Thank you Senator Brownback and Senator Kennedy for allowing me to testify at this hearing on behalf of the Service Employees International Union.

My name is Diane Sosne, and I am registered nurse (RN) and co-chair of SEIU's Nurse Alliance. Today I am speaking on behalf of the over 1.4 million members of the SEIU, 110,000 who are nurses and 120,000 nursing home workers in our health care division. SEIU is committed to achieving access to quality health care for all who live and work in America - and quality jobs for all who dedicate their lives to caring for others.
We are a nation of immigrants that has benefited from the talent and expertise of immigrants in every occupation. Today countless nurses, doctors, and other health care givers who have come from other countries are working in the United States. SEIU has embraced these dedicated workers. They are making our union stronger through their diversity and energy, and they have joined our movement for quality patient care.

We are proud of our SEIU immigrant members working in home healthcare, nursing homes and hospitals. We are very aware of the staffing crisis, because our members are working in health facilities with too few staff, and too many patients with increasingly complex and chronic health conditions. SEIU is uniquely qualified to be a partner in the health care staffing dialog as the largest health care union. SEIU's Committee for Interns and Residents (CIR) members are doctors working in inner city hospitals, many of whom are in this country through the H1-B visa program. Other SEIU members are health caregivers in some of the toughest public hospitals in New York, New Jersey, Washington D.C. and Los Angeles.

Hospitals today are expecting too few nurses to care for far too many patients. That reality was confirmed by a recent national poll of acute care RNs commissioned by the SEIU Nurse Alliance. In that survey, more than one third of all nurses surveyed said that patients on their units experience missed or delayed medication or treatments at least once a week - usually as a result of inadequate staffing.

If the problem were just too few nurses in this country, easing immigration might make sense. But, since the root cause of the nursing shortage isn't lack of nurses. Working conditions such as short staffing are driving existing staff away from the profession. Immigration is a bandaid to cover the real problem. Unsafe working conditions diminish quality care for patients and make it unsafe for nurses to practice. The risk of making fatal mistakes and putting licenses on the line is causing nurses to leave the profession in record numbers. In fact, nurses who come to this country on visas will be facing the same unsafe, poor work environments that are driving tens of thousands of American nurses out of hospitals.

The proportion of the nation's registered nurses working in hospitals declined from 68 percent in 1988 to 59 percent in 2000, as a result of industry and occupation restructuring.

The same problems exist in nursing homes where nine in 10 homes lack staffing that is needed to provide high quality care, according to the Health Care Financing Administration (HCFA). The problem is not a nurse aide shortage but a retention crisis that has led to a revolving door workforce. Heavy workload, high risk of injury from lifting and bathing patients, and low wages have combined to create 100 percent turnover among nursing home caregivers each year on average. By the year 2020, when the U.S. baby boomer generation will be in greatest need of care, and a shortage of 400,000 nurses in the United States is projected.

We do not oppose Immigration as one approach to solving the nursing shortage. But, the priority in our health care system should be to attract and retain health care-givers. Today, only 55 percent of acute care nurses plan to stay in hospitals until they retire. And yet, fully 68 percent say they would be more likely to stay in hospitals if staffing levels in their facilities were adequate.

SEIU believes we can reduce our staffing shortage by increasing funding and financial support for nurse and nurse aide education, recruitment and retention by increasing wages and improving working conditions. These kinds of initiatives should be implemented first before turning to immigration as the solution.

We can attract more American workers to the profession by removing barriers and expanding the pool of potential health caregivers. We need to change the complexion of nursing, we need to recruit more men, and improve the racial and ethnic diversity. Finally, more emphasis should be placed on welfare-to-work programs. Former welfare recipients could be encouraged to choose healthcare as profession if Congress would define post-secondary education programs as a qualified work activity.

However, we acknowledge that new caregiver recruitment and education programs alone won't solve the problem. They will only treat the symptoms, not cure the disease. Unless we address the poor working and quality patient care conditions plaguing our caregivers today, the best we can hope for is a revolving door - with nurses and nurse aides leaving hospitals and nursing homes as fast as they enter.

But I'm certain that all of our members - regardless of where they come
from - would agree that trying to solve the current nursing crisis by bringing in more health caregivers from around the world is a short-sighted response. Regardless of nationality, the working conditions are driving health care givers away from these jobs. We should not exploit immigrant workers because conditions in this country may be better than from where they came. Neither American nor foreign-born workers should be subjected to these working conditions.

First of all, the nursing shortage is a worldwide phenomenon. As a member of the global community, our nation should not draw trained nurses away from poor countries that need them even more desperately than we do.

Nor should we selectively adapt our immigration policies to cater to the needs of one particular industry. What we really need is broad reforms of our immigration laws. It's no secret that an estimated 9 million undocumented workers reside in the United States today. But lesser known is the fact that because of the way our current laws work, many of those people are actually working outside of their chosen professions - including health care professions. The time has come for our nation to take a hard look at how best to protect the rights and enhance the quality of life for everyone who lives and works in the United States. SEIU as a member of the AFL-CIO is calling on Congress to allow undocumented workers already in this country to be able to legalize, (a copy of AFL-CIO resolution is attached to this testimony).

