Hospitals fear flow of foreign nurses could stop due to change in policy.

The New Year will not be a merry one for California hospitals.

Come Jan. 1, 2005, hospitals that had been relying on foreign nurses to fill an acute nursing shortage will see that flow slow to a trickle.

About half of the 11,000 licenses issued by the state each year are given to foreign nurses, the majority going to Filipinos. But a shortage of employment-based visas is expected to cut sharply into those numbers, according to immigration attorneys who have been tracking the issue.

Hospitals have just begun to learn about the unexpected problem over the last several weeks, catching many flat footed as the New Year approaches.

"The rug has been pulled out from under hospitals in the United States of America to be able to bring in foreign nurses," said Jim Lott, executive vice president of the Hospital Association of Southern California.

California's nursing shortage has been exacerbated by the state's landmark nurse ratios that require specific staffing levels for various hospital wards. Gov. Arnold Schwarzenegger recently moved to relax the regulations, but hospital officials said the move will not eliminate the problem.

The visa revelation came to light last month when the State Department issued its monthly allocation bulletin, which showed a backlog in the number of employment-based permanent visas available to applicants from the Philippines, India and China.

Since then, immigration attorneys have been notifying their clients, which include hospitals and employment recruiters, that come Jan. 1, the already lengthy process of sponsoring foreign nurses from those countries could be extended another two years.

Moreover, the backlog will prevent new foreign nurses from coming to this country on tourist visas and then working at a hospital while they await a decision on their permanent residency application. This has been a back door method that some hospitals have used to legally employ foreign nurses.

Immigration attorneys said the result could be thousands fewer nurses available to California hospitals in 2005. "For the new stream of people it all ends on Jan. 1," said Carl Shusterman, a Los Angeles immigration attorney who has 100 hospitals as clients.

Good new, bad news

The problem arose, ironically, because the U.S. Citizenship and Immigrations Services agency began working through a huge backlog of visa applications from all countries that had built up since 9/11. New security rules were later put in place.

The agency, which had been processing a relatively small number of applications each month, started to process 20,000 monthly. While many of the applications were submitted years ago, they were counted against this year's annual allotments for each country, quickly using them up. Each year, there are roughly 140,000 employment-based visas available to all foreigners with allotments to specific countries.

The Philippines, China and India have been particularly hard hit because they generally have more applicants for employment-based visas than slots available.

The Philippines, in particular, has more universities per capita that any other Asian country (a legacy of the United States colonial involvement), and nurses there are trained in English. Moreover, the practice of Filipinos immigrating to the United State for nursing jobs is so well established that many schools teach specifically to U.S. standards, said Meladee Stankus, who owns a Phoenix staffing firm that serves California hospitals.

"We have hospitals that don't have the nurses to take care of patients," said Stankus, a former nurse. "These nurses are taking jobs that U.S. nurses don't want--at night, downtown, geriatric."

Most nurses brought to this country are sponsored by hospitals and complete the visa application process in their home countries after completing their education abroad. That process, which involves waiting months for an interview at U.S. consulate, can take up to 18 months.

But with the recent speed-up by the Immigration Services agency, new applicants from the Philippines (and India and China, which also supply some nurses) will be cut to a trickle while the old backlog is worked through.

Shusterman said this will completely shut off the alternate process that allowed Filipinos with tourist and some other non-employment visas to work in the United States, while they await a decision on their application for permanent residency.

Quick fix

Chris Bentley, a spokesman for the Immigration Services agency, said he wasn't aware of the issue, but noted that the number of foreign workers allowed into the country each year was not up to the agency.

"As an organization we can only work within the confines that Congress gives us. Once we reach those quotas and caps we have to shut down those programs," he said.

The American Hospital Association is looking for a quick fix by finding a member of Congress who can carry an amendment in the next couple of months that could be tacked onto legislation headed for the White House.

Former Rep. Bruce Morrison, D-Conn., a Washington lobbyist who chaired a House subcommittee on immigration law, is working with the association to draft an amendment that would allow employment-based visa quotas that went unused for the past few years to be re-allocated. That technical fix was employed in 2001 when there was a surge of visa applicants from foreign workers needed by the computer industry.

"There is no conspiracy here. It's not like somebody set out to do a bad thing," he said. "The (government) to its credit has been starting to resolve some of its backlog problem. I see no problem why the administration would have a problem (with such an amendment)."