Filipino-American Club of the Jersey Shore, Monmouth County, New Jersey, filamorg.com

" Since the 1990s, the United States has had a growing shortfall of professional nurses, particularly for hospitals. Various factors have contributed to the problem, such as hospital-staffing reorganizations, more career choices for women who might otherwise have chosen nursing and an increase in nursing homes and other managed-care facilities.

"It's really impossible to compete with salaries in the United States," says Pittman, who estimates that a nurse can earn up to 10 times their salary in the source country.

That has led to problems, however, with some unethical recruiters taking advantage of nurses in other countries who may be willing to relocate to the United States.

Nursing recruiters have blossomed in foreign countries, particularly in India and the Philippines, but also in more impoverished countries. According to AcademyHealth, there were 30 recruiters of foreign-educated nurses in the 1990s. Now, there are about 300.

To respond to the problem, a code of ethics for recruiting foreign-educated nurses was recently unveiled at the National Press Club in Washington by a task force of healthcare professionals, attorneys and recruiters, among others.

The title of the document is long: The Voluntary Code of Conduct for the Ethical Recruitment of Foreign-Educated Nurses to the United States.  The goal of the document -- referred to by its authors as, simply, "The Code" -- seems more straightforward, by comparison: To create a standard of ethical behavior for recruiting healthcare professionals beyond the borders of the United States.

Although the code is voluntary, Pittman says she expects most members of the healthcare-recruiting industry to endorse it and eventually comply with monitoring to assure adherence to the standards.

Among the issues addressed in the code are transparency during the recruitment process, such as providing full documentation to the foreign-educated nurses, and fair labor standards for recruited nurses once they reach their destination in the United States.

Archiel Buagas says she wishes the code had been in place when she was recruited from the Philippines in 2005. The Filipino nurse says she was lured by the promise of earning vastly more than she could in her own country and signed a contract with a recruiter in the Philippines to work in the United States.

Neither she nor her fellow Filipino nurses who signed through the agency were provided with copies of their contract, she says.

In fact, Buagas says, none of the nurses were allowed to keep any copies of the contract, so others could review the terms of the agreement.

When she arrived in New York, Buagas says, she found what other healthcare professionals from the Philippines who signed with the same agency discovered: incomplete or missing paperwork, assigned work that differed from what was promised, delayed visas, and delayed or missing pay for hours worked.

"Because we didn't have the permits, and we didn't really have money, they made us work as clerks," says Buagas, who still lives and works in New York. "When we were paid, it was always, always lacking one day." She resigned in 2006.

Today, Buagas works for the Jacobi Medical Center and her bad experiences are behind her. Although she says she doesn't regret leaving the Philippines for the United States, she does wish her earlier years here had been easier.

"If the code was there before I started the process of application, I would have known earlier what the red flags were," she says.

Marcia Faller, executive vice president of operations for San Diego-based AMN Healthcare Services Inc., says the standards set by the code can help weed out the "bad apples" of the recruiting industry. O'Grady Peyton International, a subsidiary of AMN, is considered the largest recruiter of foreign-educated nurses.

Faller says the code is intended to prevent the sort of negative experiences -- and potential bad press -- that befell Buagas and other nurses. AMN Healthcare was among the early endorsers of the code, she says.

'I think recruiters such as us and others that have endorsed the code really do believe this is a very positive step for recruiters," Faller says. "It basically says, as a recruiter, I need to educate the person I'm recruiting. They have a right to know and understand what the employment setting is going to look like. I have to abide by the law, I need to give them a contract, and they need to have time to review the contract."

The code also calls for a system for foreign-educated nurses to complain about what they view as violations of ethical behavior on the part of the recruiter as well as monitoring of recruiters on standards compliance.

Pittman says the monitoring aspect of the code has not yet been implemented, but she hopes it will be within the year.

As a policy organization with about 55 staff members, she says, AcademyHealth is not in a position to provide monitoring itself.

AcademyHealth will create a third-party monitoring entity, however, as well as flesh out an enforcement process for the code, she says. Helping to establish this goal is the MacArthur Foundation, which will provide up to $500,000 in seed money over the next three years.

Pittman and Faller say that reputable recruiters will likely both endorse the code and ultimately subscribe to its monitoring requirements.

"That stage, I think, is very important, to make sure that we do have that kind of bar," says Faller. "

September 25, 2008

Copyright 2008© LRP Publications
-------------------------------------------------------

Click here for the document, "The Voluntary Code of Conduct for the Ethical of Foreign-Educated Nurses . to the United States.

Click here for "List of Endorsers and Letters of Support" 

Click here for "Task Force on the Ethical Recruitment of Foreign-Educated Nurses"

Click here for "Webcast Presentation from Youtube.com.