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INS Policy Costs Tens of Thousands of American Lives Each Year

by Brian E. Grutman

INS has a policy that denies that critical care registered nurses are professional workers. Based on this policy, INS denies H-1B visa applications made by hospitals wishing to bring foreign critical care registered nurses to work in the United States as temporary workers. This INS policy is costing many lives every day. The Attorney General, the Director of the INS and INS Center Directors, by enforcing this policy, are directly responsible for the death each year of tens of thousands of Americans. Foreign registered nurses, if allowed into the US on H-1B visas, would save most of these lives.

A recent report in the Journal of the AMA (JAMA. 2002;288:1987-1993), in the Science News Update October 23/30, 2002, reports that nurse understaffing causes death in patients after surgery. Each additional patient assigned to a nurse above the normal load increases the likelihood of death in each of the patients under that nurse's care by 7% within 30 days, as well as a 7% increase in the odds of failure to rescue.

The report gives specific examples. An increase in the number of patients tended by a registered nurse from 4 to 6 patients would be accompanied by a 14% increase in mortality. An increase from 4 to 8 patients would be accompanied by a 31% increase in mortality.

Please be clear. The report does not say that understaffing may cost lives. It says that understaffing costs lives, in very substantial numbers. Across America, most nurses presently have a workload that is greater than what would be considered a medically normal workload.

INS’s position is that their interpretation is the proper interpretation of the law and that they are only enforcing the law. This is not true. Specialty critical care nurses, who require much more education and training than ward nurses, qualify under the Immigration & Nationality Act. Who among us would want a loved one, who has just had surgery and is in a critical care unit, to be tended by a nurse just out of a two year nursing school, without experience, additional education and training? INS takes the position that critical care positions are not specialty occupations, and that a recent graduate of a two year program qualifies to care for such a patient. Critical care nurses are professional, have years of training and education above their basic degree, and are needed to save all of our lives.

It is only INS's interpretation of “professional” and how it enforces its regulations that keeps these nurses out of the United States. Congress does not have to change any laws. Instead of being allowed to come to the United States to keep our parents and loved ones alive, most of the foreign nurses are instead going to work in Saudi Arabia and other Arab States, as well as Europe and Britain, where they are welcomed. Our people should have the same right to a quality health care as a Saudi Arabian. The nurses, certainly, would prefer coming here.

There is a terrible shortage of registered nurses in the United States, a shortage conceded both by the INS and by the US Department of Labor (DOL). The DOL concedes that registered nurses are in short supply virtually everywhere in the US. This means that the nurses that we do have are overworked and that each has too many patients to tend. Each foreign nurse brought to a hospital will reduce the mortality rate at that hospital. Each nurse brought into the US reduces other nurses’ workloads, results in a higher survival rate of 7%, 14%, 22%, 31% or more. The great majority of our hospitals would jump at the chance to bring in these nurses, not as a cure to the problem, but rather to ease the shortage and save lives.

Our people are dying and INS refuses to help. INS, instead of being part of the solution, is part of the problem. INS is bending over backwards to deny desperately needed nurses entry into the United States. Our leaders should be looking for ways to reduce mortality in American medical facilities. The easiest way is by bringing in more nurses. Clearly, INS must change this policy.

INS allowed a number of nurses to enter as specialty critical care workers in the years 2000 and 2001, but then stopped. There was no reason for INS to stop approving these H-1B visas. There is, however, a most compelling reason for INS to presently approve H-1B visa petitions for critical care nurses: the lives of your parents, children, spouses, friends and neighbors which are presently being lost, not because of the law, but merely because of INS policy.

About The Author

Brian E. Grutman is the Executive Vice President of Pilot Employment Agency II, INC., a company that brings foreign nurses to the US. Pilot Employment Agency II, INC. is located at 90 John Street, Suite 612, New York, NY 10038. For more information, please contact Brian Grutman at Ph: 212-344-9525, Fax: 212-344-9524, Email:

The opinions expressed in this article do not necessarily reflect the opinion of ILW.COM.

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