Background

With the persistent and even deepening shortage of nurses in the United States over the last ten years, international nurses from around the world have seized the opportunity to gain employment in U.S. health care facilities. Not only have employment opportunities been readily available for qualified RNs, their U.S. offers of employment also provided them the ability to achieve permanent resident status in the U.S.

However in January 2005 the availability of the much sought after ‘Green Card’ permanent resident visa was significantly impaired when six month processing delays were encountered as there were more people applying for Green Card visas than were available in the current year. This delay was temporarily remedied in May 2005 when an additional 50,000 visas were made available to RNs and PTs only. Unfortunately these visas were fully allocated by November 2006 and extended processing delays have returned. Under the current circumstances new Green Card petitions can still be filed, however a new Green Card application filed in February 2007 would result in a visa being issued sometime in 2011 or 2012.

This is an untenable situation for U.S. health care employers who are facing a lingering shortage that is only going to grow as the result of increasing retirements at the same time the demand for the services they provide is increasing. It is also extremely worrisome to international nurses, many of whom entered nursing with the specific goal or working in the U.S.

What Is Likely to Happen Next?

It is widely agreed among many U.S. immigration attorneys, immigration advocates, professional recruitment firms and other stakeholders that reforms to U.S. immigration laws will be made and likely sooner rather than later. Further, the anticipated reforms are expected to be very positive as they relate to RNs and other health professionals. Expectations are that the annual limit on the number of available Green Card visas will be raised significantly. This may not even be that important as there are also some serious proposals being considered that would simply exempt RNs, PTs and perhaps others from any annual numerical cap on visas for years to come.

Some U.S. employers are continuing to recruit internationally at this time as new Green Card petitions can be filed and they expect that immigration reforms will be passed soon. For certain, more U.S. employers than ever before will undertake international recruitment once immigration reforms are passed.

Positioning Yourself for the Best Opportunities

As U.S. employers have gained some experience in recruiting internationally over the past ten years they are have learned to place a strong emphasis on an applicant’s recent and current clinical skills. Nurses who may have many years of experience but have been away from bedside nursing for two or more years will find far fewer employers interested in them than a nurse who may have less experience that is current and ongoing. The solution here is obvious; if you are not currently working at the bedside you should immediately seek a position that will enable you to refresh and further develop your clinical skills.

Also, it is a high priority for many U.S. employers that international applicants have passed at least some if not all of the required examinations that are required to obtain a RN license in the U.S. At the very minimum, international nurses should have passed the IELTS English language exam before submitting their application. While the cost of the required exams does present a barrier for some international applicants, many U.S. employers will reimburse the cost of the required exams to the applicant once they accept a job offer from them or commence employment.

With the relatively recent expansion of NCLEX test centers to twelve countries around the world, including the Philippines, it is now easier than ever for nurses to access the NCLEX exam. Employers are very likely to consider NCLEX passers as priority applicants. The bottom line is that the more initiative you show by taking and passing the required exams, the better your prospects will be among the best U.S. employers.

It is said that knowledge is power. This is particularly true for you as you consider the myriad of recruitment ads that appear in newspapers and websites around the world. Using your common sense is a good place to start. Never forget ‘that if it is too good to be true in usually is.’ The following tips on how to evaluate U.S. employment opportunities will assist you in ensuring that your dream to work in the U.S. does not end up being a nightmare.

Direct Placement or Staffing Agency

Direct placement refers to circumstances where a nurse is recruited by a hospital or nursing home or through a recruitment agency hired by a hospital or nursing home for employment by that specific facility. In these cases the nurse will always become a regular direct employee of that hospital or nursing home for the entire duration of any recruitment agreement that they may enter into. Alternatively, staffing agencies recruit nurses to become employees of the staffing agency. The staffing agency will then seek contracts with hospitals and nursing homes where the nurse is usually assigned anywhere between three months and one year. Nurses employed by staffing agencies may not know where in the U.S. they will be deployed until shortly before the time for them to arrive in the U.S. and in some cases they may also be shifted to multiple employers in multiple locations over the course of one or two years. While both direct placement and staffing agency employment offer pros and cons, the vast majority of applicants prefer direct placement because they know where they will be going, for whom they will be working and the have a stronger assurance that they will not be relocated to other facilities. Always ask yourself, is this a direct placement or staffing agency opportunity.

Wages and the Cost of Living

The rate of pay being offered by U.S. employers is likely the most misunderstood aspect of employment in the U.S. by international nurses. Why do some employers offer $21.00 per hour while others are offering $34.00? The answer is almost always … cost of living.

The cost of living, particularly the cost of housing, varies greatly across the U.S. It is critical that you understand what the relative cost of living is in the area that you are considering relocating to. According to a recent home price comparison by a major U.S. real estate brokerage, a home in San Francisco cost twice as much as the same home in Miami and five times as much as in Dallas. Similar realities exist for the cost of apartment rentals. The reality is that nursing wages in San Francisco are not double of those in Miami and they are certainly not five times as much as they are in Dallas. You will find a number of helpful websites by doing an internet search on the phrase, ‘U.S. cost of living comparisons.’

The reality is that the salaries offered by most direct employers in a given area will be similar and very competitive as no employer can afford to pay less than their competition while there is a shortage of staff. According to bankrate.com, a nurse earning $24.00 per hour in Atlanta, Georgia would need to be earning $37.00 per hour in San Diego, California to have a bout the same standard of living. Never automatically accept any job offer solely based on the hourly rate of pay being offered, be sure that you understand what it is likely to cost you to live in that location.

Understanding Benefits Packages

Many recruitment ads go to great lengths professing to offer everything from paid vacation, to health insurance, even a free laptop computer. If any advertisement is offering something that no one else is, remember, “if it is too good to be true, it usually is.” Ask specific questions and expect to receive specific answers. If you are only getting vague or general responses, you definitely need to proceed with caution. The benefits packages offered by direct employers generally more comprehensive than those offered by staffing agencies.