We can't outsource nursing, so we're in-sourcing it

Here's a Job Americans Would Do -- by Robert Kuttner

America has a nursing shortage, so Republican Senator Sam Brownback of Kansas has the perfect solution: imports. His provision in the Senate's immigration bill would waive the ceiling on the number of foreign nurses who can immigrate. Most come from poorer countries like the Philippines and India.

According to The New York Times, which first reported on this little-noticed provision, the American Hospital Association reports about 118,000 vacancies for nurses, and the federal government projects a nurse shortage of 800,000 by 2020.

Outsourcing is killing plenty of American jobs. But nursing is a good job that can't be outsourced, because the patients are here. Hey, no problem. We'll just in-source foreign workers.

Nursing is not one of those jobs you hear about in the immigration debate that ``Americans don't want to do." Plenty of Americans would love to be nurses. However, as shortages grow, working conditions deteriorate, and nurses suffer burnout.

Nor is nursing a job where low pay discourages Americans from taking the jobs. Hospital-based nurses earn an average of over $60,000. The problem isn't the pay; it's the over work. But the deeper cause of the shortage and the speed-up is our failure to invest in educating the next generation of nurses.

Community colleges and four-year universities lose money on costly nurse training programs and can't recruit enough teachers of nursing, since senior hospital positions offer better pay. As a consequence, there is far more demand for nursing degrees than there are slots for students. Hospitals are also under compensated for their role in training nurses.

This would seem a no-brainer. As the economy globalizes, many jobs won't stay in America. But here is a well-paid, professional job that stays here and that Americans want to do. Instead of passing more tax cuts and importing lower-wage immigrants, how about investing in our own people?

As for those other jobs that Americans ``won't do," we should invest in better pay. The truth is that plenty of Americans would do landscaping work, clean hotel rooms, wash dishes, pick vegetables, and perform the other kinds of labor increasingly done by immigrants, just as earlier generations of Americans were willing to work in hot, dirty factories and dig ditches. It's just that they want to be paid decently for the work.

Every so often, even in this era of outsourcing and automation, somebody opens a factory in the American heartland. Maybe they pay $15 to $18 an hour, plus health benefits. And, funny thing: though the work is far from glamorous, people start lining up and camping out to apply for the jobs.

Raise wages, improve working conditions, and Americans will materialize. But won't that be inflationary? Here are some statistics that suggest it needn't.

Last September, Robert Gordon and Ian Dew-Becker, economists from Northwestern University, observed that productivity and per-capita GDP had roughly doubled in three decades, while median wages had hardly budged. So they conducted a study titled ``Where Did All the Productivity Go?"

They found that nearly all of it had gone to the richest 10 percent of the population, and the most extreme gains to the richest 1 percent, who now have a share of national income equal to the bottom 50 percent. The people who really made out were the top one- 10th of 1 percent -- one American in 1,000.

So if we had a distribution of income more like the one that prevailed in 1966, when chief executives made ``only" 60 times what a normal worker made instead of 600 times, we could raise the wages of ordinary people without adding to the nation's overall wage bill.

How to raise wages? By the usual methods that obtained before a plutocracy of CEOs and Wall Streeters specializing in conflicts of interest grabbed the economy by the throat: higher minimum wage laws, enforcement of the Wagner Act recognizing the right to form unions, and the use of federal reimbursements to set decent wage levels in human service work.

How to pay for that? Restore progressive taxation on the wealthiest.

Which brings me back to nurses. In Massachusetts, harried nurses are now pushing for regulation of nurse-patient ratios. That's a necessary stopgap. But the deeper problem is shortage; and the deeper remedy is social investment in the education of more nurses.

Patients deserve good care, and nurses deserve to be treated like professionals. Let's invest in training the nurses that we need, instead of stripping poor countries of nurses that their people need.

(Robert Kuttner is co-editor of The American Prospect . His column appears regularly in the Globe.)