A change in the way the U.S. government handles certain visa applications will likely discourage foreign nurses from coming to the United States, exacerbating a nursing shortage felt across the nation, particularly in California, hospital officials and immigration advocates say.
The change means that a foreign nurse seeking work in the U.S. would have to wait more than three years to get a permanent residency card. That's at least a year longer than it took in the past.
The directive, which took effect in January, affects primarily nurses from the Philippines -- the main source of overseas nurses for U.S. hospitals -- as well as China and India. Some other skilled and professional workers are also affected.
"Every avenue of adding nurses to the workforce that is cut off from California will make the shortage more acute," said Claudia Rosenfeld, vice president of human resources for the Hospital Assn. of Southern California. "And of all the states, California will be the most adversely impacted because we absorb the majority of these nurses."
Gov. Arnold Schwarzenegger cited the nursing shortage last year when he issued an emergency order suspending a law requiring one nurse for every five patients at California hospitals.
The governor's order would have imposed a 1-to-6 ratio, but on Friday, a Sacramento County Superior Court judge ruled that Schwarzenegger had no authority to suspend the law.
In the past, a U.S. hospital could petition on behalf of foreign nurses, who would apply for immigrant visas in their home countries. If they were approved, each would get a green card upon arrival in the U.S. The process typically took 18 to 24 months.
For qualified nurses already in the U.S. and sponsored by a hospital, the procedure was faster. They could get temporary work permits while waiting for green cards to be approved. The initial permit was usually issued in 60 to 90 days, said Los Angeles immigration lawyer Carl Shusterman, who represents about 100 hospitals nationwide.
Once permanent residency was approved, the nurses could apply for their families to join them, Shusterman said. "The nurses could go straight to the front of the line. Now they have to wait three years," he said.
This is because the government is holding off processing certain permanent residency petitions filed after March 1, 2002, until it determines that enough visas have been issued to all those who previously applied.
At least 140,000 visas are available annually for "employment-based preference immigrants" with special skills, such as nurses.
State Department spokeswoman Kelly Shannon said more people apply for such visas than are allotted for the Philippines, China and India.
"We don't want to lose our ability to give visas to people from these countries," Shannon said, adding that the aim of temporarily refraining from processing new work petitions was to "stem the flow of applicants for visas from these countries, so that we don't run out of numbers before the end of the fiscal year."
Hospitals have long relied on foreign-born nurses to decrease the nation's nurse deficit, which U.S. authorities and healthcare specialists have estimated could reach 275,000 by 2010.
California ranks 49th nationwide -- ahead of only Nevada -- in terms of its number of registered nurses per 100,000 of population, according to comparative studies conducted by nursing industry researchers, said Rosenfeld, the hospital association official. There are 563 nurses in California per 100,000 people, Rosenfeld said. The average number of registered nurses per 100,000 of population nationwide is 1,197, researchers have found.
And the Golden State trains only half of the average 11,000 additional nurses it needs each year, Rosenfeld said.
A third of foreign-registered nurses seeking work in the U.S. go to California, Rosenfeld said.
"If fewer nurses come, or we lose some of the ones that we have now because they have temporary visas, it would exacerbate the shortage," said Barbara Patton, a senior vice president at the Camden Group, a healthcare consulting firm in El Segundo.
Protesting the new visa process, the American Hospital Assn. has asked Congress to modify it for foreign nurses, arguing that the nursing shortage was affecting patient care, contributing to emergency room overcrowding and increasing waiting times for surgery.
In response, Rep. Tom Lantos (D-San Mateo) has introduced a bill, H.R. 139, that proposes to recapture unused work-based immigration visas from countries that do not use up their annual allotments.
"We cannot simply stand by and allow the nursing shortage to ensnarl the quality of American healthcare," Lantos said.
State Department officials acknowledged that the new visa process might affect nurses but said it was not intentional.
At Glendale Adventist Medical Center, Gwen Matthews, the facility's senior vice president for clinical services, expressed concern over having access to fewer foreign nurses.
International nurses who already have work permits and jobs here count themselves lucky. But many fret that they could be separated from their families for years while they wait for permanent residency.
One such nurse is Marisol Enriquez DeGuzman, a nurse from the Philippines, who choked back tears as she reminisced about her daughters, 2-year-old Sophia Ysabelle and Maria Mikaela, 3. She left them with her husband, Arnaldo, more than 18 months ago
"It's just so unfortunate that they need nurses in the U.S., and I came to respond to their call, knowing that I would soon be reunited with my family here," said DeGuzman, 36.
The almost daily phone calls home to the Philippines are distressing, DeGuzman said. They inevitably end in tears.
She canceled a trip home last Christmas, fearing that the new visa directive might prevent her from returning to her job at an L.A.-area hospital.