Public health professor co-authors commentary on immigrant nurses

Proposed federal legislation would offer lawmakers an opportunity to improve labor conditions for immigrant nurses, a public health school professor wrote in a commentary published last week.

Patricia Pittman’s commentary, published in the New England Journal of Medicine Jan. 22, called for the addition of protective measures to the Fairness for High-Skilled Immigrants Act, which eliminates caps on employment-based visas for all countries and reserves 4,400 visas for immigrant nurses. Pittman wrote that the legislation would benefit the international nurse-staffing industry.

“By creating a guaranteed number of visas for nurses, nurse staffing agencies will be able to more easily bring in international nurses,” she said in an email.

Pittman said contracts in the international nurse recruitment industry often include a contract breach fee that “holds them captive in their first job,” at which they receive less pay than American nurses. She said the nursing industry’s business model has become “even more unfair to nurses” because of the prevalence of company lawsuits against nurses for breaching contracts.

Pittman said lawsuits typically result in settlements, in which the involved parties are sworn to silence about the matter, allowing workplace issues to persist.

She said the legislation offers a “unique opportunity” to offer more protections to immigrant nurses because of its bipartisan support, which makes it more likely to pass. The act is currently awaiting a U.S. Senate vote, according to government records.

“There is a window of opportunity now to include these measures because Congress is giving the industry what it wants, making it more likely that legislators could negotiate conditions,” Pittman said.

In her commentary, Pittman advocated for the addition of five measures that would limit employment contracts international staffing agencies create to a maximum year-long duration. She also pushed for measures that would require that contracts cannot include recruitment fees or contract-breach fees.

Some recruiting agencies illegally double-bill nurses, charging them fees that can cost up to six months of a nurse’s salary just for information about a potential job, according to a National Student Nurses’ Association report. Nurses who hand over their travel documents to their agencies may also be coerced into signing a new contract, perhaps in a different location and with less pay, the report states.

The proposed measures mandate that international staffing agencies should specify a job for nurses before their arrival in the United States and allow nurses to start that job within a week of arriving, according to the bill. Pittman recommends prohibiting contracts that prevent nurses from filing lawsuits against their agency or employers.

Nursing and immigrant rights experts said the act will mitigate the current nationwide nursing shortage – which will protect immigrant nurse working conditions by reducing overtime hours – but added that specific additions to the act would better protect nurses from exploitation.

Delia Furtado, an associate professor of economics at the University of Connecticut who specializes in immigration and labor markets, said removing the cap for highly-skilled immigrant nurses would increase the number of nurses working in the United States, alleviating the shortage and allowing fewer nurses to work overtime.

“A big issue for nurses is just that they are overworked,” Furtado said in an email. “Having more well-trained nurses would certainly help with this. Especially in areas of the country where there are not enough native-born nurses.”

María Pabón, a law professor at Loyola University New Orleans who specializes in immigrant rights, said the current bill without any revisions could alleviate nursing shortages and stabilize the industry so immigrant nurse exploitation is less prevalent.

Once in the workplace, immigrant nurses are also more likely to experience discrimination, unequal payment, longer work hours and less access to workplace benefits, according to a 2017 paper published in the National Institutes of Health.

But Pabón cautioned that the bill carries the “potential unintended consequence of backlogs” that would delay lawful employment immigration. Eliminating a cap on employment visas from each country would lead to up to a seven-year wait to enter the United States and would result in an influx of immigrants from larger countries like China and India but few from smaller nations, according to reporting from Bloomberg Law.

She said Pittman’s proposed measure requiring that contracts allow nurses to file lawsuits against employers and agencies would be beneficial. Pabón added that immigrant nurses already face a “dearth” of lawyers who could represent them in court and shouldn’t have to face further limitations on opportunities for legal compensation.

“Taking away a person’s day in court is taking advantage of the immigrant nurses’ unequal bargaining position,” Pabón said in an email.

Sally Moyce, an assistant professor at Montana State University’s college of nursing, said immigrant nurses often opt to work as caregivers or aides because their nursing education or license isn’t formally recognized in the United States.

“It would be nice to see legislation that encourages nurse immigration and that makes it easier for nurses to work in the United States,” Moyce said in an email. “The United States clearly needs highly skilled nurses from diverse backgrounds and cultures to meet our patient population, yet our policies make it difficult for them to transition to work here.”

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