Honey Sambayon sees life as a nurse in Florida as a way to solve a problem.
For two years, Sambayon, a 35-year-old native of the Philippines, has been away from her son, working in the operating rooms of Saudi Arabia’s hospitals to support him.
But the pair’s luck might be changing. It started with a Facebook post.
“We offer immigrant visa (‘green card’) sponsorship for eligible Registered Nurses,” wrote Cyndi Peters, an international recruitment manager for AdventHealth, a U.S.-based health care system headquartered in Florida.
They were hiring at nursing homes and hospitals in seven states, including Florida. The post included a link to apply online.
“I’d like to be in Florida because the weather is like the Philippines,” said Sambayon, who knows other Filipinos living in Orlando. “And in the United States, we can be citizens. I will be able to get my family there, especially my son. He can come and we can live together as a family, unlike in Saudi Arabia.”
Amid a growing workforce shortage, Florida nursing homes are joining hospitals in recruiting nurses from abroad to adequately staff facilities.
Some home care agencies have also begun to recruit overseas workers as well.
“The demand for long-term care facilities is huge,” said Brian Hudson, senior vice president for Avant Healthcare Professionals, a company that is not affiliated with AdventHealth and recruits nurses from other countries to work in the U.S. He declined to name any specific Florida nursing homes or home health agencies, citing client privacy.
“Florida is typically in the top three for these nurse openings nationwide — but what you’re seeing right now is really kind of a perfect storm, with a nurse shortage and then a pandemic,” he added.
AdventHealth is actively hiring for 10 overseas nurses at nursing homes across Central Florida, according to Ashley Jeffery, a spokesperson for the health care company. Two of its facilities are in Tampa Bay.
This is the first year the company is seeking nurses from abroad for its long-term care homes, Jeffery said. Advent continues to hire internationally for many nursing jobs at area hospitals as well.
These employees will have the opportunity to obtain green cards after their arrival, which will allow them to live and work permanently in the United States. Nurses who do not have prior experience working in long-term care will receive “transcultural assimilation” training.
Companies like ADEX Medical Staffing, Max Populi LLC and Tallahassee Memorial Healthcare are also actively hiring overseas nurses to staff Florida health care facilities throughout the state, according to online job postings.
Increased demand, larger backlog
Long-term care facilities and other health care providers would employ many more nurses from abroad if they could, Hudson said.
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The pandemic created a backlog. Approximately 5,000 international nurses have been approved for visas to work in the U.S. but are still waiting for them to be issued due to processing delays, according to a September 2021 report from the American Association of International Healthcare Recruitment.
Before the pandemic, nurses were typically on hold for about 120 days between passing the licensing exam that allows nurses to work in the U.S. and placement in a U.S. workplace. Today, the wait is closer to six to 12 months, Hudson said.
Nurses and other staff at Florida long-term care facilities who hold citizenship in other countries and have come to the U.S. by other means have faced similar challenges due to immigration pileups.
“We have about 20 folks, many of them asylum-seekers, that we risk losing unless their employment authorization renewals come in,” said Verónica Otero, spokesperson for DSI Management LLC, a company that hires nurses with citizenship in other countries to work in central Florida assisted-living facilities, nursing homes and home care agencies.
“We lost three already,” she added.
Employee authorization documents, which are not required for green card holders but are typically issued to people who are waiting for a final decision on their asylum case, allow a person claiming persecution in their home country to temporarily work in the United States.
These too have faced renewal delays.
“Once someone comes in and works with you, under those conditions, they’re really not going to be taking chances and going from one job to another,” said Otero, who said the employees the company places have a 10 percent higher retention rate than the general nurse population. “Because often their families are surviving by them sending packages from here to their country.”
Robyn Magalit Rodriguez, a professor of Asian American Studies at the University of California-Davis who researches overseas migrant workers, said it’s important to consider factors that lead employers to seek workers internationally.
“How have work functions shifted that make the job harder to fill?” she said. “It’s often very much driven by employers who drive wages down and create conditions under which they can be assured of cheap, compliant workers.
“The question becomes more: Is the issue a labor shortage, or is the issue a shortage in the kinds of labor that employers want?” Rodriguez added.
This exchange of employees becomes woven into the societal fabric of countries that send, as well as those that receive, workers. Remittances sent home from migrant workers accounted for 10 percent of the Philippines’ gross domestic product in 2020, for example, according to the most recent World Bank data.
Even if immigration processing times improve, long-term care facilities and home care agencies face a particularly steep challenge.
With care for seniors come added requirements, making these positions harder to staff than hospitals. “The skill sets are varied,” said Hudson. “Home care really is unique to the United States too — most countries take care of their elderly in their family units, so it’s difficult to translate those skills for a brand new international nurse coming over.”
Sambayon will have to pass her licensure exam before she can work in the United States. She’d prefer to continue work in hospital operating rooms — but she’s open to placement in a nursing home as well, she said.
“Personally, senior care? I think it’s a little bit challenging,” she said. “But I have friends from other countries who are doing geriatric nursing — and they’re having fun.”