Rather than seeking stopgap measures to ease the crunch in the short term, we need to fix the system for the long term. Fundamentally, the only real and lasting solution to the growing nursing shortage lies in the establishment of safe staffing standards in our hospitals and nursing homes.

We must make safe staffing a requirement for all hospitals receiving federal taxpayer dollars. We must make sure the federal government is providing adequate oversight of our hospitals. We must protect the rights of patients and the rights of health care workers who blow the whistle on problems with patient care. We must take action immediately to stop the hemorrhaging - by banning mandatory overtime for nurses, just as we do for train engineers, air traffic controllers, truck drivers, and other occupations where public safety is at risk.

Perhaps most of all, we must make sure that workers have a voice in the decisions that affect their professions, their jobs, and their livelihoods. We must involve nurses in the process of designing solutions to the staffing crisis. Any employment based immigration program must involve workers -- not just employers.

Understaffing in our nation's hospitals is a serious problem. It's a problem that will only be solved through the joint efforts of public officials, nurses, and hospital administrators. And it's a problem that must solved if we are to guarantee quality care for patients - and keep skilled nurses in our hospitals.

SEIU, is committed to the following principles:

l The creation or expansion of temporary or permanent visa programs for health care professionals must be evaluated in light of a comprehensive analysis of the projected needs of the health care industry and the adequacy of measures to train and retain American nurses.

l Immigrant health caregivers should meet existing licensing and certification requirements.

l Immigrant workers should be allowed to stay in this country under any visa program. We should not seek immigrant workers from around the world with the expectation of using them to solve our workforce problem temporarily, and then sending them home. It should be the worker's choice to stay.

l Where established labor/management relationships exist, unions must have a direct role in the labor certification process - such as a joint labor/management visa application process.

l Immigrant workers must be guaranteed all labor protections, including whistleblower protections for both patient quality care and labor rights.

l SEIU is concerned that the health care industry is seeking a quick fix by asking for renewal of the H1-A visa program, which was widely abused by temporary agencies and nursing homes.

l SEIU also opposes efforts by industry to relax the H1-B or expand H1-C requirements so that more RN's and health caregivers workers in general can be made eligible.

l SEIU supports legalization of undocumented workers currently living and working in this county. It is time for undocumented workers already working paying taxes and living in the U.S. to come out of the shadows and work legally without fear. Many are already working in home health care industry, nursing homes and hospitals. Many other undocumented workers could work in these professions because of their foreign training but are not allowed to work because of their undocumented status.

We look forward to working with this committee to crafting a comprehensive solution to the shortage of health care professionals facing this country. Thank you again for allowing me to testify.

I look forward to answering you questions.

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Attachments:
Biography
AFL-CIO Resolution 2/16/2000

Diane Sosne, RN, MSN, is Co-Chair of the Service Employees International Union (SEIU) Nurse Alliance Sector Council, representing more than 110,000 members, and a member of SEIU's Executive Board. She is also president of SEIU 1199NW, a local union of nurses and other health care employees in Washington State. She has been a registered nurse for over 30 years. In 1983, she and her colleagues at Group Health Cooperative of Puget Sound founded District 1199NW.

Sosne has served as the local's president since 1984. Since then, membership in 1199NW has grown by more than 9,500 new members. Over the last decade, SEIU 1199NW has negotiated some of the best union agreements for nurses in the country, giving nurses input in decisions about staffing levels in their hospitals.

SEIU represents 1.4 million members and is the largest and fastest-growing union in the AFL-CIO. It is also the nation's largest health care union, representing 710,000 health care workers.

February 16, 2000
New Orleans, LA
Immigration

The AFL-CIO proudly stands on the side of immigrant workers. Throughout the history of this country, immigrants have played an important role in building our nation and its democratic institutions. New arrivals from every continent have contributed their energy, talent, and commitment to making the United States richer and stronger. Likewise, the American union movement has been enriched by the contributions and courage of immigrant workers. Newly arriving workers continue to make indispensable contributions to the strength and growth of our unions. These efforts have created new unions and strengthened and revived others, benefitting all workers, immigrant and native-born alike. It is increasingly clear that if the United States is to have an immigration system that really works, it must be simultaneously orderly, responsible and fair. The policies of both the AFL-CIO and our country must reflect those goals.
The United States is a nation of laws. This means that the federal government has the sovereign authority and constitutional responsibility to set and enforce limits on immigration. It also means that our government has the obligation to enact and enforce laws in ways that respect due process and civil liberties, safeguard public health and safety, and protect the rights and opportunities of workers.
The AFL-CIO believes the current system of immigration enforcement in the United States is broken and needs to be fixed. Our starting points are simple:
" Undocumented workers and their families make enormous contributions to their communities and workplaces and should be provided permanent legal status through a new amnesty program.
" Regulated legal immigration is better than unregulated illegal immigration.

" Immigrant workers should have full workplace rights in order to protect their own interests as well as the labor rights of all American workers.

