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Hospitals Recruit International Nurses to Fill Pandemic Shortages

Hospitals Recruit International Nurses to Fill Pandemic Shortages

BILLINGS, Mont. — Before Mary Venus was offered a nursing job at a hospital here, she’d never heard of Billings or visited the United States. A native of the Philippines, she researched her prospective move via the internet, set aside her angst about the cold Montana winters and took the job, sight unseen.

Venus has been in Billings since mid-November, working in a surgical recovery unit at Billings Clinic, Montana’s largest hospital in its most populous city. She and her husband moved into an apartment, bought a car and are settling in. They recently celebrated their first wedding anniversary. Maybe, she mused, this could be a “forever home.”

“I am hoping to stay here,” Venus said. “So far, so good. It’s not easy, though. For me, it’s like living on another planet.”Originally published in Kaiser Health News.

Administrators at Billings Clinic hope she stays, too. The hospital has contracts with two dozen nurses from the Philippines, Thailand, Kenya, Ghana and Nigeria, all set to arrive in Montana by summer. More nurses from far-off places are likely.

Billings Clinic is just one of the scores of hospitals across the U.S. looking abroad to ease a shortage of nurses worsened by the pandemic. The national demand is so great that it’s created a backlog of health care professionals awaiting clearance to work in the U.S. More than 5,000 international nurses are awaiting final visa approval, the American Association of International Healthcare Recruitment reported in September.

“We are seeing an absolute boom in requests for international nurses,” said Lesley Hamilton-Powers, a board member of AAIHR and a vice president for Avant Healthcare Professionals in Florida.

Avant recruits nurses from other countries and then works to place them in U.S. hospitals, including Billings Clinic. Before the pandemic, Avant would typically have orders from hospitals for 800 nurses. It currently has more than 4,000 such requests, Hamilton-Powers said.

“And that’s just us, a single organization,” added Hamilton-Powers. “Hospitals all over the country are stretched and looking for alternatives to fill nursing vacancies.”

Foreign-born workers make up about a sixth of the U.S. nursing workforce, and the need is increasing, nursing associations and staffing agencies report, as nurses increasingly leave the profession. Nursing schools have seen an increase in enrollmentsince the pandemic, but that staffing pipeline has done little to offset today’s demand.

In fact, the American Nurses Association in September urged the U.S. Department of Health and Human Services to declare the shortage of nurses a national crisis.

CGFNS International, which certifies the credentials of foreign-born health care workers to work in America, is the only such organization authorized by the federal government. Its president, Dr. Franklin Shaffer, said more hospitals are looking abroad to fill their staffing voids.

“We have a huge demand, a huge shortage,” he said.

Billings Clinic would hire 120 more nurses today if it could, hospital officials said. The staffing shortage was significant before the pandemic. The added demands and stress of covid have made it untenable.

Greg Titensor, a registered nurse and the vice president of operations at Billings Clinic, noted that three of the hospital’s most experienced nurses, all in the intensive care unit with at least 20 years of experience, recently announced their retirements.

“They are getting tired, and they are leaving,” Titensor said.

Last fall’s surge of covid cases resulted in Montana having the highest rate in the nation for a time, and Billings Clinics’ ICU was bursting with patients. Republican Gov. Greg Gianforte sent the National Guard to Billings Clinic and other Montana hospitals; the federal government sent pharmacists and a naval medical team.

While the surge in Montana has subsided, active case numbers in Yellowstone County — home to the hospital — are among the state’s highest. The Billings Clinic ICU still overflows, mostly with covid patients, and signs still warn visitors that “aggressive behavior will not be tolerated,” a reminder of the threat of violence and abuse health care workers endure as the pandemic grinds on.

Like most hospitals, Billings Clinic has sought to abate its staffing shortage with traveling nurses — contract workers who typically go where the pandemic demands. The clinic has paid up to $200 an hour for their services, and, at last fall’s peak, had as many as 200 traveling nurses as part of its workforce.

The scarcity of nurses nationally has driven those steep payments, prompting members of Congress to ask the Biden administration to investigate reported gouging by unscrupulous staffing agencies.

