the new nurses and for the hospitals.  IHGi views the immigration process as a system somewhat in disarray where hospitals and nurses both need expertise to survive the maze of regulations and requirements they face.

After 10+ years of supplying IT staff and High School Teachers they have overcome most of the obstacles that exist today and act in a very proactive way with the various certification bodies so that they are prepared for the future.

The bottom line for hospitals is that the optimum solution still is to grow your own.  The Nursing industry in conjunction with industry has begun to address it with programs such as “the Campaign for Nursing’s Future” and congress has passed scholarship programs for students and faculty.  However, with the shortages today they will have to reach out to other resources.  In order to avoid the missteps that many of their peers have experienced, it probably is best to find some organization that has been there and done that already.