" Labor and business should work together to design cooperative mechanisms that allow law-abiding employers to satisfy legitimate needs for new workers in a timely manner without compromising the rights and opportunities of workers already here.
" Labor and business should cooperate to undertake expanded efforts to educate and train American workers in order to upgrade their skill levels in ways that enhance our shared economic prosperity.

" Criminal penalties should be established to punish employers who recruit undocumented workers from abroad for the purpose of exploiting workers for economic gain.
Current efforts to improve immigration enforcement, while failing to stop the flow of undocumented people into the United States, have resulted in a system that causes discrimination and leaves unpunished unscrupulous employers who exploit undocumented workers, thus denying labor rights for all workers.
The combination of a poorly constructed and ineffectively enforced system that results in penalties for only a few of the employers who violate immigration laws has had especially detrimental impacts on efforts to organize and adequately represent workers. Unscrupulous employers have systematically used the I-9 process in their efforts to retaliate against workers who seek to join unions, improve their working conditions, and otherwise assert their rights.
Therefore, the AFL-CIO calls for replacing the current I-9 system as a tool of workplace immigration enforcement. We should substitute a system of immigration enforcement strategies that focuses on the criminalization of employer behavior, targeting those employers who recruit undocumented workers from abroad, either directly or indirectly. It should be supplemented with strong penalties against employers who abuse workers' immigration status to suppress their rights and labor protections. The federal government should aggressively investigate, and criminally prosecute, those employers who knowingly exploit a worker's undocumented status in order to prevent enforcement of workplace protection laws.
We strongly believe employer sanctions, as a nationwide policy applied to all workplaces, has failed and should be eliminated. It should be replaced with an alternative policy to reduce undocumented immigration and prevent employer abuse. Any new policy must meet the following principles: 1) it must seek to prevent employer discrimination against people who look or sound foreign; 2) it must allow workers to pursue legal remedies, including supporting a union, regardless of immigration status; and 3) it must avoid unfairly targeting immigrant workers of a particular nationality.
There is a long tradition in the United States of protecting those who risk their financial and physical well-being to come forward to report violations of laws that were enacted for the public good. Courageous undocumented workers who come forward to assert their rights should not be faced with deportation as a result of their actions. The recent situation at the Holiday Inn Express in Minneapolis highlights the perversity of the current situation. Therefore, the
AFL-CIO calls for the enactment of whistleblower protections providing protected immigration status for undocumented workers who report violations of worker protection laws or cooperate with federal agencies during investigations of employment, labor and discrimination violations. Such workers should be accorded full remedies, including reinstatement and back pay. Further, undocumented workers who exercise their rights to organize and bargain collectively should also be provided protected immigration status.
Millions of hard-working people who make enormous contributions to their communities and workplace are denied basic human rights because of their undocumented status. Many of these men and women are the parents of children who are birthright U.S. citizens. The AFL-CIO supports a new amnesty program that would allow these members of local communities to adjust their status to permanent resident and become eligible for naturalization. The AFL-CIO also calls on the Immigration and Naturalization Service to address the shameful delays facing those seeking to adjust their status as a result of the Immigration Reform and Control Act.
Immediate steps should include legalization for three distinct groups of established residents: 1) approximately half-a-million Salvadorans, Guatemalans, Hondurans, and Haitians, who fled civil war and civil strife during the 1980s and early 1990s and were unfairly denied refugee status, and have lived under various forms of temporary legal status; 2) approximately 350,000 long-resident immigrants who were unfairly denied legalization due to illegal behavior by the INS during the amnesty program enacted in the late 1980s; and 3) approximately 10,000 Liberians who fled their homeland's brutal civil war and have lived in the United States for years under temporary legal status.
Guestworker programs too often are used to discriminate against U.S. workers, depress wages and distort labor markets. For these reasons, the AFL-CIO has long been troubled by the operation of such programs. The proliferation of guestworker programs has resulted in the creation of a class of easily exploited workers, who find themselves in a situation very similar to that faced by undocumented workers. The AFL-CIO renews our call for the halt to the expansion of guestworker programs. Moreover, these programs should be reformed to include more rigorous labor market tests and the involvement of labor unions in the labor certification process. All temporary guestworkers should be afforded the same workplace protections available to all workers.
The rights and dignity of all workers can best be ensured when immigrant and non-immigrant workers are fully informed about the contributions of immigrants to our society and our unions, and about the rights of immigrants under current labor, discrimination, naturalization and other laws. Labor unions have led the way in developing model programs that should be widely emulated. The AFL-CIO therefore supports the creation of education programs and centers to educate workers about immigration issues and to assist workers in exercising their rights.
Far too many workers lack access to training programs. Like all other workers, new immigrants want to improve their lives and those of their families by participating in job training. The AFL-CIO supports the expansion of job training programs to better serve immigrant populations. These programs are essential to the ability of immigrants to seize opportunities to compete in the new economy.
Immigrant workers make enormous contributions to our economy and society, and deserve the basic safety net protections that all other workers enjoy. The AFL-CIO continues to support the full restoration of benefits that were unfairly taken away through Federal legislation in 1996, causing tremendous harm to immigrant families.