Angelite Nurses

Seeing no end to the outmigration of Filipino nurses and doctors, a former health secretary has taken steps to “tame the exodus” and achieve a win-win situation for both the Philippines and foreign countries employing our medical professionals.

For a number of years now, Dr. Jaime Galvez-Tan, former Department of Health (DoH) Secretary, has been working for partnerships among countries recruiting Filipino nurses and doctors.

Tan, who initiated an extensive study on the exodus of medical professionals and its effects in the Philippine healthcare system, has formulated ways to improve the situation by seeking bilateral agreements with receiving countries such as Canada, Finland and Australia, among others.

“I have accepted globalization and I have accepted that Filipino nurses are bound to go. Let us tame the exodus; you cannot stop them; that is their human right. Let us tame it,” said Tan, an educator at the University of the Philippines (UP) College of Medicine and founder of Health Futures Foundation, Inc., which trains community health workers nationwide.

Though lacking official government backing, Tan was able to secure on-going negotiations from recruiting countries such as Finland, Canada, Australia and Bahrain to establish a trust fund for health human resources development.

“We can turn migration into a positive force rather than a negative force.”

The proposed RP-Partner trust foundation seeks the adoption of a Philippine region such as Iloilo, Surigao, Agusan del Norte and Agusan del Sur with the recruiter pouring direct investments in its health system.

Tan is also negotiating for employed nurses to return to the Philippines after two years of service abroad to share their knowledge among Filipino nurses for a period of six months. “I call this brain circulation,” he said.

For nurses who may opt to stay and teach in the Philippines, Tan has asked recruiting countries to provide a Masters Degree scholarship to be provided by the state or the hospital where the nurse is employed.

Other negotiations in the “win-win” bilateral agreement include the provision of three nursing scholarships in a Philippine nursing school partner for every Filipino nurse recruited by the state or the hospital and the improvement of a healthcare facility for every 10 nurses recruited.

For 20 nurses recruited, a nursing school should be improved and for 50 recruited Filipino nurses, Tan seeks for the improvement of a training hospital.

Tan’s research shows the Philippines remains the top exporter of nurses to the world and the number two exporter of doctors, following India.

MANILA, FEBRUARY 9, 2010 (STAR) By Sheila Crisostomo  - For the last three years, the number of registered Filipino nurses taking the US National Council Licensure Examination (NCLEX) has been declining, indicating that fewer Filipino nurses are seeking work in the United States, a labor organization said. Trade Union Congress of the Philippines (TUCP) secretary-general Ernesto Herrera said only 15,382 took the US licensure exam for nurses in 2009, compared to 20,764 in 2008. In 2007, 21,299 Filipino nurses took the NCLEX.
The former senator said there is a need to “build up the competitiveness of Filipino nurses in foreign labor markets.” One way is to shut down the 152 nursing schools previously classified by the Commission on Higher Education as “substandard.”
Herrera also proposed that nursing schools publish their passing rates in the annual licensure exam “so that buyers of nursing education may be guided accordingly.”
He said the Technical Education and Skills Development Authority (TESDA) should also provide free second-language training to nurses seeking employment in non-English-speaking countries.
Herrera also said that many nursing students do not get proper clinical training in hospitals because there are too many of them.
“Hospitals can no longer accommodate all our nursing students in emergency rooms, operating rooms and delivery rooms. There are just too many of them waiting in line to observe procedures,” he said.
“The capabilities of all state-owned hospitals, whether run by the Department of Health or by local governments, to provide superior clinical training to junior and senior nursing students (must be strengthened),” he added.

Rape allegations were reported in a quarter of city's 119 nursing homes in those two and a half years, records show

Authorities have investigated at least 86 cases of sexual violence against elderly and disabled residents of Chicago nursing homes since July 2007, but only one of those cases resulted in an arrest, a Tribune investigation has found.

Allegations of criminal sexual assault, or rape, were reported in a quarter of Chicago's 119 nursing homes during those 2 1/2 years, government records show.

State law requires nursing homes to notify police immediately when they receive an allegation of sexual violence or abuse. However, no police reports were filed in connection with at least nine alleged sexual attacks reported by the state Department of Public Health, according to Chicago police records released to the Tribune. In a 10th case, the allegation was reported to police months after the incident.

Police and state investigative reports depict the terror endured by elderly and disabled women in some city nursing facilities where predatory males troll through common areas and unlocked bedrooms with little supervision.

Almost all of the 86 cases the Tribune examined involved residents attacking other residents. Only a handful of the alleged attackers were employees or visitors; the lone successful prosecution was of an orderly.

The frightening atmosphere is another consequence of Illinois' unusual reliance on nursing homes to house younger psychiatric patients with sometimes violent criminal records. Many understaffed facilities are ill-equipped to treat these residents or monitor their behavior.

Government records show that the 30 Chicago facilities where rapes were reported were roughly twice as likely to house convicted felons and mentally ill patients as the 89 city nursing homes without a sexual assault allegation.

At Rainbow Beach Care Center on the South Side, a 61-year-old woman said she was afraid to fight or scream and could only say, "No, no, no, please," as she was allegedly raped by a schizophrenic 47-year-old man with a "history of inappropriate sexual behavior toward females," according to a state health department report. When a police report was filed months later, it said the woman had called the sex "consensual."

A physician had previously ordered that the alleged attacker be given periodic shots of the drug Depo-Provera, a form of chemical castration used on male sex offenders. But state health inspectors found no medical record indicating those shots were given. State investigators also said the facility failed to conduct a "thorough investigation" to determine whether the same man had raped a second woman.

A few miles away at All Faith Pavilion, a female resident was hospitalized in a "catatonic state" with a swollen black eye, broken nose and human bite marks, state records show. She told authorities she was raped by a schizophrenic48-year-old male resident in the facility. The woman remained hospitalized for at least a month, a state report said.

No charges were brought in the Rainbow Beach and All Faith cases.

The owners and administrator of All Faith declined interview requests. Eric Rothner, a co-owner of Rainbow Beach, issued a written statement saying: "Every day, we confront a unique set of challenges and we deal with them realizing that if it were not for our facilities, our residents would be living on the streets. All of us caring for this population are keenly aware of these issues and work to overcome them 24 hours a day, seven days a week."

'Something hidden'

Most of the 30 city homes with alleged attacks had substandard staffing levels, which experts call a key indicator of patient safety. Of the 23 homes that federal authorities have rated on a ratio of nursing staff to residents, 21 were rated "below" or "well below" average on staffing levels, while two others were deemed average, the Tribune found.

In addition to 48 reports of criminal sexual assault, which is a felony, Chicago police records show 28 allegations of criminal sexual abuse at city nursing facilities since July 2007. Those sexual abuse cases, which include charges of molestation and groping, can be misdemeanors under some circumstances.

One of the nine alleged attacks that did not turn up in police records released to the Tribune came to light in May 2008 during a state inspection of Rothner's Sheridan Shores Care & Rehabilitation Center on the North Side. Three "alert and oriented" women described "the fear they were experiencing at night time" when they awoke to find strange men in their rooms, sometimes standing over their beds, according to the state inspection report.

One woman said: "It scared me to death!" Another recounted staving off "2 attempted rapes during the night when male residents entered her room using the stairwell," the state report said. A facility investigation confirmed one woman's allegation about a male intruder standing over her bed, but Sheridan Shores' administrator denied to state investigators knowledge of any attempted rape.

Although both police and state health inspectors investigate allegations of sexual violence in nursing homes, the Tribune found that the two agencies rarely communicate with each other about the incidents and do not typically share reports on violent incidents or pool their expertise and resources.

The extent of the violence in Chicago nursing homes was unknown to the state ombudsman's office, which fields abuse complaints from nursing home residents and their families. That agency investigated only two sexual abuse allegations in Chicago homes during a recent 12-month period, according to its records, while police listed 27 reports of sexual assault at city nursing homes during that time.

"We believe the reports are less frequent than they should be — we think there is something hidden here," said Karen Roberto, a Virginia Tech professor who studies sexual assaults against the elderly in nursing facilities.

The small number of arrests related to recent rape allegations in Chicago nursing homes — 48 rape reports, one arrest — sharply contrasts with figures on sexual assault allegations citywide, official figures show.

Last year, Chicago police investigated 1,446 criminal sexual assault reports and made 450 arrests. Though some rapes can involve multiple defendants and some arrests can be linked to reports from the previous year, that amounts to roughly one arrest for every three reports.

Similarly, the FBI estimates that nationally there were 89,000 rape reports to law enforcement agencies in 2008 and 22,584 arrests.

Prosecution pitfalls

Experts say a variety of factors can interfere with investigating or prosecuting sexual assault reports in nursing homes. Often the victims suffer from dementia or appear delusional and can't describe the attacks in enough detail to assist investigators.

