Health Care Blog

The only chance for positive immigration reform is through piecemeal (smaller) immigration legislation. Unfortunately the prospects for piecemeal legislation are also small, as there is little motivation in Washington DC to liberalize visa quotas given that the US’ nearly 10 percent unemployment rate. In light of these real world factors, the odds of a Schedule A visa bill in 2010 are very low.

Longer term, the odds are much better. While the nursing shortage temporarily has abated, economists predict that the US’ nursing shortage is expected to grow dramatically in the next decade. This supply will be filled by internationally-trained nurses in the forthcoming years. Of course this is of little comfort to US businesses that have spent countless hours developing their international connections and international nurses who have met all licensure and Visa Screen rules, only to have the US visa quota system let them down.

The one bright spot is that we’re starting to see promotion of retrogressed dates. The DOS predicts that the Worldwide EB3 (including Philippines) should be well into 2004 by the end of the summer. If we see the same progression in FY2011 that we saw in FY2010, the Worldwide EB3 date should move through 2005 and into 2006 by the end of FY2011.

While the US nursing shortage certainly has eased in recent months, economists and government officials all agree that this is a temporary condition. The U.S. nursing shortage is projected to grow to between 260,000 and 500,000 registered nurses by next decade. If even the smallest estimates are correct, a shortage of this magnitude would be twice as large as any nursing shortage experienced in this country since the mid-1960s.

Only 3,120 international test takers took and passed the NCLEX in the first quarter of 2010. That’s the smallest number of international test takers since at least 2006, which is the earliest data on the NCSBN website.

In 2006, about 20,907 internationally educated RNs passed the NCLEX exam for an average of 5,227 per quarter. In 2007, the volume jumped; 22,827 internationally educated nurses passed the NCLEX exam, or 5,707 per quarter. With the onset of retrogression, 2008 saw a decline; 18,905 internationally educated RNs passed the exam, or 4,726 per quarter. In 2009, the international NCLEX pass number shrunk to 13,799 per year (3,450 per quarter).

It is obvious that reasonable visa opportunities for international nurses must happen or else the US is going to find that it has a massive nursing shortage and international nurses are no longer there to fill the gap.

The matter began in 2006 when a group of nurses walked off their jobs at the nursing home. The nurse’s lawsuit filings have alleged unfavorable working conditions and unfair contractual clauses. Sentosa Care contends that the walk-off was illegal.

Under the recommended plan, all currently-licensed RNs would be “grandparented,” and would not have to obtain the Bachelors degree. Instead, all diploma and associate degreed RNs, who obtain licenses after 2012 would need to obtain a Bachelors degree within 10 years of the initiation of their license.

Nurses who failed to obtain the Bachelors degree would have their licenses put on “hold”. This “hold” is similar to the action taken when a licensee fails to meet continuing education requirements in those professions that mandate continuing education as a criterion for continued registration.

Other states such as New Jersey also are considering raising their educational requirement. Advocates for the New York plan cite recent studies that show that increasing the number of baccalaureate nurses in an acute care hospital decreases the number of patient deaths. Similar legislation was introduced into the New York legislature in 2005, but was tabled because of supply concerns.

It seems inevitable that states will raise their minimum educational requirements to the level of Bachelors degree. Many countries’ minimum educational requirement is a Bachelors degree. In the US, the only state to have had a Bachelors degree minimum was North Dakota, which lowered their requirement and joined the other 49 states in the middle part of this decade.

If any state did raise their requirement to a bachelors degree, employers in that state could more liberally use the H-1B visa as a partial solution to their expected long-term nursing supply shortages. The H-1B can be used to employ some Registered Nurses.

In this Blog post, MU has done a analysis of the progress of these projections, including the just-released June 2010 Visa Bulletin. Most of the DOS’ projections are proving to be accurate, with the notable exception of All Other EB3, including the Philippines.

India EB2
June 2010: 01FEB05.
Predicted Sept 2010: February through early March 2005
MU Comment: The India EB2 visa number is right on the mark.

China EB2
June 2010: 22NOV05.
Predicted Sept 2010: July through October 2005.
MU Comment: The China EB2 visa number has already surpassed the “best case” scenario, which is good news.

India EB3
June 2010: 22OCT01.
Predicted Sept 2010: January through February 2002.
MU Comment: The India EB3 number has steadily moved since January 2010, when the India EB3 number was 22JUN01. The number looks to be on pace to meet the predicted number.

China EB3
June 2010: 22JUN03.
Predicted Sept 2010: June through September 2003.
MU Comment: The China EB2 visa number is right on the mark.

All Other EB3 (incl. Philippines)
June 2010: 22 JUN 03.
Predicted Sept 2010: April through August 2005
MU Comment: This is the prediction that is the most disheartening. By now we would have expected the All Other EB3 to be well into 2004, and maybe even into 2005. The fact that the number is still in mid-2003 leads us to believe that the predicted date will not be reached.

This is slow progress from the last few Visa Bulletins for All Other EB3 Applications. All Other EB3 has increased 9 months since February 2010 Visa Bulletin, when it was 22 SEP 2002. India EB3 has also improved about 4 months since February’s Visa Bulletin (22 JUN 01). Mexican EB3 remains unavailable, as it is expected to be until the end of the fiscal year in September 2010.

Senator Benigno “Noynoy” Aquino III is poised to become the first Philippine president elected through an automated election. President-elect Aquino is the son of former President Corazon Aquino and former Senator Benigno Aquino, Jr.

In the UK, David Cameron looks to lead the first British coalition government since World War II. The coalition agreement ends a week of discussion and negotiations between Cameron’s Conservative government and the upstart Liberal Democrats.

MU congratulates nationals of both countries on their landmark elections.