With Multiple Degrees and a Stable Job – Why Do They Still Leave?

I recently received an application from a Philippine-based RN ‘dreaming’ to work in US. The application packet, although complete and very professionally prepared, was sent through the applicant’s mother’s friend’s friend — infamously and laughably a common cultural practice in the Philippines that seeped its way into the modern workplace and overseas. Known as the ‘padrino system’ or patronage,  this is a system where one primarily gains favor through family affiliation  or friendship  before an applicant’s merit. 

The applicant is initially a BS Biology graduate of one of the best universities in the country, of which entries to both the system and the course program are cut-throat battles in the Philippine academe. Yet despite the laurels, the applicant immediately  went back to school after graduation and took up BS Nursing. Armed with this new degree, he simultaneously applied to reputable hospitals in Metro Manila while diligently preparing for the exam administered by the Texas Board of Nursing. Bright and determined, the applicant succeeded in both: got a much desired job in a famous modern hospital and passed the Texas Board exam for nurses in one take. Unfortunately for the applicant, the visa classification for RNs and professionals is on retrogression so US is definitely not in the applicant’s horizon. Unfortunately for the Philippines, if not the United States, there will be other Western countries that will employ him. Unfortunately for all the developing countries in the world such as former African colonies, Carribean Islands, East Germany, Soviet Union, India,  the case is not isolated in the Philippines. These countries’ brain drain is a brain gain to most highly developed North American, European and Asian countries.

For more info on retrogression, click here for our previous post.

This biologist turned RN wanting to work in US is a classic case of brain drain. Brain drain aka human capital flight is the not only the departure of educated or professional people from one country, it can also be from one economic sector, or field for another, usually for better pay or living conditions. Brain drain is often associated with de-skilling of emigrants in their country of destination, while their country of emigration experiences the draining of skilled individuals. Worse, a lot of these professionals emigrate to another country taking with them a fraction of value of their training sponsored by the government or other local organizations. They can’t be blamed though. They move to countries where their highly marketable skills are  financially rewarded.

Just to better illustrate the disparity in compensation, below is an official rate sheet of an RN working in an Upscale hospital in Metropolitan Manila.

The current market rate of an RN working in an Upscale hospital in Metropolitan Manila. 





















Cut this by half or third, and that’s the approximate salary of RNs working in less prestigious hospitals. Some RNs don’t even get paid and many others pay the hospital in order to get work experience.

This is the salary equivalent in US dollars based on $43.00-Php 1.00 exchange rate. 

Salaries in converted to US dollars.








Illustrated below is the estimated annual compensation  of Med-Surg and CCU RNs in Metro New York as published by http://www.salary.com. A Med Surg nurse’s median annual salary is $76, 937 ($6,412/month) while a CCU nurse gets $ 77, 303 ($6,442/month) based on a 35-40 hour work week. 


Visa Retrogression – What does it mean to professional immigrant workers?

Before June of this year, there were two major visa categories that are popular among professional immigrant workers: the H1b Visa aka work visa and EB2 or the greencard route.

H1B visa is a non-immigrant visa that allows US employers to temporarily employ professional foreign workers in specialty occupations. On the other hand, EB2 Visa is a permanent residency route for professionals holding advanced degrees (Ph.D., master’s degree, or at least five years of progressive post-baccalaureate experience) or persons of exceptional ability in sciences, arts, or business.

Unfortunately, the USCIS has announced that the 2013 H-1B visa cap has been reached as of June 11th. Any cases received after June 11th will be rejected and returned with filing fees uncashed. However, the rejected and would-be applicants may file again next fiscal year. The next blow is that the July 2012 visa bulletin shows that the ‘worldwide EB2′ visa category has retrogressed almost 3 years. This is the one category that remained consistently ‘current’ in recent years (together with EB1).

What happens now?

Photo from http://redbus2us.com. Edited by author.

For more information about RETROGRESSION, click this link.

For USCIS Visa Bulletin, click here.