In December 2008, for example, a health care worker found evidence of sexual trauma on an elderly female resident of Warren Park Health & Living Center on the Northwest Side. The woman, who was hospitalized after the alleged attack, said a man came into her room and sexually assaulted her, but she "was unable to provide any further (information)," according to a Chicago police report.

Some facility residents are afraid to speak out because they live alongside their alleged attackers, others are anxious about alienating their caregivers or being moved from the only homes they have, and many simply feel too weak to face the ordeal of police questioning and forensic examinations.

"When they're at the end of their life, a lot of times people give up. It takes a lot of strength to go to police," said Karla Vierthaler, outreach coordinator at the Pennsylvania Coalition Against Rape.

Some cases become compromised because residents delay reporting the alleged attacks until they are visited by a relative or trusted caretaker. By then, any DNA or forensic evidence can be lost.

A Tribune review of police and state health reports found that although many facility operators responded immediately to rape allegations, some unwittingly cleaned up crime scenes rather than properly preserving evidence.

Others downplayed the incidents as consensual sex. They "act in their own self-interest rather than the interests of the residents," said Holly Ramsey-Klawsnik, a Massachusetts-based sociologist and mental health clinician.

For their part, police sometimes drop their investigations too quickly when faced with the host of obstacles from both victims and facility employees, said Ronald Costen, a former criminal prosecutor who directs Temple University's Protective Services Institute.

"You have to treat these cases of sexual assault in a long-term care setting like coming across a dead body on the side of the road — you have to look for hard, forensic evidence," Costen said.

In addition, experts said, police sometimes decide that mentally ill perpetrators lack the intent needed for successful prosecution and may have a better shot at treatment in nursing facilities rather than prison.

Only one of the 48 Chicago cases involving the most serious allegation, criminal sexual assault, was referred to the Cook County state's attorney's office for felony review, according to a records search done for the Tribune by prosecutors.

Chicago police say they vigorously pursue every sexual assault allegation. "We're not real quick to drop investigations ... that's not the case," said Thomas Byrne, chief of detectives for the department. "Sexual assaults are something we take very seriously."

In April 2008, police were summoned after midnight to Somerset Place on the North Side after a mentally ill 28-year-old resident told staff that he had beaten, then raped a schizophrenic 53-year-old woman after forcing his way into her fourth-floor bedroom, records and interviews show.

The man told police "he wanted to make a confession," and a police report said he sexually assaulted his female housemate "without the victim's consent." Sent to the emergency room with a blood-filled and swollen black eye, the woman told police and Somerset employees she had been sexually assaulted.

The victim's mother, Dorothy Foster, of Bolingbrook, saw her daughter at the facility the next day. "I just broke down," Foster said. "It was so bad."

But in the end, no arrest was made in the case. According to a police detective's report, the victim refused to cooperate with officers. She and the male resident now live in different facilities.

Somerset, another Rothner nursing home, sent a description of the incident to the state Department of Public Health as required by law, and the facility has not been accused of wrongdoing in the case.

Somerset has had seven reports of alleged sexual violence since July 2007, more than any other Chicago nursing home, records show. Federal and state authorities this month moved to revoke its state nursing home license and cut off its federal funding because of citations for abuse, safety breaches and other problems. The facility is contesting those actions.

Tribune reporter Anne Sweeney contributed to this report.

dyjackson@tribune.com

gmarx@tribune.com

But state officials declined to fine the hospital.
Ronca, a 33-year-old mother of three from Pennsylvania, was put under anesthesia and prepped for brain surgery on April 10 to correct her Chiari malformation - a condition that causes terrible headaches and other debilitating symptoms.
Unbeknown to her, Dr. Paolo Bolognese was en route to a family vacation in Disney World the morning of the procedure, and Dr. Thomas Milhorat, his partner and the chief of neurosurgery, refused to cover. Milhorat told OR staffers he was busy and directed them to wake Ronca up and reschedule.
North Shore suspended the two prominent neurosurgeons for several weeks. Milhorat, 73, was forced to step down after the Daily News exposed the incident.
The Health Department slapped the hospital in September with 14 violations of the public health code, including its no-show surgeons, an anesthesiologist who put the patient under with no one to operate and lying to the patient.
In North Shore's plan of correction, which was accepted and released by the Health Department yesterday, the hospital disagreed with seven of the state's 14charges.
The hospital dismissed the surgery mishap as "a result of an unfortunate confluence of a few errors, not a 'systemic' failure resulting from the absence of bylaws or policies."
The department's decision not to fine the Manhasset institution was another slap in the face to Ronca, who is suing the doctors and North Shore's Chiari Institute.
"I cried again," Ronca told The News when she learned the hospital got off without a fine. "The Health Department never called me to hear the facts from me. It's just another betrayal."
Ronca said since the ordeal, she has suffered recurrent nightmares and pain that plunged her into a deep depression, for which she was hospitalized in October.
"I've had a lot of issues trying to come to terms with what they did to me. The Health Department just assumed there was no injury," she said.
hevans@nydailynews.com

 

Henrietta Lacks' cells were essential in developing the polio vaccine and were used in scientific landmarks such as cloning, gene mapping and in vitro fertilization.Medical researchers use laboratory-grown human cells to learn the intricacies of how cells work and test theories about the causes and treatment of diseases. The cell lines they need are “immortal”—they can grow indefinitely, be frozen for decades, divided into different batches and shared among scientists. In 1951, a scientist at Johns Hopkins Hospital in Baltimore, Maryland, created the first immortal human cell line with a tissue sample taken from a young black woman with cervical cancer. Those cells, called HeLa cells, quickly became invaluable to medical research—though their donor remained a mystery for decades. In her new book, The Immortal Life of Henrietta Lacks, journalist Rebecca Skloot tracks down the story of the source of the amazing HeLa cells, Henrietta Lacks, and documents the cell line's impact on both modern medicine and the Lacks family.
Who was Henrietta Lacks?
She was a black tobacco farmer from southern Virginia who got cervical cancer when she was 30. A doctor at Johns Hopkins took a piece of her tumor without telling her and sent it down the hall to scientists there who had been trying to grow tissues in culture for decades without success. No one knows why, but her cells never died.
Why are her cells so important?
Henrietta’s cells were the first immortal human cells ever grown in culture. They were essential to developing the polio vaccine. They went up in the first space missions to see what would happen to cells in zero gravity. Many scientific landmarks since then have used her cells, including cloning, gene mapping and in vitro fertilization.
There has been a lot of confusion over the years about the source of HeLa cells. Why?
When the cells were taken, they were given the code name HeLa, for the first two letters in Henrietta and Lacks. Today, anonymizing samples is a very important part of doing research on cells. But that wasn’t something doctors worried about much in the 1950s, so they weren’t terribly careful about her identity. When some members of the press got close to finding Henrietta’s family, the researcher who’d grown the cells made up a pseudonym—Helen Lane—to throw the media off track. Other pseudonyms, like Helen Larsen, eventually showed up, too. Her real name didn’t really leak out into the world until the 1970s.
How did you first get interested in this story?
I first learned about Henrietta in 1988. I was 16 and a student in a community college biology class. Everybody learns about these cells in basic biology, but what was unique about my situation was that my teacher actually knew Henrietta’s real name and that she was black. But that’s all he knew. The moment I heard about her, I became obsessed: Did she have any kids? What do they think about part of their mother being alive all these years after she died? Years later, when I started being interested in writing, one of the first stories I imagined myself writing was hers. But it wasn’t until I went to grad school that I thought about trying to track down her family.
How did you win the trust of Henrietta’s family?
Part of it was that I just wouldn’t go away and was determined to tell the story. It took almost a year even to convince Henrietta’s daughter, Deborah, to talk to me. I knew she was desperate to learn about her mother. So when I started doing my own research, I’d tell her everything I found. I went down to Clover, Virginia, where Henrietta was raised, and tracked down her cousins, then called Deborah and left these stories about Henrietta on her voice mail. Because part of what I was trying to convey to her was I wasn’t hiding anything, that we could learn about her mother together. After a year, finally she said, fine, let’s do this thing.
When did her family find out about Henrietta’s cells?
Twenty-five years after Henrietta died, a scientist discovered that many cell cultures thought to be from other tissue types, including breast and prostate cells, were in fact HeLa cells. It turned out that HeLa cells could float on dust particles in the air and travel on unwashed hands and contaminate other cultures. It became an enormous controversy. In the midst of that, one group of scientists tracked down Henrietta’s relatives to take some samples with hopes that they could use the family’s DNA to make a map of Henrietta’s genes so they could tell which cell cultures were HeLa and which weren’t, to begin straightening out the contamination problem.
So a postdoc called Henrietta’s husband one day. But he had a third-grade education and didn’t even know what a cell was. The way he understood the phone call was: “We’ve got your wife. She’s alive in a laboratory. We’ve been doing research on her for the last 25 years. And now we have to test your kids to see if they have cancer.” Which wasn’t what the researcher said at all. The scientists didn’t know that the family didn’t understand. From that point on, though, the family got sucked into this world of research they didn’t understand, and the cells, in a sense, took over their lives.
How did they do that?
This was most true for Henrietta’s daughter. Deborah never knew her mother; she was an infant when Henrietta died. She had always wanted to know who her mother was but no one ever talked about Henrietta. So when Deborah found out that this part of her mother was still alive she became desperate to understand what that meant: Did it hurt her mother when scientists injected her cells with viruses and toxins? Had scientists cloned her mother? And could those cells help scientists tell her about her mother, like what her favorite color was and if she liked to dance.
Deborah’s brothers, though, didn’t think much about the cells until they found out there was money involved. HeLa cells were the first human biological materials ever bought and sold, which helped launch a multi-billion-dollar industry. When Deborah’s brothers found out that people were selling vials of their mother’s cells, and that the family didn’t get any of the resulting money, they got very angry. Henrietta’s family has lived in poverty most of their lives, and many of them can’t afford health insurance. One of her sons was homeless and living on the streets of Baltimore. So the family launched a campaign to get some of what they felt they were owed financially. It consumed their lives in that way.
What are the lessons from this book?
For scientists, one of the lessons is that there are human beings behind every biological sample used in the laboratory. So much of science today revolves around using human biological tissue of some kind. For scientists, cells are often just like tubes or fruit flies—they’re just inanimate tools that are always there in the lab. The people behind those samples often have their own thoughts and feelings about what should happen to their tissues, but they’re usually left out of the equation.
And for the rest of us?
The story of HeLa cells and what happened with Henrietta has often been held up as an example of a racist white scientist doing something malicious to a black woman. But that’s not accurate. The real story is much more subtle and complicated. What is very true about science is that there are human beings behind it and sometimes even with the best of intentions things go wrong.
One of the things I don’t want people to take from the story is the idea that tissue culture is bad. So much of medicine today depends on tissue culture. HIV tests, many basic drugs, all of our vaccines—we would have none of that if it wasn’t for scientists collecting cells from people and growing them. And the need for these cells is going to get greater, not less. Instead of saying we don’t want that to happen, we just need to look at how it can happen in a way that everyone is OK with.

