Health Care/Joan Retsinas

A New Colonialism, A New Raw Material: Nurses

The United States is desperate for nurses. Since COVID, the American Nurses Foundation reports that as many as 100,000 nurses left their hospital-employers, with an estimated 200,000 staff (including nurses, physical therapists, and assistant-level staff) leaving nursing homes.

Nursing homes especially cannot lure enough “native-born” workers to fill slots.

So we import them.

Today we shudder as Middle Eastern potentates import labor from Asia. Those indentured workers live in sometimes horrific plights, unable to leave easily, bound by poverty and regulations to employers.

For decades we Americans have lured? surreptitiously hired? low-wage (often lower-than minimum wage) workers to harvest our crops, run our factories, mop our floors - jobs that without that influx might go unfilled. (See the film “A Day Without A Mexican” to get the drift.). Most of those workers have had few marketable skills, and were desperate to leave their homelands.

With nurses, we have reset that colonial mindset to modern times. We need trained workers to staff our nursing homes and hospitals. We don’t pay high enough wages to attract enough of our native-trained nurses.

So we lure those workers, generally women. They come to work in well-paid (from their vantage) occupations here. Consider the Philippines. In the late 1800s, American hospitals established training regimens that mirrored those in the United States. For decades nurses trained in the Philippines have come here. And for decades both the employers and the workers have recognized the mutual benefit. Today nurses come from around the globe, including India, Mexico, Jamaica, Nigeria and Haiti.

Now, as American nursing homes grow desperate, the recruitment has turned ugly. Wages below the legal standard in the United States. No overtime pay. “Free housing” that translates into an empty room in a nursing home. Too few staff for too many patients — a mismatch that endangers both staff and patients.

An NBC exposé spotlights the abuse: “Trapped at work: Immigrant health care workers can face harsh working conditions and $100,000 lawsuits for quitting.” The recruiters have trapped the women in a maze of multi-year contracts, with exorbitant penalties for leaving. The penalties may be illegal, but the women don’t know that; and those penalties frighten the women, trapping them into conditions that a federal court likened to human bondage.

A penalty for leaving is not inappropriate: the recruiter and hospital/nursing home incur expenses for immigration filing, for temporary housing, for airfare. But while staff report accepting and paying penalties for breaking a contract (in one instance, a nurse repaid the $16,000 stipulated in her contract, yet faced a lawsuit for much more), the recruiter can levy an additional fine, threatening “legal action.” A threat of a $100,000+ lawsuit can cement a worker in an unsafe job.

Solutions: the State Department reviews green card applications. The Department of Labor enforces labor regulations. Congress enacted the Trafficking Victims Protection Act to protect nurses from egregious lawsuits. And some industry groups, like the Alliance for Ethical International Recruitment Practices and the American Association of International Healthcare Recruitment have weighed in.

Yet the legal morass is a gray area, one that our nursing homes are exploiting, as we redefine colonialism for this post-COVID era in healthcare.

Joan Retsinas is a sociologist who writes about health care in Providence, R.I. Email joan.retsinas@gmail.com.

From The Progressive Populist, August 15, 2023

Populist.com