What does RETROGRESSION mean to professional immigrant workers and their employers? This could mean long waiting times for green cards.  This means job employment offers need to be rewritten or  projects be off-shored.  In uncertain cases such as this, not much can be done than to persevere and tuck growing disappointment. There are surely other legal routes to continue working in America while hoping that these two visas will be available again soon.

US immigration system is not ideal and reform is essential to ensure Uncle Sam does not lose talented people to help boost the economy and create jobs.Right now, all that is left to do is wait. Let us see what the future has in store.

SOURCE: http://www.uscis.gov

Disclaimer: This is a post written from a layman’s perspective and should not be regarded as an immigration advice.  For valid legal advice, consult an immigration lawyer.

Factors Affecting Tenure of Nurses

In this post some recurring patterns that may affect the duration of stay of nurses working in a facility are enumerated. These observations are derived from our interactions and involvement with different healthcare facilities mostly in the Tri-State area.

1. PsychologicalNurses, at the time of hire, may not be psychologically equipped to deal with pressures coming from work. Upon hire, recruits usually show the best of themselves and recruiters are given very little clue as to how one would fare at work.

♦What we do to counter this concern is to perform a multilayered assessment process that doesn’t just focus on credentialing, but also pays attention to attitude and personality clues of our candidates.

♦We work closely with the HR of a facility in pre-qualifying candidates. We usually send the facility representative several pre-qualified candidates to select whom she thinks will work out best for the facility.

♦Another tool we use is an Evaluation Form that functions as ‘check and balance‘ for the healthcare facility and agency. For the nurse, a regular evaluation reaffirms his work, leading to greater confidence in himself and his work that ultimately benefits everyone in the equation.

2. Personality and Culture. A big question is matchingIs the nurse, personality-wise, matched to the culture of the new workplace? In culturally diverse workplaces such as New York City where customs and traditions are fanned alive by immigrants, the ‘standard’ becomes confusing. Add to that the variety of patients’ cases, situations and other factors that come into play further blurring the lines between the acceptable and what is not.

♦We have a culturally sensitive recruitment procedure that looks deeper into a candidate profile. Insights drawn from our deliberations are then used to match our retinue of nurses to facility needs and requirements.

3. Education. A lot of local schools did not prepare the nurses for real-life work situations. Nurses, especially the new ones, have these preconceived ideas of what the ideal work setup should be as shown in media (i. e ER, Grey’s Anatomy, Nurse Jackie), which they unwittingly bring to the workplace. Comparison of their ideal versus the reality results to confusion, disappointment and in some case, extreme disgruntlement.

♦What we do to counter this issue is to let the nurses undergo our uniquely designed orientation that is most often customized according to facility requirements. This orientation covers the basics such as scheduling, policies, facility idiosyncrasies, documentation and many more. The objective is to let the nurses be given an overview of the setup of the facility of assignment. As early as possible, we proactively address all predictable issues and manage the expectation of nurses in these sessions.

4. Work EnvironmentSeveral environmental dynamics come into play as well. Factors such as union policies, lackluster attitude of ‘regular workers’ towards ‘agency workers’, minor politics, cultural insensitivity of some parties, difficulty adapting to technology required in modern patient care tasks, gaping difference in rates and benefits between regulars and agency workers, and many other factors are likely to affect the employment duration of a nurse.

One glaring example is in one huge geriatric care facility where we placed nurses that were given 2-day orientation as opposed to the 2-week to a month-long orientation of directly hired nurses. The agency nurses had some apprehensions about continuing work at the at the facility because of lack of orientation. They further reasoned that they were frequently on ‘float status’, thus requiring more orientation days in order to avoid any unwanted incident that may cost them their license.

♦The best answer here is preparation.  As mentioned earlier, a nurse that has been prepared right beforehand has a higher likelihood of staying committed to a place of assignment.

5. Options. Once issues are not resolved timely, any worker would seek other opportunities. Fortunately for nurses, they have numerous options at bay that may look like the cure-all to their employment ails. So once dissatisfied, they would rather leave than take the excruciating process of correction. The handling agency should have foresight and proactive ability in managing the issues in a timely manner.