By JC Bello Ruiz
The Ministry of Health of the Kingdom of Saudi Arabia is in urgent need of more than 6,000 healthcare workers according to the Philippine Overseas Employment Administration (POEA).

In a post on its website (www.poea.gov.ph), POEA said the KSA-Ministry of Health needs 2,000 female specialized nurses; 3,000 female general nurses; 200 male and female specialists; 200 male and female general practitioners; 200 female asst. pharmacists; 200 female physiotherapists; 200 female dental assistants; 200 female medical technologists; 100 female infection control nurses; and 100 male and female respiratory therapists.

The 2,000 female specialized nurses needed are those with specialization in Intensive Care Unit, Pediatric Intensive Care Unit, Neo-natal intensive care unit, Hemodialyis, OR, MS, ER, and cardiac nursing.

Applicants should be Bachelor of Science graduates with Board License (optional for RT; with at least 1.5 years of hospital work experience; not more than 55 years of age for doctors and not more than 40 years of age for other positions; and preferably with Saudi Council exams.

Also needed are 50 male bio-medical equipment technicians or hospital safety officers. Applicants should be BS Engineering graduates with or without board license; with at least two years hospital work experience and not more than 50 years of age.

The 100 female infection control nurses; and 100 male and female respiratory therapists; and 50 bio-medical equipment or hospital safety officers have been previously posted, POEA said.

Deadline for submission of application is on March 10, 2010.

“Qualified applicants may personally submit a detailed resumé with job description, school credentials, employment certificates, original and photocopy of the first page of the passport and six pieces 2×2 recent picture at the Manpower Registry Division, Window M, Ground Floor, POEA main office in Ortigas Avenue cor. Edsa Mandaluyong City or register online at www.poea.gov.ph or www.eregister.poea.gov.ph.

Applicants are advised to submit original documents if they submit the requirements in person. “Those who will register online will be asked to present original documents for authentification of written information before forwarding the resumé to the employer,” POEA said.

By Rose Eclarinal - ABS-CBN Europe News Bureau
Like Filipino nurses who leave the Philippines to find better job prospects elsewhere, UK’s home grown nurses are also leaving the country to seek opportunities abroad.

To replenish their workforce with only the best, some of UK’s National Health Service (NHS) hospitals are going further afield.

The Princess Alexandra Hospital NHS Trust confirms its recruitment in the Philippines.

“Here at Princess Alexandra, we want the best possible nursing staff that we can recruit. We can’t recruit everything we need from the locality or indeed from the UK. I’m quite excited about going to other parts of the world including the Philippines. Hopefully, lots of nurses will sign up and they will have a very warm welcome here when they arrive,” said the chairman of Princess Alexandra Hospital NHS Trust, Gerald Coteman.

Pinoy nurses as valuable assets

It is not the first time the hospital has recruited Filipino nurses to join its work force, and it very pleased so far with the nurses that have joined its work pool, especially with the quality of patient care and work ethics Filipinos have brought with them.

Executive Director of Nursing/Patient Care Yvonne Blucher said the compassion of Filipino nurses in dealing with patients also sets a good example for their colleagues. She added that Filipino nurses at the hospital are “actually valuable assets to the organization.”

“They are very thoughtful, considerate in patient care, they look at the holistic approach not just of the patients but also of the carers,” said Blucher.

“The NHS has very good experience in recruiting nurses in the past including those from the Philippines. We still have nurses here who were recruited some years ago, and that’s the case elsewhere in the NHS, so we are very pleased to be able to go back to the Philippines to see if we can get more nurses to come and work in our hospital,” said Coteman.

‘Every area would accommodate Filipino nurses’

As a growing organization, there are various opportunities in the hospital for Filipino nurses, such as vacancies in critical care, theatres, the general wards like emergency medicine, emergency trauma, surgery, and pediatrics, among others.

“Every area would actually accommodate Filipino nurses, every specialty, we could probably accommodate, currently.”

“But they have to be of a certain caliber, of a certain standard that actually fit in with our (organizational) values,” said Blucher.

Nelia Jalandoni applied for work at the Princess Alexandra Hospital in December. She is now taking the adaptation course in the hospital. She said all the processing fees, including visa application fee and airport tax, were covered by the agency.

“Masyadong mabilis, actually. Nag-apply ako sa kanila, online lang. Pinadala ko yung curriculum vitae ko, right there and then tumawag sila sa akin, nag schedule ng interview. All it took was just 2 weeks, actually,” said Jalandoni.

Jalandoni is also happy with the continuous support she’s getting both from the hospital and the agency that facilitated her application.

100 nurses needed

Jai-kin Resource has inked the contract to provide 100 nurses to the hospital. But its Operation Manager, Nancy Cunniff is apprehensive that she might not be able to deliver the number on the agreed dates. She said recent applicants in the Philippines are not meeting some of the most basic requirements of the NHS Trust. Applicants are falling short of the mandatory IELTS score, which is a score of not lower than 7 for all the areas in the test for international English language proficiency.

“Ang major na problem nila ay yung pagpasa nila ng IELTS. They should have 7 score in reading, writing, listening, speaking, and once they are qualified, they can apply for NMC kasi yan ang number one requirement,” said Cunniff.

Cunniff clarified that the average score of band 7 for all the areas will not suffice.

Apart from the IELTS, a minimum of 2 years clinical experience in a hospital setting, medical and NBI clearance are also required. If applicants have met these requirements, Jai-kin will help them apply for their Nursing and Midwifery Council (NMC) qualification in the UK.

She is looking at bringing the successful applicants to the UK in 3 installments: by the end of February, last week of April and mid July.

Interviews set for February

Louise Barnes, who is the head of Elderly Care and June Barnard, Matron of the hospital are flying to the Philippines to lead the screening process.

They said interested applicants need to sell themselves to compete for the vacancies.

“I think it’s important that they are sure with their communication skills. Communication is very important in the way that they are dealing with the public, with the family especially in the hospital environment when people are suffering from stress, etc. so it’s very important that people’s communication skills are very good,” said Barnard.

“They should have a degree of self-confidence because obviously it’s going to be daunting coming across the UK and working in a new environment,” said Barnes.

They are a little bit too shy. They have the clinical knowledge but too shy in challenging us, the medical team,” she added.

The hospital has done it in the past and it is doing it again. Its recruitment of foreign nurses, which aims to diversify its workforce and cut the shortage of staff means opportunities for work in the UK for Pinoy nurses.

But the chairman said what is imminent is not just employment for Filipino nurses but a chance to grow both personally and professionally in a culturally-diverse working environment.

“It’s a partnership. It’s not just telling our staff what they need to do to develop. It’s also asking them how they want to develop, where they see themselves in 3, in 5 year’s time. We can have that discussion and we can decide and we can support their aspiration in terms of development,” said Coteman.

