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.

International Nursing: What it’s Like to be a Nurse Overseas

International Nursing: What it’s Like to be a Nurse Overseas

While Catherine Browning, DNP, RN, PMHNP-BC, now works at the Arthur Center Community Health in Mexico—well, in Mexico, Missouri, that is—there was a time when she worked overseas. In honor of International Nurses Day, we asked her about her experiences. Here’s what she had to say (what follows is an edited version of our Q&A):

Catherine Browning, DNP, RN, PMHNP-BC, graduate of Chamberlain’s Doctor of Nursing Practice (DNP) degree program

When you worked as an International Nurse, where did you work? When? What did your job entail?

I worked at a Psychiatric Nursing Faculty in Kuwait from 2001 – 2009. I worked at Kuwait University and I worked at the Public Authority for Applied Education and Training’s College of Nursing. My job entailed teaching BSN and ASN students, both Kuwaitis and Arab and African students of varying nationalities. I taught in the classroom, and I accompanied my students to their clinical settings in medical hospitals, clinics, and the state psychiatric hospital. I provided counseling to many people over the years, including many war victims.

Why did you choose to go overseas to work as a nurse?

For as long as I can remember, I always wanted to live and work on the other side of the world. As a child, I dreamed of being a nurse in Africa. Later, I had fantasies of being in the Middle East. I wanted to help people, especially those of other cultures. I knew I could learn so much from them and I wanted to offer what help I could. Though I dreamed of going there someday, that dream seemed far away for many years and almost unlikely to be achieved.

Was I in for a huge culture shock. Not only was the flight a grueling 17-plus hours, but once I arrived to the Kuwait airport, security questioned and detained me for hours. There were signs of military and security presence everywhere. After all, Saddam Hussein had only invaded Kuwait during the Gulf War 10 years previously.

Kuwait University had a rigorous schedule for me to follow during the week of visiting hospitals, meeting with colleagues and students, giving talks and interviews, and touring the psychiatric hospital. I was totally overwhelmed by the language, the heat, the intimidating men in flowing gowns and headdresses, and the somewhat antiquated hospitals. I almost talked myself out of working there and then the second to last day I toured the psychiatric hospital. I was terrified. I kept thinking, “How can I do this? I don’t understand the language. I am not familiar with the culture. How do I know who to trust and how can patients know it’s safe to trust me?” And then I stepped foot on the women’s psychiatric ward, and after that the men’s psychiatric ward, and suddenly I knew everything would be OK. I recognized the client’s symptoms and immediately knew how to interact with them non-verbally. I learned to ask for help, and I felt a great connection with the patients.

By the time I arrived back to America a few days later, there was an email awaiting me saying I was offered the job.

How was working as a nurse different there? What were the biggest challenges of your job?

Working as a nurse in the Middle East didn’t take all that much adjusting. I learned right away that nursing is nursing and the patients we serve and the professional nursing values we uphold are the same everywhere. As long as I remained true to what I know and believe about nursing, I was confident and comfortable in my nursing and teaching roles. The biggest challenge was learning to maneuver through the complex bureaucracy to finally get my housing and my salary and my health insurance set up. Those things took months and that was a stressful time.

What were the greatest rewards?

My greatest rewards of working in Kuwait were:

  • Forming amazing, life-giving bonds with my students, their families, and new friends I grew to know and greatly respect and love. The Arab people were so kind and hospitable to me. They appreciated the wisdom and learning I had to share and so often I felt like I really made a big difference in someone’s life.
  • Having whole new cultural and travel opportunities in that part of the world. I studied Arabic, listened to lots of Arab music, wore Arab perfume, burned Arab incense, grew to love Arab food, and shaped my life to be more and more like those living in the culture. I loved the hot, dry climate and my health was better than ever before. I traveled during my vacation time to most of the Arab countries. I was so excited to spend time in Egypt, Turkey, Syria, Jordan, Lebanon, Palestine/Israel, and the Gulf countries. I also got to know really well people from Africa and India, and I even traveled to India, which was another dream come true.
  • The job provided more holiday time and greater income than I was accustomed to and that was very beneficial for my mental health. Having lengthy holiday and vacation time, in particular, really taught me the importance of resting, renewing, and enjoying life.