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ADI 1Pointer/Symonds Lab Nurses Neg

Kritik Link: Otherization ............................................................................................................. 3

Turn: Racism ................................................................................................................................. 4

Racism Turn Extension ................................................................................................................. 5

Turn: AIDS ..................................................................................................................................... 6

AIDS Turn Link Extensions ......................................................................................................... 7



Aids Turn Link Extensions ......................................................................................................... 10

AIDS Turn Extensions ................................................................................................................ 11

Philippines Brain Drain Turn 1NC Shell .................................................................................. 12

Philippines Brain Drain Turn 1NC Shell .................................................................................. 13

Link: Brain Drain – Generic ...................................................................................................... 14


Link: Brain Drain – Recruitment Key ...................................................................................... 16


Link: Brain Drain – Philippines ................................................................................................. 18

Link: Brain Drain – Philippines ................................................................................................. 19

Link: Brain Drain – Filipino Economy ...................................................................................... 20

Link: Brain Drain – Economy .................................................................................................... 21

Link: Brain Drain – India ........................................................................................................... 22

Specific Link: Brain Drain – Philippines and India – Lifting the Cap ................................... 23

Internal Link: Economic Stability Key to Political Stability ................................................... 24

Uniqueness: No Filipino Nursing Migration Now .................................................................... 25

Uniqueness: Filipino Economy High .......................................................................................... 26

Uniqueness: Filipino Economy High .......................................................................................... 27

Solvency Answers: Doesn’t Solve Long-Term .......................................................................... 28

Solvency Answers: Alternate Causality – Poor Working Conditions ..................................... 29


Solvency Answers: Healthcare ................................................................................................... 30

Solvency Answers: Immigrant Nurses Fail ............................................................................... 31

Solvency Answers: Lifting the Cap Doesn’t Solve .................................................................... 32

Solvency Answers: Delay ............................................................................................................ 33

Healthcare Advantage Answers: Status Quo Solves the Aff ................................................... 34

Healthcare Advantage Answers: Status Quo Solves the Aff ................................................... 35

Uniqueness: U.S. Largest Importer of Nurses .......................................................................... 36

Domestic Nurses Counterplan 1NC Shell .................................................................................. 37

Domestic Nurses Counterplan: Solvency – Capicity/Funding ................................................. 38

Domestic Nurses Counterplan: Solvency – Funding ................................................................ 39

Domestic Nurses Counterplan: Solvency – Funding ................................................................ 40

Domestic Nurses Counterplan: Solvency – Education ............................................................. 41

Domestic Nurses Counterplan: Politics – Obama Loves It ...................................................... 42


Kritik Link: Otherization

Working visas fuel otherization which marginalizes the outsider

Drevdahl & Shannon 7(Denise, Kathleen, PhD RN, MN RN, Advances in Nursing Science

Vol. 30, No. 4, pp. 290–302 )Construction of some groups as being more valued and with more due respect and privilege than others occurs in all societies. Becoming the “other”36—the unwanted outsider—is a process that “defines and secures one’s own identity by distancing and stigmatizing an(other).”37(p1933) “Othering” serves to establish what is “normal” (us) and what is “abnormal” (them). Part of that process is seeing lower wage immigrants as abnormal in that they are rarely seen as individuals “with agency, skill or resilience, with capacity to contribute and be an asset to their new communities.”37(p1935) Instead, they are burdens to society who use up supposedly limited resources, including medical resources. Consequently, “othering” leads to negative emotions such as distrust, dislike, and resentment that then are linked to particular groups according to signifiers such as race, nation of origin, and language. Once an individual or group has been marked as “not us,” they are seen as existing on the outer boundaries of society, marginalized by the majority of that society.38 This positioning away from the Center (ie, dominant structures, policies, and other sources of power) generally means the marginalized have limited access to resources, are subject to differential treatment, and exert minimal social influence and authority.† Although Vasas claimed that “marginalized people are invisible to those in the Center,”38(p196)

this is not the case for the unwanted foreign worker. The Center is constantly reminded of the worker’s presence through such symbols as the fence being built on the US-Mexican border and the individuals who serve in the US Border Patrol. Individuals, social structures, and policies that maintain the Center also function to maintain the margins.38 Thus, immigration policies function to further perpetuate a process of “othering,” especially with unequal allocation of assistance in securing a work visa.


Turn: Racism

These nurses are susceptible to unfavorable working conditions and racial discrimination

Kingma 8(Mireille, PHD RN, OJIN: The Online Journal of Issues in Nursing. 13(2)).

One of the most serious problems migrant nurses encounter in their new community and workplace is that of racism and its resulting discrimination (Chandra & Willis, 2005). Incidents are, however, often hidden by a blanket of silence and therefore difficult to quantify (Kingma, 1999). Migrant nurses are frequent victims of poorly enforced equal opportunity policies and pervasive double standards. Some migrant nurses are experiencing dramatic situations on the job where colleagues purposefully misunderstand, undermine their professional skills, refuse to help, and sometimes bully them , thus increasing their sense of isolation (Allan & Larsen, 2003; Hawthorne, 2001; Kingma, 2006). If we recognize that international migration will continue and probably increase in coming years, the protection of workers is a priority issue and should be safeguarded in all policies and practices that affect migrant health professionals.

REJECT RACISM AT EVERY TURN:BARDNT 1991 (JOESEPH, MINISTER, DISMANTLING RACISM)To study racism is to study walls. We have looked at barriers and fences, restraints and limitations, ghettos and prisons. The prison of racism confines us all, people of color and white people alike. It shackles the victimizer as well as the victim. The walls forcibly keep people of color and white people separate from each other; in our separate prisons we are all prevented from achieving the human potential that God intends for us. The limitations imposed on people of color by poverty, subservience, and powerlessness are cruel, inhuman, and unjust; the effects of uncontrolled power, privilege, and greed, which are the marks of our white prison, will inevitably destroy us as well. But we have also seen that the walls of racism can be dismantled. We are not condemned to an inexorable fate, but are offered the vision and the possibility of freedom. Brick by brick, stone by stone, the prison of individual, institutional, and cultural racism can be destroyed. You and I are urgently called to join the efforts of those who know it is time to tear down once and for all, the walls of racism.


Racism Turn Extension

It is unfair to bring who the US needs and kick out who it discriminates as being ‘unskilled’

Drevdahl & Shannon 7(Denise, Kathleen, PhD RN, MN RN, Advances in Nursing Science

Vol. 30, No. 4, pp. 290–302 )

Having adequate numbers of RNs to care for an increasingly older and potentially frail US population accelerates immigration processes for those qualified professionals deemed to be in short supply. However, the same immigration officials do little to provide manual/low-wage laborers with similar opportunities. In fact, substantial resources are expended in either preventing the immigration of many low-wage workers or deporting them back to the originating countries. One such attempt is illustrated by a March 2007 arrest of 360 immigrant workers at the Michael Bianco Inc factory, a military contractor. The workers were primarily from Central America and constituted the majority of the 500-person factory work force.30 Since many families were unaware of the raid, family members just seemed to “disappear,” with working parents (including single parents) separated from their children, and children channeled into social service agencies. The Washington Post reported that after the raid, 1 child telephoned a hotline asking for her mother, and a breastfed infant was hospitalized for dehydration when its mother was sent to a detention center in Texas.30 US law clearly and explicitly discriminates. Although there are federal and state statues making some forms of discrimination illegal, this is not the case for some immigrants seeking work in the United States. Visas come with mandatory requirements that are not expected of US native born residents, including labor certification.31 Thus, current immigration laws contradict basic principles of tolerance and acceptance making immigration restrictions “a form of government-mandated employment discrimination.”32(p2) Using the argument of a US nursing shortage as mandate for increasing professional nurse recruitment in developing countries creates an international promulgation of injustice. For a nation founded on the concept of equality, this unfairness based solely on being born outside US territory collides with social justice doctrines. It is ironic that a nation that often sees itself as a global leader in upholding justice and in protecting the vulnerable has yet to implement policies that treat all humans as equal.


Turn: AIDS

The plan exacerbates AIDS, malaria, and other diseases globally

The Chronicle Newspaper 2007 (Africa News; “Malawi; ‘Brain Drain’ in Health System Continues Unabated”) Lexis-Nexis

Most nurses who have left Malawi have immigrated to the United Kingdom (UK), offering that country their services in the past. But now the United States of America (US) is fast becoming another attractive destination after many nurses are having an extension to their working visa being rejected in the UK, even after having worked there for nearly 5 years. The American Hospital Association has reported that the US last year needed an extra 118,000 nurses, a demand that will rise to 800,000 by 2020. In order to cater for this shortage a little un-noticed provision in the Immigration Bill is expected to be used. This could intensify the drain of nurses from the developing world . Reaction has been swift and filled with outrage with Physicians for Human Rights (PHR), a US advocacy group saying that this provision could undermine the multi-billion dollar effort by the US to combat AIDS and Malaria by potentially worsening the already existing shortage of health workers in poor countries like Malawi. "We're pouring water in a bucket with a hole in it, and we (US) drilled the hole," declared Holly Burkhalter from PHR when the proposals were first made. There is no doubt, the public health sector in Malawi is already badly hit by the "Brain Drain" in the large exodus of medical professional personnel leaving the country for greener pastures in the developed world.

DISEASES THREATEN HUMAN SURVIVALZIMMERMAN AND ZIMMERMAN 1996 (Barry and David, both have M.S. degrees from Long Island University, Killer Germs p 132)

Then came AIDS…and Ebola and Lassa fever and Marburg and dengue fever. They came, for the most part, from the steamy jungles of the

world. Lush tropical rain forests are ablaze with deadly viruses. And changing lifestyles as well as changing

environmental conditions are flushing them out. Air travel, deforestation, global warming are forcing never-before-encountered viruses to suddenly cross the path of humanity. The result—emerging viruses.

Today some five thousand vials of exotic viruses sit, freeze-dried, at Yale University—imports from the rain forests. They await the outbreak of diseases that can be ascribed to them. Many are carried by insects and are termed arboviruses (arthropod borne). Others, of even

greater concern, are airborne and can simply be breathed in. Some, no doubt, could threaten humanity’s very existence . Joshua Lederberg, 1958 winner of the Nobel Prize in Physiology or Medicine and foremost authority on emerging viruses, warned in a December 1990 article in Discover magazine: “It is still not comprehended widely that AIDS is a natural, almost predictable phenomenon. It is not going to be a unique event. Pandemics are not acts of God,

but are built into the ecological relations between viruses, animal species and human species…There will be more surprises,

because our fertile imagination does not begin to match all the tricks that nature can play…” According to Lederberg, “The survival of humanity is not preordained …The single biggest threat to man’s continued dominance on the planet is the virus” (A Dancing Matrix, by Robin Marantz Hening.


AIDS Turn Link Extensions

Increasing nurse migration removes nurses from Sub-Saharan Africa and exacerbates the health crisisPittman et al 7 (Patricia, Ph.D., Executive Vice President of AcademyHealth, Health Services Research 42(3), Part II, June 2007)gw

Sub-Saharan Africa represents the most dire scenario. There, health systems are historically poorly developed and now, due in part to nurse shortages, some are in a state of crisis. Dovlo reports in this issue that there is a double burden experienced by these countries: already weak health systems tend to exacerbate the rate of migration leading to a surge in vacancy rates (Dovlo 2007). In Zambia, the nurse to population ratio is 0.22 to 1,000, a figure that is more than 40 times less than that of the United States (WHO 2006). Destination countries for African nurses are not limited to the wealthiest nations; there is considerable migration within the region, in particular to South Africa, as nurses seek better lives. But across this region, governments are indignant when recruiters from wealthier nations capitalize on the crisis. They argue that there is an urgent need and obligation for wealthy governments to reorient foreign aid to help improve work conditions and retain health professionals in source countries.