This new class of caregiver is booming, and quite unregulated

When Esther Heckbert told her mother she wanted to leave the Philippines to work as a babysitter abroad, her mother was leery. “She said, ‘babysitter? You’re done university!’ ” The two were folding laundry at their home in Isabela. Esther, who has a degree in business administration, had high hopes. “I said, a babysitter abroad can make a lot of money. From there, you can upgrade yourself: you can get citizenship.” For decades, thousands with the same profile—young, female, Filipino—have come to Canada to work as babysitters. Twenty-five years since arriving, Esther has helped rear dozens of Canadian tots: first as a nanny and then as the owner of a nursery school. But a few years ago, she sensed a changing wind.

She left babysitting behind, sought retraining, and now works under a more whimsical title: granny nanny.

She joins a growing rank of babysitters-turned-eldercare workers: a nod to shifting demographics. In 2008, just under 14 per cent of the Canadian population was over 65; it will be more than 25 per cent by 2044. At the same time, seniors are increasingly shunning the option once pressed on them: nursing homes. Now, most care to frail, older adults is provided outside facilities, says Norah Keating, human ecology professor at the University of Alberta. As more seniors stay home, we’re racing to import and train professionals to care for them. That dash has created a new class of caregivers, many of whom are undertrained, unregulated and unprotected—and with this a new set of problems.

A sizable chunk of that class comes through the same provision that allows us to bring in people to care for our kids: Canada’s Live-In Caregiver Program. Unlike other temporary foreign workers, live-in caregivers are eligible for permanent resident status after meeting program requirements. More than 100,000 have come since the LCP’s inception in 1992. Most are Filipino. Most stay for good. In the early years, the LCP was effectively a babysitter-recruiting apparatus for parents. But increasingly, seniors are turning to it for 24/7 live-in care. Back in the Philippines, women are catching on. Erwin Pascual, a Filipina immigrant who runs a private career college in Toronto, says more recruiters in the Philippines are marketing eldercare courses. “The demand started going up about seven years ago,” says Pascual. And supply has risen to match. By some accounts there is a backlog of applicants in Manila, biding their time.

It can be a treacherous wait. “There are so many bad agencies out there that are exploiting and taking advantage of these girls,” says Tova Rich, who runs the Family Matters Caregiver agency in Thornhill, Ont. Many charge the women “upwards of $10,000.” (The federal government is reviewing a bill that would ban charging caregivers recruitment fees.) Then there’s the problem of what Rich calls “phantom employers.” The LCP mandates a single-employer contract, and agencies may promise a candidate, and the Canadian government, a job that doesn’t exist, says Rich. By the time the woman finds out, she’s already paid the fee—or moved here. Last year Rich was asked by a Filipino caregiver to help her relative, a woman brought over for a bogus job who, without work, was forced to live in a basement owned by the agency. “We had to rescue this girl at like 10 at night,” says Rich. “We were horrified.

We went in and there were three or four mattresses on the floor. There must have been 10 or 12 girls, all talking and cooking. We said: pack your bags.”
That’s an extreme case. But the reality of Filipinas being recruited into the homes of sick seniors and asked to function as de facto nurses is in itself a sign of a subtler kind of exploitation, says Leah Diana, who works at the Philippine Women Centre of B.C. LCP applicants, she explains, need two years of post-secondary education and relevant experience.

And so, many are professionals: midwives, nurses, and even the occasional doctor. For Diana, that requirement, in combination with a system that makes it tough for foreign-trained nurses to get accredited, means we’ve created a flow of low-cost “unregulated nursing” into Canada. Employers seek out Filipino nurses through agencies, she insists: women who can monitor insulin levels and give injections, in addition to offering personal care. But officially the women are brought in as babysitters—and paid minimum wage. It’s why Diana’s group has launched an “End it, don’t mend it” campaign, aimed at scrapping the LCP. Playing on that slogan, Immigration Minister Jason Kenney has pledged to “mend the program, not end it.”

Deanna Santos, a lawyer of Filipino origin who advises live-in caregivers about their rights, likewise wants to do away with the LCP’s live-in requirement, as well as employer-specific contracts. Both, she says, can bind caregivers to abusive households. “Because of their desire to gain the prized permanent resident status, they endure abuses.” Allegations levelled last spring at Brampton, Ont., MP Ruby Dhalla brought some of these issues to the fore.

Caregivers working with Dhalla’s mother said they were forced to do chores like shining shoes and washing cars: tasks outside the purview of the LCP.

Dhalla has denied the charges. But lately, complaints of this sort have reached the ears of higher-ups. In December, the federal government offered proposals to revamp the LCP, including instituting an employer blacklist.

Of course, potential for abuse existed when the program focused on babysitters. But working with seniors can amplify strains. Dementia patients, for instance—a group projected to grow in numbers, according to a report released this week—are prone to violent outbursts. Albert Banerjee, a York University Ph.D. student, found 90 per cent of facility-based caregivers in Canada have experienced “physical violence.” The situation is similar in home care. Caregivers contacted for this story reported abuse ranging from racial assaults to getting punched in the face. “Many older people were raised in a generation where the Chinese were the enemy—or where blacks were seen as lesser people,” says Charmaine Spencer, a gerontologist at Simon Fraser University. “Many changed their attitude over the years.” But as they age, or develop dementia, “they lose their inhibitions.”

For all the pitfalls, Esther Heckbert found the eldercare field to be an attractive one. And so, a few years ago, as many former live-in caregivers do, she decided to advance to the next level: she enrolled as a student in a personal support worker (PSW) course. The official designation qualifies caregivers to work in nursing facilities, for one, where they provide basic care like bathing and meal preparation. Some Canadians are referred to a certified PSW by a doctor; in such cases their needs are assessed by the Canadian Association for Community Care, which allots an amount of subsidized care. Families can also approach agencies to hire one.

Thousands of Canadians get certified as PSWs each year. But even that process has its hazards, sometimes opening doors to unfit caregivers. Last year, a number of private colleges were busted for selling fake diplomas and graduating woefully unqualified PSWs. A Toronto Star story featured one school that passed students in weeks, versus the year it takes at an Ontario community college. Miranda Ferrier of the volunteer group PSW Canada says she’s had to “break the news” to PSWs that “they can no longer work [because] their certification is nothing. There’s no regulation,” she says. “None.” PSWs have no professional body, no counterpart to the College of Nurses. New trainees are not required to sit for provincial exams. The courses are not standardized, and can be taken at either community colleges or private schools. All this, Ferrier insists, leaves not only seniors, but also their caregivers, unprotected.

“The baby boomers are coming,” says Ferrier. “We need to be prepared. And we’re not close.” She started PSW Canada as a hopeful precursor to an official college. But the Health Professions Regulatory Advisory Council rejected that idea in 2006, deciding Ontario PSWs should not be regulated.

“HPRAC also concludes that the closest alternate form of regulation—a personal support worker registry—should not be implemented,” the report noted. “They said they already belong to agencies and there is a kind of oversight through that,” says SFU’s Spencer. The other view, she says, was that PSWs are too poor to support a regulatory body. “It was kind of a Catch-22. Because without a regulatory body they weren’t in a position to improve their conditions.”

On the job, PSWs are rushing to meet growing demand. Pat Irwin, an eldercare consultant, describes many agencies as “body shops of people,” where hordes of exhausted caregivers are pushed from house to house. The typical time slot for care is one hour. Kirsten Elder, an Ontario PSW, describes a shift: just enough time, if she moves speedily, to give her clients “a bath, make them something to eat, medication reminders for most. Once they’re dressed, the paperwork. That’s usually the hour.” The pay: around $13.

For many granny nannies, whatever their designation, it’s a labour of love. Esther Heckbert, for instance, has a few tricks for working with dementia patients. “I sing. And while singing, I do my work.” What songs? “I have to know the person! I’ll ask them what they like. We can sing together.” Kelly McHaffie, of PSW Canada, still finds time to nickname patients: like “Chickadee,” the lady who eats like a bird. This year, one of McHaffie’s beloved patients died. She went in on her days off to care for the woman: “I got into bed with her. And she put her arms around me and we laid there together. It was comforting for her.”

But often, in the rush of one-hour time slots, the “chemistry” gets lost, says Irwin; agencies are too focused on the “great market opportunity.” Irwin’s inspiration for her career in eldercare consulting—her own father’s struggle to find care—is admirable. But it’s hard not to flinch at what she calls herself: a “rent-a-daughter.”

By Rose Eclarinal
Fifteen Filipinos in Worcestershire, England lodged a complaint against the Healthcare Training Academy (HTA), a college offering Non-vocational Qualification (NVQ) courses, including Caregiver diploma, in Kidderminster, Worcestershire.

They claim they have paid the full tuition fee for their relatives in the Philippines to study in said college but none of them were able to come to the UK.

