Health and Long-Term Care: Are Immigrant Workers Indispensable?

Despite this country's success in educating increasing numbers of healthcare workers, the United States cannot keep up with the demand for more. The demand is fueled by an aging popu- lation that is experiencing more chronic conditions that require care, increas- ing rates of illnesses related to the rising rates of obesity at all age levels, and the "technological imperative" that drives Americans to seek more services regardless of potential outcome. With a healthcare-demand trend line that shows no signs of falling, how can this country ensure an adequate supply of healthcare professionals and paraprofessionals to meet the needs of an aging population? One solution has been an increasing reliance on workers from other countries, with the migration of nurses receiving particular attention (Aiken et al., 2001). The growth of nurse migra- tion from some developing countries has been stimulated by poor pay and working conditions there and active recruiting by developed coun- tries (Buchan, Kingma, and Lorenzo, 2005; Pitrman, et al., 2007). For developed countries like the United States, recruiting nurses from other countries offers a "quick fix" to staffing shortages. The migrating nurses gain improved salaries and career oppor- tunities, and they have an opportunity to send "re- mittances" back home. Indeed, migrant workers in the United States sent back $250 billion to their homes in 2005 (International Labour Organization, 2006). But how does this migration solution affect longer-term outcomes for the healthcare and long-term-care systems, healthcare workers, and consumers, both in the U.S. and in the workers' home countries? In exploring whether immigrant workers are indispensable to developed countries, this article focuses on the United States as an important case study of a situation that many other countries are either facing now or will face in the near future. In a global context, the U.S. offers an interesting look at a country that has a long history of acculturating immigrants, which some other developed and developing countries lack. To explore these issues, and their implications for both policy and practice, this article focuses on the migration of nurses- RNs for the most part, but also licensed practical nurses (KENs) and certified nurse assistants (CNAs), where data exist, in both acute (hospital) and long-term-care settings. HOW IMPORTANT ARE FOREIGN WORKERS? How important are foreign-educated healthcare workers in meeting U.S. demand? As noted, the numbers have increased dramatically in recent years. For example, in 2000, some 5,231 newly licensed registered nurses (RN.s) working in the U.S., or 6.1 percent, were educated in another country. By 2007, this number had more than quadrupled, to 22,815, which was 16.4 percent of all new RN.s (Redfoot and Houser, 2005; National Council of State Boards of Nursing, 2008.) (2007 number is imputed from reported pass rates.) Using census data, Buerhaus, Staiger, and Auerbach (2008) found that the number of full-time RN.s who were foreign-born grew by 93,036 between 2002 and 2006 -making up 37 percent of the growth in the number of full-time RN.s during that time. By 2006, the increase in the number of full-time foreign-born RN.s exceeded that of U.S.-born RN.s. The increasing use of foreign-born nurses is not unique to the United States. The Organisation for Economic Co-operation and Development (oecd) (2007) reviewed immigration patterns of healthcare workers in developed countries, finding that 10.7 percent of nurses in oecd countries were foreign-born in 2000. The percentage in the U.S. was slightly higher (11.9 percent) and was much higher in many other countries, such as Switzerland (28.6 percent) and Luxembourg (25.8 percent). While the phenomenon of more international nurses is widespread in developed countries, the absolute number of foreign-born and foreign-educated nurses is by far the largest in the United States. Nearly half of the foreign-born nurses in oecd countries were in the United States in 2000 (47 percent). …