global reach of the nursing shortage: The American Nurses Association questions the ethics of luring foreign-educated nurses to the United States, The

To be eligible to practice in the United States, foreign-educated nurses entering on temporary or permanent employment-based visas must go through a screening process, which includes a predictor examination that forecasts their likely performance on the National Council of State Boards of Nursing's licensure examination (NCLEX), English proficiency testing, a review of the nurse's educational preparation comparing it with the standard U.S. curriculum, and a check of the nurse's license in her home country to ensure that it's valid and unencumbered.

Legislative Efforts

On the national front, the ANA is fighting passage of the Rural and Urban Health Care Act of 2001 (S 1259 and HR 2705). This legislation would dramatically expand the existing H-1C temporary nursing visa program established in 1999 and strip away workplace protections for foreign-educated nurses that the ANA fought to include in the original law.

In South Carolina, nurses are fighting a bill that would allow Canadian nurses to practice in the state without having to pass the NCLEX. "The Canadian nurse bill is a tricky bit of business," said South Carolina Nurses Association (SCNA) executive director Judith Thompson. "The hospital administrators who pushed their senators to introduce the bill are in a world of hurt. They can't hold on to their staff, because hospitals in neighboring Charlotte, North Carolina, have better pay scales."

The SCNA and the state board of nursing both object to the legislation on several counts and have testified against its passage at two state hearings, she said.

In Virginia, an effort is underway to allow nurses from Canada to become licensed in the state simply by endorsement, according to VNA executive director Jan Marshall Johnson, MS, RN. The VNA previously was successful in changing a legislative measure that would have allowed foreign-educated nurses to work in nursing homes without a license for 180 days. Instead, they can work only 90 days, the same as new U.S. nurse graduates.

Other Strategies

As a member of the ICN, the ANA helped develop that organization's soon-to-be released ethical guidelines on international recruitment. Closer to home, the ANA has been promoting its stance on immigration law to members of Congress, the Bush administration, and the American Hospital Association, which all support the increased employment of foreign-educated nurses. Foley is a member of the AHA Workforce Committee that's currently developing recommendations to address the nursing shortage.

The American Nurses Association has been lobbying for the passage of one federal bill that would ban mandatory overtime and another that would ensure continued funding for the Nurse Education Act, by which awards are granted to students willing to practice in designated shortage areas. Further, the ANA has been working with its State Nursing Associations to push health care facilities to adopt the ANA's "Principles for Nurse Staffing," which are aimed at ensuring high-quality patient care.