Before being offered a job as a nurse at a local hospital, Maria Venus had never heard of Billings and had never been to the United States. Born in the Philippines, she researched her alleged move over the Internet, dropped her fears of Montana’s cold winters, and took a job without seeing her eyes.
Venus has been in Billings since mid-November, working in the surgical rehabilitation unit at Billings Clinic, Montana’s largest hospital in its most populous city. My husband and I moved into an apartment, bought a car and settled down. We recently celebrated our first wedding anniversary. Maybe, she mused, this could be the “eternal home.”
“I hope to stay here,” Venus said. “Everything is going well. However, it is not easy. To me, it is like life on another planet.”
Billings Clinic hopes she will stay, too. The hospital has contracts with two dozen nurses from the Philippines, Thailand, Kenya, Ghana and Nigeria, all of whom are expected to arrive in Montana by summer. Most likely more nurses from remote locations.
The Billings Clinic is just one of many hospitals in the United States that are looking overseas to help alleviate the pandemic’s exacerbated nurse shortage. The national need is so great that there is a queue of medical professionals waiting for permission to work in the United States. More than 5,000 foreign nurses are awaiting final visa approval, the American Association for International Health Recruitment said in September.
“We are seeing an absolute boom in foreign nursing requests,” said Leslie Hamilton-Powers, AAIHR board member and vice president of Avant Healthcare Professionals in Florida.
Avant recruits nurses from other countries and then works to place them in US hospitals, including the Billings Clinic. Before the pandemic, Avant used to order 800 nurses from hospitals. He currently has over 4,000 such requests, Hamilton Powers said.
“And that’s just us, one organization,” added Hamilton Powers. “Hospitals across the country are overwhelmed and looking for alternatives to fill nursing vacancies.”
Overseas-born workers account for about a sixth of US nurses and the need for them is growing, according to Nursing Associations and Recruitment Agencies, as nurses are increasingly leaving the profession. Nursing Schools Increased Student Enrollment after the pandemic, but this talent flow has done little to offset today’s demand.
In fact, the American Nursing Association called on the US Department of Health and Human Services in September to declare the nursing shortage a national crisis.
CGFNS International, which certifies the credentials of foreign medical workers to work in America, is the only such organization authorized by the federal government. Its president, Dr. Franklin Schaffer, said more hospitals are looking overseas to fill their talent gaps.
“We have a huge demand, a huge deficit,” he said.
The Billings Clinic would hire 120 more nurses today if it could, according to hospital officials. The shortage of personnel was significant even before the pandemic. The additional demands and stress caused by the covid made it untenable.
Greg Titenor, Registered Nurse and Vice President of Operations at Billings Clinic, noted that the hospital’s three most experienced ICU nurses with at least 20 years of service have recently announced their retirement.
“They get tired and go away,” Titensor said.
A spike in covid cases last fall resulted in Montana having the highest rate in the country for a while. The intensive care unit of the Billings Clinics was overcrowded with patients.… Republican Governor Greg Gianforte has deployed the National Guard to Billings Clinic and other Montana hospitals; the federal government sent pharmacists and a team of naval medics.
While the surge in Montana has subsided, the number of active cases in Yellowstone County, where the hospital is located, is one of the highest in the state. Billings Hospital’s intensive care unit remains overcrowded, mostly with COVID-19 patients, and signs continue to alert visitors that “violent behavior is unacceptable,” recalling the threat of violence and abuse that healthcare providers face as they progress. of how the pandemic continues.
Like most hospitals, the Billings Clinic sought to reduce staff shortages with contract traveling nurses who typically travel where the pandemic calls for it. The clinic paid up to $ 200 an hour for its services, and at its peak last fall had up to 200 traveling nurses on its staff.
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A shortage of nurses in the country has led to such high payouts that it has prompted members of Congress to ask the Biden administration to investigate reports of fraud by unscrupulous recruitment agencies.
Whatever the reason, meeting the hospital’s staff shortage with mobile nurses is not sustainable, said Priscilla Needham, chief financial officer at the Billings Clinic. She noted that Medicare does not pay the hospital more if it needs to hire more expensive nurses, and does not pay enough when a coronavirus patient has to stay in the hospital longer than a typical coronavirus patient.
Between July and October, hospital care costs increased by $ 6 million, Needham said. Money from the Federal Emergency Management Agency and the CARES Act helped, but she expected November and December to increase spending further.
Dozens of agencies place foreign nurses in US hospitals. Billings’ chosen firm, Avant, is first training nurses in Florida in hopes of facilitating their relocation to the United States, according to Brian Hudson, senior vice president of the company.
Venera, who has nine years of experience as a nurse, said her training in the US involved overcoming cultural barriers such as paying taxes and getting car insurance.
“Patient care is the same all over the world,” Venus said, “but the culture is very different.”
Shaffer of CGFNS International says foreign nurses are interested in the United States for a variety of reasons, including opportunities to advance in their education and careers, earn more money, or perhaps get married. For some, according to Avant’s Hudson, the dominant idea is to live the “American Dream.”
The hitch has brought nurses into the country quickly enough so far. Once a job is offered and accepted, foreign-born nurses require a final visa interview at the Department of State, and there is a waiting list for these interviews. Powers explained that due to the pandemic, many of the US embassies where these interviews take place remain closed or work fewer hours than usual.
Although the gap has narrowed in recent weeks, Powers described the delays as difficult. Nurses waiting in their countries, she stressed, have passed all the necessary exams to work in the United States.
“It was very frustrating that the nurses were ready to come and we just couldn’t bring them in,” Powers said.
Upon arrival, the international nurses in Billings will remain Avant staff, although the clinic may offer permanent positions after three years. The clinic’s administration stressed that nurses are paid the same as local nurses with the same experience. In addition, the hospital pays for Avant.
Hudson said more than 90% of Avant’s international nurses choose to stay in their new communities, but Billings Clinic hopes to improve that figure. Bringing them into town will be critical, said Sara Agostinelli, the clinic’s director for Diversity, Equity, Inclusion and Affiliation. She even offered winter driving lessons.
The added variety will benefit the city, Agostinelli said. Some nurses will bring their spouses; some will bring their children.
“We will be contributing to what Billings looks like and who Billings is,” she said.
Pae Junthanam, a nurse from Thailand, said he was initially worried about going to Billings after learning that Montana’s population is nearly 90% white and less than 1% Asian. However, the chance of moving up the career ladder outweighed the fear of relocation. He also hopes that his partner with 10 years of experience will soon be able to join him.
Junthanam said that since his arrival in November, his neighbors welcomed him warmly, and the owner of a store, upon learning that he was working as a nurse who had recently arrived from Thailand, thanked him for his service.
“I’m far from home, but I feel like it’s like another home to me,” he said.
Kaiser Health News is the national health policy news service. It is an editorial independent program of the Henry J. Kaiser Family Foundation and is not affiliated with Kaiser Permanente.