Our office is always open to suggestions on how we can further improve our services. We customize our services according to a healthcare facility’s current setup, preferences, and situation. We are available for consultation. Email me at mprimero@meridiannurse.com for an appointment.

Happy Father’s Day!

Switching Roles

The man’s name is Rommel. Rommel’s routine everyday included dropping and picking up 3 kids in school, and running errands, making the house tidy, preparing meals, doing the laundry  in between. His wife is a successful nurse practitioner who works full time in a large New York hospital and serves as consultant in several other healthcare facilities. She leaves at 7 am and goes home past 8 every night. After she parks the car in the house garage, the exhausted and work-weary wife turns to the TV until she falls asleep. Rommel, who just took out the dishes from the rack, then makes sure the children are ready for bed. With the children in slumber, he can then prepare the things he need to survive the following day before he goes to bed.

This is Rommel’s life. There are more husbands like him today. They are slowly redefining the word ‘father’. Roles are being switched by occupational demands and requirements, but fathers will always be fathers in our hearts.

Happy Father’s Day!

Happy Mother’s Day from Meridian Nurse Recruiters Staff and Friends!

Culture at Work

“Culture is about societal norms, communication preferences, and global outlook. At the organizational level, this includes which leadership styles are most effective, and how workers interact with each other. In dealing with customers, it’s about understanding customer segmentation, digital readiness, and inclination to participate.”                                                         

From How to Engage Your Customers and Employees

Wang, Ray. “How to Engage Your Customers and Employees.” Harvard Business Review. 9 May 2012. Web. 10 May 2012.

Healthcare – Online Application Form

Talk to a job counselor about your career options. Simply fill out this form. Explore your options and develop your career plan for free!

You may also email your resume to jobs@meridiannurse.com

Can A Nurse Be In Two Places At Once?


A 92-year-old woman with heart failure, pulmonary fibrosis, anemia, and other problems came to the emergency department with viral pneumonia. Once her condition stabilized, she was transferred to the cardiac care unit (CCU).

Still in the CCU 2 days later, the patient got out of bed, even though both side rails were up, the footboard was on the bed, and the nurses had warned her to stay in bed. The nurses’ notes indicated that she was confused.

The next day, reports on the patient’s mental status varied. At 8:30 a.m., her physician assessed her and didn’t find her condition serious enough to order restraints. At 12:30 and 2:00 p.m., the nurse documented that the patient thought she was at home. When the nurse checked her at 3:20 p.m., however, she was alert and oriented. Thirty minutes later, she was on the floor. Her right hip was fractured.

The patient underwent an open hip reduction and internal fixation and was discharged 10 days later. Using a walker, she was able to walk with assistance. After three follow-up examinations, the fracture had healed and the patient didn’t have pain.

Seven months after her admission to the hospital, the patient was readmitted for numerous disorders, including sepsis, renal failure, and acute pulmonary edema. She died 9 days later. Her children sued the hospital, the physician, and the nurse for negligence regarding their mother’s fall.

In court, the testimony revealed that the nurse had been assigned exclusively to this patient. However, after she had checked the patient at 3:20 p.m., a code was called on another patient. Hospital policy also required her to respond to the code, so she left her patient for 30 minutes.

A jury found in favor of the plaintiffs and awarded them $555,000 in damages. Although the defendants appealed, the appeals court upheld the decision but reduced the amount to $500,000.

The lesson? Nurses are vulnerable even when they follow the rules. By adhering to the facility’s policy, this nurse was drawn into a no-win situation.


Credits: This article was referenced from http://www.nso.com/nursing-resources/article/25.jsp

How the Experts Would Fix Health Care – Businessweek

People are living longer. Life-threatening diseases have been eliminated. What were once considered medical miracles are now commonplace procedures. Yet there’s a near-universal sense that the U.S. health-care system is a heaving mess, rife with errors and injustices. It’s expensive, too. By 2020 related costs will reach an estimated $4.6 trillion, nearly 20 percent of gross domestic product. So how do we fix health care? That’s the question Bloomberg Businessweek Chairman Norman Pearlstine put to our esteemed panel: Dr. Ralph de la Torre, chairman and chief executive officer of Steward Health Care System; Dr. Gregory Curfman, executive editor of the New England Journal of Medicine; Gail Wilensky, economist and senior fellow at Project HOPE; Ronald Williams, former chairman and CEO of Aetna; and Jonathan Bush, CEO, president, and chairman of Athenahealth. Their conversation has been condensed and edited.


