RN: Refusing nonsense

Nurses who have made aliya with certification and expertise from Western countries discover that, even with a nursing shortage here, they cannot practice their beloved profession without facing obstacles.

Nurse 370 (photo credit: courtesy)
Nurse 370
(photo credit: courtesy)
It’s too soon to discuss policy with new Health Minister Yael German.
But with the current nursing and medical assistance shortage, many are hoping that one area where change will be implemented is health services. This is especially true considering the fact that the Health Ministry now belongs to the successful Yesh Atid party, whose election platform was based on a commitment to improving quality of life for the middle class.
It’s common for nurses who have made aliya with certification and expertise from Western countries – even where the caliber of medical services is high, including the US – to discover that they cannot practice their beloved profession here without facing obstacles. Not only do such difficulties affect these qualified individuals, but ordinary citizens, who would benefit greatly from improved and more readily available care, are also negatively impacted.
Yehudis Schamroth, who made aliya in 2001, is an American-born-andraised certified registered nurse anesthetist with 30 years of working experience.
However, she legally cannot perform any nursing task whatsoever here, no matter how basic.
Schamroth travels to America several times a year – all expenses paid – where she independently administers general and local anesthetics, spinal epidurals and ophthalmic blocks for any type of adult or pediatric surgery. There has been an anesthesia provider shortage in the US for a long time, she says, which enables her to work at American hospitals and surgicenters. Thus, working abroad has been her main source of income for the last 12 years, although she would prefer to use her expertise in her newly adopted country.
Fluency in Hebrew at a university entrance level is only one of the challenges Schamroth and many others in similar predicaments have been facing.
The sore point is that two of her brothers- in-law, also immigrants, were permitted to work in Israeli hospitals immediately, notwithstanding their lack of Hebrew knowledge. They are now fluent, she says, having learned on the job.
“Nothing has changed here since 10 to 15 years ago, when a doctor submitted his application and had only to work under observation for a few months, and that was it,” she explains. “Why can’t a nurse do that? Nothing is being done to assist qualified nurses to expedite their licenses here. Physicians, with no requirements for ulpan or [professional] testing, are being grandfathered in because there’s a physician shortage as well. I want to get the word out so that we can get the same done for us.”
ALTHOUGH SHE is a faculty member at the Hadassah University Medical Center School of Nursing, Dr. Caryn Andrews, an experienced American nurse practitioner with two board-certified specialties in family practice and oncology, is also not permitted to practice her profession here. She teaches in the classroom but is prohibited from supervising students at clinics.
“I have a list of over 50 nurses who have made aliya, and most have been unable to get a nursing license despite many years of experience. As for me, I have a bachelor of science in nursing, a master of science in nursing and a PhD, but I cannot touch a patient.”
According to a Magen David Adom volunteer, teenagers who take a crash 60-hour training course can take blood pressure and pulse. These are tasks that Andrews and others like her are technically forbidden to do here.
“There are many stories like mine and, unfortunately, most have just given up and gone on to other professions,” Andrews adds. “Many spend two to three years studying for accreditation here, remaining unemployed throughout.
“A colleague flies each month to work in Switzerland. Others travel back and forth to the US several times a year, just in order to earn enough to sustain themselves. With the nursing shortage in Israel, this makes no sense.
“I also have nurses who call me before making aliya, and at this point in time, I tell them that the licensure is so hard, and I discourage them. I’m so sad to say that. It happens all the time.
“On the other hand, there are nurses from abroad who have successfully navigated the system, but they are few and far between.”
Nursing education in Israel is based on the American curriculum and uses English-language texts, she points out.
Also, many nurses making aliya offer to work in environments where they could improve their language skills and have asked for temporary licenses. All have been turned down by the Health Ministry nursing department.
Andrews, moreover, took the Hebrew proficiency exam twice and “failed both times by just one point.” She tried to appeal, bringing along a physician who agreed that she should be certified here, but it didn’t help. She would have accepted a paid internship, but that, too, is unavailable to immigrant nurses here.
At a palliative care conference in Tel Aviv, Andrews mingled with Israeli hospice nurses who were “shocked that I couldn’t be a nurse here. They used the word ‘haval’ [what a shame].”
Denise Rosen, a UK-educated nurse who made aliya twice – first in 1990, before the massive immigration from the former Soviet Union, and again a few years later – describes the bureaucracy that she encountered: “In 1990, I got an Israeli license and I did get a position, but then I left to study. I came again 19 years ago and made aliya for the second time. There were changes in the system because of the influx from Russia and problems with false licenses in many professions. Doctors from certain [mainly non-Western] countries also had to take exams, and they still do. In 1995, they wanted to see my highschool qualifications and the equivalent of SAT scores; they were more interested in that than in my nursing qualifications or in the fact that I already had been working here as a nurse. I had been qualified since 1989 and in Israel in 1990. But only when they saw my high-school grades did they transfer the license.”
Six years ago, Rosen decided to further her education and obtained bachelor’s and master’s degrees in nursing from Ben-Gurion University. “I didn’t do it for money,” she says. “I wanted to contribute more. The pay was the same with the first degree. I just completed the master’s, so perhaps it will be higher, but nothing significant.”
