It was an unceremonious arrival, but Robert Mawhinney recalls it fondly. As the car pulled up about midnight at the Doubletree Hotel in Orange, the door opened and a fussy 5-month-old infant was thrust into Mawhinney's arms.
Mawhinney, who had been waiting at the hotel to welcome the child's mother to America, immediately assumed responsibility for finding hot water to mix up a batch of baby formula.
It was an unusual assignment for the administrator of Midwood Community Hospital in Stanton, but one he gladly accepted. For it marked the arrival of his first nurse recruit from Ireland, who landed at Los Angeles International Airport with her baby and a toddler in tow.
Today, Mawhinney has three nurses on his staff from Ireland and three more on the way, and he is rolling out the red carpet for each.
Besides giving the nurses a hearty welcome, Mawhinney is paying their plane fares and providing a free month's rent in comfortable, furnished apartments. The combined recruitment costs average about $6,500 per nurse.
Like Midwood Community, an increasing number of American hospitals are recruiting nurses from foreign countries to alleviate a critical shortage of domestic nurses.
In some cases, hospital administrators and nurse recruiters are going abroad on their own, placing advertisements in foreign publications and interviewing candidates directly.
Others are turning to a new but growing group of independent recruitment agencies that handle screening, visa applications and professional licensing requirements. In return, hospitals generally pay the agencies a fee of 10% to 20% of the nurses' first-year salaries.
Still others are doing business with a second group of agencies that provide foreign nurses on a contractual basis. The nurses work as employees of the agencies, which pay their salaries and provide them with housing, uniforms and plane tickets to and from their home countries.
The influx of foreign recruits reflects the declining population of U.S. nurses as increasing numbers of women pursue less traditional, and usually more lucrative, career options.
Faced with chronic staff shortages and unable to recruit sufficient numbers of domestic nurses, many hospitals have decided that hiring foreigners is more cost-effective than paying skyrocketing fees for temporaries.
Some hospitals are old hands at overseas recruitment, having given it a whirl during the nursing crunch of 1979-1982, while others are trying it for the first time.
Although reliable national figures are not available, the Hospital Council of Southern California estimates that 4,650 foreign nurses are working on temporary working visas in California.
Arthur Sponseller, the council's vice president of human resources, estimated that about 30,000 of the 200,000 registered nurses in California are foreign educated. That figure, which includes foreign nurses who have become permanent U.S. residents, has increased significantly since the last wave of foreign nurse recruitments in the late 1970s, he said.
Because of the necessity of hiring nurses with a firm grasp of English, the recruitment tends to be concentrated in the United Kingdom, Ireland and Canada. But it also has reached into Australia, New Zealand, Scandinavia, China, Korea, the Caribbean and English-speaking African nations.
The Philippines, where English is widely learned as a second language, has traditionally produced a surplus of nursing school graduates and has exported more nurses to the United States than any other country. Nearly 3,000 of the foreign nurses working in California on temporary visas are from the Philippines, according to the Southern California Hospital Council.
In the international competition for nurses, the United States has an edge because its salaries for nurses are relatively high. Average annual salaries for registered nurses in the United States in 1987 ranged from $21,000 to $29,000, according to a survey published by the American Journal of Nursing.
A separate Journal survey showed that registered nurses in Southern California received salaries considerably higher than the national average last year, ranging from $21,000 to $41,000. According to the Hospital Council of Southern California, staff nurses with one to three years of experience now earn about $32,000 a year.
Although salaries paid by U.S. hospitals are not high enough to entice sufficient numbers of Americans to enter nursing school or remain in the profession, they typically are two to three times the pay received by nurses in England. The discrepancy is even greater in the case of developing countries like the Philippines, where an average registered nurse earns only $100 a month.
Ann Gardner, a 25-year-old Irish nurse who left a $10,000-a-year job in a British hospital to take a $30,000-a-year position at Midwood Community, said most of her nursing school classmates are no longer practicing in Great Britain because of low salaries and poor working conditions.