Pearlstine: Is it possible, given the culture of the U.S., to change the way we implement health care and impose some things that have worked well overseas?

Williams: In Europe, there’s a notion of solidarity. If you’re 80 years old and you do not qualify for a hip replacement, it’s OK as long as your neighbor does not qualify for a hip replacement. In the U.S., [it’s] “I’m going to get mine or you’re going to hear from my attorney.” We have to have a thoughtful, mature debate recognizing there are limits to the country’s resources and care should be delivered based on the physician’s judgment.

Fix This/Health Care panelists

Wilensky: The horse has left the barn when it comes to using what other countries have done. A lot of what they do is not only to have a [central] budget, where there is a decision by the national government how much should be allocated for the national program of health care, but they have direct controls on all the stuff that costs money. We have a plethora of everything that costs money—specialists, freestanding MRI centers, many freestanding ambulatory centers. That’s going to be very hard to rein in. God help the politician who tries.

De la Torre: At this point it’s hard to tell whether the culture created the structure or the structure enabled the culture. But we do have a problem in both. What we’ve done is create a system that has 2,600 physicians intertwined with our 12 community hospitals who completely share risk upside and downside and share quality upside and downside. And so we begin to align incentives to provide the appropriate care.

Wilensky: The problem in health care that you don’t have in other industries is that you’re mostly using somebody else’s money. It’s not that you can’t have market-based incentives, but it makes it much more difficult. Even if you have high-deductible plans, anybody who has any serious medical problem, i.e., enters a hospital for any reason, is going to blow through any threshold you set up. Which means you’re either using third-party payment in the private sector or you’re using government parties. And that’s why the notion of trying to have people with aligned incentives is so important.

Williams: I do believe this is where the private sector will move much faster than the federal government. We don’t need Congress. We can enter into a relationship with a hospital system, and before I left Aetna we had signed up with 12 different systems to collaborate and share data with the notion that the hospital can do well by moving people down the spectrum of care and improve the quality with reduced costs. The problem we have is in alignment. If a hospital has a CAT scanner, and it can reduce the use of that CAT scanner but not generate enough revenue, it’s a self-defeating activity.

Bush: What we’re good at—better than Norway—is we like situations where there are many buyers, many sellers. We love that stuff. We love Groupon (GRPN). We love to shop for an edge. But in health care we don’t get to. If you look at the claims in AthenaNet—all of these tests and all of these encounters—if the patient could take home $20, what percentage would they be more than happy to handle over the phone? What percentage would they have happily done not downtown but on Route 9 at the mini-mall? It’s a big percentage.


Where can technology help?

Curfman: I think what you’re referring to is health information technology and whether there is money to be saved by putting electronic medical records in place and transferring medical information among caregivers more efficiently. Some doctors are rather resistant to this.

Wilensky: You’re not rewarded for doing it.

De la Torre: The biggest cost of pulling AthenaNet or any other electronic record into a doctor’s office is not the cost of the record. It’s an incredible productivity hit to the physicians who are already strained by decreasing reimbursement. All of a sudden in the first six months, they plummet. We see productivity drop 30 percent across the board while we first deploy it.

Are there things on the horizon that simplify that process?
Bush: We don’t do anything over the Internet. Aetna was a huge early mover—how you got it going, I don’t know, Ron—but I’d say literally 25 percent of all of the federal standard transactions that have been created by fabulous committees over the generations are actually doable today electronically. [Yet] none are Internet-based. AthenaNet’s been doing very well, so we’re growing quickly, and other companies are starting cloud-based medical records. The nice thing about these is we’ve got everybody—30,000 doctors, 25 million patients—all in one database and we can reconcile. When we build one connection into one of Ralph’s laboratories, every doctor in Massachusetts who might want to use that lab can now go in with their accession electronically, see when the test is done, and find out when it gets back.