Nurses are key to solving the AIDS epidemic in AfricaAvert 10 (International AIDS Charity, http://www.avert.org/aidssouthafrica.htm)gw

One measure seen as vital in scaling-up treatment access, while making best use of available resources, is task-shifting in the health sector. This means permitting health care workers to become involved in particular stages of treatment provision where currently they are not allowed. Under task-shifting, nurses, rather than doctors, can initiate antiretroviral therapy; lay counsellors, rather than nurses, can carry out HIV tests, as well as provide support for orphans usually done by social workers; and pharmacy assistants, rather than pharmacists themselves, can prescribe ARV drugs.76 77 It is believed task-shifting vastly increases the access points to treatment and care by reducing the ‘bottlenecks’ in the system created by a lack of staff able to perform certain tasks. Many campaign groups supported task-shifting and claimed it was crucial to the goal of making HIV treatment much more widely available. Four prominent HIV/AIDS organisations called on the national and regional health departments to issue directives permitting the transfer of certain responsibilities and asked professional medical, nursing and pharmacist bodies to support task-shifting.78 A recent study in South Africa supported task-shifting to nurses, after it found that the care of patients receiving ART was not inferior when they were monitored by nurses rather than by doctors.79 Dr Eric Goemaere, Medical Coordinator for MSF in South Africa and Lesotho, said, “Our experience in Khayelitsha and Lusikisiki, as well as from other countries shows that unless we are able to utilise the skills and capacity of professional nurses at the primary health clinics, the congestion and overwhelming demand will negatively impact patient care. Other countries have changed their regulations to allow nurses to start patients on ART and lay counsellors to administer HIV tests. When will South Africa wake up?”80 In the 2010 budget speech, the Health Minister, Motsoaledi announced that “human resource capacity” was one of the “teething problems” experienced whilst implementing plans to increase the number of health facilities providing ARVs from 496 to 4,333.81



Africa needs more than a million healthcare workers and the major cause of this is due US and Europe taking nurses and doctors away from Africa

Dugger 04 (Africa Needs a Million More Health Care Workers, Report Says. CELIA W. DUGGERPublished: November 26, 2004. http://query.nytimes.com/gst/fullpage.html?res=9C05E3DE123EF935A15752C1A9629C8B63&sec=health)

Africa needs to nearly triple the number of its health workers if it is to reverse plummeting life expectancies and combat pandemics of disease, a research group of more than 100 scholars and experts said in a report released today. So far, the global health debate has focused on lowering prices for AIDS drugs and increasing financial aid from wealthy countries. But money and drugs will fail unless poor countries have enough people to tend the sick, according to the research group, the Joint Learning Initiative, financed by the Rockefeller Foundation and the Bill and Melinda Gates Foundation, among others. ''These are not sexy issues like a miracle drug, but they hark back to the core issues of health,'' said Dr. Lincoln Chen, an author of the report and the director of Global Equity Center at Harvard. The academics, health officials and other specialists in the Joint Learning Initiative said rich countries must take steps to slow what the report calls ''fatal flows'' of nurses and doctors from poor African countries to Europe and North America. By the group's calculations, Africa needs a million more health workers. Wealthy nations must educate enough of their own nationals, the group says, rather than rely on doctors and nurses whose training has been paid for by African countries that are losing the fight against disease. The African Union estimates that poor countries subsidize rich ones with $500 million a year through the migration of health workers. The group of specialists also supports growing efforts to channel doctors and nurses from rich countries, as well as from nations that willingly export health workers -- Cuba, Egypt, India and the Philippines -- to volunteer in Africa. It mentioned that the Institute of Medicine in the United States has recommended an AIDS corps of American professionals to help care for and treat people with H.I.V./AIDS. The Joint Learning Initiative also called for the creation of an education fund that would pay to educate tens of thousands of health workers who are not doctors and nurses but are trained to diagnose and treat major killers in Africa -- pneumonia, AIDS, malaria and tuberculosis -- as well as to perform basic life-saving surgeries like Caesarean sections. Such workers, used for decades in many African countries, are not attractive to employers in Western nations that rely on credentialed professionals. African countries had banded together at the international assembly of the World Health Organization this year to push rich countries to compensate them for the loss of migrating health workers, but the group said in its report that computing who should pay how much and to whom was impractical in the fluid and largely undocumented global market for health professionals. Instead, it said rich countries should voluntarily contribute to an education fund. ''Political pressures and public embarrassment are likely to grow as manpower shortages in the midst of health crises become linked to rich country's poaching of medical workers from those same countries,'' the Joint Learning Initiative's report said. The Joint Learning Initiative commissioned studies that documented the importance of health workers in lowering death rates for infants, children under 5 and women in childbirth, controlling for the effects of higher income and female literacy in each country. Researchers found that mortality rates fell with the rise of health worker density, defined as the number of doctors, nurses and midwives per 1,000 people.

Africa has reached crisis levels in low amounts nurses and nurses are vital to the health care system

Polt 09 (“Working Abroad as a Nurse A Great Demand for Nurses Worldwide”. By Caroline A. Polt, RNhttp://www.transitionsabroad.com/publications/magazine/0403/working_abroad_as_a_nurse.shtml)

in college I dreamed of having an international career. Several years after my sister ventured off to foreign lands to teach English, I decided to pursue the same route—not as an English teacher but as a nurse. Now it's my sister who is visiting me in a foreign land!

Since the skills and knowledge that U.S.-educated nurses possess are highly regarded internationally, the profession can open doors to a wide array of possibilities for working abroad. The call for nurses is a cry heard from all corners of the globe, from developed nations to the developing world. According to the World Health Organization (WHO), "Nurses are the largest category of health workers. Nursing personnel make up over 50 percent of the health workforce in every country of the world. In many countries in the developing world, more than 80 percent of health workers are nurses.” Because of a global nursing shortage and a higher demand for nursing services, healthcare organizations are faced with staffing dilemmas that are reaching crisis levels in certain places. The Honor Society of Nursing, Sigma Theta Tau International, reports that "Canada, the Philippines, Australia, and Western Europe are reporting significant nursing shortages. Reports of shortages are also coming from Africa and South America

http://www.transitionsabroad.com/publications/magazine/0403/working_abroad_as_a_nurse.shtml



Nurses can effectively treat HIV and AIDS via anti-retroviral therapySanne et al 10 (Ian, founder and director of the Clinical HIV Research Unit, The Lancet, 376(9734),, July 2010, Pages 33-40)gw

This study reports the findings of a prospective, randomised, controlled study comparing nurse-managed versus doctor-managed ART. A composite endpoint indicative of multiple aspects of ART delivery showed that nurse monitored therapy was not inferior to doctor monitored therapy. These findings lend support to observational data from other treatment programmes reporting successful use of task shifting in HIV care in both resource-limited (South Africa, Rwanda, and Lesotho)[28], [29], [30] and [31] and resource-rich (UK) countries,[32] and [33] and for other disease management.34 Expansion of ART services is urgently needed in resource-poor countries to achieve universal access targets by 2010,35 and further expansion will be needed with the start of universal testing and treating strategies.36 We noted no difference in mortality, viral failure, or immune recovery between the study groups. This study therefore lends supports to the strategy of task shifting, and suggests that HIV management by nurses can be safe and effective, probably even for those starting therapy with advanced HIV infection, although further studies with longer follow-up might be needed in this subgroup.

http://www.sciencedirect.com.proxy.library.vanderbilt.edu/science?_ob=PublicationURL&_tockey=%23TOC%234886%232010%23996230265%232194845%23FLA%23&_cdi=4886&_pubType=J&view=c&_auth=y&_acct=C000006878&_version=1&_urlVersion=0&_userid=86629&md5=42c2e9ddefa20c6df4b6c6727eeda320

http://www.sciencedirect.com.proxy.library.vanderbilt.edu/science?_ob=PublicationURL&_tockey=%23TOC%234886%232010%23996230265%232194845%23FLA%23&_cdi=4886&_pubType=J&view=c&_auth=y&_acct=C000006878&_version=1&_urlVersion=0&_userid=86629&md5=42c2e9ddefa20c6df4b6c6727eeda320


Aids Turn Link Extensions

US recruitment of foreign Nurses is destroying South Africa's HIV fighting capabilitiesBrush 4 (Barbara Brush, Assoc. Prof of Nursing, Boston College, http://content.healthaffairs.org/cgi/content/full/23/3/78#R49)While the United States has only recently begun active nurse recruitment in South Africa, former Commonwealth countries such as the United Kingdom and Australia have already drawn large numbers of nurses from this area of the world. Between 1998 and 2002 the United Kingdom alone recruited 5,259 nurses from South Africa, along with 1,166 from Nigeria, 1,128 from Zimbabwe, and 449 from Ghana. The accelerated recruitment of experienced African nurses is straining an already fragile health care infrastructure in many African countries, which have been battered by AIDS and deprived of resources because of economic and political upheaval. Sixteen African countries have an average of 100 nurses per 100,000 population; ten countries average fifty nurses per 100,000; nine report twenty per 100,000; and three have fewer than ten nurses per 100,000.21 In stark contrast, U.S. and U.K. ratios are 782 and 847 per 100,000, respectively.22 In 2000 more than double the number of new nursing graduates in Ghana left that country for positions abroad.23 In response, the Ghanaian government is now begging recruiting nations to cease taking its nurses. Economic burden. The loss of qualified nurses places considerable economic pressure on exporting African countries.25 In 1998 the United Nations Conference for Trade and Development estimated that every professional, ages 25–35, who migrated from South Africa represented an annual loss of $184,000 for that country.26 Receiving countries obtain the financial benefit of the migrant’s professional education and training, while sending countries bear these costs. The loss of valuable workers has been so costly that the South African Nursing Council has proposed an export tariff on nurses leaving to work abroad.

Recruitment of foreign nurses is negating foreign aid to AfricaChanguturu 5(Dr. Sreekanth Changuturu, M.D., Harvard Medical School, http://www.nejm.org/doi/full/10.1056/NEJMp058201)For years, the National Health Service (NHS) of the United Kingdom relied heavily on the direct recruitment of nurses from African countries such as Botswana, Ghana, Malawi, Nigeria, Kenya, South Africa, Zambia, and Zimbabwe — all former British colonies. These very countries have been among those hit hardest by the HIV pandemic; some have a prevalence of HIV infection of 30 to 40 percent, with a majority of the young, working population debilitated by disease, and are reporting huge nursing shortages themselves. In 1999, Ghana's losses to emigration included 320 nurses the same number of nurses certified in the country each year; twice as many were lost the following year. More than half the nursing positions in Kenya and Ghana remain unfilled. As a result, many health clinics in Kenya have closed and many others are severely understaffed. The nursing shortage in the developing world is being felt more intensely even as increased foreign aid becomes available to provide drugs for millions of people with AIDS. If this funding is to accomplish its goal, more nurses are needed to dispense drugs, monitor patients, run clinical trials, and train new nurses. According to estimates by Harvard University's Joint Learning Initiative on Human Resources for Health and Development, sub-Saharan Africa's low-income countries will need to more than double their workforces in the coming years — by adding at least 620,000 nurses — to be able to tackle their severe health emergencies. It seems like a cruel joke to play: providing funds for AIDS care but simultaneously taking away the nurses who can give that care.


AIDS Turn Extensions

Increasing the ability for nurses to immigrate will seriously affect Africa’s health system – guarantees increased disease spread

The Chronicle Newspaper 2007 (Africa News; “Malawi; ‘Brain Drain’ in Health System Continues Unabated”) Lexis-Nexis

The provision is intended to assist the US government fill the gap of a shortage of nursing staff needed for their health system. At present the US has 500 special visas for nurses each year that makes it possible for nurses and their immediate family members to get a green card and live in the US. The possibility of recruiting foreign nurses to cater for the needs of the US has drawn some negative responses from experts from within the US and Africa who have been following the situation of the "Brain Drain" from the African continent. Experts believe that the lifting of the immigration cap on nurses will have a serious affect on the African continent's health system where HIV/AIDS, Malaria and Tuberculosis (TB) are at epidemic levels and hospitals are inundated with patients who need nursing care. Already, some African countries are demanding that the developed countries tapping into their health system for personnel should pay some sort of compensation towards the loss of medical care workers.


