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Thursday, September 13, 2007


From: Wallstreet Journal

Diagnosis: Critical

It's been reported in these columns and elsewhere that the dysfunctional U.S. immigration system contributes to labor shortages in agriculture. Less well-known is that low green card quotas have also left the U.S. with an undersupply of nurses that threatens patient care.

"The aging U.S. population and low domestic production of nurses in the U.S. has created a nursing shortage that carries deadly consequences," says a new study by Stuart Anderson of the National Foundation for American Policy. "[A] shortage of nurses at U.S. hospitals is leading to increased death and illness for Americans."

Estimates of the looming shortage vary. The Bureau of Labor Statistics and Department of Health and Human Services project that more than a million new and replacement nurses will be needed over the next decade. Health analysts David Auerbach, Peter Buerhaus and Douglas Staiger cite a lower but still substantial 340,000, though even that "is three times larger than the size of the current shortage when it was at its peak in 2001." All agree that the coming retirement of 77 million baby boomers means something will have to give.

Wage increases in recent years have attracted more people to nursing. In California, annual average salaries for full-time registered nurses grew to $69,000 in 2006 from $52,000 in 2000, a 32% gain. According to the Bureau of Labor Statistics, the nationwide mean salary for registered nurses today is nearly $60,000. Better pay alone, however, won't solve the problem, or at least not anytime soon.

Despite more interest in the profession, faculty shortages and inadequate facilities have prevented nursing programs from expanding enrollment. More than 70% of schools responding to a 2006 American Association of College Nursing survey listed faculty shortages as a reason for not accepting all qualified applicants. In 2005 nursing schools rejected 147,000 qualified applicants, citing lack of classroom space and clinical placement sites for students.

When growers can't find field hands, food rots and businesses lose money. But when hospitals can't find nurses, patient care suffers. "The effectiveness of nurse surveillance is influenced by the number of registered nurses available to assess patients on an ongoing basis," concluded a 2002 Journal of the American Medical Association study. The study -- which looked at general, orthopedic and vascular surgery patients at hospitals -- found a 31% increase in patient mortality when a nurse's workload rose to eight from four patients.

"Given that even optimistic projections of raising wages and increasing domestic nurse production assumes a continued shortage of a decade or more," writes Mr. Anderson, "policymakers concerned about the impact of the nursing shortage on patient deaths and illnesses must consider relaxing current immigration quotas."

The long-term solution here is to increase nursing faculty and teaching facilities. But in the short run, Congress could help enormously by easing the limit on foreign nurses allowed entry to the U.S. That's what lawmakers did in 2005 when they allocated 50,000 extra green cards with a priority for foreign nurses. They were used up in 18 months. About 4% of U.S. registered nurses are foreign-trained, which means many hospitals couldn't function without them.

More such green cards are needed now, before hospital understaffing contributes to more preventable illness and death.

The issue of Immigration Voice, in a nutshell

1. Green Card Delays :

The Employment based green card system is completely broken due to excessive delays and backlogs in petitions of nearly half a million highly skilled workers who are certified by US Government to be doing a job that no US citizen is willing, qualified or able to do. The delays in obtained permanent residency are due to 2 reasons: Numerical caps on employment-based green cards and processing delays in adjudication of files. Today the system takes anywhere between 6-12 years to grant Green cards to some of the best and brightest of the world who have chosen America as their future home.

These future Americans are facing huge quality of life issues and their employers are facing difficulty in attracting more of the best and brightest of the world due to the broken system. The system prevents these workers from accepting promotions and switching jobs for the time-period it takes to process their files. By stagnating career growth and suffocating the creativity of the most innovative and technical minds of the world, America is creating a class of future Americans, who would see no career growth for 6-12 years and making under-achievers of these individuals.

The pressure on these individuals to go back to their home countries are increasingly each day as many world economies, especially India and China are booming and they also happen to be the country of origin of more than half of these skilled foreign-born workforce. If America delays reform of the broken system of employment based immigration, the pressure on these individuals to go back would neutralize the incentive to wait here and tough it out with the broken system. It would result in a reverse brain drain where the talent and human capital flows from developed west to the burgeoning Asian economies. The reverse brain drain would exacerbate the effects of overseas outsourcing on economy. These future Americans have waited for reform for more than 2 years but congress hasn’t reformed the system yet. The fight for the best and brightest in the world is America’s to lose.

2. The Discriminatory Per-Country Rationing of Green Cards That Exacerbates the Delays :

Today, the employment based skilled immigrants face more backlogs if they are from India, China, Mexico or Philippines than what backlogs they would face if they were born anywhere but these 4 countries. This is due to the fact that green cards from the annual quota are rationed at 7% per country. Unused visas from the remaining countries that don’t use the 7% allocated visas are mostly never allotted to these 4 countries that have the highest number of scientists, engineers and technology workers willing to make America their future home. It is discriminatory to have laws that subject immigrants from 4 nations to more backlogs and the resulting hardship from such backlogs.