Williams: Technology adoption is not a technology problem—it’s a human behavior problem. And part of it will change as the new generation of physicians enters practice. They’ve grown up with technology. They think paper is strange.

Curfman: There’s no question that medical information needs to be made electronic. It’s going to improve care. I’m very doubtful whether we’re going to save a whole lot of money there.

Wilensky: Outside of health care, if you come up with a new technology, you don’t get any extra brownie points. If it does it better, you’re in. If it does it better and it’s more expensive, you’ve got to be able to convince the buyer it’s worth the additional cost. In health care we need to understand who exactly benefits and how much they benefit.

De la Torre: Our experience has been that health information technologies are probably not useful in 60 percent to 70 percent of patients. The patient who comes to see a doctor once a year doesn’t benefit tremendously. The 20 percent to 30 percent who utilize 80 percent of the resources, as Medicare data have shown, those are the people who need a lot of integration. Now, when you’re talking $30,000 to $40,000 to deploy an electronic medical record to a physician, another $15,000 for the IT hookup—those numbers applied to 70 percent of the patients who don’t actually benefit is what makes it hard to justify that expenditure. That said, people always tell me, “Isn’t part of the problem that all of this expense comes in the last six months of life?” And I say, “No. The real problem is that you never know when the last six months are.”

Bush: If you knew, you’d go have a scotch.

Curfman: The numbers are very clear. Ten percent of the population consumes 63 percent of the total health-care dollars in the country. One percent consumes 20 percent of the health-care dollars. Fifty percent of them consume nothing at all. So this is the issue, and we have to get a better handle on those 10 percent.

How much of that could be addressed through prevention?
De la Torre: You have to think of it as a spectrum. It begins with obesity, so you prevent obesity. You prevent obesity [in] a kid, and that prevents diabetes. Then diabetes begets peripheral vascular disease. Peripheral vascular disease and coronary disease beget congestive heart failure. Everyone agrees that investing in the beginning of the spectrum is going to yield tremendous benefit. But because we didn’t do that 10 or 15 years ago, we’re going to be paying for those ramifications now and we need to make an investment on top of that for the future. So for a while we’re going to be double-paying systems.

Do we overtest, or does testing actually lead to better diagnosis?
Curfman: The U.S. Preventive Services Task Force recently came out with a D rating for PSA testing for prostate cancer. They don’t recommend it for routine screening. And that recommendation has had zero impact. PSA testing continues, and we spend $3 billion a year only for the tests. But then there are all of the biopsies and the surgery that may follow, the cascade that’s initiated by the testing. We’re facing another issue just like this using CT scanning for lung cancer screening. We recently published in the New England Journal that routine regular CT scanning in smokers can reduce mortality from lung cancer by 20 percent. But how many of these scans do you have to do and at what cost? Uh, you have to do 1,000 scans to prevent one lung cancer death. These scans are quite expensive. Many will bring up false positive results, which brings more expense.

Wilensky: But you have to protect the hospitals and the physicians.

So health care won’t be fixed without tort reform?
Wilensky: Institutions and physicians who follow evidence-based medicine and have patient safety measures in place shouldn’t be liable unless they’ve engaged in criminally negligent behavior.

Williams: There needs to be some safe harbor for people who are following clinical guidelines, applying their own clinical judgment, not [doing] cookbook medicine.

De la Torre: You don’t actually believe that’s a solution to health-care reform? The core of the problem is at the foundation. The very way we deliver care in America is flawed. And until we tackle that foundation, we can talk about the fringe of whether we’re going to paint the walls white or green or whether we’re going to have nice terraces. It doesn’t matter. Our foundation is flawed.

If we’re going to look out a decade from now, what will make health care better than it is today?
De la Torre: We cannot stay in a revenue-driven system. We have to get to a system that tackles the cost side of the equation also. A necessary driver needs to be in place to get America to grapple with changing the way it consumes health care. The U.S. is about to insure everyone with the Affordable Care Act. The best thing about health-care reform as it’s currently passed is that it’s going to bring America near bankruptcy. It’s going to finally force us as a society to act. The bad side is, boy, if we don’t act we’re in trouble.

