SAN FRANCISCO, CA—A Filipino nurse quit his job and sold all his belongings, all for the promise of a lucrative job at an American hospital. Little did he know that the recruiter wouldn’t show up and would run away with his money. This nurse had settle for another job in Saudi Arabia, a far cry from his American dream.

A fellow nurse had better luck and was even promoted supervisor in another hospital. But his salary was much lower than that received by American nurses under him, a difference of almost $10 in a workplace where every penny counts.

Several other Pinoy nurses hired under recruitment agencies were treated as second-class citizens. “They assume that Filipinos don’t have lives,” one of them complained, citing instances when they would be plucked out of precious “off” days for another round of hard labor. To think that they were chronically paid less than other agency nurses.

So, do you still want to be a nurse in the United States?

Groundbreaking report, “a crucial first step”

These sad stories and more of the same are revealed in a groundbreaking report by a US-based policy research group on the “burgeoning”—but largely uncharted—American nursing industry.

The study by AcademyHealth zeroes in on unethical practices of recruitment of foreign educated nurses (FENs), particularly Filipinos.

The 41-page report released last November identified at least 25 problems reported by FENs interviewed for the study. Many of these abuses allegedly came at the hands of “staffing” agencies for which many FENs end up working at a much lower salary besides finding themselves in substandard living conditions.

Many of the nurses interviewed were Filipinos, who, according to a 2007 survey of the American Hospitals Association, were working in 84 percent of US hospitals hiring FENs.

Former Health Secretary Jaime Galvez Tan, who furnished the Inquirer a copy of the study, said the report was a crucial first step in addressing unethical recruitment practices in the US.

He said all eyes were on the Philippines because it was the biggest supplier of nurses worldwide. AcademyHealth said it “remains the most important source-country for the United States,” which, according to its study, would have a demand for around 800,000 nurses by 2010.

RP is test case

“The US is finally taking notice,” Galvez Tan told the Inquirer in an interview on the unethical recruitment of FENs. “The Philippines is a test case. What happens to us can also happen to other countries because we are the largest exporter of nurses.”

Galvez Tan, who is advocating a “win-win” solution to the nursing migration phenomenon, was the lone Filipino in the AcademyHealth meeting in Washington last November.

AcademyHealth is a “professional society” of around 4,000 “public policymakers, business decision makers, health services researchers, policy analysts, economists, sociologists, political scientists, consultants, clinicians, and students.”

The study is the initial report in a two-year project titled “International Recruitment of Nurses to the United States: Toward a Consensus on Ethical Standards of Practice.” It seeks to identify ways to “reduce the harm and increase the benefits of international nurse recruitment for source-countries and for migrant nurses themselves.”

“Despite the growing importance of the international nurse recruitment industry, no governmental or nongovernmental organization monitors the industry’s size, scope, and operations,” it said.

Two main issues

AcademyHealth raised two main issues—how FENs can be recruited “in a way that does not disrupt the delivery of vital health services to local populations of source countries, especially those countries with poor health systems and high burdens of disease” and how the rights of FENs can be “guaranteed throughout the processes of recruitment and integration into the US.”

The Philippines figured prominently in the study because of the huge Filipino labor force in the American health service market. Galvez Tan estimated that 10,000 to 15,000 Filipino nurses were leaving the Philippines for greener pastures elsewhere every year.

AcademyHealth cited the Philippines as among the countries whose governments were “actively facilitating the departure of nurses.”

‘Staffing’ agencies like janitorial and security services

“At least among small countries, the sustainability of the ‘nurse for export’ scenario is currently being tested in the Philippines,” the study said. “The government has historically supported the export of nurses, and the private sector has demonstrated an ability to produce more nurses than the Philippines.”

The study results were hardly encouraging.

Concerns were raised over the practice of recruitment by “staffing” agencies, whose structure were not unlike security or janitorial services in the Philippines. On top of recruiting FENs, a number of them then become employers of nurses. As a result, their nurse-employees get less than what they were supposed to get in working directly for hospitals.

“Staffing” is one of three recruitment models for foreign health care professionals in the US. The others are “direct” recruitment where hospitals transact directly with applicants, and “placement” where FENs are “placed” in health care organizations by recruitment agencies.

“Many FENs working for staffing agencies reported that they are paid as much as $10 less per hour, or about 25 percent less, than direct-hire nurses and, in some cases, FENS from other agencies who work in the same facility,” the study said.

Questionable practice

AcademyHealth noted that most of the nurses interviewed in the study earned somewhere between $20 and $28 per hour, compared to directly hired FENs occupying the same position whose salary rate was between $30 and $38 per hour.

The study cited a Commission on Graduates of Foreign Nursing Schools (CGFNS) survey showing that “18 percent of recruiters charge nurses a fee for their services, a questionable practice considering that such recruiters also receive payment from employers.”

Galvez Tan said recruiters received as much as $30,000 from some US hospitals for every nurse they recruited. “It’s really unethical,” he lamented. “Recruits should not be made to pay.”

He also deplored the practice of American states bidding the highest amount just so recruitment agencies could supply their demand for nurses as soon as possible. A bid of say, $30,000 for each recruit, is apparently not unwise, considering that hospitals reportedly spent $92,442 to replace a nurse.

Of 124 recruiter websites visited by AcademyHealth researchers in August 2007, 64 percent were “active” in the Philippines, the highest rate among nine regions exporting nurses. India was second at 45 percent.

One recruiter told the group that about 35 percent of agencies in the US were “using the staffing model.” A separate CGFNS survey said 45 percent were into the scheme.

In all, AcademyHealth listed at least 25 problems mentioned by FENs included in the study.

Selling of contracts

One complaint was that nursing applicants were duped into working under staffing agencies or doing a job entirely different from the one stipulated in the contract. One nurse reportedly worked as a nanny for an agency owner.

Contracts were all but sacred, more FENs complained: “Some nurses sign contracts to work with a particular employer and, upon arrival, learn that they must work for another employer.”

Others cited the “selling” of contracts to another agency, forcing recruits to work for the new company’s hospital or nursing home.

Nurses wanting to get out of the bind could either pay a “breach” fee ranging from $8,000 to $50,000 or be sued for contract breach.

“The original recruiter may sue nurses who break contracts and may pursue them for family land deeds put up as collateral,” said the study.

Prevailing sentiment

In the AcademyHealth meeting last November, Galvez Tan said the prevailing sentiment among participants was to encourage “self-regulation” among recruitment agencies. But he argued that a one-track approach would never solve the problem of unethical recruitment practices.

“I’d like to see the day when the US government will have a broad national policy against unethical recruitment,” he said.

Esguerra is an Inquirer reporter on a study grant at the University of San Francisco in California.