There “definitely” is a nursing shortage, she says. One of the subjects in the master’s program was economics in nursing, and they “stressed a large, large shortage.”
DR. SHAY Pintov, special medical consultant for the Immigrant Absorption Ministry, agrees that there’s a dearth of nursing care, which he terms a crisis.
He said, “There are vast differences between the qualifications of nurses – registered nurses – in Israel and in the States. Part of this gap is a difference in responsibility and approach, and how the Israeli system works.
“Any nurse who comes to Israel has to pass the process of at least a year [of study] before she’s eligible to get an Israeli license. One of the gaps is the Hebrew language. Others are differences in the American and Israeli systems,” including special courses that are only in the Israeli curriculum. There are certain adjustments, such as the medications here that are different as well.
“On top of this, there are professions in America like nurse practitioners that don’t exist at all under Israeli law. This prevents nurses with higher degrees from getting a license in Israel, and it also decreases their motivation to come and work in Israel because they cannot practice according to their abilities and licensing... I know quite a few nurses willing to come to Israel, but the licensing and the structure are problematic.”
The Smokler Center for Health Policy Research, according to its website, “works with the national government and health care providers and insurers to provide objective data and independent analyses to assist in planning and evaluating these initiatives.” According to a recent study on perceived strengths and weaknesses in the Israeli system that was done in 2011, based on healthcare perceptions and experiences of American physicians following aliya, several “complained about the nursing shortage, which required them to perform tasks that they would not be called upon to do in the US.”
According to Pintov, nurse practitioners would be an asset to the Israeli medical system, but as it stands now, “it’s a catch-22.
They are highly educated, and no one knows how to deal with them. It’s a big pity.” In contrast, he adds, American-trained physicians, since January 2012, depending on which state they had been practicing, require only “additional practicing adjustment.
They don’t need new licenses.”
Asked why the system is so much tougher for nurses, he replies: “I don’t know. The bureaucracy in Israel is very unjust. It’s a ridiculous situation.”
“With the shortage of nurses, there needs to be more nursing faculty to educate more nurses, and turning away highly educated nurses from abroad is counter-productive,” Andrews notes.
SHOSHANA KESNER, a registered nurse from the US, holds a bachelor’s in nursing and midwife certification, as well as a doctorate in homeopathic medicine, although she hesitates to use the title “Dr.” here.
“Homeopathy isn’t a recognized specialty here,” she explains. “People practice, but they’re not recognized in a formal manner.” Here, seven years ago, she had to reinvent herself professionally, and she founded Binah Baby, a support center for mothers and babies based in Beit Shemesh.
“I work with mothers and babies, educating them on postpartum expectations and parenting skills, explaining the immunization and all different things related to child medical care,” she says. “In Israel, I can’t work as a nurse because of certification. The process is too complex. It’s in Hebrew.
It’s too complicated, and quite frankly, I already paid my dues. I wouldn’t want to spend years retraining.
“I don’t mean to complain. I choose to live here,” notwithstanding the challenges.
“But what I want to do is to contribute to the well-being of growing families in Israel. If I could work here in my field, I wouldn’t have created Binah Baby.”
As Kesner sees it, they lose out here.
“They’re not utilizing the superior training and strengths of so many nurses. I’m committed and passionate about what I do, so much so that I’m investing my own savings to create a variation of my specialty. I am paying in order to work.”
At Binah Baby, “I don’t take temperatures.
I don’t take blood pressure. I don’t weigh babies. I will not perform any act that could be considered a medical act here,” for reasons of legality.
In an attempt to discuss the situation with Shoshana Riba, national head nurse at the Health Ministry, this writer was told that Riba was unauthorized to speak with the media. A secretary said that no one at the ministry would be available for a telephone conversation, and she gave instructions to send specific questions in an email.
Ministry spokeswoman Einav Shimron- Grinboim confirmed in a brief return correspondence that nurses from abroad must take an exam, although she offered no reasoning for the disparity in treatment between nurses and doctors.
“Under law, the absorption process for nurses is uniform,” she wrote.
She acknowledged that for a number of years, the subject of expert nurses providing independent care to patients has been broached.
There was no opportunity for further clarification.
Schamroth often encounters circumstances where laypeople are seen performing medical duties, such as in private practices, and she asks about their qualifications.
“Many would never make the mark today, as the rules have changed,” she observes. For example, she knows a podiatrist who performs foot surgery in his home office without a license here, and a doctor’s assistant at a clinic who gives intravenous sedation. “They’ve been doing it for so long that nobody bothers them. Meanwhile, I come here with all my education and experience, and I can’t even insert an IV.”
Despite her grievances, Schamroth remains upbeat and has “never stopped working.” Besides traveling regularly overseas, she offers her expertise here by teaching CPR and other lifesaving skills “Nurses earn so little here, and we have to do so much to qualify,” she says. “I can’t even volunteer. They make it so difficult. There is so much bureaucracy. We want to contribute here so badly. We are nurses. This is who we are. This is what we do.”
It was recently announced that Yesh Atid will also be chairing the Knesset Committee for Immigration, Absorption and Diaspora Affairs. New Knesset member Dov Lipman, an immigrant from the US, will be on that committee, and he also plans to act as a congressman for English-speaking olim – bringing hope to many that meaningful changes could be implemented.