On December 18, 1989, Congress passed the Immigration Nursing Re-
lief Act.∞
The Act enabled h-1 visa nurses who were present in the
United States on September 1, 1989, and had worked for three years as a
registered nurse in the United States, to adjust their status to permanent
resident. It exempted h-1 visa nurses and their immediate family mem-
bers from current immigrant visa numerical limitations and backlogs.
Through their passage of this legislation, Congress members acknowl-
edged the critical role that this group of nurses plays in the contemporary
U.S. hospital workplace and other medical facilities.
However, the Immigration Nursing Relief Act also attempted to in-
stitutionalize the end of U.S. hospitals’ recruitment of foreign-trained
nurses. Congress members took seriously the concerns of American
nurses who had argued that the presence of foreign-trained nurses in the
United States adversely a√ected their employment opportunities. The
second major feature of the 1989 Act was the establishment of a complex,
multifaceted attestation requirement for those U.S. hospitals interested
in hiring new nonimmigrant nurses. This feature required that these
hospitals attest to a critical need for nonimmigrant nurses’ labor, the
absence of an adverse e√ect on the wages and working conditions of the
hospitals’ other registered nurses, the payment of the same wage rate for
nonimmigrant rns and other rns similarly employed, and an active
e√ort to recruit and retain American workers.
However, the U.S. government’s ability to control future migrations
of foreign-trained nurses to the United States and to ensure fair working
conditions for both foreign-trained and American nurses was limited. In
January 1998, Billy Denver Jewell, Holly Arthur Estreller, Sidney and
Veronica Hewitt, and Haesook Kim pleaded guilty to illegally bringing
hundreds of registered nurses from the Philippines into the United
States to work in convalescent homes and other medical facilities. Ex-
pecting wages of $13 to $15 per hour, these nurses earned as little as $5
per hour as nursing assistants.≤
Using the provisions of the 1989 Act, Jewell petitioned the ins and the
Department of Labor for the use of Filipino nurses’ labor in twenty-two
nursing homes that he owned. However, the Hewitts and Kim recruited
at least fifty of these nurses to work in medical care facilities throughout
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