Bush: I’m bullish. There’s a future of cost reduction primarily driven by the fact that we’ve recessed our economy a little so we’re paying more attention to it.

Wilensky: Two things for me are reforming the payment system so you change incentives and reorganizing delivery systems so you can better achieve coordination.

Williams: We need more and better physician leadership. I think the work that people like Ralph are doing is critical, but you can probably count the institutions on both hands that have the demonstrated level of leadership to produce the type of care we would aspire to in terms of aligning incentives and reengineering the system.

Curfman: We have too much health care. Our health-care system needs to be smaller, and we need to be able to make wiser choices about the use of new technologies. And at the same time we have to place much more emphasis and align incentives on preventative health care.

For more video and conversation on Fix This/Health Care, visit: http://www.businessweek.com/fix-this/health-care.html.



via How the Experts Would Fix Health Care – Businessweek.


Physicians and hospitals must make websites more patient-friendly, study says – American Medical News

Accessibility is the key to a good consumer experience, especially for health care organizations.

By PAMELA LEWIS DOLAN, amednews staff. Posted March 5, 2012.

If physicians are planning to launch a new website or revamp an old one, a study says they’re better off not looking at other medical sites for inspiration — especially on how to write or present their content.

A study in the January/February issue of the Journal of Healthcare Management looked at what makes an effective website and measured how some of the nation’s hospitals and health systems are doing.

Consumers compare health system websites with other consumer sites such as Amazon and eBay, according to the report. That comparison can influence perceptions of the health organizations.

The study examined elements that contribute to a good website user experience, including accessibility, content, marketing and technology. Researchers analyzed 636 websites listed in the American Hospital Assn. directory. They used a webcrawler to assess the websites’ ability to be found on a search engine. The researchers used weighted, multi-item scales to assess each element based on current benchmarks. Websites were graded on each element, then an overall score was calculated.

The accessibility scale assessed ease of use; the content scale assessed overall quality of the content; the marketing scale assessed how readily information is found using search engines; and the technology scale looked at how well each site was designed.

Of all the elements that make a good consumer experience, accessibility is especially relevant to health care organizations, said Eric Ford, PhD, a study author and professor of business at the University of North Carolina, Greensboro. The study said accessibility is often lacking on health organization websites.

Health care organization websites need to reach as many people as possible, the study said. This means the content should be accessible to those with low computer literacy levels as well as those who have physical disabilities that limit their ability to use a mouse or who use nonstandard browsers.

“Given the service domain in health care, the issue of accessibility is all the more important,” the study’s authors wrote.

Ford said the general rule for most consumer sites is to write at an 11th-grade reading level. The study’s analysis found that many hospital sites write to a graduate degree level, he said.

He said many health care organization sites use jargon-heavy language that the average person has a hard time understanding. For example, some websites have data related to ventilator-acquired pneumonia, but they used only the acronym. Or they used “nosocomial infections” instead of the more understandable term “hospital-acquired infections.”

“While it makes sense to those of us who work in the field day in and day out, to the average person just trying to figure out what’s going on, it requires a fair amount of health care-specific knowledge and probably not where we need to be on the front page of most hospital websites,” Ford said.

The report notes that as more organizations serve as accountable care organizations, the accessibility of their websites will be even more important.

“If organizations are to serve as ACOs, then it stands to reason that consumers are going to use their websites as a portal to their personal health record as a means to coordinate care and as a tool for assessing provider quality,” the report said.

In general, Ford said, hospitals and health systems have “good, not great websites.” But they are gradually improving and have shown gains from a similar analysis a year ago, he said. Two areas he suspects will present challenges during the next few years are social media and quality reporting on the websites.

The importance of social media is growing, the report said.

“The absence of a Twitter account usually indicates that a website has no following in the social media domain,” the authors wrote. Ford said several organizations had Twitter feeds or Facebook pages, but they were very limited and not drawing much Web traffic.

via amednews: Physicians and hospitals must make websites more patient-friendly, study says :: March 5, 2012 … American Medical News.