The serious shortage of registered nurses in the United States has led many employers to recruit foreign nurses to fill the ever-widening staffing gap, a trend that is likely to persist for many years.

The recruitment of foreign nurses and healthcare workers by the United States and other developed countries has grown to such proportions that it is affecting the sustainability of entire health systems in some developing countries, depriving them of knowledge, skills and expertise—often at the expense of governments that have paid for the education of these nurses.

While the right of foreign-born nurses to pursue economic opportunity is unquestioned, there is a delicate balance between the human resource needs of developed countries such as the United States, the rights of the individual nurse to better him or her self economically and contribute to his or her family’s financial well-being, and a collective concern for the strained and desperately needy health systems of the exporting nations.

Several organizations have called for programs in which the receiving countries would pay restitution to the countries from which the nurses and health professionals have emigrated. Others have called for tighter regulation on recruiting practices.

Many nurses come into the U.S. through the H-1B visa program. The number permitted entry through this program is negotiated as part of the General Agreement on Trade in Services (GATS), an international agreement signed by the U.S. in 1995.

Currently the U.S. has committed to permit up to 65,000 persons annually to enter and work in the U.S. under our H-1B visa program. Employers who hire H-1B visa nurses must meet certain requirements as specified in GATS—they must  pay the prevailing wage, not use foreign-born nurses to undermine domestic labor conditions, show they have not laid off domestic workers and are working to recruit U.S. workers, have notified U.S. workers they are applying for H-1B workers, and have no strike at their enterprise.

The U.S. services industry, along with other World Trade Organization (WTO) countries, has proposed creating a GATS visa that would allow workers to work temporarily in any other WTO country on the basis of the employment law of the worker's home country.

This would mean that a nurse could work in the U.S. under an employment contract that specifies that she will be paid $2 an hour, must work mandatory overtime, can be fired for getting pregnant and can be fired for union organizing. Under the GATS visa proposal, such a contract could stand as long as it complies with the originating country's labor laws, even though such a contract would clearly violate U.S. law.

Here you will find the AFT Healthcare program and policy council's position on immigration and healthcare workers, as well as documents regarding the GATS and the fight for fair and equitable labor practices concerning foreign healthcare workers.