America has had per-country ceilings since decades on family based and diversity-lottery based visas and it makes sense to have uniform distribution of visas to countries where the basis for immigration is family relationship and family reunification. However, the employment based immigration is driven by employer petitions filed by employers who want the retain the employee and facilitate employee retention based on skills, knowledge, education and talent. Employability has nothing to do with country of birth. We do not allow employers to discriminate hiring based on their nationality or country of origin. Therefore, the employment-based immigration, which is a derivative benefit of employment, should also be free from rationing based on nationality or country of birth.


Tuesday, September 11, 2007

Gov. Schwarzenegger Leads Multi-State Push for Immigration Reform to Protect Skilled Workforce

Governor Arnold Schwarzenegger, joined by Governors from 12 other states, today sent the following letter to the leaders of the U.S. Senate and House of Representatives urging Congressional action this year on immigration reform that recognizes states' needs to remain competitive in a global economy:

September 11, 2007

Dear Senator Reid, Senator McConnell, Speaker Pelosi and Representative Boehner:

As the chief executives of our respective states, we appreciate the enormity of the task involved in reforming our nation's immigration laws. Like you, we recognize the paramount importance of protecting and preserving the safety and interests of the United States and its citizens while recognizing the states' and nation's economic needs.

Fundamentally, we believe that our states' businesses should be able to find the world's best-educated workers among our own citizens. Toward that end, we continue to make significant investments in math and science education and are ensuring that our states' two- and four-year colleges and universities are able to accommodate more students who are preparing for high-demand fields, especially in engineering, math and computer science.

While we concentrate on building a highly skilled and competitive workforce for increasing opportunities in high-tech jobs, unfortunately, today, we and our nation face a critical shortage of highly skilled professionals in math and science to fill current needs. Until we are able to address this workforce shortage, we must recognize that foreign talent has a role to play in our ability to keep companies located in our state and country; and, therefore, need to ensure the increased availability of temporary H1-B visas, and permanent resident visas (green cards).

Under the current H1-B system, the number of visas available has been running out faster and faster each year. The current base cap of 65,000 was arbitrarily set in 1990, and today bears no relation to our economy and our state's demand for skilled professionals. In fact, in fiscal year 2007, the supply of H1-B visas did not last eight weeks into the filing period, and ran out more than four months before the fiscal year even began; and in fiscal year 2008, the supply ran out on the first day of the filing period.

Our green card system, also last devised in 1990, faces severe shortages that most heavily impact the high technology industry, forcing some of the most innovative contributors to our economy to wait well in excess of five years for a green card. Because of these delays we are seeing more and more of these talented individuals leave their U.S. jobs and return home.

If states like ours are to remain world leaders in innovation and intend to continue to see the job growth that is so vital to our economies, we must keep our employers in our states and ensure there is a skilled workforce in this country to fill their immediate needs. While wholesale immigration reform may not be possible in the 110th Congress, we urge Congressional action this year that recognizes states' immediate need to recruit and retain professionals in key sectors, while we continue to produce here at home the skilled workforce our companies need in the long-term.

Christine Gregoire
Governor of

Governor of

Mitch Daniels
Governor of

Bill Ritter
Governor of

Deval Patrick
Governor of

Dave Freudenthal
Governor of

Eliot Spitzer
Governor of
New York

Janet Napolitano
Governor of

Jim Doyle
Governor of

Kathleen Sebelius
Governor of

Tim Pawlenty
Governor of

Jim Gibbons
Governor of

Rick Perry
Governor of


A frightening report from Stuart Anderson of the National Foundation for American Policy. First, the report reviews data on patient mortality rates and points out strong evidence to suggest that the fewer nurses per patient in a hospital, the more likely the patient will die. And it's not a slight correlation. Increasing a nurses patient load from four to eight, according to an American Medical Association study, is accompanied by a 31% increase in mortality. How much more blunt does the message need to be? The current blockade of foreign nurses is literally killing people.

Read More:

U.S. Nursing Shortage Contributing to Death and Illness for U.S. Patients

Increasing Nursing School Faculty and Immigration Quotas Are Best Options, Study Finds

By: National Foundation for American Policy

Arlington, Va. – As Congress considers its next steps on health care and immigration, the National Foundation for American Policy (NFAP), an Arlington, Va.-based policy research group, has released a new study finding the current nursing shortage is leading to increased death and illness for Americans at U.S. hospitals. An extensive review of the medical literature finds that the aging U.S. population and low domestic production of nurses in the United States has created a nursing shortage that carries serious consequences for U.S. hospital patients.