Philippines Brain Drain Turn 1NC Shell

Filipino economy high

Philstar 7/28, (http://www.philstar.com/Article.aspx?articleId=597650&publicationSubCategoryId=200, 7/28/10, “Economy expected to grow faster in second quarter”)The economy is seen growing at a faster rate in the second quarter, a senior government official said today. "The second quarter could be higher than the first quarter as some leading economic indicators have so far been pointing to that direction," Myrna Asuncion, acting director for policy planning at economic planning agency, told reporters. The higher car sales, a healthy banking sector, stronger exports and consumption are just among the positive indicators that drove growth from April to June, Asuncion said. Depending on the performance of the economy during the period, the government might have to revise its full year target of 5 percent and 6 percent, Asuncion said. The Philippine economy expanded at a faster rate of 7.3 percent in the first quarter.

Economy recovering but domestic jobs are key

Cabicungan, 7/27, (http://newsinfo.inquirer.net/inquirerheadlines/nation/view/20100727-283329/%20Aquinos-first-SONA-We-can-dream-again, Cabicungan, Gil, “Aquino’s first SONA: We can dream again “)

The President was upbeat in his approach to the economy. He said that “many have already expressed renewed interest and confidence in the Philippines.” He said that investors had proposed to rent the Philippine Navy headquarters on Roxas Boulevard and the Naval Station in Fort Bonifacio, Taguig City. “Immediately, we will be given $100 million. Furthermore, they will give us a portion of their profits from their businesses that would occupy the land they will rent,” Mr. Aquino said. He said that from public-private partnerships, the economy would grow, construct tourism infrastructure and improve agriculture and possibly be a supplier to the global market. “Creating jobs is foremost on our agenda, and the creation of jobs will come from the growth of our industries,” he said. This will come, he added, if processes are streamlined to make them predictable, reliable and efficient for those who want to invest, the President said.

Workers need to stay in the Philippines to avoid downturn

Pesek, 7/31 (http://www.todayonline.com/Commentary/EDC100731-0000031/Kafkaesque-economy-has-last-chance-to-get-it-right, Pesek, William, 7/31/10)

Minor successes in reducing the budget deficit were spun as big victories. So was the fast-increasing number of Filipinos leaving the country and their families to work abroad; the dynamic is really a weakness. The Arroyo years were a lost period, a time when the nation should have tended to its weak foundations and didn't. Thanks to the handiwork of the central bank governor Amando Tetangco, the government was able to sell debt and avoid a crisis. It's no longer enough to rely on the fancy footwork of monetary-policy makers. It's time for leaders to create jobs at home, improve competitiveness and increase economy efficiency.

Unstable economy is the perfect opportunity for political instability and illegitimacy of the government-history proves.

Bienen & Gersovitz 85 (Henry S., Mark, International Organization Cambridge Journals, 39(4), p. 735)

Although IMF conditionality is rarely by itself a major cause of political instability, a regime that has lost legitimacy for other reasons becomes especially vulnerable to its opponents during negotiations with the IMF and during the implementation of an IMF package. The Ferdinand Marcos regime in the Philippines, for example, has suffered from poor economic performance, but it has faced accelerating opposition and loss of legitimacy over human rights violations and in the wake of the assassination of Benigno Aquino, a leader of the political opposition. After the assassination capital fled abroad, increasing the severity of Filipino debt problems. Fragility has made it more difficult for the regime to negotiate with the IMF.

http://www.todayonline.com/Commentary/EDC100731-0000031/Kafkaesque-economy-has-last-chance-to-get-it-right

http://www.todayonline.com/Commentary/EDC100731-0000031/Kafkaesque-economy-has-last-chance-to-get-it-right

http://newsinfo.inquirer.net/inquirerheadlines/nation/view/20100727-283329/%20Aquinos-first-SONA-We-can-dream-again

http://newsinfo.inquirer.net/inquirerheadlines/nation/view/20100727-283329/%20Aquinos-first-SONA-We-can-dream-again


Philippines Brain Drain Turn 1NC Shell

Philippine stability key to solving terrorism

De Castro 9 (Renato Cruz, Contemporary Southeast Asia, 31(3), p.399)In the mid-1990s the Philippines and the United States revived their dormant alliance after China's occupied Mischief Reef, a small atoll in the disputed Spratlys archipelago and lying 130 miles off the country's easternmost island of Palawan. On the heels of the 11 September 2001 Al Qaeda attacks in the United States, the two allies further revitalized their security relationship to address transnational terrorism. In the process, Manila was able to secure vital US military and economic assistance for its counter-terrorism/ insurgency campaign against domestic insurgents, i.e. Abu Sayyaf Group (ASG), the New People's Army (NPA) and the Moro Islamic Liberation Front (MILF). Since that time, the two allies have taken gradual but significant steps to transform their alliance as a hedge against the geostrategic challenges posed by China's rising power. This transformation involves deepening the two countries' military relations through organizational planning, professional training and the development of interoperability for a long-term mobilization strategy in a potential US-China military/diplomatic face-off.

Unchecked terrorism will result in extinctionYonah Alexander, professor and director of the Inter-University for Terrorism Studies in Israel and the United States. “Terrorism myths and realities,” The

Washington Times, August 28, 2003

Unlike their historical counterparts, contemporary terrorists have introduced a new scale of violence in terms of conventional and unconventional threats and impact. The internationalization and brutalization of current and future terrorism make it clear we have entered an Age of Super Terrorism [e.g. biological, chemical, radiological, nuclear and cyber] with its serious implications concerning national, regional and global security concerns. Two myths in particular must be debunked immediately if an effective counterterrorism "best practices" strategy can be developed [e.g., strengthening international cooperation]. The first illusion is that terrorism can be greatly reduced, if not eliminated completely, provided the root causes of conflicts - political, social and economic - are addressed. The conventional illusion is that terrorism must be justified by oppressed people seeking to achieve their goals and consequently the argument advanced by "freedom fighters" anywhere, "give me liberty and I will give you death," should be tolerated if not glorified. This traditional rationalization of "sacred" violence often conceals that the real purpose of terrorist groups is to gain political power through the barrel of the gun, in violation of fundamental human rights of the noncombatant segment of societies. For instance, Palestinians religious movements [e.g., Hamas, Islamic Jihad] and secular entities [such as Fatah's Tanzim and Aqsa Martyr Brigades]] wish not only to resolve national grievances [such as Jewish settlements, right of return, Jerusalem] but primarily to destroy the Jewish state. Similarly, Osama bin Laden's international network not only opposes the presence of American military in the Arabian Peninsula and Iraq, but its stated objective is to "unite all Muslims and establish a government that follows the rule of the Caliphs." The second myth is that strong action against terrorist infrastructure [leaders, recruitment, funding, propaganda, training, weapons, operational command and control] will only increase terrorism. The argument here is that law-enforcement efforts and military retaliation inevitably will fuel more brutal acts of violent revenge. Clearly, if this perception continues to prevail, particularly in democratic societies, there is the danger it will paralyze governments and thereby encourage further terrorist attacks. In sum, past experience provides useful lessons for a realistic future strategy. The prudent application of force has been demonstrated to be an effective tool for short- and long-term deterrence of terrorism. For example, Israel's targeted killing of Mohammed Sider, the Hebron commander of the Islamic Jihad, defused a "ticking bomb." The assassination of Ismail Abu Shanab - a top Hamas leader in the Gaza Strip who was directly responsible for several suicide bombings including the latest bus attack in Jerusalem - disrupted potential terrorist operations. Similarly, the U.S. military operation in Iraq eliminated Saddam Hussein's regime as a state sponsor of terror. Thus, it behooves those countries victimized by terrorism to understand a cardinal message communicated by Winston Churchill to the House of Commons on May 13, 1940: "Victory at all costs, victory in spite of terror, victory however long and hard the road may be:

For without victory, there is no survival."


Link: Brain Drain – Generic

Nurse migration passes significant costs onto source countries Giona 07 (Afr Newslett on Occup Health and Safety 2007 Fabrizio Giona)

The main costs of health professionals' migration are paid by developing countries as they lose a significant number of nurses, physicians, and other health professionals (brain drain). In 2000 over 500 nurses left Ghana to work in other industrialized countries (twice the number of the new generation of nurses graduating that year). In Malawi, between 1999 and 2001, over 60% of nursing staff left to work elsewhere. Between 2001 and 2002, a total of 16,000 international nurses arrived in the UK mainly from India, the Philippines, and South Africa. In 2004, 1,018 new nurses coming from countries outside EU were registered in Ireland; 59% came from India, 26% from the Philippines, and 5% from South Africa (5). This flight causes further deficiencies in developing countries. In 2003, Malawi reported that only 28% of its nursing positions were covered, and in the same year South Africa had a deficiency of over 32,000 nurses (3). The loss of these professionals destabilizes health systems, making the countries poorer and less and less able to provide assistance to their patients. The situation is not helped by the small number of nurse training institutes (only 288 in Africa out of a total of 5,492 in the world, equal to 5.2%) (1). The nurses remaining in the structures short of staff often face depressing working conditions: morale and work satisfaction diminish while inefficiencies increase resulting in additional push factors that contribute to further exacerbation in the lack of nursing staff. The migration of nurses incurs another significant cost to the source countries: their investment in education and training which in most developing countries is fully sponsored or strongly financially supported by the government. This relevant investment is wasted when a nurse or a physician migrates permanently to an industrialized country.

Nursing shortages have serious implicationsBooth 02 (The Nursing Shortage: A Worldwide Problem; Rachel Booth, RN, PhD, Dean and Professor, University of Alabama School of Nursing)

"Nurses and midwives around the globe are leaving the health system, driven away by underpay, hazardous working conditions, lack of career development, as well as professional status and autonomy. In addition, there is a sharp decline in new recruits to the profession for similar reasons. If the world's public health community does not correct this trend, the experts agreed, the ability of many health systems to function will be seriously jeopardized"(1).Although thousands of miles and many differences separate countries and cultures, the message describes a worldwide problem. The simple truth is that nurses are not there for the people who need them most. Regardless of the country, the public's perception of their nurses resound with great similarities. That is, nurses hold the system together and serve as the advocate, health provider, educator, and administrator for making the system work well for them; nurses possess the highest level of integrity and honesty of any other health care workers and administrators; nurses are the ones who care about patients and their families; and "nurses are the backbone of the health care systems".

U.S. need for nurses drives shortages in source countriesAiken 07 (HSR: Health Services Research 42:3, Part II “U.S. Nurse Labor Market Dynamics Are Key to Global Nurse Sufficiency” Linda H Aiken, PhD, FAAN, FRCN, RN Claire M. Fagin Leadership Professor in Nursing, Professor of Sociology, and Director of the Center for Health Outcomes and Policy Research)

The United States plays a pivotal role in the global migration of nurses. It has the largest professional nurse workforce of any country in the world, numbering almost 3 million in 2004 (USDHHS 2006). The United States has almost one-fifth of the world’s stock of professional nurses and about half of English-speaking professional nurses. With a nurse labor force of this size, even modest supply–demand imbalances exert a strong pull on global nurse resources. A looming projected shortage of nurses in the United States that could reach 800,000 by 2020 (USDHHS 2002) is thus cause for concern among other countries also experiencing nurse shortages.



