COMING TO AMERICA
Lorraine Steefel, RN, MSN, CTN
Monday June 16, 2008

Foreign nurses must rely on the integrity of the nurse recruiter and their prospective employer when considering employment in the U.S.

Ethical struggles related to the exploitation of nurses recruited abroad have once again surfaced. On the positive side, there are many healthcare facilities that recruit overseas and commit to the development and acculturation of those they employ. But not all foster equitable outcomes, as press reports recount.

Here's a look at past and present recruitment-related events and the underpinnings of ethical recruiting.

Tarnished reality

A glance at two historical examples of foreign nurse recruitment uncover mistreatment of the nurses. In 2001, The Washington Post reported that some hospitals offered overseas nurses salaries that were less than those offered to comparable U.S. nurses, by crediting overseas nurses with only half of their years' experience. That same year, Filipino nurses in Missouri were awarded $2.1 million for failure to receive comparable wages as U.S.-born nurses in the same facility.

Most recently, the press is covering the case of Filipino nurses accused of endangering patients at a nursing home in Suffolk County, N.Y. The group was dubbed the Sentosa 27 (26 RNs and one physical therapist) after the Philippine-based Sentosa Recruitment Agency that recruited them.

The accusations stem from the nurses' alleged decision to "walk off their jobs" in April, 2006 to protest work-related issues. The nurses counter that they "resigned" after their concerns were ignored and not satisfactorily addressed, not before, they say, they endorsed the care and custody of their patients to the incoming charge nurse.

Archiel Buagas, RN, BSN, one of the Sentosa nurses, maintains that promises made by recruiters were broken. The nurses' expectations as per contract included being hired by and working directly for the nursing home facility that sponsored each of them and the ability to begin work immediately as RNs on arrival in N.Y. with processed limited permit applications.

Buagas says that upon their arrival in N.Y. most of the nurses found themselves working as agency employees and at nursing home facilities different from the ones that sponsored them. Because most of their limited permit applications had not been processed, they could not immediately begin work as RNs and had to take lesser-paying jobs to support themselves during the interim. The paid working hours in a 40-hour work week were unilaterally reduced from 37.5 hours to 35 hours. Some nurses were not paid for actual hours worked; some were underpaid their hourly rates; and some were not paid night shift differentials and holiday pay.

Despite the filing of an amicus brief by the American Nurses Association and its affiliate, the New York State Nurses Association, with the N.Y. State Supreme Court that supports a motion to drop criminal charges against the nurses, 10 of the RNs who worked at the same facility are still being prosecuted by the Suffolk County district attorney [for patient endangerment], said their counsel Felix Vinluan, Esq., via e-mail communication. The Appellate Division, of the N.Y. Supreme Court, Second Department, Brooklyn, had issued an order staying the criminal prosecution, meaning, the trial would not proceed as scheduled on April 28. Vinluan says that, in effect, the criminal case pending before the N.Y. Supreme Court is frozen. If the Appellate Division grants the writ of prohibition, there will be no trial and the case closed. If it does not grant the writ of prohibition, the trial will proceed.

In a press release, the ANA said that "…they [the Sentosa nurses] were brought to N.Y. under false pretenses and denied the rights guaranteed by their employment contract.

"We had dreams of working in the U.S. and of being treated fairly," says Buagas. "Instead we were not listened to, given due process, or treated with respect."

Ethical standards

As the level of migration increases, the ethics of recruitment should be considered.

"Ethical recruitment of nurses is a hiring process free from intimidation, misleading information, and exploitation," says Kristin Hellquist, MS, director of Policy and Government Relations, National Council of State Boards of Nursing (NCSBN), Chicago.

In an effort to spotlight ethical recruitment, NCSBN presented its position statement Ethical Recruitment of Nurses for Licensure in 2006. According to the NCSBN, ethical recruitment includes —

• Transparency in all communications and any offers of employment

• Making available all information necessary for an informed decision concerning the circumstances and laws bearing on crossing borders, immigration, labor environment, and the potential new living and working conditions

• Full disclosure of requirements for nurse competency in the workplace, including legal prerequisites for licensure and maintenance of licensure

• Adoption of high ethical standards in nurse recruiting

• Development of sanctions for those engaging in unethical practices

NCSBN supports the right of individuals to migrate to the country of their choosing, as allowed by law. "Foreign nurses who find themselves in situations where ethical recruitment is in question have two significant bodies of law - employment and immigration - to look to for recourse," says Hellquist.