They are blaming HTA for failing to produce the necessary documents for the issuance of the student visa of their relatives. They also alleged that HTA wittingly misrepresented itself as a ‘legitimate college’ when, in fact, it is not accredited by the Accreditation Service for International Colleges or ASIC to accept foreign students.

‘I have been totally fooled’

Clive Marshall-Lewis is married to a Filipina. He was keen on helping his wife send her nephews in the Philippines to a recognized college in the UK. He found out about HTA and decided to enroll his nephews in the school.

“They offered a complete package: the people will be inducted in the Philippines, then they will come over here to study and all the visas and all the legalities will be dealt by,” said Marshall-Lewis.

He paid a total of £3,200 for the enrolment of his 2 nephews. But both nephews were not granted student visas to study in the UK. To this day, he is waiting for his refund from HTA.

“I’m English and I’m dealing with English people in my own country and I have been totally fooled. So what chance do other people have who are vulnerable, have no visas? This is the disgusting part of it. They are preying on people who are not familiar with our country and our ways and only wants the best life for themselves,” said Marshall-Lewis.

Eden Sumagpao had the same hopes for his relatives. He works as nurse in the UK and he wanted his relatives to complete a Caregiver diploma at HTA. He paid some £6,000 for three enrollees.

In the contract and receipts he showed ABS-CBN Europe News Bureau, the payment package for 3 students includes full tuition fee for the whole year, meet and greet facility at Birmingham Airport where the students will be collected, transportation to the accommodation, daily transfer from accommodation to college, and initial accommodation for the first four weeks.

But like Marshall-Lewis’ nephews, Sumagpao’s relatives were not issued student visas. They failed to come to the UK and attend classes at HTA.

“Same reason ang binibigay ng school (HTA), sinasabi nila na ang papers ay kulang at naghihintay na lang sila ng registration,” said Sumagpao.

Sumagpao decided to enroll his brother-in-law in another college in the UK late last year. He said he did not encounter the same problem he had with HTA. His brother-in-law is now in the UK, studying not in HTA but in another college. The payment he made to HTA has yet to be recovered.

Lourdes Gadose and Nenita Edge both paid a total of £2,000 for the enrolment of their respective relatives at HTA.

“They said if you pay cash, instead of £3,000 you only pay £2,000. So I paid £2,000. Na- check din namin sa internet na wala pala silang license,” said Gardose.

Harassment and failure to pay wages

Jurita Nicolas and Soledad Olarte were former students of HTA. They also have cousins in the Philippines who applied to study at HTA.

The 2 decided to transfer to another college when Nicolas’ cousin was interrogated by an Immigration Officer at a UK airport after entering the country from the Philippines. Nicolas’ cousin was also informed by the same Immigration officer that HTA requires the necessary permit and accreditation to operate. When the HTA management learnt about the airport incident, the 2 were allegedly “belittled” and harassed.

“Sabi sa amin, dalawa kami–you Filipinos, you know nothing (about the law here). Masakit sa dibdib,” said Nicolas.

“Sana huwag na rin silang mag-apply sa agency na partner ng HTA sa Pilipinas. Kasi yung iba nangungutang pa. Kawawa naman sila, di ba? Pinapangakulaan lang na ganito, ipapadala daw ang legal papers, wala naman,” said Olarte.

To this day, HTA has not issued them certificates for the previous courses they have completed at the college.

It was a different story for Babeth Aduana. She thought she hit a jackpot when HTA offered her a job to teach at the college. She was also promised that her student visa will be converted to work permit. But her visa was renewed. She also did not receive portions of her salary from HTA.

Aduana’s work contract shown to ABS-CBN Europe News Bureau stipulates that her work commenced on March 2, 2009.

“Ang nangyari, after a month, pinasuweldo ako. Then after 2 months, di na kami pinasuweldong mga empleyado. At nalaman pa namin na di nila nai-file ang aking visa na due for renewal,” said Aduana.

No Accreditation

The Filipinos found out much later that HTA, at the time that it was recruiting foreign students, was still in the process of securing accreditation from ASIC.

ASIC is a regulatory body for colleges in the UK that are accepting international students. Without the ASIC accreditation, HTA should not have recruited or accepted international students.

The Pinoy complainants said the “no accreditation” status of HTA is the crux of the visa problem for its potential students back in the Philippines.

In a separate investigation conducted by ABS-CBN Europe News Bureau, ASIC’s CEO, Maurice Dimmock confirmed that HTA is not accredited with ASIC.

The list of ASIC accredited colleges is also posted in its official website.

ABS-CBN Europe News Bureau also invited HTA to answer some allegations made against them, but it has not replied to the registered mail, e-mail, phone calls and various efforts made to reach its management.

Courts favor complainants

Nenita Edge decided to bring the matter to the courts of law in the UK. She filed a claim at the Kidderminster County Court to recover the money she paid HTA.

The decision handed out by the court in October favors Edge. The court ordered HTA to pay Edge a total of £2033.32, which includes interest.

In a separate claim lodged by Babeth Aduana at the Employment Tribunals in Birmingham, the Employment Judge ordered a payment of a little over £2,000 for “unlawful deduction of wages.”

Both Aduana and Edge are still awaiting payment from HTA.

Eden Sumagpao shows the receipts of payment for tuition fee from HTA/Photo courtesy of Rose Eclarinal, ABS-CBN Europe News Bureau

Trading Standards confirms investigation

The Filipinos who claim they have been “duped” also lodged a complaint against HTA at the Trading Standards, a regulatory body for fair trading in the UK.

In a letter sent to ABS-CBN Europe News Bureau by John Dell, Division Manager of Trading Standard Service in Worcestershire County Council, it confirmed that an investigation is on-going.

“I regret that I am unable to give you any specific information on HTA other than the fact that we are investigating complaints made against them by Filipino students.”

“The complaints are being investigated for alleged offences under the Consumer Protection from Unfair Trading Regulations and possibly other legislation.”

“On conviction, the maximum penalty under the above legislation is a fine and up to 2 years imprisonment with compensation to any victim,” the letter said.

The Filipino complainants said they were enticed to enroll their relatives in HTA because of the good package and promo offered by the college to international students. But they failed to investigate and look into some details that could have avoided this problem.

As baby boomers continue to require more medical care as they age, the number of nurses needed to meet their needs may not be found.

Currently, the average age of a nurse in Ohio is 48. In addition, roughly four in 10 nurses nationwide will retire in the next 10 to 15 years.

One of the reasons is a lack of instructors.

"Over 40,000 qualified individuals were turned away from nursing programs and the reason is because we have max enrollment within all of our programs," said Andrea Lindell, Dean of the UC College of Nursing.

Lindell says the situation at her institution is in-line with the nationwide outlook.

"Our college of nursing in a seven year time period went from approximately 700 to 800 nursing students to 1,800," said Lindell. "We are filled to capacity because of the availability of our resources and the number of qualified faculty we have to teach."

So as more people require care but have fewer caregivers to treat them, Debbie Boerschig, a Nurse Practitioner for UC Health, fears the level of care will slip.

"Errors, I mean that would be the biggest thing I would be afraid of is making errors," said Boerschig.

Nursing numbers did come up this year with the economic downturn. More people entered the field and more people delayed retirement. Experts, however, say the growth will likely be short-term and will not be sustained when the economy recovers.

Lindell suggests the time is now to find a solution to the problem.

"I am very concerned that if we do not look to the future and plan for the future as to how we provide resources to establish a broader based number of nurses we will be increasingly faced with waiting for the qualified nurse, the professional nurse, to provide the quality of care that we're used to," said Lindell.

Copyright 2009 The E.W. Scripps Co. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.

Tomorrow when we ring in the New Year we’ll also be ringing in the International Year of the Nurse. No kidding. The designation honors the centennial of the death of Florence Nightingale (she died on August 13, 1910). It launches at noon everywhere on January 1 with the Million Nurse Global Caring Field Project, a “global meditation” led by noted nursing theorist Jean Watson, and events will continue throughout the year.

Most of you were probably aware that the United Nations had developed eight Millenium Development Goals (MDGs) that nations should achieve to end poverty and improve the health, education, and quality of life of their peoples. Three of the eight goals are specifically focused on health, but the others all have an impact on health one way or another.

The target date for achieving the goals is 2015, but as countries have implemented programs to achieve these goals they’ve become acutely aware that, without nurses in sufficient supply, they will fall short. For example, how do you reduce the maternal death rate during childbirth if there are few skilled health professionals to provide prenatal care or assist at births? How do you treat TB and HIV when there are no health workers to dispense and monitor drug therapy?

The Florence Nightingale Museum, the Nightingale Initiative for Global Health, and Sigma Theta Tau International are collaborating on the initiative and seek “to recognize the contributions of nurses globally and to engage nurses in the promotion of world health, including the UN MDGs.” This coincides with the work of the World Health Organization (WHO) Office of Nursing and Midwifery over the past few years to increase the visibility and importance of nurses’ roles, both within the WHO and in its member countries. (Here’s my report from the May 2008 WHO meeting.) At the 2010 General Assembly in May, when member nations gather in Geneva, they will consider a resolution reaffirming the crucial role of nurses and midwives in advancing health.

