Newly hired nurses at Rogue Valley Medical Center can ask "Where does it hurt?" in half a dozen languages besides English.

Newly hired nurses at Rogue Valley Medical Center can ask "Where does it hurt?" in half a dozen languages besides English.

They may be new to RVMC, but five foreign-trained nurses who just started work at the hospital bring a wealth of international experience to Southern Oregon. Emma Comejo and Ana Lim cared for patients in the Philippines and United Arab Emirates before coming to Medford. Maya Dhilip worked at hospitals in India and Singapore. Prem Sharma worked in Great Britain, as did Henry Vizmanos, who had his first nursing job in the Philippines.

Now they're absorbed in learning American-style nursing and adjusting to life in the United States. Medford didn't quite fit the image of America they had acquired from television and movies.

"We were expecting skyscrapers," Lim said.

"It was all trees and mountains," Comejo added.

They've discovered that American hospitals have more high-tech equipment than those in other countries, and nurses here have fewer mundane chores than their foreign counterparts.

"In the U.K. nurses clean commodes and wash (patient) bottoms," Vizmanos said. "Here CNAs (certified nursing assistants) do that because nurses are quite busy."

"We have a lesser scope (of care), but we have bigger responsibilities here," Comejo said.

Physicians in the U.S. treat nurses more as equals, she said. "Doctors work on their own here. In other countries you have to be with them when they're doing their rounds. Here, they just do it themselves."

Vizmanos said he and his colleagues from overseas have been "overwhelmed" by the friendly reception they've received at RVMC.

"They've welcomed us with open arms," he said. "It's helped us build our self-esteem."

RVMC managers decided to look abroad to fill some of the dozens of nursing jobs that have gone unfilled during the current shortage of nurses, said Anne Shevlin, RVMC's interim director of patient care. Shevlin said nurses are in short supply all over the United States, and competition is fierce.

"We're competing for the same new nurses and experienced nurses that everybody in the country is," she said.

Shevlin said many foreign-trained nurses are eager to come to the United States to get experience with state-of-the-art equipment. Others come from countries where wages are low to earn money they can send home to family members. Many American nurses earn as much as $50,000 per year, while nurses in less developed countries may earn less than one-tenth that amount.

Foreign nurses have worked in the United States for decades, but their numbers have soared in recent years as the nursing shortage worsened. A 2004 survey conducted by the U.S. Health Resources and Services Administration estimated that 3.5 percent (about 100,000) of the nurses practicing in the United States received their training in a foreign country. In some states, such as California, foreign-educated nurses account for as much as 25 percent of all registered nurses.

Just over half (50.2 percent) of all foreign-trained nurses working in the United States come from the Philippines. Canada is the next largest source (20.2 percent), followed by the United Kingdom (8.4 percent), Nigeria (2.3 percent), Ireland (1.5 percent), and India (1.3 percent). Nurses also come from 50 other countries in smaller numbers, according to the HRSA study.

In Oregon, where there are about 38,000 registered nurses, 1,346 (about 3.5 percent) received their training overseas, according to data collected by the Oregon State Board of Nursing. Canada and the Philippines are the largest sources of foreign-trained nurses working in Oregon, followed by far smaller numbers from Great Britain, India, Korea, Australia, China, Germany, South Africa and Japan.

Foreign-trained nurses are likely to account for a growing share of jobs while the nursing shortage continues, said Paul Foster, president of O'Grady Peyton International, a Florida-based medical staffing company that supplied RVMC's new foreign-trained nurses.

"International nurses aren't the (total) solution," Foster said, "but they're a part of the solution."

Foster said O'Grady Peyton recruits nurses from 35 countries, validates their credentials and training, and offers their services to hospitals around the world. The company places about 500 foreign-trained nurses per year.

RVMC selected Comejo, Vizmanos and their colleagues from a pool of candidates and interviewed them by phone before choosing them. O'Grady Peyton hired them and made all the legal arrangements for them to work in the United States.

They signed a contract with O'Grady Peyton, rather than RVMC, to work here for 18 months.

"We are their employer," Foster said. He said he did not know the specific details of the RVMC contract. RVMC officials declined to share the financial details of their contract with O'Grady Peyton.

Shevlin said the arrangement is similar to that of American nurses known as "travelers," who sign brief (typically 13-week) contracts with an agency to work in a specific hospital. The system helps hospitals fill short-term staffing needs and gives nurses an opportunity to work in different communities.

She said hospitals typically pay agencies $60 per hour and more for traveling nurses, based on their experience and skills. The agency in turn determines what each nurse is paid.

Nurses at RVMC have a contract with the hospital through the Oregon Nurses Association. A nurse with no experience starts out at $25 per hour (plus fringe benefits) and a nurse with 25 years of experience earns about $38, plus benefits.

Contract language in labor agreements between hospitals and the nurses union varies from hospital to hospital, but nurses who work through a third-party contracting agency are generally permitted to work without joining the union as long as they do not take work from union members, said Paul Goldberg, assistant executive director of labor relations for ONA.

Goldberg said the union had not previously heard of nurses being hired on contract for as long as 18 months.

While Oregon is expanding its nursing education opportunities, the need for nurses continues to grow as the population ages and more people move here. The Oregon Center for Nursing, established in 2001 to address the state nursing shortage, predicts that more than 15,000 additional nursing jobs will develop in Oregon alone over the next 15 years.

Shevlin said two more foreign-trained nurses will be coming to RVMC during July to work at the birth center. She noted that the average age of nurses is 48 at RVMC and its sister hospital, Three Rivers, in Grants Pass.

"Over the next five or 10 years," she said, "we're going to lose a lot of those nurses."

Reach reporter Bill Kettler at 776-4492 or e-mail bkettler@mailtribune.com.