Bloomberg – Erica De Boer, the chief nurse at America’s largest rural health network, thought she could finally offer some relief to her overburdened staff and thousands of patients. More than 160 reinforcement nurses were due to arrive in the coming months to Sanford Health’s Midwest centers, from as far away as Manila and Lagos, Nigeria. But now only 36 will come, we hope.
The United States is in the midst of a visa rollback, when the surge in demand collides with annual caps, clogging the processing line. The delays are particularly serious for the main visa category used by hospitals. Currently, government officials have only just begun working on applications submitted two years ago, Just at the time many hospitals started hiring foreign nurses and applying for their visas.
Experts estimate that at least 10,000 foreign nurses have been delayed indefinitely, a delay that would certainly exacerbate an already serious shortage nationally. After the pandemic prompted 100,000 nurses to leave their jobs due to burnout or early retirement, American hospitals looked abroad to fill the void.
“We simply can’t see that many patients,” said De Boer, a 30-year nursing veteran who plans to hire more expensive contract staff in the short term and push to see more patients online when possible. Foreign workers were an important part of the strategy to fill 1,000 nursing vacancies at Sanford Health in the coming years. “We had these international nurses,” he added.
roller coaster
Carissa Canlas is one of them. This 37-year-old woman must already be in Fargo, North Dakota, working at Sanford Health Hospital in that city. Instead, she is stuck in her native Philippines, working long hours in the United States processing claims for a health insurance company.
“This puts an end to everything you were planning. “It’s really like a roller coaster for the workers who are still here waiting,” Canlas said in a Zoom interview from her home in Manila, where she lives with her husband and 2-year-old son. “I’m close “Very, that’s why it’s so painful.”
It takes several years to sponsor a green card employee. It is expensive, with initial costs of about $10,000 per applicant. Excludes language and skills training, flights, accommodation and other fees.
Among member companies, about 10,000 foreign nurses were affected by the setback, said Patty Jeffrey, president of the American Association of International Healthcare Staffing (which represents most staffing companies in the sector).
“It’s going to get really bad.” Jeffrey said. “There is already a widespread shortage, and then comes the decline in visas.”
To fill that gap, Sanford Health plans to hire so-called commuters, or nurses who travel around the country on short-term contracts. But they cost about three times the hourly wage of regular nurses, It is about $39 nationwide. While temporary staffing helps, it makes it difficult to provide quality, consistent care, according to Theresa Larson, vice president of nursing for the network in Fargo.
artificial intelligence
Sanford Health is also testing non-human options. Denny Sanford, the billionaire founder of First Premier Bank and the hospital network’s namesake, has invested $350 million in technology improvements.
The health network uses “virtual caregivers,” where cameras allow a nurse to monitor up to 16 patients on a screen at a time. Sanford Health also partnered with software company Flexwise to deploy an artificial intelligence tool that predicts patient volume and sets schedules accordingly.
The health network, which serves more than a million patients, is piloting a program to bring two-room clinics to small towns. The nurse provides basic care and communicates with doctors via computer when necessary. Next year, they also plan to open a center in Sioux Falls, South Dakota, which will serve as a hub for all of this telehealth and virtual care. “There is no cheap solution for us,” Larson said.
In fact, these expensive solutions are beyond the reach of many hospitals. As many as two-thirds of the nation’s hospitals likely ended up in debt last year, double what they were at the end of 2019, according to the American Hospital Association. Nearly 30% of all rural hospitals in the United States are at risk of closing due to financial pressures, Based on 2023 data from the Center for Healthcare Quality and Payment Reform.
All this advanced technology has its limits, too.
Practice
One October afternoon in the mental health unit at Sanford Health Hospital in Fargo, four nurses gathered around a patient who was having a nervous breakdown.
Here, the hospital treats patients with severe psychological disorders, such as schizophrenia. The single-story facility is equipped with soft handles that minimize damage, and access requires passing through two separate sets of security doors. 24-hour video monitoring is not a substitute for hands-on therapy and nursing supervision.
Andrew Hidalgo, 40, is one of the nurses on the ground. He recently arrived from Manila and works about 36 hours a week. Sanford’s health facilities are more advanced than those in their country, the Philippines. It was difficult for him to find work in the hospital.
International nurses like Hidalgo are overrepresented in the field of behavioral health, a stressful and sometimes dangerous job. “I can’t control what will happen every time I work, but I can control my behavior.” “I think about my family and the future I can offer them,” Hidalgo said from a small conference room downtown.
Hidalgo spends most of her time directly interacting with patients, about five per shift. When he walks through the halls, he waves at them and they scream his name. “You have to have a connection with your patients to gain their trust,” he says.
The waiting game
Relying on internationally trained nurses like Hidalgo is only part of the solution, according to American Nurses Association President Jennifer Mencic Kennedy.
The crux of the problem is the nursing turnover rate, which remains at 27% in the United States. Kennedy’s organization made more than 100 recommendations to address root causes, including better safety policies and flexible schedules, and hospitals were slow to accept them, Kennedy said.
“We have to reform our work environment,” he added. “Why would we expect to be able to provide a less-than-good work environment for anyone, whether they are a coach overseas or a coach in the United States?”
Back in Manila, Canlas is trying to be optimistic despite the uncertainty. Her best friend, Krystle Saldívar, arrived in Fargo in May and is preparing for her first winter in North Dakota.
“Sometimes you wonder if it was really God’s will for me to go to the United States. But it’s my dream,” Canlas said. “So you have no choice but to wait.”
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