One event to mark the year is a special commemorative service on April 25 at the National Cathedral in Washington, DC. (Details will be forthcoming at this Web site.) Why not plan a road trip with colleagues—attend the service, reflect on the importance of what we do as nurses, and then celebrate with your friends and colleagues.

Nurses work hard every day. When was the last time you took time to think about what you do and the difference it makes to those who are at the receiving end of your knowledge and skill? If you can’t make it to DC, what are you going to do to honor what you and your colleagues do every day?

Lieutenant-Colonel Maureen Gara, who has died aged 93, had an exacting and adventurous career in wartime field hospitals and afterwards was a distinguished military nurse.

On June 14 1944, after the first Normandy landings, Maureen Gara, a Nursing Officer with 79th General Hospital, left in a convoy to set up a large field hospital at Bayeux. On the way to Southampton, people from towns and villages which had been devastated by German bombing cheered her and her colleagues through the streets.

After a sleepless night on the troopship, she clambered down a scramble net into a landing craft, only to find that rough seas prevented the vessel from reaching shore for four hours.

She spent her first night on land in trenches with a 24-hour ration pack for sustenance. There was a battle raging outside Caen, the racket was tremendous, and the ground shook beneath her.

At 10 o'clock the following morning, trucks took her to the site for the hospital. The place was buzzing with troops – Pioneers, Reme, Sappers and Royal Army Service Corps. The marquees were up, generators were humming, boiling water was bubbling in huge cauldrons, kitchens had been assembled and trenches dug.

Crates were unpacked and an enormous Red Cross laid out. By four o'clock in the afternoon, the first casualties were arriving. Four hundred came in that night.

Mary Anne Gara, always known as Maureen, was the eldest of seven children in a family of subsistence farmers. She was born in rural Ireland, near Carrick, County Donegal, on January 18 1916. Her mother died suddenly and Maureen's aunt took over care of the family, leaving the girl free to pursue her ambition to become a nurse.

Maureen went to a convent school and won a scholarship which enabled her to continue studying beyond the age of 14. After qualifying at a training school in Manchester, she volunteered to join the reserve of Queen Alexandra's Imperial Military Nursing Service (QAIMNS) and, in December 1943, was sent to the 79th General Hospital at Watford.

It was a mobilisation unit housed in the dreary, dark buildings of a St Agatha's orphanage. Gara was met by a woman in full battledress, boots and gaiters who trained her and the other nurses in military medical procedures, tentage and drill. The first task was to make up 600 bed rolls in readiness for deploying as a field hospital at the front.

In April 1944, she moved to Peebles Hydro, Scotland, where she trained in chemical warfare and mountaineering. In May, the hospital moved to East Anglia with a large concentration of troops ready for D-Day. In her spare time, she and other nurses were sent out on to the lawns to sew a huge red cross made out of hessian.

The surgeons in the hospital in Normandy, she said afterwards, were the best that Britain could provide. Casualties had to be kept moving so that there were always trestle tables available. There was an airstrip nearby and an efficient evacuation system was organised.

Penicillin was regarded as the new miracle drug but in emergencies there was not time to test patients for allergic reactions. On one occasion, a soldier that she was treating had a violent reaction to the drug and reached for a scalpel to kill himself. Only with great difficulty did she prevent him doing so.

The alarm was raised one night when movement was spotted in bushes near the sleeping quarters. The hunt for a suspected prowling German soldier was called off when the real culprit, a stray cow, poked its head into Gara's tent.

While she was in Normandy, she used to watch the Luftwaffe bombers flying overhead on bombing raids. They deliberately avoided bombing the hospital area and one particular aircraft with distinctive markings always dipped its wing as it passed over the hospital. Some years later, at an event in Germany, Maureen Gara mentioned this. One of the pilots present said: "Madam, that was my plane."

In September, Gara moved with the hospital to Holland for the battles of Arnhem and the Rhine crossing. On the way, she stopped in Brussels for her first proper bath since leaving England.

After the war, she applied to join the Regular QAIMNS, later designated the Queen Alexandra's Royal Army Nursing Corps (QARANC), and was posted to India. She subsequently served in the Middle East, in Singapore and at the Commonwealth Hospital, Terendak, Melaka, Malaysia, where she was deputy matron.

In 1967, she was promoted lieutenant-colonel and posted to the QARANC training centre as chief instructor. Two years later, she was awarded the Royal Red Cross for excellence in military nursing and she moved to the Queen Alexandra Hospital, Millbank, as matron. She retired in 1971.

Settled in the Aldershot area, she became involved with the Normandy Veterans and Queen Alexandra Associations and served as a trustee and subsequently chairman of the latter for a total of 11 years. She never lost her love of her native Ireland and its traditional music – her father and two of her brothers played the fiddle. She also enjoyed travelling and went on several world cruises.

In 2004, to commemorate the 60th anniversary of D-Day, a stamp of St Vincent and the Grenadines was printed in her honour.

Maureen Gara died on October 19. She never married.

Registered nurse Shirley Cooley, right, helps nursing student Anna Hung-Chan give a vaccine to a newborn at Mount Carmel East hospital on the Far East Side.

The bad economy might make it seem as if there's no shortage of nurses in central Ohio, but experts say the situation is temporary.

"We are seeing nurses who might have been considering leaving the profession, ready to retire, and they're not doing that," said Janice Lanier, deputy executive officer of the Ohio Nurses Association.A recent report from the Health Policy Institute of Ohio projects that Ohio is one of three states, along with Texas and California, that will have the greatest need for nurses in a decade.

Researchers expect Ohio to be short 32,000 nurses by 2020.

Besides an aging population with more chronic medical conditions, impending health reform could mean that 1.3 million uninsured Ohioans will have insurance.

"They can start coming into (medical) practices, and what's that going to do to the demand on getting in?" said William Hayes, president of the policy institute. "We have to be ready for the need."

Advanced-practice nurses, including nurse practitioners, could provide newly insured people with primary medical care.

"Just because we don't have the shortage hitting us over the head every day now, we should not take it off the policy plate," Lanier said.

There are more than 2.4 million registered nurses in the United States, making it the largest health profession. The average age of an Ohio nurse is 47, and the median age of a nursing faculty member is 51.

Nursing schools still have waiting lists, but that's because there are not enough faculty members to train future nurses, experts say.

Plus, some local hospitals aren't hiring nurses the way they did a few years ago because of the economy.

Sarah Strohminger, a junior at MedCentral College of Nursing in Mansfield, said she knows of nursing graduates who could not find work in Mansfield or Columbus.

Strohminger, president of the Ohio Nursing Students' Association, said she plans to work as a patient care assistant at MedCentral to get her foot in the door at the hospital.

Ann Schiele, president of the Mount Carmel College of Nursing, said all 160 nurses who graduated from there in May have found jobs.

"It may not have been their first position of choice … but by August every student that I was aware of had a position," she said.

Ohio State University Medical Center, which hasn't made the cutbacks that other local hospital systems have, continues to hire nurses, including at least 140 new graduates every year.

"There is not a shortage in central Ohio of new grads, but there will always be a shortage of specialized nurses," said Karen Bryer, director of medical-center recruitment at Ohio State.

Specialized nurses include those trained to work in intensive-care and neonatal units, and advanced-practice nurses such as nurse anesthetists.

Schiele expects the local hiring lull to end in about three years, and then there will be an immediate need for nurses. By then, aging faculty members will be retiring.

"It's all very important that we get the funding to educate the faculty in the master's and doctoral programs," she said.

That's where state officials could come in. The state could help pay off student loans or provide grants, tuition assistance for nurses who want to teach, or a refundable tax credit for nursing faculty members.

There have been some state policy moves to address the shortage.

These include changing the Nurse Education Assistance Loan Program in the state's budget bill this year to forgive student loans of nursing master's students who teach nursing at an Ohio school, Allison Kolodziej, Gov. Ted Strickland's spokeswoman wrote in an e-mail.

Lanier said policymakers shouldn't wait until hospitals complain that there aren't enough nurses.

"There's nothing worse from a patient-safety perspective than having an entire floor staffed with brand-new nurses," Lanier said. "You need to have that mix."

shoholik@dispatch.com

NEW YORK (CNNMoney.com) -- America could be facing a nursing shortage that will worsen exponentially as the population grows older.

The problem: Baby boomers are getting older and will require more care than ever, taxing an already strained nursing system.

America has had a nursing shortage for years, said Peter Buerhaus, workforce analyst at Vanderbilt University School of Nursing in Nashville, Tenn. But by 2025, the country will be facing a shortfall of 260,000 RNs, he said.

"In a few short years, just under four out of 10 nurses will be over the age of 50," said Buerhaus. "They'll be retiring out in a decade. And we're not replacing these nurses even as the demand for them will be growing."