Whatever the cause, satisfying the hospital’s personnel shortage with traveling nurses is not sustainable, said Priscilla Needham, Billings Clinic’s chief financial officer. Medicare, she noted, doesn’t pay the hospital more if it needs to hire more expensive nurses, nor does it pay enough when a covid patient needs to stay in the hospital longer than a typical covid patient.

From July to October, the hospital’s nursing costs increased by $6 million, Needham said. Money from the Federal Emergency Management Agency and the CARES Act has helped, but she anticipated November and December would further drive up costs.

Dozens of agencies place international nurses in U.S. hospitals. The firm that Billings Clinic chose, Avant, first puts the nurses through instruction in Florida in hopes of easing their transition to the U.S., said Brian Hudson, a company senior vice president.

Venus, with nine years of experience as a nurse, said her stateside training included clearing cultural hurdles like how to do her taxes and obtain car insurance.

“Nursing is the same all over the world,” Venus said, “but the culture is very different.”

Shaffer, of CGFNS International, said foreign-born nurses are interested in the U.S. for a variety of reasons, including the opportunity to advance their education and careers, earn more money or perhaps get married. For some, said Avant’s Hudson, the idea of living “the American dream” predominates.

The hitch so far has been getting the nurses into the country fast enough. After jobs are offered and accepted, foreign-born nurses require a final interview to obtain a visa from the State Department, and there is a backlog for those interviews. Powers explained that, because of the pandemic, many of the U.S. embassies where those interviews take place remain closed or are operating for fewer hours than usual.

While the backlog has receded in recent weeks, Powers described the delays as challenging. The nurses waiting in their home countries, she stressed, have passed all their necessary exams to work in the U.S.

“It’s been very frustrating to have nurses poised to arrive, and we just can’t bring them in,” Powers said.

Once they arrive, the international nurses in Billings will remain employees of Avant, although after three years the clinic can offer them permanent positions. Clinic administrators stressed that the nurses are paid the same as its local nurses with equivalent experience. On top of that, the hospital pays a fee to Avant.

More than 90% of Avant’s international nurses choose to stay in their new communities, Hudson said, but Billings Clinic hopes to better that mark. Welcoming them to the city will be critical, said Sara Agostinelli, the clinic’s director of diversity, equity, inclusion and belonging. She has even offered winter driving lessons.

The added diversity will benefit the city, Agostinelli said. Some nurses will bring their spouses; some will bring their children.

“We will help encourage what Billings looks like and who Billings is,” she said.

Pae Junthanam, a nurse from Thailand, said he was initially worried about coming to Billings after learning that Montana’s population is nearly 90% white and less than 1% Asian. The chance to advance his career, however, outweighed the concerns of moving. He also hopes his partner of 10 years will soon be able to join him.

Since his arrival in November, Junthanam said, his neighbors have greeted him warmly, and one shop owner, after learning he was a nurse newly arrived from Thailand, thanked him for his service.

“I am far from home, but I feel like this is like another home for me,” he said.

Nursing Side Gigs: Love and Joye Baked Goods

Nursing Side Gigs: Love and Joye Baked Goods

This is part of a regular series about side gigs—nurses with interesting side jobs or hobbies. This month, we spotlight a nurse who sells baked goods through her business Love and Joye.


 

Alyssa of Love and Joye

Alyssa Joye Vesey, RN

During the holidays, many of us include baking as part of what we do. It’s a tradition.

For Alyssa Joye Vesey, RN, who works for Walden University’s College of Nursing as the RN Field Education Coordinator in the Office of Field Experience, baking has become her side gig in her business Love and Joye.

 

How did you come up with the idea for Love and Joye? Why did you want to do this? How long have you been doing it? Do you only cook and bake particular items?  

I have had a strong passion for cooking ever since I was a child, but I did not have any prior baking experience until I moved to the United States in 2017. Where I came from in the Philippines, people do not have ovens at home because every street corner has a bakery.

When I was adjusting to my life in the U.S., I found myself craving the Filipino baked goods I used to purchase. I couldn’t find them in grocery stores, so that encouraged me to try baking. I fell in love with it, and just started trying to bake Filipino desserts and pastries. I also explored and made other desserts from around the world that interested me.

My friends and coworkers encouraged me to start selling the goods I made because they felt bad asking me to bake for them for free. In 2019, I decided to start selling and sharing what I bake in my community in Minneapolis through Love and Joye.