Nurse Migration causes health care shortages in developing countries Senior 10 (Senior, Kathryn Bulletin of the World Health Organization, May2010, Vol. 88 Issue 5, p327-328, “Wanted: 2.4 million nurses, and that’s just in India”)

In every country, rich or poor, the story is the same. There are not enough nurses. The developed world fills its vacancies by enticing nurses from other countries, while developing countries are unable to compete with better pay, better professional development and the lure of excitement offered elsewhere. A World Bank report released in March describes the severity of the shortage of nurses in the Caribbean and Latin America alone. English-speaking Caribbean nations currently have 1.25 nurses for every 1000 people; 10 times fewer than countries in the European Union and the United States of America (USA). Around three in every 10 nursing positions currently remain unfilled and the report predicts that Caribbean countries will be short of 10 000 nurses to help care for their ageing population by 2025. According to Deena Nardi, director of the Nurse Delegation Programme at the International Council of Nurses, the Caribbean is particularly prone to losing its nurses. “The global migration of nurses is particularly severe in smaller island nations such as Jamaica, where 8% of its generalist nurses and 20% of its specialist nurses leave for more developed countries each year,” she says. Between 2002 and 2006, more than 1800 nurses left the Caribbean to work abroad. “People do not leave only for higher salaries – moving for better work conditions and the opportunity to progress professionally are also part of the problem.” “These ‘push’ factors are very hard to fix ,” says Christoph Kurowski, World Bank sector leader for human development, and author of the report. Nardi stresses that the Caribbean countries are not an isolated example. “In Malawi, there are only 17 nurses for every 100 000 people,” she says. In India, nurse shortages occur at every level of the healthcare system. According to Dileep Kumar, chief nursing officer at the Ministry of Health and director of the Indian Nursing Council, 2.4 million nurses will be needed by 2012 to provide a nurse-patient ratio of one nurse per 500 patients. “The data show that the states with the worst health-care human resource shortages are also the ones with the worst health indicators and highest infant and child mortality,” says Nidhi Chaudhary, from the World Health Organization’s office in New Delhi, India. In Indonesia there is a shortage of nurses at health-care facilities but, in contrast with other countries, there are also many unemployed nurses. “The problem here is connected with mismanagement of nurse hiring and placement due to lack of resources,” says Achir Yani Syuhaimie Hamid, president of the Faculty of Nursing at the University of Indonesia. According to the standards set by the Ministry of Health, the ideal ratio of nurses to patients in Indonesian hospitals is 2:1 to allow for shift working, 24-hour coverage and maternity- and sick-leave. “


Link: Brain Drain – Recruitment Key

Developing countries need their nurses, suffer from recruitmentBrush et. al, 2004 (Barbera L., Julie Sochalski, and Anne M. Berger. Recruiting Foreign Nurses To U.S. Health Care Facilities Health Affairs, May/June 2004; 23(3): 78-87.)

As the United States and other developed countries look to international nurse recruits to balance their national nurse supply and demand, however, sending countries are increasingly questioning the impact on their own health care systems. In perhaps the most striking example, the Wall Street Journal noted that the growing number of Filipino nurses migrating abroad is creating a domestic shortage and beginning to strain the Philippines’ health care system rather than providing an economic benefit as it had in previous years.18 A growing number of other countries are facing a situation similar to that of the Philippines. New offshore recruiting initiatives by developed countries have targeted English-speaking nurses from sub-Saharan Africa, Southeast Asia, and the Caribbean. Experienced nurses, especially those with specialty skills in surgical, neonatal, or critical care nursing, are in particularly high demand.While the United States has only recently begun active nurse recruitment in South Africa, former Commonwealth countries such as the United Kingdom and Australia have already drawn large numbers of nurses from this area of the world. Between 1998 and 2002 the United Kingdom alone recruited 5,259 nurses from South Africa, along with 1,166 from Nigeria, 1,128 from Zimbabwe, and 449 from Ghana.19 The accelerated recruitment of experienced African nurses is straining an already fragile health care infrastructure in many African countries, which have been battered by AIDS and deprived of resources because of economic and political upheaval.20 Sixteen African countries have an average of 100 nurses per 100,000 population; ten countries average fifty nurses per 100,000; nine report twenty per 100,000; and three have fewer than ten nurses per 100,000.21 In stark contrast, U.S. and U.K. ratios are 782 and 847 per 100,000, respectively.22 In 2000 more than double the number of new nursing graduates in Ghana left that country for positions abroad.23 In response, the Ghanaian government is now begging recruiting nations to cease taking its nurses.



Nurse migration leads to detrimental shortages in developing countriesKingma, 2007 (Mireille. Nurses on the Move: A Global Overview. HSR: Health Services Research 42:3, Part II ( June 2007) http://www3.interscience.wiley.com/cgi-bin/fulltext/117996596/PDFSTART)

Nurses migrating to industrialized countries often leave behind an already disadvantaged system, thus worsening the working conditions. The nurses who remain assume heavier workloads, experience reduced work satisfaction and low morale. This contributes to high levels of absenteeism and has an adverse impact on the quality of care (Chikanda 2005; Dovlo 2005). A country’s health system is weakened by the loss of its workforce, and the consequences in certain cases can be measured in lives lost (WHO 2006). The insufficient presence of supervisors, mentors, and educators threatens not only current care delivery but the preparation of future generations of nurses. Left with an inadequate nursing workforce, many developing countries lack the resources to implement programs to improve the health of the poor. In Lesotho, with a shortage of 700 nurses, the implementation of a government campaign for confidential HIV testing and counseling was postponed (IRIN 2006). In Swaziland, the nursing shortage is considered the main obstacle for the expansion and long-term maintenance of critical antiretroviral therapy programs (Kober and Van Damme 2006). For many developing countries, a serious consequence of the nursing shortage is the heavy nurse to patient workload, which in turn continues to drive nurse migration. A nurse from the main referral hospital in Lesotho reports that 70 nurses tend to almost 3,400 patients, an average of close to 50 patients per nurse (Associated Press 2006). In Malawi, a major hospital reported that half of its nursing posts were vacant, and only two nurses were available to staff a maternity ward with 40 births a day (ICN 2004). In Zimbabwe, the Minister of HealthCare and Welfare estimates the nurse to patient ratio to be 1:700 but researchers found that nurses working in provincial hospitals may work with a nurse to patient ratio of 1:522 while in district hospitals the ratio may be as high as 1:3,023 (Chikanda 2005). Such ratios cannot support excellence in health care delivery.


Link: Brain Drain – Philippines

Nurse exportations hurt the Philippines Masselink 10 (Leah Masselink School of Nursing, University of North Carolina at Chapel Hill, Carrington Hall, CB #7460, Chapel Hill, NC 27599, United States)

Despite the contribution of health worker remittances to the economy, the Philippines’ health system has remained poorly funded: as of 2005, health spending represented only 3.2% of its gross domestic product, a ranking of 178th among 194 World Health Organization countries (www.who.int). Public investment in health has actually declined in recent years. The Department of Health’s budget fell from P15.4 billion (US$275 million) in 2004 to P13.8 billion (US$250 million) in 2005 (Philippine National Statistical Coordination Board—www.nscb.gov.ph). In addition to being poorly funded, the Philippine health system is also plagued by shortages and serious mal-distribution of physicians, nurses and other health workers between urban and rural areas (Lorenzo et al., 2007 ).Staffing shortages in the Philippine health care system have been exacerbated by migration of physicians and nurses (Brush & Sochalski, 2007), particularly from rural areas (Lorenzo et al., 2007 ). Migration has also contributed to rapid turnover in urban hospitals (Lorenzo et al., 2007 ) because nurses often pursue employment opportunities overseas once they have gained enough experience. Thus, many domestically employed nurses are relatively inexperienced. Some policymakers have characterized this trend as “brain drain” and warned that it will undermine the Philippines’ nursing education sector, its health system and its future as a source country of nurses (Folbre, 2006).

Loss of nurses hurts developing countries’ health care facilities

Bieski 7(Tanya, Salisbury University MD, Nursing Econimis, 25(1).)

Nurses migrate in search of better wages, working and living conditions, as well as educational and career advancements (Carney, 2005). However, donor countries, who struggle to keep health care facilities open, are faced with issues including loss of skilled personnel, loss of eco-nomic investment, and high turnover rates. Loss of skilled personnel is frequently referred to as “brain drain,” where experienced personnel move to receiving countries leaving behind inexperienced personnel, who must work alone in poor conditions (Kline, 2003). Prystay (2002) reported that nursing directors in the Philippines were concerned about high turnover rates, thereby leaving novice nurses to staff hospitals. Kline (2003) discussed a loss of economic investment in education. Filipino nurses who remained faced poor wages and working conditions and minimal incentive from government officials to improve wages and working conditions (Prystay, 2002).


Link: Brain Drain – Philippines

Nurses are a key section of Filipino migrant workersGoode 9 – (Angelo, International Studies Department, De La Salle UniversityEast Asia, 26(2), June 2009)gw

With human capital as the nation’s wealthiest resource, it might be an idea to visit ideas on good governance within the realm of political, economic and social processes, which could provide some insight. Among human exports in the Philippines, nurses and care-givers comprise the biggest chunk of professional labour (see Table 1), and therefore the following case study on Filipino nurse migration is relevant to this investigation into the role Philippine human capital plays in economic growth and development.

Remittances by Filipino workers are key to the Philippines economyGoode 9 – (Angelo, International Studies Department, De La Salle UniversityEast Asia, 26(2), June 2009)gw

Money sent by Overseas Filipino Workers (OFWs) back to the Philippines is a major factor in the country's economy, amounting to more than US$17 billion last year in cash remittances according to the World Bank [15]: 43). It is perhaps for this reason that the Philippine economy performed better in 2007 as compared to previous years, marking the country as the fourth largest recipient of foreign remittances behind India, China, and Mexico [15]: 43). Not too long ago, President Gloria Macapagal-Arroyo coined the term Overseas Filipino Investor or OFI for Filipino expatriates who contribute to the economy through remittances, buying property and creating businesses [25]. Evidently, national economic and development policies consider and seemingly encourage the export of Filipino human capital. As it stands however, remittances only prop up the economy in that Filipino families have more spending power, but the money doesn’t go into national investments that can help development in the long run. Anomalies such as this draw attention to the importance of labour migration as a development strategy, and the ways in which migrant remittances can be managed appropriately for the betterment for Philippine society.


Link: Brain Drain – Filipino Economy

Public Health jobs in Philippines key to their economy

Doikno, 7/28 (http://www.bworldonline.com/main/content.php?id=14916, Diokno, Benjamin, 7/28/100In the near term, economic recovery may remain weak. Joblessness will continue to increase as job openings will be limited and as the number of new entrants to the market rises. This means that the government has to be more proactive. It has to put in place several job creation projects that would employ people in productive activities -- public health in the countryside, reforestation and cleaning of rivers and creeks, public construction in rural areas. I have a sense that workers would like to know what job creation programs by the government are in store for them. At the same time, overseas workers are wondering whether jobs at home would be available and when, so they can plan their reentry to the country. Clearly the workers were disappointed. But it’s not too late. Mr. Aquino may want to continue his conversation with the Filipino people on certain specific issues. He can do it on a weekly or monthly basis, in a forum of his choice, and in a style that he’s comfortable with. He can start with jobs and overseas employment policy. Mr. Aquino may then proceed to talk about other equally important issues: population management, energy, water, budget deficit reduction, poverty reduction.

http://www.bworldonline.com/main/content.php?id=14916


Link: Brain Drain – Economy

Migrant nurses create economic instability in donor countriesKlein, 2004 (Donna S. Push and Pull Factors in International Nurse Migration. Journal of Nursing Scholarship. Volume 35 Issue 2, Pages 107 – 111. 23 Apr 2004. http://www3.interscience.wiley.com/cgi-bin/fulltext/118855563/PDFSTART)

The movement of nurses from donor to receiving countries can create hardships in donor countries because of the loss of skilled personnel and loss of economic investment in education. The migration of nurses from developing countries, such as from African countries, results in the loss of “scarce and relatively expensive-to-train resources” (Buchan, 2001, p. 204). Many African countries have had significant increases in incidence and prevalence of infectious diseases such as AIDS, malaria, and tuberculosis, thus placing further demands on already overburdened health care systems. The World Health Organization (WHO) reported that at the end of 2000, 25.3 million people in Sub-Saharan Africa had HIV/AIDS (WHO, 2000). Difficulties created by migration particularly from the Sub-Saharan region come less from the loss of people in absolute numbers than from the loss of the few qualified professionals (Ojo, 1990). The loss of nurses in this region results in even fewer skilled nurses, increased care demands on the nurses who remain, and further deterioration of inadequate health care systems. In addition to African countries, some other donor countries also have scarce nurse resources and can ill afford to lose nurses to migration. WHO (1998) estimates showed the distribution of health personnel per 100,000 of the population. China, India, and Pakistan indicated 99, 45, and 34 nurses respectively per 100,000 persons. In comparison, the US reported 972 nurses (for 1996), the UK reported 870 nurses (for 2000; Buchan & Seccombe, 2002), Australia reported 830 nurses (for 1998), Canada reported 897 nurses (for 1996), and Ireland reported 1,593 nurses (for 1998) per 100,000 persons.