The study “Deadly Consequences: The Hidden Impact of America’s Nursing Shortage” by Stuart Anderson can be found on the NFAP website at
Among the study’s findings:

- A Journal of the American Medical Association (JAMA) study on general, orthopedic and vascular surgery patients at hospitals implied “the odds of patient mortality increased 7 percent for every additional patient in the average nurse’s workload in the hospital.” The study found that increasing a nurse’s workload from 4 to 8 patients would be accompanied by a 31 percent increase in patient mortality. It concluded: “These effects imply that, all else being equal, substantial decreases in mortality rates could result from increasing registered nurse staffing, especially for patients who develop complications.”

- A 2004 Health Services Research study, authored by North Carolina University at Chapel Hill Professor Barbara Mark (and others), concluded: “Our findings indicate the clear benefit of increasing nurse staffing to reduce hospital mortality . . .” The authors of the paper noted, “In an environment of a progressively severe nursing shortage, policy decisions related to effective and efficient deployment of an increasingly scarce resource
– registered nurses – and how change in nurse staffing affects change in quality of care could not be more important.”

- A 2007 Health and Human Services report, prepared by the Minnesota Evidence-based
Practice Center, concluded, “Higher registered nurse staffing was associated with less hospital-related mortality, failure to rescue, cardiac arrest, hospital acquired pneumonia, and other adverse events. The effect of increased registered nurse staffing on patients safety was strong and consistent in intensive care units and in surgical patients. Greater registered nurse hours spent on direct patient care were associated with decreased risk of hospital-related death and shorter lengths of stay.”

- A study of Canadian hospitals found a 10 percent increase in registered nurse staff
caring for acute medical patients was associated with 5 fewer deaths in 1000 discharged patients.

- An August 2006 Archives of Pediatrics and Adolescent Medicine paper on neonatal
intensive care units reported: “Our findings suggest that registered nurse staffing is associated with the risk of bloodstream infection among infants.” The findings suggested, “Increasing registered nurse staffing by 1 full-time equivalent could possibly reduce the risk of bloodstream infection by 11 percent.” Wage increases alone are unlikely to solve the nursing shortage. Even with substantial increases
in salaries and nurse graduation rates, the nursing gap is likely to persist for another decade, analysts note. Financial considerations are likely to constrain wage growth, while capacity issues bedevil nursing schools. The study recommends policymakers focus on the two most practical solutions to alleviate the impact of the nursing shortage on U.S. patients.

1) Increasing nursing faculty and school
infrastructure and;

2) Raising immigration quotas to facilitate the entry of foreign nurses.
So far, U.S. nursing schools have shown they do not have enough capacity to accommodate significant increases in their graduation rates. “In 2005, schools of nursing were forced to reject 147,000 qualified applicants because of shortages of faculty, classroom space, and clinical placement sites for students.” Given that even optimistic projections assume a continued nurse shortage lasting a decade or more, policymakers concerned about the shortage’s impact on U.S. hospital patients must consider relaxing current immigration quotas.

“Immigration alone cannot solve the nursing shortage but it can alleviate many of its most damaging impacts on patients,” said NFAP Executive Director Stuart Anderson, the author of the study. Anderson served as Executive Associate Commissioner for Policy and Counselor to the Commissioner of the INS (August 2001 to January 2003) and as Staff Director of the Senate Immigration Subcommittee.

Due to inadequate green card quotas, a skilled foreign professional could wait 5 years or more to immigrate legally to the United States. In the high tech sector, some professionals and researchers can gain entry on temporary visas, particularly H-1B visas, although the supply of those has been exhausted before the start of the past four fiscal years. Today, the vast majority of nurses cannot enter the United States and work on temporary visas. Congress recognized the labor supply problems with nurses when in 2005 it allocated 50,000 extra green cards (for permanent residence) with a priority for foreign nurses and others who qualified under Schedule
A (DOL designation of shortage occupations) to be sponsored by employers in the United States.

That extra green card allocation has been exhausted.
Health analysts David Auerbach, Peter Buerhaus and Douglas Staiger recently estimated that the current nursing shortage would grow to 340,000 by 2020. “A shortage of 340,000 is three times larger than the size of the current shortage when it was at its peak in 2001,” note the authors. “At that time, many hospitals closed patient programs and nursing units, and the national average hospital RN vacancy rate was 13 percent.” They note the shortage “continues to constitute a serious threat to access and efforts to improve the quality and safety of health care.”


Will all the anti-immigrants out there please sign a pledge that they will only live in nursing homes that employ American-born workers? And, uh, add, American-born home health care providers to that list. Then it will be fun to watch their kids ship them off to a Mexican or Indian nursing home (both of those countries are now becoming popular destinations for Americans looking for more affordable and high quality service).

OK, I'm being a little mean, but the report just issued by Brandeis University Professor Walter Leutz makes it pretty clear that we're going to be completely dependent on immigrants to care for us when we're old. I have no doubt we'll come to that realization eventually. The only question is whether we change immigration policies soon enough to head off a lot of the damage.

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