That's because nursing schools are already maxed out.

"We've got to find another portal to bring nurses into the profession," said Claire Zangerle, chief executive of the Visiting Nurse Association of Ohio and former chief nursing officer at the Cleveland Clinic. "We don't have enough nursing instructors, so therefore the capacity of nursing schools is very limited."

The nursing profession has benefited from the recession, which has prompted new nurses to sign up for school and older nurses to postpone retirement, Buerhaus said.

Some 243,000 registered nurses entered or re-entered the profession during the recession that began in 2007, he said, including many who were forced out of retirement by financial difficulties.

But as the economy improves that kind of growth is unlikely to continue. And experts stress that there will be a nursing shortage even if every nursing school is at capacity.

A lack of teaching staff is the biggest hurdle to minting new RNs, according to Cheryl Peterson, director of nursing practice and policy for the American Nurses Association

"The problem on the supply side is that our current nursing education capacity is at its limit," she said. "[Nursing schools] are pumping out about as many as they can."

Dr. Mary O'Neil Mundinger, the dean of Columbia University Nursing School in New York, said the number of applicants jumped 20% this year to about 400. She said the roster includes professionals seeking a career switch from Wall Street, law and even the opera.

"Making choices between these extremely well qualified applicants is really daunting," she said, noting that the school has capacity for only half the applicants.

Indeed, Claire Zangerle from the Visiting Nurse Association of Ohio said her niece spent two years on a waiting list before getting accepted into a nursing school.

It's hard to recruit and retain nursing instructors when they can usually make more money working in a hospital.

The average starting pay for an RN is about $56,000, according to the American Nurses Association. Mundinger said that the most ambitious graduates can earn as much as $90,000 if they're willing to work long hours, including weekends and night shifts, in busy metropolitan hospitals.

"They need to pay nursing faculty a wage that is attractive enough," said Peterson of the ANA, "You have nurses working in hospital units who are making more than the nurses in education."

Barry Pactor, international director of global health care for consulting company HCL International, agrees that more nurses should be trained within the U.S. system. But as a short term solution for this "huge shortage," he said the U.S. government should loosen immigration restrictions on foreign health care workers.

"I don't see this as foreign nurses taking American jobs, because these are vacancies that already exist and cannot be [filled] by nurses currently in training," he said. "We'd be filling in the gaps until the training can catch up with the demand."

The frantic knocking of home health nurse Orphia Wilson startled the boy's parents awake just after dawn.

Their 3-year-old son, who suffered from chronic respiratory failure and muscular dystrophy, had stopped breathing.

The boy's mother raced to his side and began performing CPR as Wilson stood by. It was too late. Jexier Otero-Cardona died at a Hartford, Conn., hospital the next day.

In the months that followed Jexier's May 2005 death, Connecticut health officials discovered that Wilson had fallen asleep, then ignored -- or possibly turned off -- ventilator alarms that signaled the boy was not getting enough oxygen, state records show.

And Jexier, they learned, was not the first child to die under Wilson's care. Seven months earlier, she had lost her registered nursing license in Florida for similar lapses in the death of another boy in 2002. In that case, 21-month-old Thierry LaMarque Jr. had stopped breathing while Wilson was caring for him at her Orlando home. Instead of calling 911, she tried CPR, then drove the boy's limp body three miles to his parents' house.

"She said she panicked," recalled the boy's mother, Glenda Brown, who was summoned home and found her dead son still strapped into his car seat. "Why would you bring him to my house if he passed at your house?"

Wilson's case highlights a dangerous gap in the way states regulate nurses: They fail to effectively tell each other what they know. As a result, caregivers with troubled records can cross state lines and work without restriction, an investigation by the nonprofit news organization ProPublica and The Times found.

Using public databases and state disciplinary reports, reporters found hundreds of cases in which registered nurses held clear licenses in some states after they'd been sanctioned in others, often for serious misdeeds. In California alone, a months-long review of its 350,000 active nurses found at least 177 whose licenses had been revoked, surrendered, suspended or denied elsewhere.

Such breakdowns are readily fixable. Yet state regulators aren't using their powers to seek out this information, or act on what they find, the investigation found.

Florida officials, for instance, didn't notify Connecticut authorities when they sanctioned Wilson -- even though she'd told them that she also held a Connecticut license. And Connecticut's nursing board renewed Wilson's license three times after Thierry's death, relying on her pledge that she hadn't been disciplined or investigated elsewhere.

By simply typing a nurse's name into a national database, state officials can often find out within seconds whether the nurse has been sanctioned anywhere in the country and why. But some states don't check regularly or at all.

The failure to act quickly in such cases has grave implications: Hospitals and other healthcare employers depend on state nursing boards to vouch for nurses' fitness to practice.

"It only takes one outlier to end up killing a bunch of patients," said Robert E. Oshel, who retired last year as an associate director at the federal agency that runs discipline databases on health providers. "The fact that the vast majority of nurses don't cause problems and are fine professionals . . . doesn't mean you shouldn't be very vigilant against the few who aren't."

State practices vary

Because there is no federal licensing of nurses, each state sets its own standards on punishable behavior.

In general, states can discipline a nurse based solely on the actions taken by another state. But they vary widely in how quickly -- or harshly -- they act on this information, according to interviews with regulators in 14 states.

Under the law in Virginia and Louisiana, for instance, officials must immediately suspend nurses' licenses for serious misconduct in another state. Nurses are barred from practicing unless they successfully appeal.

Missouri, on the other hand, must personally serve all accused nurses with written charges and offer hearings to contest them. If nurses can't be found, their licenses remain clear and they are free to continue practicing, said Lori Scheidt, executive director of Missouri's nursing board.

Delays in several states left Craig Smart free to practice. In 2000, he surrendered his license in Florida after testing positive for cocaine and flunking a treatment program. It took eight years for five other states in which he was licensed to respond to Florida's action. California was the last to revoke his license, in 2008, after he had practiced here for several years, apparently without incident.

Even when states share borders, they sometimes fail to heed each other's disciplinary actions. At least 10 nurses, for example, hold clear licenses in Massachusetts despite being disciplined next door in Rhode Island, including suspensions for drug thefts and violence.

Nurse Karen Rheuame's Rhode Island license was suspended in 2007 after she was arrested on suspicion of assaulting a woman in a wheelchair in a hospital emergency room and trying to steal her pocketbook, according to state disciplinary records. She also had numerous other convictions and, records show, had once brought two beers to work, which she explained to her boss were for "the ride home."

But she's free to practice in Massachusetts. A health department official there said regulators are reviewing Rheuame's case and others to see if action is warranted, but they haven't received any complaints about the nurses in Massachusetts.

Rheuame said she'd made mistakes but has completed rehabilitation for addiction. "I'm not going to minimize what I did," she said. "I've really turned my life around since then."

There is ample information available for states to identify nurses disciplined by other jurisdictions. Two separate databases attempt to track disciplinary actions from every state. States are required to report to one, run by the federal government, within 30 days of taking an action. Reporting to the other, operated by the National Council of State Boards of Nursing, is voluntary.

Each database can be programmed to alert a state whenever a nurse it has licensed runs into trouble in another state.

When checking a nurse's record, nursing officials say they almost uniformly use the council's database; it's free and the government's is not. In fact, federal statistics show that nursing boards accessed the government database fewer than 300 times total in 2007 and 2008.

In addition, ProPublica and The Times found that the federal database is incomplete, despite the requirement that all states report discipline to it. Many actions appeared to be missing when reporters tried to match known cases by date of discipline to a version of the database in which confidential information had been removed.

Some regulators are vigilant, while others are not.

Louisiana, for example, checks the council database every day for discipline involving its nurses, its board director said. Rhode Island does it once a month, an official said.

New York, by contrast, uses it primarily to look into the backgrounds of people applying for nursing licenses. It typically does not check it for problems involving the 266,000 registered nurses already licensed to practice in New York.

Barbara Zittel, head of the New York board, said she relies on other states to notify her if one of her nurses has been disciplined and she counts on the nurses themselves to honestly disclose their problems. It works, she says, "unless someone is lying to us."

Officials at the National Council of State Boards of Nursing said they don't tell nursing boards how often to consult their database. But tools are there to help them. State boards imposing discipline, for instance, can send out warnings known as "speed memos" to flag other states.

But the council's database continues to have significant weaknesses. Nearly all states report their disciplinary information to the council, according to its website. Yet only 37 states and the District of Columbia supply it with the names of all their licensees.

As a result, it's difficult for regulators to know who is licensed in the 13 other states, including California, and when to alert them about discipline. Those states account for more than 40% of the nation's approximately 3.5 million registered nursing licenses.

The council cannot force states to submit names, and states have a financial incentive not to: They make money by charging nurses to verify their licenses, test scores and training to authorities in other states. For example, a nurse licensed in California who wants credentials to practice in Arizona must pay California $60 to confirm her background. Those sorts of checks netted California nearly $1 million in fiscal 2009. New York, which charges $20 a check, earns more than $250,000 a year.