Reports from the Philippines are mixed regarding effects on the health care system and the economy when large numbers of nurses leave for other countries. The migration of Filipino nurses is an example of the push factors of the economic conditions of oversupply, minimal employment opportunities, and the political factors of an aggressive export policy (Hawthorne, 2001). Sison (2002) reported that Filipino government officials viewed the exporting of nurses as a new growth area for overseas employment. The 175 nursing schools in the Philippines produce more than 9,000 graduates yearly, of whom 5,000 to 7,000 become licensed. Governmental encouragement for nurse migration is understandable, given the amount of money returned to the country in remittances. Lindquist (1993) reported over $800 million received in remuneration per year from Filipinos living abroad, money on which the Filipino economy had become highly dependent. Filipino nurses are sought in many Englishspeaking countries because of the Western-oriented nursing curriculums with English as the primary instructive language, making Filipino nurses “marketable to foreign countries” (Ortin, 1990, p. 11).


Link: Brain Drain – India

Immigration of nurses undermines Indian healthcare and allows epidemic diseases to run rampantDavis and Hart 10 (Ted and David, School of Public Policy at George Mason, Review of Policy Research, July 2010, 27(4), p509-526)gw

High-skill migration in medicine and nursing poses a different set of challenges than it does in IT services. Primary medical care is a personal service that requires the presence of skilled professionals. The essential nature of health care services means that the loss of doctors and nurses from developing nations to developed nations may have significant negative consequences. One fact is certain in this field: many Indian health care needs are not met. The country suffers from epidemic diseases that have been eradicated in most of the rest of the world, while treatment of chronic conditions is highly uneven. In 2004, there were six doctors to every 10,000 inhabitants in India (OECD, 2007). This ratio is about a quarter of that in the United States, which is a major destination of Indian doctors. OECD (2007) reports that approximately 18 percent of doctors employed in OECD countries are foreign born. India is the largest source country for these foreign-born doctors. The foreign-born share of doctors in the United States is higher than the OECD average at 25 percent. The enormous size of the U.S. health sector means that the United States dominates medical migration into the OECD. Over 50,000 Indian-born doctors and 15,000 medical students/residents live in the United States (AAPI, 2009). Only 3.5 percent of nurses working in the United States were born outside the country, but international recruitment of nurses is growing rapidly. India is a major target for nursing recruitment (Pittman, Aiken, & Buchen, 2007). The total number of foreign-born health workers in the United States has been increasing at an annual rate of more than 3 percent.


Specific Link: Brain Drain – Philippines and India – Lifting the Cap

Removing the immigration cap will hurt the Philippines and India – taking away their nursing staff.

Dugger 06, Celia. "U.S. Plan to Lure Nurses May Hurt Poor Nations." The New York Times - Breaking News, World News & Multimedia. 24 May 2006. Web. 29 July 2010. <http://www.nytimes.com/2006/05/24/world/americas/24nurses.html?_r=1&pagewanted=print>. JRL

As the United States runs short of nurses, senators are looking abroad. A little-noticed provision in their immigration bill would throw open the gate to nurses and, some fear, drain them from the world’s developing countries.

The legislation is expected to pass this week, and the Senate provision, which removes the limit on the number of nurses who can immigrate, has been largely overlooked in the emotional debate over illegal immigration.

Senator Sam Brownback, Republican of Kansas, who sponsored the proposal, said it was needed to help the United States cope with a growing nursing shortage.

He said he doubted the measure would greatly increase the small number of African nurses coming to the United States, but acknowledged that it could have an impact on the Philippines and India, which are already sending thousands of nurses to the United States a year.

The exodus of nurses from poor to rich countries has strained health systems in the developing world, which are already facing severe shortages of their own. Many African countries have begun to demand compensation for the training and loss of nurses and doctors who move away.

The Senate provision, which would remain in force until 2014, contains no such compensation, and has not stirred serious opposition in Congress. Because it is not part of the House immigration bill, a committee from both houses would have to decide whether to include the provision on nurses if the full Congress approves the legislation.

Public health experts in poor countries, told about the proposal in recent days, reacted with dismay and outrage, coupled with doubts that their nurses would resist the magnetic pull of the United States, which sits at the pinnacle of the global labor market for nurses.

Removing the immigration cap, they said, would particularly hit the Philippines, which sends more nurses to the United States than any other country, at least several thousand a year. Health care has deteriorated there in recent years as tens of thousands of nurses have moved abroad. Thousands of ill-paid doctors have even abandoned their profession to become migrant-ready nurses themselves, Filipino researchers say.

“The Filipino people will suffer because the U.S. will get all our trained nurses,” said George Cordero, president of the Philippine Nurse Association. “But what can we do?”The nurse proposal has strong backing from the American Hospital Association, which reported in April that American hospitals had 118,000 vacancies for registered nurses. The federal government predicted in 2002 that the accelerating shortfall of nurses in the United States would swell to more than 800,000 by 2020.“There is no reason to cap the number of nurses coming in when there’s a nationwide shortage, because you need people immediately,” said Bruce Morrison, a lobbyist for the hospital association and a former Democratic congressman.


Internal Link: Economic Stability Key to Political Stability

Economic Instability leads to political instability-empirically proven by Argentina and Indonesia prove

Change 7 (Roberto, Rutgers University, Journal of Monetary Economics, 54(8), p.2409)

That financial crises are often associated with political instability is undisputable. In two recent and spectacular episodes, Indonesia 1998 and Argentina 2001, economic and financial difficulties were followed by massive popular revolts, which ultimately toppled the incumbent governments. In spite of the notoriety of these and other cases, our understanding of them and, more generally, of the links between financial turmoil and political crises remains rather poor. Yet such an understanding may be crucial, most significantly for the formulation and evaluation of public policy. Indeed, some observers of Indonesia and Argentina reached the conclusion that those crashes were driven primarily by social, institutional, and political degeneration. One logical implication of that position is that international assistance, in terms of advice or resources, to countries in such circumstances is not advisable, as it is bound to be wasted in the absence of deep institutional and political reform.1 That analysis, therefore, denies the relevance of existing theories of financial crises, in particular those which emphasize liquidity, self-fulfilling panics, and the desirability of an international lender of last resort, in situations in which political instability seems to be the dominant force. But the view that crises like those of Indonesia and Argentina are just the manifestation of underlying political forces relies upon the implicit assumption that the political equilibrium is largely exogenous with respect to economic and financial events. That assumption is itself questionable. The popular uprisings in Indonesia and Argentina appeared to be caused by widespread anger about the economic adjustment measures proposed by the incumbent governments as the best way to overcome ongoing financial difficulties.2 So it is not too hard to argue that political instability is an endogenous response to the economic environment.


Uniqueness: No Filipino Nursing Migration Now

In View Of Economic Downturn, US Is Filling The Nursing Demand With It’s Own Citizens.

Icamina 9 Paul. "U.S. Not Issuing Visas for Nurses | Daily Updates | Pinoy Herald." PINOY HERALD - Bridging the Filipino American Community. Philippine Daily News, World News, U.S. News, Pinoy News, Washington DC, Northern Virginia, Maryland . 28 Jan. 2009. Web. 29 July 2010. <http://www.pinoyherald.org/news/daily-updates/us-not-issuing-visas-for-nurses.html>. JRL

Nursing jobs are simply not there for thousands of Filipinos hopeful of going to the United States. At the moment, “The U.S. still needs nurses but it’s not giving out visas for nurses now. It needs to legislate to provide additional work-related permanent visas for nurses,” says Dean Josefina Tuazon of the University of the Philippines Manila-College of Nursing.Observers believe visas for foreign-trained nurses will be issued again this year when the U.S. Congress, upon the urging of patients and the health-care industry, approves the quota for foreign-trained nurses

that has already been filled up. “Although the U.S. still needs more nurses, in view of the recent U.S. recession and financial crisis, working nurses there now put in additional hours while others are going back to nursing, thus local nurses are filling local demand.”


Uniqueness: Filipino Economy High

Philippine economy stabilized- unemployment and poverty rate at healthy levels for economic growth Entrepenuer,7 (Financial Management and News Site, “Philippine economy exhibits stability.” July 1, 2007, http://www.entrepreneur.com/tradejournals/article/166584502.html)

It is well known that the President of the Philippines is an economist in addition to being a skilled politician. During her tenure as President, she has made a series of highly unpopular decisions, which have contributed significantly to the development of the Philippine economy.

A recent speech reveals the President's pride in her accomplishments. Among her remarks: "Our unemployment rate is the lowest in a generation. Our poverty rate is the lowest as well. Our economy has reached a new level of maturity and stability with some of the strongest macroeconomic fundamentals in a decade."

No matter that this remark glosses over the difficulties to come-these are serious accomplishments.

According to International Monetary Fund (IMF) statistics, the Philippine economy grew 5.4 percent in 2006. The IMF estimates GDP growth in 2007 at 5.8 percent, and also at 5.8 percent for 2008.

A June 14, 2007 posting on the website of the Philippine Daily Inquirer (Makati City, as central Manila is known) of a late 2006 speech by the publisher of a Philippine business news magazine, added detail specific to the country's consumer economics. Remarking that the Philippines had grown an average of 4.7 percent over the past 22 consecutive quarters with productivity increasing 25 percent over the past five years, the publisher said, "Economic growth now outpaces population growth at a ratio of two to one."

What this means for consumers is that the Philippine economy now has the ability to feed, clothe, and educate its population well into the future.

The publisher said that several industrial sectors-services, agriculture, industry and manufacturing-have contributed strongly to Philippine growth. "Adding vibrancy to these sectors is consumer spending and the rise of cellular technology," he added. Personal consumption expenditure accounts for 69.6 percent of the economy's total output [2006].

Much of the volume of consumer spending is based on remittances from Filipinos working abroad. A significant portion of consumer spending goes toward technology, and cellular technology is prominent. The Philippines is made up of 7,107 islands. And 98 percent of these islands are currently linked by wireless technology. "For the first time, the country is united by one medium, the cellular phone," said the publisher.

Internet usage is also a factor. Just under 10 percent of the country's population is connected to the Internet.

Two significant trends: First, food is no longer the biggest item in household budgets. And the second has to do with the coming generation. "Filipino teenagers now spend more on internet cafes, prepaid phone cards and post paid cell phone bills, while trying to economize on food, beverages, personal care, transportation, clothes and reading materials."

