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Dear Editor:
Having just read Mr. Latour's article, and the letters to the editor. I would like to add input, as the nurse who filed an H1A complaint which resulted in one of the largest back pay cases in DOL history. Some things that are overlooked in Mr. Latour's article about the H1A visa are that: When the H1A visa experienced sunset hospitals were downsizing and substituting unlicensed persons for RNs. As nurses knew then and we all know now that was a poor strategy. Registered nurses were told in 1995 that they should close 20% of their nursing schools and that by 2005 20% of the current RN workforce would not be able to find work in the industry. This information came from what were considered to be very credible groups on the subject specifically the PEW Commission. Many RNs moved on to other work because the acute care workplace was becoming less desirable and there were many better opportunities for them in other industries. Add to this the fact that RN salaries had been flat since 1992 and that there was evidence of widespread abuse of the visa status and one can understand sunset of the act.

In fact, the H1A visa legislation was greatly flawed. Because it provided no requirement for nurses entering the country to meet the standards required to pass our licensing exam, numerous individuals, who could not pass the test, were kept in the country illegally and were exploited. See New York Times article January 15, 1998 U. S Breaks Up Ring That Smuggled Nurses. "Prosecutors said 570 nurses had been illegally placed in positions paid substandard wages and lived in crowded conditions." This was because the attestation required to bring nurses into the country required very little of potential employers. Employers also knew there was little chance they would be caught violating the law because few would understand how to file a complaint. The scenario that occurred in Texas was repeated in numerous other states.

Furthermore, when the H1A visa was passed industry promised that it would be a temporary measure, while they worked with the education community to improve the production of domestic nurses. In fact, industry did nothing of the sort. They eliminated education money and discontinued their efforts to collaborate with the profession to alleviate the causes of the nursing shortage of the late '80s and early '90s citing the PEW and other statistics. Nursing knew this was short sighted and reported their concerns to the Institute of Medicine in 1996.

While there may be a need to reconsider the temporary visa status for RNs to enter this country, the immigration of nurses should not be viewed as a fix by anyone for the nursing shortage. Poor immigration policy as illustrated by the H1A visa program has not proved in the past to improve the shortage problem and in the end probably contributed to it. The new bills that have been introduced in Congress to expand the H1C program fall short. The proposals have many of the flaws of the past temporary visa bills for nurses. They try to bypass entry standards deeming them too cumbersome. They provide a turn around time for the reviewers of attestations that is unreasonable and they only require regulators to establish that all of the blanks have been filled in on the forms. Temporary visa legislation needs to do better than this if it is to improve the nursing shortage.

I would also ask if Mr. Latour knows that the World Health Organization and the International Council of Nurses have both questioned the ethics of brain-draining other countries of their nurse populations when in fact there is a world wide shortage of nurses. Mr. Latour should be aware that the nursing shortage is not new. Since the 1930s, the DOL has been reporting to Congress that major contributors to the nursing shortage are unfavorable working conditions and poor wages.

Women have grown up in this country. They know they can get higher wages and better treatment in male dominated professions. If we want nurses in this country, both women and men, then we need to continue the current efforts to improve the image of the profession and to give those who work in it the respect and pay they deserve. Any immigration policy changes should enhance those goals, not detract from them.

Stephanie Tabone MSN, RN
Director of Practice
Texas Nurses Association

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