Explain what Love and Joye offers, is, does, and if you ship around the country.   

Love and Joye

Love and Joye

Love and Joye is a small business in Minneapolis that offers mostly Filipino delicacies. But it is not limited to that because I also make a variety of cakes and cupcakes for birthdays and parties.

I love to share my Filipino heritage through food, which is one of the most powerful ways of connecting people. I have sent my baked goods to family members in some parts of the country like Washington, Florida, New York, and California. However, due to my schedule, I am not yet able to ship orders around the country, but I dream to be able to do so someday.

Do you find that this is easy to do even while working as a nurse?

I find it manageable to have a food business on the side because of a strategy I set in place. I ask my customers to provide a timeframe of when they need their orders so I can plan. It helps that my work schedule is consistent, and I have weekend rest days. I mostly accept orders when they are placed a week or two in advance.

What are your biggest challenges with this side gig? What are your greatest rewards?

The biggest challenge is the limitation on the number and types of orders I can accept due to my current schedule. I always want to do more for my business and for my community, but due to time constraints, I can’t always. Even though my job has a relatively consistent schedule, there are some weeks that are much more highly demanding and busier than others.

My greatest reward in running the Love and Joye food business is the satisfaction of knowing that people like what I make for them, and the conversations it creates. It is an opportunity to share with people where I come from and an opportunity for me to learn the same about them. I do not pay for advertising, so I let my customers do it for me.

What do you like most about Love and Joye?

I love seeing the reaction on people’s faces when they try Filipino food for the first time. The reaction ranges from a big smile to a look of confusion, like their face is asking, “What’s in this? I’ve never had anything like it before!”

There is only one Filipino restaurant in Minneapolis, so my business creates more opportunity for people to try something new. Through Love and Joye, I can bring them to the Philippines without leaving Minnesota.

COVID Exacts High Toll Among Filipino Nurses

COVID Exacts High Toll Among Filipino Nurses

Data from National Nurses United (NNU) suggests that while only 4% of US nurses are Filipinos, some 30% of the nearly 200 RNs who have died from COVID-19 are Filipino Americans. NNU believes that overall, nurses are primarily endangered by PPE shortages and restrictive guidelines limiting access to tests, but Filipino nurses tend to face additional risks.

The odds of being exposed to the virus tend to be higher for Filipino nurses and healthcare workers. One reason for their vulnerability is based on sheer numbers, particularly in California and New York. One fifth of California nurses are Filipino, and according to a ProPublica analysis of 2017 US Census data, 25% of the Filipinos living in New York work in the health care industry. The types of jobs they take also increase the likelihood of exposure. A 2018 Philippine Nurses Association of America survey (cited by ProPublica) found a large proportion of respondents working in bedside and critical care, and a StatNews report noted that “because they are most likely to work in acute care, medical/surgical, and ICU nursing, many ‘FilAms’ are on the front lines of care for Covid-19 patients.” The StatNews story added that Filipino frontliners often “work extra shifts to support their families and send money back to relatives in the Philippines. Those extra hours, and extra exposure to patients, mean higher risk.”

Roy Taggueg, of the Bulosan Center for Filipino Studies at University of California, Davis recently told NBC News that in addition to the low rates of testing in their communities, Filipino nurses are also more likely to reside in multi-generational households, which makes them and their families more vulnerable to the virus. He explained, “One person might be going out, but they definitely are bringing everything back with them when they come home from work, because they’re forced to work out there on the front line. We’re talking about their parents, their kids, all of that. It’s a very particular position to be in, and it’s one that I think is unique to the Filipino and Filipino American community.”

While many nurses have been speaking out about the lack of tests and inadequate PPE, Filipino nurses usually find it more comfortable to remain silent. Cris Escarrilla at the San Diego chapter of the Philippine Nurses Association of America remarked, “We don’t really complain that much. We are able to adapt and we just want to get things done.” Zenei Cortez, president of National Nurses United and the California Nurses Association acknowledged this, saying “Culturally, we don’t complain. We do not question authority. We are so passionate about our profession and what we do, sometimes to the point of forgetting about our own welfare.” However, Cortez thinks that the younger generation of Filipino nurses seem to be finding their voices: “What I am seeing now is that my colleagues who are of Filipino descent are starting to speak out. We love our jobs, but we love our families too.”