Philippine peso on the rise – Long term goals to sustain are coming in place

Alcuaz, 7/26 (http://www.businessweek.com/news/2010-07-26/philippine-peso-advances-as-president-vows-to-boost-economy.html, Francisco, 7/26/10)

The Philippine peso rose the most in two weeks as President Benigno Aquino’s State of the Nation address spurred optimism that the government’s programs will boost investment and quicken economic growth. The currency climbed to its highest level in a month as Aquino said talks with investors offering to build roads and other infrastructure would produce “good” results. In his first speech to Congress, the president backed bills that would help control the budget deficit and promised to speed up business registration. Aquino’s address helped to boost “expectations surrounding economic activity arising from public-private partnerships and lessening bureaucracy,” said Jonathan Ravelas, a market strategist at Banco de Oro Unibank Inc. in Manila. The peso rose 0.4 percent to 46.12 per dollar at the close of trading in Manila, according to prices from inter-dealer broker Tullett Prebon Plc. That was its biggest gain since July 9, and the currency’s strongest level since June 23.

http://www.businessweek.com/news/2010-07-26/philippine-peso-advances-as-president-vows-to-boost-economy.html


Uniqueness: Filipino Economy High

Filipino Economy on the rise – Tech export

Anstey, 7/13 (http://www.businessweek.com/news/2010-07-13/philippine-export-growth-quickens-boosting-economy.html, Anstey, Christopher, 7/13/2010 “Philippine Export Growth Quickens, Boosting Economy”)

Philippine exports rose at a faster pace in May as the global recovery spurred demand for electronics, sustaining the nation’s economic expansion and supporting President Benigno Aquino’s efforts to boost incomes. Asian exports rebounded this year as customers in the U.S. and Europe increased purchases of Philippine-made Texas Instruments Inc. semiconductors and South Korea-produced Hyundai Motor Co. cars. Still, Bangko Sentral ng Pilipinas may keep its benchmark interest rate at a record-low 4 percent this week to support the nation’s recovery as the European debt crisis threatens global growth, economists surveyed by Bloomberg say. “Rising exports would mean more jobs for Filipinos and may spur investments,” April Tan, head of research at CitisecOnline.com Inc. in Manila, said before the report. “If the global economy is cooperative, it will make it easier for the president to meet his objectives of increasing growth and cutting poverty.”

http://www.businessweek.com/news/2010-07-13/philippine-export-growth-quickens-boosting-economy.html


Solvency Answers: Doesn’t Solve Long-Term

Immigration won’t solve for longAiken 07 (HSR: Health Services Research 42:3, Part II “U.S. Nurse Labor Market Dynamics Are Key to Global Nurse Sufficiency” Linda H Aiken, PhD, FAAN, FRCN, RN Claire M. Fagin Leadership Professor in Nursing, Professor of Sociology, and Director of the Center for Health Outcomes and Policy Research)

Increased reliance on immigration may adversely affect health care in lower-income countries without solving the U.S. shortage. The current focus on facilitating nurse immigration detracts from the need for the United States to move toward greater self-sufficiency in its nurse workforce. Expanding nursing school capacity to accommodate qualified native applicants and implementing evidence-based initiatives to improve nurse retention and productivity could prevent future nurse shortages.

Reliance on nurse immigration doesn’t provide long-term solutions Aiken 07 (HSR: Health Services Research 42:3, Part II “U.S. Nurse Labor Market Dynamics Are Key to Global Nurse Sufficiency” Linda H Aiken, PhD, FAAN, FRCN, RN Claire M. Fagin Leadership Professor in Nursing, Professor of Sociology, and Director of the Center for Health Outcomes and Policy Research)

Increased reliance on immigration may adversely affect health care in lower-income countries without solving the U.S. shortage. The current focus on facilitating nurse immigration detracts from the need for the United States to move toward greater self-sufficiency in its nurse workforce. Expanding nursing school capacity to accommodate qualified native applicants and implementing evidence-based initiatives to improve nurse retention and productivity could prevent future nurse shortages.

Though a viable option to minimally pacify the nurse shortage, it is not nearly a solutionFong, 2005 (Tony. Nurse visa crisis eases. Modern Healthcare, p. 28. 13 June.)

Facing a national nursing shortage of 150,000, hospitals received some respite in May when President Bush signed legislation freeing up to 50,000 visas for foreign nurses.The proposal, included in an $80 billion supplemental appropriations law, frees up visas unused from 2001 to 2004 when heightened concerns about terror created changes in immigration policies that in turn led to a logjam of visa applicants and delays in processing them.Only a certain number of visas are issued each year, limited both in total and per country. Unused visas cannot be carried over from year to year.``We're doing all we can here to grow our own supply of U.S. nurses, but the current workforce shortage and the growing demand for care mean that many hospitals must look outside the U.S. for highly qualified RNs,'' says Carla Luggiero, senior associate director of federal relations at the American Hospital Association.Despite the availability of the visas, the level of relief it will provide to hospitals is viewed by those in the industry to be minor. ``It is certainly not a solution. The nursing shortage is pretty vast,'' Luggiero says.


Solvency Answers: Alternate Causality – Poor Working Conditions

Nurse shortages loom because of poor working conditions Campell 09 (International Action Needed to Tackle Nurse Migration, Nursing Standard, 7/22/2009, Vol. 23 Issue 46, p32-33)

Heavy workloads and insufficient staff impact patient care and health outcomes, are leading some nurses to question their commitment to the profession, according to a global survey conducted by the International Council of Nurses (ICN) in collaboration with Pfizer Inc. Titled Nurses in the Workplace: Expectations and Needs, the survey included 2203 nurses from 11 countries around the world. The results, announced at ICN’s 24th Quadrennial Congress in Durban, South Africa, provide a detailed look at the opportunities and challenges facing nurses today. ‘Nurses represent the largest group of healthcare providers in the world. We were keen to better understand nurses’ views of their work and the environment in which they practice across the world,’ said David Benton, ICN Chief Executive Officer. Nurses globally are thinking about leaving the profession, which will further impact already burdened healthcare systems, especially in countries such as Kenya,Uganda and South Africa,’ said Benton. ‘It is urgent to respond to their needs with adequate staffing, greater independence and greater involvement in decision-making. Nurses must be involved in crucial policy conversations as healthcare systems grow, develop and change.’

Current hospital working conditions alienate immigrant workers Oulton 06 (Policy, Politics, & Nursing Practice Supplement to Vol. 7 No. 3, August 2006, Judith A. Oulton, MEd, RN)

When we give a voice to nurses, we hear them say, “I’m leaving because of understaffing, because we don’t have the human resources, because the skill mix is not right, because I go home at night and I am frustrated and unhappy and dissatisfied with myself that I cannot give the kind of care I want to give. I am frustrated and tired because of the lack of support, because I do not have professional parity, because there is not the teamwork I wanted to see, because my salary and benefits are not what I want. There is not the opportunity for autonomy and for control of workload. My promotional prospects are poor.” Nurses are changing jobs, leaving the country, and leaving nursing. They are leaving because of the lack of access to continuing education, the lack of professional development, the stress, the workplace violence, the bullying and the harassment, and as nurses in Ghana have said, because of a lack of feeling valued. In too many countries, there is a critical shortage of nurses willing to work under the present pay and working conditions offered. And this shortage is not limited to clinical practice. It also includes nursing faculty, who are needed to prepare current and future generations of nurses.


Solvency Answers: Healthcare

Nurse migration undermines effectiveness of healthcare – migration hurts educationHancock 08 (Nurse migration: the effects on nursing education. International Nursing Review 55,258–264 P.K. Hancock1, 2 MA Ed, RGN, RCNT, RNT Senior Nursing Lecturer, Centre for Health and Social Care Studies and Service Development, School of Nursing and Midwifery, The University of Sheffield, South Yorkshire, 2 Honorary International Nursing Adviser, British Council, Manchester, UK)

Mass rapid nurse migration undermines nurse education globally. Although nurses generally regard themselves as being apolitical or politically inactive, nurses worldwide need to participate in the political life of their country. They should look beyond the immediate frustrations of nurse shortages and recognize that nurse education is the foundation of quality patient care. It is essential that decisions about its development and delivery are not left entirely to the politicians and business persons if patient safety and the integrity of nurse education are to be protected. Nursing Associations through the International Council of Nurses should continue to strive to develop partners in democratic decision making at a variety of levels, both grass root and global, and to legislate and regulate nurse preparation and training. This is essential if we are to avoid a situation where as the Philippine Free Press reported in 2006, there are ‘thousands of graduates who are unqualified to become nurses’.

Foreign nurses mask the problem and don’t solve the root cause of lack of nurses

Kline 3.( Donna, Journal of Nursing Scholarship, 35(2).p.109)

Nursing leaders in the US are concerned about the use of immigration as a means to address the nursing shortage.Glaessel-Brown (1998) reported that using foreign nurses as “readily available, expendable workers postpones sustained efforts to resolve professional problems leading to a more stable work force and self-sustaining cycles” (p. 327). In her testimony before the House Education and Workforce Committee, Mary Foley (2001), then president of the American Nurses Association, echoed Glaessel-Brown’s opinion that using foreign nurses to fill shortage positions only delayed action on the serious workplace issues that have driven American nurses away from the profession.

Lack of education will still put US in lack of skilled workers

Hemme 7(Barbara, Harper College, Forum on Public Policy: A Journal of the Oxford Round Table, p.11)

Third world and newly industrialized economies are spending education dollars to train a new workforce. Their initial goal is for the workforce to emigrate, earn currencies that are worth more in the home country, and then send those monies back to the home country to boost its economy. This situation can only last so long, before the economy of the new country begins to expand. Then those countries are likely to try to retain workers, leaving a shortfall for other economies that depend on them. The United States is falling behind in financing our education systems. Almost daily we hear of school districts that are underfunded. The other side of this argument is that the school systems should not be funded because they are outdated and do not meet the needs of our society. No matter which side is correct, our children suffer from lack of quality education compared to other countries. Eventually even third world countries and new industrialized countries will become fully industrialized. In the past this process would have taken decades. Our global society has changed that pattern. If we use China as an example of this process, one only has to realize that it took them a very short period of time to move some of their citizens from a poor, working class to a strong middle class who now demand more.


Solvency Answers: Immigrant Nurses Fail

Foreign nurses cannot adequately communicate in USAllen 9 (Marshall, Journalist The Las Vegas Sun, http://www.lasvegassun.com/news/2009/mar/10/foreign-nurses-can-fall-communication-gap/) KRA

Yu “Philip” Xu, a professor at UNLV’s school of nursing who is originally from China, has studied the phenomenon in depth and has developed a unique training program to address the challenges. Xu’s research has shown that foreign nurses have a difficult transition to the American health care system. A study he conducted on Chinese nurses in the United States found they often felt socially isolated and paralyzed by their communication inadequacies.

Differences in jobs make it difficult for immigrant nursesAllen 9 (Marshall, Journalist The Las Vegas Sun, http://www.lasvegassun.com/news/2009/mar/10/foreign-nurses-can-fall-communication-gap/) KRA

Foreign nurses are also forced to adjust to differences in the job description in the United States, Xu’s research has shown. Asian nurses are accustomed to family members doing tasks like bathing and feeding the patient, and may feel such jobs are beneath their level of education, one of his studies found. In addition, many international nurses are not accustomed to the amount of independent judgment and time spent documenting medical care that’s required by the American system, his studies said.

The language barrier of foreign nurses can lead to deaths Allen 9 (Marshall, Journalist The Las Vegas Sun, http://www.lasvegassun.com/news/2009/mar/10/foreign-nurses-can-fall-communication-gap/) KRA

Language and communication problems can have a direct effect on the quality of patient care, and on the perceptions patients have of their care, Xu said. An estimated 100,000 people die every year as the result of medical errors in the United States, and communication problems are believed to be a leading cause. Xu said

http://www.lasvegassun.com/news/2009/mar/10/foreign-nurses-can-fall-communication-gap/







Solvency Answers: Lifting the Cap Doesn’t Solve

The Nursing Shortage will only increase even with lifting the visa cap

Doheny, Kathleen 2006 (Workforce Management; “Treating the nurse shortage: Nursing in critical condition; Profession calls for a homegrown cure, not boosting visas for foreign talent”) Lexis-Nexis

But those who favor lifting the visa cap for nurses-including the American Hospital Association-view it as a viable short-term remedy as more permanent strategies, such as increasing nursing school faculty, are gradually implemented. Both sides agree on one point: While the immigration bill is viewed by many as moribund, the nursing shortage is alive and well and won't be fixed any time soon. It will only deepen, perhaps reaching a deficit of more than 1 million positions by 2020, according to estimates from the Health Resources and Services Administration. And the nursing shortage won't just impact health care industry employers, experts warn. The lack of nurses could eventually affect all employers, either directly or indirectly, McKeon and others say. ``Waiting times in the emergency rooms are getting longer,'' says Beth Brooks, a senior partner at JWT Employment Communications, a global recruitment, marketing and internal communications agency specializing in health care. The nursing shortage is affecting or will affect ambulatory care, long-term care and doctors' offices, she says. Sooner or later, nearly every employer will probably have workers affected by the shortage. ``Nursing units are being closed,'' Brooks says. ``In parts of the country, emergency rooms are going on diversion, sending patients to other hospitals. Elective procedures are being canceled or delayed indefinitely.'' While she isn't aware of any study linking the shortage of nurses and its effect on health care with lower worker productivity or higher absenteeism, the potential for that effect is obvious. Currently, 118,000 registered nurses are needed to fill vacancies in U.S. hospitals, according to a report released by the American Hospital Association in April. Shortages at nursing homes also are significant, according to a survey of 6,000 facilities in 2002 by the American Health Care Association. It found 15 percent of staff RN positions were vacant, and that nearly 14,000 RNs would be needed to fill those vacancies. From 2004 to 2014, the U.S. health care system will need more than 1.2 million new nurses, according to a 2005 Bureau of Labor Statistics report. Recruiting new nurses was viewed as more difficult in 2004 than in 2003 by 40 percent of hospitals surveyed in an American Hospital Association 2005 workforce survey.


