Unfair Treatment of Immigrant Nurses Needs to Be Addressed, New Commentary Says

WASHINGTON, D.C. (Jan. 22, 2020) – Lawmakers have the opportunity to improve labor conditions within the international nurse-staffing industry by adding employment rules to a bipartisan bill currently under debate in the Senate, concludes a commentary published today in the New England Journal of Medicine.

The Fairness for High-Skilled Immigrants Act, currently pending a vote in the U.S. Senate, would remove caps on employment-based visas from any single country and reserves 4,400 employment-based visas for immigrant nurses. If signed into law, the proposed legislation would be a win for the international nurse-staffing industry, but may also exacerbate current unfair labor practices, writes Patricia (Polly) Pittman, PhD, FAAN, the commentary’s author and a professor of health policy and management at the George Washington University Milken Institute School of Public Health (Milken Institute SPH).

International staffing agencies often recruit workers from low-income countries with limited employment options. The workers contractually agree to low-paying jobs that make it difficult for them to leave later on. Nurses who do try to leave are often sued by the agency, leading to garnished wages and seized bank accounts.

“There is a unique opportunity right now to address the unfair treatment and exploitation of many immigrant health care workers,” Pittman said. “Under the current standard industry practices, nurses are forcibly retained by staffing agencies for about three years by way of exorbitant contract breach fees that labor migration experts compare to debt servitude.”

In September 2019, a court decision shed light on the unfair practice when a federal judge ruled that a New York nurse-staffing agency unfairly treated more than 200 nurses recruited from the Philippines. The court ruled that the agency violated the Trafficking Victims Protection Act by including unlawful provisions in the nurses’ contracts.

In the commentary, Pittman and co-author Adam R. Pulver, JD, an attorney at Public Citizen Litigation Group who has represented immigrant nurses in staffing-related cases, write that the proposed legislation in Congress could address the unfair treatment if they consider “five key measures for any legislation authorizing additional visas for international nurses.”

“Our experience speaking with and working with nurses shows that agencies rely on foreign nurses’ unfamiliarity with the U.S. legal system to get them to agree to contracts that no American nurse would,” Pulver said. “These are commonsense measures that Congress should pass now.”

The five measures are 1) No recruitment or contract-breach fees are permitted, with U.S. government visa fees paid by employers; 2) Employment contracts should last no longer than one year; 3) Nurses should have a job at a specific organization and location identified by the agency before arriving in the United States; 4) The job should begin within one week of the nurse arriving in the United States; and 5) contracts should not prohibit nurses from taking legal action against the agency if needed.

“Recruitment and staffing agencies should compete in a fair and free labor market with competitive wages and safe working conditions,” Pittman said. “No health care worker should be subjected to such unconscionable practices.”

The commentary, “Unethical International Nurse-Staffing Agencies — The Need for Legislative Action,” was published Jan. 22 in the New England Journal of Medicine. The authors’ views expressed in the commentary are their own and do not represent their affiliated universities or institutions.