Foreign nurses help fill shortage

BILLINGS, Mont. — Before Mary Venus was offered a nursing job at a hospital here, she’d never heard of Billings or visited the United States. A native of the Philippines, she researched her prospective move via the internet, set aside her angst about the cold Montana winters and took the job, sight unseen.

Venus has been in Billings since mid-november, working in a surgical recovery unit at Billings Clinic, Montana’s largest hospital in its most populous city. She and her husband moved into an apartment, bought a car and are settling in. They recently celebrated their first wedding anniversary. Maybe, she mused, this could be a “forever home.”

“I am hoping to stay here,” Venus said. “So far, so good. It’s not easy, though. For me, it’s like living on another planet.”

Administrators at Billings Clinic hope she stays, too. The hospital has contracts with two dozen nurses from the Philippines, Thailand, Kenya, Ghana and Nigeria, all set to arrive in Montana by summer. More nurses from far-off places are likely.

Billings Clinic is just one of the scores of hospitals across the U.S. looking abroad to ease a shortage of nurses worsened by the pandemic. The national demand is so great it’s created a backlog of health care professionals awaiting clearance to work in the U.S. More than 5,000 international nurses are awaiting final visa approval, the American Association of International Healthcare Recruitment reported in September.

“We are seeing an absolute boom in requests for international nurses,” said Lesley Hamilton-powers, a board member of AAIHR and a vice president for Avant Healthcare Professionals in Florida.

Avant recruits nurses from other countries and then works to place them in U.S. hospitals, including Billings Clinic. Before the pandemic, Avant would typically have orders from hospitals for 800 nurses. It currently has more than 4,000 such requests, Hamilton-powers said.

“And that’s just us, a single organization,” added Hamilton-powers. “Hospitals all over the country are stretched and looking for alternatives to fill nursing vacancies.”

Foreign-born workers make up about a sixth of the U.S. nursing workforce, and the need is increasing, nursing associations and staffing agencies report, as nurses increasingly leave the profession. Nursing schools have seen an increase in enrollment since the pandemic, but that staffing pipeline has done little to offset today’s demand.

In fact, the American Nurses Association in September urged the U.S. Department of Health and Human Services to declare the shortage of nurses a national crisis.

CGFNS International, which certifies the credentials of foreign-born health care workers to work in America, is the only such organization authorized by the federal government. Its president, Dr. Franklin Shaffer, said more hospitals are looking abroad to fill their staffing voids.

“We have a huge demand, a huge shortage,” he said.

Billings Clinic would hire 120 more nurses today if it could, hospital officials said. The staffing shortage was significant before the pandemic. The added demands and stress of COVID have made it untenable.

Greg Titensor, a registered nurse and the vice president of operations at Billings Clinic, noted three of the hospital’s most experienced nurses, all in the intensive care unit with at least 20 years of experience, recently announced their retirements.

“They are getting tired, and they are leaving,” Titensor said.

Last fall’s surge of COVID cases resulted in Montana having the highest rate in the nation for a time, and Billings Clinics’ ICU was bursting with patients. Republican Gov. Greg Gianforte sent the National Guard to Billings Clinic and other Montana hospitals; the federal government sent pharmacists and a naval medical team.

While the surge in Montana has subsided, active case numbers in Yellowstone County — home to the hospital — are among the state’s highest. The Billings Clinic ICU still overflows, mostly with COVID patients, and signs still warn visitors “aggressive behavior will not be tolerated,” a reminder of the threat of violence and abuse health care workers endure as the pandemic grinds on.

Like most hospitals, Billings Clinic has sought to abate its staffing shortage with traveling nurses — contract workers who typically go where the pandemic demands. The clinic has paid up to $200 an hour for their services, and, at last fall’s peak, had as many as 200 traveling nurses as part of its workforce.

The scarcity of nurses nationally has driven those steep payments, prompting members of Congress to ask the Biden administration to investigate reported gouging by unscrupulous staffing agencies.

Whatever the cause, satisfying the hospital’s personnel shortage with traveling nurses isn’t sustainable, said Priscilla Needham, Billings Clinic’s chief financial officer. Medicare, she noted, doesn’t pay the hospital more if it needs to hire more expensive nurses, nor does it pay enough when a COVID patient needs to stay in the hospital longer than a typical COVID patient.

From July to October, the hospital’s nursing costs increased by $6 million, Needham said. Money from the Federal Emergency Management Agency and the CARES Act has helped, but she anticipated November and December would further drive up costs.

Dozens of agencies place international nurses in U.S. hospitals. The firm Billings Clinic chose, Avant, first puts the nurses through instruction in Florida in hopes of easing their transition to the U.S., said Brian Hudson, a company senior vice president.

Venus, with nine years of experience as a nurse, said her stateside training included clearing cultural hurdles like how to do her taxes and obtain car insurance.

“Nursing is the same all over the world,” Venus said, “but the culture is very different.”

The hitch so far has been getting the nurses into the country fast enough. After jobs are offered and accepted, foreign-born nurses require a final interview to obtain a visa from the State Department, and there’s a backlog for those interviews. Powers explained because of the pandemic, many of the U.S. embassies where those interviews take place remain closed or are operating for fewer hours than usual.