Solvency Answers: Delay

The time consuming process of getting visa's for foreign nurses makes solving the nursing shortage almost impossibleHanlon Law Group 09 (11/19/09, Findlaw Knowledgebase, http://knowledgebase.findlaw.com/kb/2009/Nov/32307.html) SRS

What makes this shortage all the more difficult to understand is the fact that there are hundreds of qualified, available nurses from other countries who are willing to immigrate to the United States but, because of the immigration system, cannot get a visa to enter the country. There are two different categories of visas foreign nurses can apply for to enter the US to work: nonimmigrant visas and immigrant visas. Nonimmigrant visas are temporary visas that allow them to enter the US for a limited amount of time. There are three types of nonimmigrant visas nurses may be eligible for: H1-B visas, TN visas and H-1C visas. Nonimmigrant visas present a couple of difficulties. First, they are valid for a limited amount of time, whereas the nursing crisis is an ongoing problem. Second, there are very few available nonimmigrant visas for which nurses can apply. For example, H1-B visas are only available to those who have a bachelor's degree or higher and many nurses do not have the required educational degree. TN visas, on the other hand, are only available to qualified nurses from Canada and Mexico. Lastly, H1-C visas, which were created specifically to address the nursing shortage, are limited to only 500 per year and currently only 14 hospitals have the required certification to qualify for the visas. Immigrant Visa Process Makes it Difficult to Bring Nurses to US The second option, immigrant visas, allows foreign nurses to receive permanent residence in the US, otherwise known as a "green card." Nurses typically are eligible for EB-3 visas, or a "third preference employment-based visa." In order to apply for an immigrant visa, the foreign nurse must be sponsored by a US employer, like a hospital. The employer then must enter a lengthy application process before the foreign nurse can become eligible to apply for a visa. The process includes filing an I-140 petition and labor certification with the US Citizenship and Immigration Services (USCIS) office. Generally, employers seeking to sponsor workers for EB-3 visas also must complete a lengthy application process with the US Department of Labor (DOL) to certify that there is a shortage of US workers for the position and that hiring a foreign worker will not have an adverse affect on the wages or working conditions of US workers. However, nursing is considered a "Schedule A" occupation. This means that the DOL has pre-certified that there is a documented shortage of nurses and that hiring foreign nurses will not displace or adversely affect US nurses. The Schedule A designation is supposed to speed up the application process for employers trying to sponsor foreign nurses by allowing them to bypass the DOL process and skip ahead to filing the petition and labor certification with the USCIS. But even with this designation, it still takes the USCIS an estimated 15 months to process an I-140 Immigrant Visa Petition for a Schedule A nurse. The biggest barrier, however, to bringing more foreign nurses to work in the US is not the application processing time, but how long it takes after the application has been processed until a nurse receives a visa. Once the USCIS has approved the application for the foreign nurse, the nurse then is given a priority date and placed in line for a visa with all of the other approved EB-3 applicants. The current wait time for an available EB-3 visa number is 3-7 years. So this means that hospitals who filed successful petitions for foreign nurses as far back as 2002 still may be waiting for the nurse to begin work. Once the visa number becomes available, then the foreign nurse must either apply for a visa at the US consulate or embassy in his or her home country. If the nurse currently is in the US on a different type of visa, he or she then must apply for a change of immigrant status. Either one of these processes may take months more to process.

http://knowledgebase.findlaw.com/kb/2009/Nov/32307.html


Healthcare Advantage Answers: Status Quo Solves the Aff

The new health reform law will improve the U.S. healthcare systemKrisberg 7/22 (Kim, Medscape, The Nation's Health, 7/22/2010, http://www.medscape.com/viewarticle/724266)

Millions of Americans will now have access to affordable, quality health insurance, thanks to the historic health reform legislation President Barack Obama signed into law in March. The long-awaited law is, in part, the culmination of decades of work by health and public health advocates, such as APHA, who celebrated the law as a significant step forward in fixing the nation's broken health system. "For nearly a century, providing quality, affordable care to all Americans has eluded our grasp," said APHA Executive Director Georges Benjamin, MD, FACP, FACEP (E). "This measure will strengthen our public health system, invest in prevention, improve the health of the American people and move us closer to providing comprehensive and affordable health coverage for all Americans." Beyond the insurance reforms, the landmark law, known as the Patient Protection and Affordable Care Act, is also a momentous victory for public health and prevention. The law creates a dedicated Prevention and Public Health Fund that will provide $15 billion over 10 years to support community prevention and research activities as well as strengthen state and local public health capacity. In addition to the new funds, which represent the largest commitment to prevention and wellness in U.S. history, the health reform law establishes a National Prevention, Health Promotion and Public Health Council, which will be chaired by the U.S. surgeon general and tasked with coordinating the development and implementation of a national prevention strategy.

http://www.medscape.com/viewarticle/724266


Healthcare Advantage Answers: Status Quo Solves the Aff

Squo is solving now for nursing shortages

Ream 10 (Kathleen, ANSR Alliance Contact, Testimony of the Americans for Nursing Shortage Relief Alliance Regarding Fiscal Year 2011 Appropriations for Title VIII – Nursing Workforce Development Program) OS

The link between health care and our nation’s economic security and global competitiveness is undeniable. Having a sufficient nursing workforce to meet the demands of a highly diverse and aging population is an essential component to reforming the health care system as well as improving the health status of the nation and reducing health care costs. To mitigate the immediate effect of the nursing shortage and to address all of these policy areas, ANSR requests $267.3 million in funding for the Nursing Workforce Development Programs under Title VIII of the Public Health Service Act at HRSA in FY 2011. The requested increase should be directed at the Title VIII programs that have not kept pace with inflation since FY 2005: Advanced Education Nursing, Nursing Workforce Diversity, Nurse Education, Practice and Retention, and Comprehensive Geriatric Education. These programs, which help expand nursing school capacity and increase patient access to care, would greatly benefit from the 10% increase awarded in proportion to their FY 2010 funding levels.

Health care reform solves the advantage

Mason 10 (Diana, PhD, RN, FAAN, The American Journal of Nursing, 110(7) p. 24) OS

The new law includes federal support for developing the health care workforce, including nursing, with a particular emphasis on expanding the number and preparation of primary care providers. For the first time, the federal government will explore using funds from Medicare to support graduate nursing education through limited pilot projects. Just as there is graduate medical education (GME) funding through Medicare to support the clinical education of physicians in hospitals, there will be graduate nursing education (GNE) funding, a breakthrough that has been decades in the making. (An upcoming Policy and Politics will provide details of the many workforce measures that are included in the bill.)The law includes various measures to promote primary care, prevention, chronic care management, transitional care, and care coordination –all services that nurses provide. Advanced practice RNs (APRNs) and RNs will be highly sought after as health care delivery systems test ways to shift their focus from acute care to preventing hospitalizations. Many previously uninsured or underinsured individuals will be seeking care, particularly primary care. Job opportunities in primary care should proliferate. The law also includes authorization for expanding the capacity of nurse-managed centers, which have been serving uninsured and Medicaid populations for decades. If nurse-managed centers can expand their capacity, they'll be able to help the nation meet the increased demand for primary care. The law also includes support for expanding existing communtiy health centers or establishing new ones in areas where there's a shortage of health care providers. Nurses will be crucial to such expansion.


Uniqueness: U.S. Largest Importer of Nurses

The US is the largest importer of foreign nurses Aiken & Cheung, 2008 (Linda H. Aiken and Robyn Cheung. NURSE WORKFORCE CHALLENGES IN THE UNITED STATES: IMPLICATIONS FOR POLICY. Organisation for Economic Co-operation and Development. 01 Oct 2008. http://www.who.int/hrh/migration/Case_study_US_nurses_2008.pdf)

Healthcare organizations in the United States have actively recruited professional nurses from abroad for over 50 years in response to cyclical nurse shortages in hospitals and nursing homes (Brush and Berger, 2002; Aiken, Buchan, Sochalski, Nichols, & Powell, 2004; Aiken, 2007; Polsky, Ross, Brush, Sochalski, 2007). Until the early 1990s, the inflow of registered nurses educated abroad generally did not exceed 4 000-5 000 a year (Buerhaus et al., 2004). But in the period 1994 through 2006, the annual number of newly licensed registered nurses from abroad tripled to more almost 21 000 in 2006 (see Table 7) making the U.S. the largest importer of professional nurses in the world. Foreign educated nurses increased as a percent of new entrants from 9% in 1990 to 16% in 2006. Immigration of persons in the category of practical or vocational nurses has remained constant over time at about 1 400 a year accounting for about 2% of new LPN entrants to the workforce. For the most part trends in nurse immigration parallel trends in enrollments in nursing schools. Both enrollments, as argued earlier, and immigration are driven by employer demand, particularly in the hospital sector. If there are fewer jobs, nursing school enrollments decline as does nurse immigration because hospitals are not recruiting at home or abroad.

The US is the primary destination for migrant nursesAiken & Cheung, 2008 (Linda H. Aiken and Robyn Cheung. NURSE WORKFORCE CHALLENGES IN THE UNITED STATES: IMPLICATIONS FOR POLICY. Organisation for Economic Co-operation and Development. 01 Oct 2008. http://www.who.int/hrh/migration/Case_study_US_nurses_2008.pdf)

The U.S. is the destination of choice for many migrating nurses from both developed and lower income countries because of high wages, opportunities to pursue additional education, and a high standard of living (Kingma, 2006). The prolonged nurse shortage in the U.S. and the large shortage projected for the future have motivated more nurse recruitment abroad by hospital employers and commercial recruiting firms (Brush, Sochalski, & Berger, 2004). Almost 34 000 foreign educated nurses took the NCLEX-RN registered nurse license exam in 2005 (44% passed), suggesting a great deal of interest among foreign educated nurses in working in the U.S. (National Council of State Boards of Nursing).

Close to a third of the estimated 218 720 foreign educated nurses in the U.S. are from the Philippines. The second most important source region for foreign born nurses is the Caribbean and Latin America which has contributed almost 50 000 nurses. Western developed countries including Canada, Western Europe, Australia and New Zealand rank third with a total of almost 33 000 nurses (see Table 9).


Domestic Nurses Counterplan 1NC Shell

Text: The United States Federal Government should guarantee that no native applicants to nursing schools in the United States are denied admission due to capacity restrictions. The United States Federal Government should also substantially increase financial incentives for prospective nursing professors. Funding and enforcement guaranteed.

Nursing schools need funding – capacity is the key internal linkAiken, 2007 (Aiken, L. H. (2007), U.S labor market dynamics are key to global nurse sufficiency. Health Services Research. 42, Vol.3, Part II, pp.1299-1320.)

Production capacity of nursing schools is lagging current and estimated future needs, suggesting a worsening shortage and creating a demand for foreign-educated nurses. About 8 percent of U.S. registered nurses (RNs), numbering around 219,000, are estimated to be foreign educated. Eighty percent are from lower-income countries. The Philippines is the major source country, accounting for more than 30 percent of U.S. foreign-educated nurses. Nurse immigration to the United States has tripled since 1994, to close to 15,000 entrants annually. Foreign-educated nurses are located primarily in urban areas, most likely to be employed by hospitals, and somewhat more likely to have a baccalaureate degree than native-born nurses. There is little evidence that foreign-educated nurses locate in areas of medical need in any greater proportion than native-born nurses. Although foreign-educated nurses are ethnically more diverse than native-born nurses, relatively small proportions are black or Hispanic. Job growth for RNs in the United States is producing mounting pressure by commercial recruiters and employers to ease restrictions on nurse immigration at the same time that American nursing schools are turning away large numbers of native applicants because of capacity limitations.