When states turn over their lists of licensed nurses to the national council, that group earns such verification fees. "The decision to join is a revenue loss for them," said Kathy Apple, the council's chief executive officer. "That's difficult for some states."

Barbara Morvant, executive director of Louisiana's board, said the trade-off was worth it. After the board submitted the names of all its licensees last year, it saw an immediate upswing in the number of disciplinary actions it discovered.

"While it was a loss of revenue to our state, it was a benefit to the public," she said.

To estimate the scope of the problem nationwide, ProPublica and The Times searched the records of the nation's largest state, looking for examples of nurses licensed in California who had been disciplined elsewhere.

California's Board of Registered Nursing has historically done little on its own to ferret out such problems. Until last year, the state did not even ask nurses renewing their licenses whether they had been disciplined by another state.

Moreover, the board only checked nurses' records against the council's database of disciplinary actions when they applied for a California license. Since August, California also has been checking the database when the board begins an investigation of a nurse.

Sanctions found

Reporters went further, checking the full roster of 350,000 licensed nurses against a public version of the council database. They found that at least 643 California nurses had sanctions elsewhere, including the 177 whose licenses had been revoked, suspended, denied or surrendered.

Among them are:

* Jose Martinez, who surrendered his license in Texas in July 2008 after being accused of performing a rectal exam on an 11-year-old girl without a doctor's order or a witness present. In a letter to the Texas board, Martinez acknowledged his misconduct. "Yes, I made a mistake and, yes, I am guilty. After 4 years as a tech and 12 years as a nurse I slip and fall. . . . I guess I deserve what is coming to me."

His California license is active, without restrictions, and does not expire until July 2010.

* Jeffrey Strong, whose license was indefinitely suspended in Virginia in September 2008 after he allegedly left his post at a hospital psychiatric ward with the medication cart unattended. He had previously been disciplined for medical errors at another hospital in the state, including failing to monitor a patient who fell and as a result required emergency surgery.

"I was not providing safe care on that unit at that time and could not now," he wrote the Virginia nursing board in December 2007 about that earlier discipline. Strong has a clear license in Florida as well as California.

* Randy Hopp, who was convicted in 2004 of assaulting a nursing home resident in Minnesota. It was the fourth facility since 1998 at which he had been accused of mistreating a resident, records show. The nursing boards in Minnesota and Missouri placed him on probation, and Kansas imposed restrictions on his practice. Hopp surrendered his license in Texas. In California, his license remains clear.

Martinez and Strong could not be reached for comment. Hopp declined to comment, saying the discipline was in the past. Reporters could not determine if or where they and others in this article were working, because this information is not collected by most states.

Asked about this article's findings, California officials said regulators will now check for out-of-state discipline for every licensee by the end of March. At its February meeting, the nursing board plans to discuss additional steps to better use the council's database.

California is also working to speed up the pace of discipline.

In the past, the board took a median of 13 months to file public accusations against nurses after their licenses were first revoked, surrendered, denied or suspended by another state, according to a review of 258 such cases since 2002.

Three of these nurses got work and stole drugs from California hospitals after they had surrendered their licenses across the border in Nevada for previous wrongdoing there.

Experts and regulators say the patchwork nature of nursing regulation in the country underscores the importance of a complete national database. State regulators should be required not just to submit their licensees, they said, but to routinely check to see if their nurses have been disciplined elsewhere.

Currently, only information about completed sanctions is available. Some experts say formal accusations, detailing charges against nurses, should be included too. "The more information that's available as quickly as possible and shared as fully as possible . . . the better off you are," said Oshel, the former federal official.

Such efforts might have kept Orphia Wilson from moving easily from Florida to Connecticut. Within days after Florida regulators revoked her license in October 2004, they reported the action to the federal government's database. Sometime later, the information was put into the council database.

As is their practice, however, Florida officials didn't report their action to other states. Connecticut, as is its practice, did not regularly check the national databases.

The next year, Wilson once again renewed her Connecticut license, checking "no" when asked if she had been disciplined elsewhere.

Wilson, who did not respond to requests for comment, wrote in a sworn statement to investigators later: "I am very sorry about the deaths of the babys I cared for. Believe me I went through my share of guilt."

The month after Jexier's May 2005 death, she was back at work, as a supervisor in a Connecticut nursing home.

Connecticut suspended Wilson's license in June 2006 and revoked it several months later. The nurse was sentenced to jail last year for reckless endangerment and hiding her Florida discipline from Connecticut.

In an e-mail response to questions, a Connecticut health department spokesman blamed Wilson for hiding her past, and said communication among states has improved.

Christopher T. Godialis, who prosecuted Wilson for the Connecticut chief state attorney's office, said a system that relies chiefly on the honesty of such nurses does so at its peril.

"The way the situation is set up now, there's no way for Connecticut to have known about what happened in Florida unless Orphia had told them," he said. "The state didn't check anything."

BAY NEWS 9 -- With the currently shortage of nurses in Florida, many students are studying for a career in nursing.

But that's led to another problem: classrooms don't have enough space to accomodate all the students who want to pursue nursing as a career.

A new nursing school called Nursing Career Connections has initiated an online program, where a student can become an LPN after completing classes and a four-month trip to the Phillipines for clinical work.

The Florida Center for Nursing says by 2014 there will be more than 36,000 new nursing jobs available, but nowhere near enough people to fill those jobs.

Watch the Story

Filipino nurses are reportedly choosing other countries over the United States for employment. “The deepening recession in America has clearly diminished the desire of some Filipino nurses to seek employment there,” said former senator Ernesto Herrera, secretary general of the Trade Union Congress of the Philippines (TUCP).

Herrera said that a total of 8,272 Filipino nurses sought to practice their profession in the US by taking the National Council Licensure Examination or NCLEX for the first time from January to June. 

The figure, according to Herrera, was 1,565 fewer compared to the 9,837 who took the exam in the same six-month period in 2008.

Pinoy nurses are reportedly trying out other foreign labor markets particularly the United Kingdom and the Middle East.

“Actually, fewer nurses from India, Korea, Canada and Cuba are seeking US jobs as well,” Herrera said.

Nurses from India who took the NCLEX for the first time in the first semester were down 56 percent (to 750 from 1,715). Those from South Korea were down 35 percent (to 613 from 934); from Canada down 36 percent (to 314 from 494); and from Cuba down 38 percent (to 192 from 309).

The TUCP said that the four countries are the other top suppliers of foreign nurses to America.

In the whole of 2008, there were a total of 20,746 Filipino nurses who took the NCLEX for the first time or down 3.5 percent compared to the 21,299 Pinoy nurses that took the test for the first time in 2007.

Filipino accounted for 37 percent of the 22,500 foreign-educated nurses who took the NCLEX for the first time in the first semester, according to Herrera.

The Philippines now has some 600,000 nurses actively looking for jobs here and abroad, or forced to perform work outside their profession. They include the 99,837 who passed the local nursing licensure examinations from July 2008 to July 2009.

The government tapped 10,000 of the Filipino nurses and deployed them under the Nurses Assigned in Rural Service (NARS). It allows nurses to serve in the country’s depressed municipalities for six months in return for a monthly allowance of P8,000. - via www.abs-cbnnews.com

The U.S. nurse shortage is getting worse, but are more visas the answer—or would improved training capacity, working conditions, and pay do the trick?

For more than a decade, the U.S. has faced a shortage of nurses to staff hospitals and nursing homes. While the current recession has encouraged some who had left the profession to return, about 100,000 positions remain unfilled. Experts say that if more is not done to entice people to enter the field—and to expand the U.S.'s nurse-training capacity—that number could triple or quadruple by 2025. President Barack Obama's goal of expanding health coverage to millions of the uninsured could also face additional hurdles if the supply of nurses can't meet the demand. 

Some lawmakers are looking to the immigration pipeline as one means to raise staffing levels. In May, Representative Robert Wexler (D-Fla.) introduced a bill that would allow 20,000 additional nurses to enter the U.S. each year for the next three years as a temporary measure to fill the gap. If the bill doesn't pass on its own, lawmakers may include it in a comprehensive immigration reform package. Obama is slated to meet with congressional leaders on June 25 to discuss reforming U.S. immigration laws. 

Hospital administrators such as William R. Moore in El Centro, Calif., a sparsely populated town 100 miles east of San Diego, see the Wexler bill as a potential life raft. Moore is chief human resources director at El Centro Regional Medical Center, a 135-bed public hospital that typically has 30 open positions for registered nurses (RNs). While it's hard to lure nurses from nearby big cities (San Diego is 100 miles west), Moore says he could quickly recruit dozens of eager, qualified nurses from the Philippines if the government allocated more visas. "All we want is temporary relief," says Moore. "Let us get a group of experienced RN hires from the Philippines, and we won't ask for more."