Nursing Shortage – Philippines Recruitment, part 1

In the Philippines - recruiting RNs
In the Philippines – recruiting RNs

The nursing shortage in the United States is well documented and is intimately understood by providers, residents, and patients.  While some studies suggest the crisis will hit in the future when the baby boomers fully hit the system, the truth is that the crisis has been impacting many markets for years already.  I doubt there’s one more significant factor to transforming long-term care (and real health reform) than to solve the nursing shortage crisis now.  What happens in a nursing shortage … ?

  • Providers are forced to become the employer of choice if they want to compete to be the provider of choice.
  • Weakly led providers ‘settle’ for ‘warm bodies’ since they’re AFRAID of losing any scarce nurses.  What they fail to realize is that the more nurses you’ve settled for, the more difficult it is to attract and retain the outstanding ones. But, that’s a topic for a different post.

A small sample of the coverage & statistics this year:

  • March 8, 2009 Reuters: “An estimated 116,000 registered nurse positions are unfilled at U.S. hospitals and nearly 100,000 jobs go vacant in nursing homes, experts said.”
  • August 1, 209 “Our health care system requires an immediate modification of Federal laws relating to recruitment of qualified foreign nurses in order to operate at an efficient and effective level.”
  • June 2009 American Association of Colleges of Nursing: ” … the ratio of potential caregivers to the people most likely to need care, the elderly population, will decrease by 40% between 2010 and 2030. Demographic changes may limit access to health care unless the number of nurses and other caregivers grows in proportion to the rising elderly population.”

But, the quote that TROUBLES me the most is from President Obama: “The notion that we would have to import nurses makes absolutely no sense,” Obama said at a health-care forum in March. “There are a lot of people [in the U.S.] who would love to be in that helping profession, and yet we just aren’t providing the resources to get them trained—that’s something we’ve got to fix.”  My problem with that statement is that it is out of touch with reality.  Sounds good theoretically/academically.  But, thousands of hospitals, nursing homes, clinics, offices need nurses yesterday!  I have no problem with the long-term fix he alludes to.  But, it’s not an either/or question.  We’ve got to do BOTH …

I had a wonderful trip to the Philippines last year to recruit nurses for some of our skilled nursing facilities. Between the agency I used and internal referrals, I interviewed 152 nurses during the week I was there.

Filipino nurses ready to interview
Filipino nurses ready to interview

I was profoundly impacted by the interviews. Many of them traveled 12 hours to meet with me for 15 – 30 minutes and then travel 12 hours home. Think about that. They want this so bad. They are dying for the chance to come the states. I interviewed several MDs, pharmacists, engineers, etc. who took up nursing for the chance to come here. I routinely heard of their desires to take care of their families … to lift them out of their current situation. I know this sounds corny, but I really fell in love with them and this country. I was so impressed by their friendliness, generosity, and respect. I was called ’sir’ more in that first day than in my whole life before. Everyone was so nice.

During the interviews I focused on personality, attitude, and confidence. I looked for the nurse who was cheerful, confident, interested, and eager. And, I found a lot of them. After the first day, I reviewed my notes on each interview and had about a 50% ‘Yes’ rate.

I also visited several hospitals to get a feel for the conditions of their experience. The public hospitals are in tough shape. We’re talking huge rooms (wards) with 50 people sharing beds with no privacy curtains and far less than sanitary conditions. The picture below is of an orthopedic ward’s census board of both pre- and post-op patients. 3 nurses for the 87 patients — providing all levels of care. The 3rd column of patients with ‘x’ next to the number is of the ‘extra’ patients on cots and beds in the hallway. Tough stuff.

Filipino Hospital patient board - 3 Nurses for all of those patients
Filipino Hospital patient board – 3 Nurses for all of those patients

On the other hand, the private hospitals were nice and the working conditions were much better. Although their training is good, the nurses we bring over will require quite a bit of training to ensure their successful transition.

Also … as far as the rates of pay, you need to follow federal immigration law which states the rate has to be in the range of the prevailing rate for a particular job within a particular market.  This law prevents foreign nurses/workers from depressing citizens’ wages.  The government posts that data here:

The DOL Online Wage Library:  Select the state, select the county, then you select position.  Nurses are 29-1111.

I’ll update later on the results of the interviews and describe the immigration NIGHTMARE (I mean process) … I’d love to see your comments/questions/stories on this.

Administrator-Director of Nursing Diagnostics

During the last couple years I’ve visited with over 50 nursing home administrators and their department head teams to assist them
  1. Define their facility culture,
  2. Implement world class service practices,
  3. Strengthen their teams, and/or
  4. Improve their marketing efforts
I’ve had the pleasure of working with leaders at facilities everywhere across the spectrum of performance (from beginning of turnaround to market leaders).  While I find my work fulfilling and important, I’ve concluded that those numbered areas of focus above are SECONDARY to the area in the facility that is really the FOUNDATION of everything is the relationship between Administrator and Director of Nursing.  In fact, as I look back at most struggling situations (clinical, regulatory, financial) the vast majority of them involve a weak, strained, or dysfunctional ED-DNS ‘partnership.’
The opposite is also true!  Where there is a strong, trusting, caring relationship between the administrator and the DNS, real transformation can take place – given competent, inspired leaders.
All efforts toward cultural change, implementing higher standards, or improving the facility must come AFTER the ED-DNS relationship is solid.  Otherwise, the initiatives will be planted on a weak foundation and will fall by the wayside after a few months.  Unless there is a unified front where the ED-DNS are on the same page and are authentically committed to the initiative regardless of what it is, no change will be lasting.
In healthcare we rely on DIAGNOSTICS to identify the problem.
I’ve developed a cultural diagnostic tool for administrators and directors of nursing to assess how strong their relationship is.  Scoring themselves on a series of statements will not only give them a grand total but it serves as a powerful basis for conversation as the two most important facility leaders take steps toward that optimal ED-DNS relationship of trust.
A sample of the statements to be scored:
(Scoring:  3 = Always         2 = Sometimes          1 = Rarely)
  • We run decisions for hiring, firing, and discipline by each other regardless of position. We give each other a ‘heads up’ so there are no surprises.
  • Our loyalty to each other is greater than our loyalty to anyone else in the facility.
  • We leave meetings/conversations confident that we are both completely committed to the decisions that we agreed on, even if there was initial disagreement.

You get the idea.

We often wonder why bright ideas, great programs, change initiatives fail after 2 or 3 months in the facility.  This is why.  No matter how brilliant the program/system, if the ‘top’ is not first committed to each other and second committed to the brilliant program/system, it is destined to fail.  Get this relationship right.  You get the change (culture, clinical, etc.) you desire.

Of course, this assumes competent, inspiring administrators and directors of nursing to begin with.  More on how to find and retain those all-stars later …