Nursing shortage is the effect of a professor shortage – funding key

Dugger 06, Celia. "U.S. Plan to Lure Nurses May Hurt Poor Nations." The New York Times - Breaking News, World News & Multimedia. 24 May 2006. Web. 29 July 2010. <http://www.nytimes.com/2006/05/24/world/americas/24nurses.html?_r=1&pagewanted=print>. JRL

The American Nurses Association, a professional trade association that represents 155,000 registered nurses, opposes the measure. The group said it was concerned the provision would lead to a flood of nurse immigrants and would damage both the domestic work force and the home countries of the immigrants. “We’re disappointed that Congress, instead of providing appropriations for domestic nursing programs, is outsourcing the education of nurses,” said Erin McKeon, the group’s associate director of government affairs. Holly Burkhalter, with Physicians for Human Rights, an advocacy group, said the nurse proposal could undermine the United States’ multibillion-dollar effort to combat AIDS and malaria by potentially worsening the shortage of health workers in poor countries. “We’re pouring water in a bucket with a hole in it, and we drilled the hole,” she said. There are now many more Americans seeking to be nurses than places to educate them. In 2005, American nursing schools rejected almost 150,000 applications from qualified people, according to the National League for Nursing, a nonprofit group that counts more than 1,100 nursing schools among its members. One of the most important factors limiting the number of students was a lack of faculty to teach them, nursing organizations say. Professors of nursing earn less than practicing nurses, damping demand for teaching positions.


Domestic Nurses Counterplan: Solvency – Capicity/Funding

Domestic nurse education solutions should be preferred to foreign recruitmentAiken, 2007 (Aiken, L. H. (2007), U.S labor market dynamics are key to global nurse sufficiency. Health Services Research. 42, Vol.3, Part II, pp.1299-1320.)

The United States lacks a national capacity to monitor nurse labor market dynamics and has no national nurse workforce policy, despite dire predictions about impending shortages. Indeed, health workforce policy was not ranked among the top 10 policy priorities in a recent survey of experts by the Commonwealth Fund (2004). The implications of health care cost containment policies for nursing supply and demand are rarely, if ever, considered prospectively. Immigration policies are not part of a broader strategy to ensure sufficient availability of nurses to meet national needs. There is little coherence between international development and immigration policies. Unlike many other countries where the government fully funds nursing students to become qualified nurses, U.S. nurses pay for their own education, helped by tax subsidies to public educational institutions and limited scholarship and student loan programs. In recent years, out-of-pocket costs of higher education have increased significantly. Enrollments in nursing schools are thus sensitive to nurse labor market dynamics, as exemplified by the reduction in graduations between 1995 and 2001 of up to 25,000 nurses a year. Public policy, at a minimum, should establish the capacity to monitor changes in nurse labor market dynamics, consider how changes might impact on longterm availability of nursing services, and offer suggestions when indicated for public and/or private sector responses.

Increasing incentives to become nurses is critical to solve their impacts and prevent brain drainKingma 2 (Mireille, Director, International Centre for Human Resources in Nursing,Nursing Inquiry, Volume 8(4), Pages 205-212)gw

The majority of member states of the World Health Organization report a shortage, maldistribution and misutilisation of nurses. International recruitment has been seen as a solution in most countries. Policy-makers appear to ignore that this can only be a short-term measure and a temporary relief — treating the symptoms and often avoiding the disease. Creating a professional environment that would attract individuals of high calibre to practice nursing in their national settings is necessary if positive long-term effects are desired. This would help resolve many of the problems created by the current 'brain drain' experienced by the great majority of countries. The negative effects of international migration on the 'supplier' countries may be recognised today but are not effectively addressed.


Domestic Nurses Counterplan: Solvency – Funding

Shortage of nursing colleges in U.S. drives the current influx of health laborers Aiken 07 (HSR: Health Services Research 42:3, Part II “U.S. Nurse Labor Market Dynamics Are Key to Global Nurse Sufficiency” Linda H Aiken, PhD, FAAN, FRCN, RN Claire M. Fagin Leadership Professor in Nursing, Professor of Sociology, and Director of the Center for Health Outcomes and Policy Research)

Production capacity of nursing schools is lagging current and estimated future needs, suggesting a worsening shortage and creating a demand for foreign-educated nurses. About 8 percent of U.S. registered nurses (RNs), numbering around 219,000, are estimated to be foreign educated. Eighty percent are from lower income countries. The Philippines is the major source country, accounting for more than 30 percent of U.S. foreign-educated nurses. Nurse immigration to the United States has tripled since 1994, to close to 15,000 entrants annually. Foreign-educated nurses are located primarily in urban areas, most likely to be employed by hospitals, and somewhat more likely to have a baccalaureate degree than native-born nurses. There is little evidence that foreign-educated nurses locate in areas of medical need in any greater proportion than native-born nurses. Although foreign-educated nurses are ethnically more diverse than native-born nurses, relatively small proportions are black or Hispanic. Job growth for RNs in the United States is producing mounting pressure by commercial recruiters and employers to ease restrictions on nurse immigration at the same time that American nursing schools are turning away large numbers of native applicants because of capacity limitations.

Federal money needed to support domestic nurse programs- solves back shortageDunham, 7 (Will Dunham, Journalist for Reuters, “U.S. healthcare system pinched by nursing shortage”, http://www.reuters.com/article/idUSTRE5270VC20090308, March 8, 2009)

(Reuters) - The U.S. healthcare system is pinched by a persistent nursing shortage that threatens the quality of patient care even as tens of thousands of people are turned away from nursing schools, according to experts. The shortage has drawn the attention of President Barack Obama. During a White House meeting on Thursday to promote his promised healthcare system overhaul, Obama expressed alarm over the notion that the United States might have to import trained foreign nurses because so many U.S. nursing jobs are unfilled. Democratic U.S. Representative Lois Capps, a former school nurse, said meaningful healthcare overhaul cannot occur without fixing the nursing shortage. "Nurses deliver healthcare," Capps said in a telephone interview. An estimated 116,000 registered nurse positions are unfilled at U.S. hospitals and nearly 100,000 jobs go vacant in nursing homes, experts said. The shortage is expected to worsen in coming years as the 78 million people in the post-World War Two baby boom generation begin to hit retirement age. An aging population requires more care for chronic illnesses and at nursing homes. "The nursing shortage is not driven by a lack of interest in nursing careers. The bottleneck is at the schools of nursing because there's not a large enough pool of faculty," Robert Rosseter of the American Association of Colleges of Nursing said in a telephone interview. Nursing colleges have been unable to expand enrollment levels to meet the rising demand, and some U.S. lawmakers blame years of weak federal financial help for the schools. Almost 50,000 qualified applicants to professional nursing programs were turned away in 2008, including nearly 6,000 people seeking to earn master's and doctoral degrees, the American Association of Colleges of Nursing said. One reason for the faculty squeeze is that a nurse with a graduate degree needed to teach can earn more as a practicing nurse, about $82,000, than teaching, about $68,000. Obama called nurses "the front lines of the healthcare system," adding: "They don't get paid very well. Their working conditions aren't as good as they should be." The economic stimulus bill Obama signed last month included $500 million to address shortages of health workers. About $100 million of this could go to tackling the nursing shortage. There are about 2.5 million working U.S. registered nurses. Separately, Senator Dick Durbin and Representative Nita Lowey, both Democrats, have introduced a measure to increase federal grants to help nursing colleges. Peter Buerhaus, a nursing work force expert at Vanderbilt University in Tennessee, said the nursing shortage is a "quality and safety" issue. Hospital staffs may be stretched thin due to unfilled nursing jobs, raising the risk of medical errors, safety lapses and delays in care, he said. A study by Buerhaus showed that 6,700 patient deaths and 4 million days of hospital care could be averted annually by increasing the number of nurses. "Nurses are the glue holding the system together," Buerhaus said. Addressing the nursing shortage is important in the context of healthcare reform, Buerhaus added. Future shortages could drive up nurse wages, adding costs to the system, he said. And if the health changes championed by Obama raise the number of Americans with access to medical care, more nurses will be needed to help accommodate them, Buerhaus said.

http://www.reuters.com/article/idUSTRE5270VC20090308


Domestic Nurses Counterplan: Solvency – Funding

Nurse education in need of major funding- CP solves for high unemployment ratesRWJF,10 (Robert Wood Johnson Foundation, “Obama Administration Recommends Freeze on Federal Nurse Education Programs”, http://www.rwjf.org/pr/product.jsp?id=56174, 2-26, 2010)

Nurse education advocates concerned that prospects are dimming for a major funding boost.For consumer and nurse education advocates, 2010 is getting off to a slow start.The year began as efforts to overhaul the nation’s health care system—and provide the first-ever permanent stream of funding for nurse education programs—appeared uncertain. Then, in early February, the Obama administration proposed a budget that would freeze the main source of federal funding for nurse education programs.The administration is now attempting to revitalize support for health care reform, and advocates are still working to ensure that nurse education programs will get the kind of significant boost this year that they had hoped for last year.Winifred Quinn, M.A., Ph.D., senior legislative representative at AARP and the Center to Champion Nursing in America, an initiative of the Robert Wood Johnson Foundation (RWJF), AARP and the AARP Foundation, said the funding is critical.Nursing education programs , she said, need more money now to hire more faculty so schools can accept more applicants. Preparing more nurses is a key way to ensure that the nation has the highly skilled nursing workforce it needs to meet Americans’ health care needs. More money is also needed to help curb the looming nursing shortage, which threatens to undermine the quality of patient care. Educating more nurses will help fill existing vacancies, Quinn said, and that will help lower the nation’s high unemployment rate.

http://www.rwjf.org/pr/product.jsp?id=56174


Domestic Nurses Counterplan: Solvency – Education

The U.S. can expand nursing education to overcome nursing shortagesAiken 7 (Linda, director, Center for Health Outcomes and Policy Research, Health Services Research, 42(3) pg. 1299 – 1320)gw

The United States has the capacity, in terms of human and economic resources, to become largely self-sufficient in its nurse workforce. There are large numbers of Americans who want to become nurses, thousands more than can be accommodated by nursing schools because of faculty shortages and other capacity limitations. The United States has a large enough labor pool and enough resources to expand higher education to increase nurse supply. Moreover, greater representation in nursing by blacks, Hispanics, and men could be achieved by expanding nursing school capacity at a time when the applicant pool is strong.


Domestic Nurses Counterplan: Politics – Obama Loves It

Obama against immigrant nurses, train nurses in the USJha 9 (Lalit K, Journalist Int’l Affairs and Gov’t operations, Washington Post,

http://in.rediff.com/money/2009/mar/06bcrisis-obama-opposes-bringing-nurses-from-overseas.htm) KRA

US President Barack Obama on Friday opposed the idea of inviting overseas nurses, including from India, to fill up the huge shortfall the United States is facing right now. America like most of the Western countries is faced with acute shortage of nurses and in recent years it has allowed medical personnel from India, China and Philippines to immigrate to work in hospitals. "The notion that we would have to import nurses makes absolutely no sense," Obama told a gathering of health experts and lawmakers at a White House meeting on health care reforms. Instead, Obama argued that the best possible approach to meet this shortfall is to train people inside the country. "For people who get fired up about the immigration debate and yet don't notice that we could be training nurses right here in the United States," he said responding to an observation made by Congresswoman Lois Capps from California.

http://in.rediff.com/money/2009/mar/06bcrisis-obama-opposes-bringing-nurses-from-overseas.htm

http://in.rediff.com/money/2009/mar/06bcrisis-obama-opposes-bringing-nurses-from-overseas.htm

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