Scheutz speaks of those days with a faint sigh. She became a nurse, but she doesn't feel she belongs on a poster.
Twenty-five years have passed since an American hospital offered her a job and a one-way plane ticket. "Everybody wants to come to the U.S.," she explains, "the appeal of green bucks and adventure."
Scheutz was one of the fresh-faced reinforcements brought in during the first great nursing shortage of the late '70s. She landed in a New Jersey hospital, and if there was considerable culture shock, there was also an increase in pay. By coming to the U.S., Filipinos can multiply their wages 25 times. She acquired her American surname after a trip to Cleveland for a friend's wedding, where she met the man she would marry. By 1980, Scheutz was an American citizen with a nursing job at the Cleveland Clinic.
But if Scheutz and other foreign nurses helped to offset the U.S. shortage of hospital staff, they have also come to understand that their enlistment was a temporary, imperfect solution.
Nurses here are a frazzled, weary bunch who work nights, weekends, holidays. Shorthanded, they're forced to rush through delicate tasks, like measuring medication, and can only pray that two patients don't go into cardiac arrest at the same time.
Perhaps most infuriating of all, they're rarely listened to by hospital management.
So when American nurses hear about the next wave of imports -- such as the hundreds to land in Cleveland next year -- they wonder why hospitals keep treating the symptoms, not the cause.
"Until you address the reasons why nurses don't want to work in your hospital, you just set up a revolving door," says Cheryl Peterson, a policy analyst with the American Nurses Association.
The dearth of nurses has been a reality for the last quarter-century. Still, no one can remember a time when it has brought the entire health care system so close to paralysis.
The reasons are many: HMOs cut deep into hospital reimbursements, nurses were laid off to salvage profits, and the remaining saw their job duties multiply. Stressed-out nurses fled the profession; fewer younger people joined it. Soon, as middle-aged nurses retire, the health care system will be inundated as never before by baby boomers.
"You think things are bad now? Wait 10 years," warns one Cleveland Clinic official.
Nurses already wring their hands over safety. "What we hear often from our members is 'I'm not able to give safe patient care. I'm working so fast, I have so many tasks, I could potentially make a very serious mistake,'" says Peterson.
That appears to be happening already, says Dr. Jack Needleman, who recently released a study on the nursing shortage's impact on care. "I estimate that hundreds or perhaps thousands of deaths each year are due to low staffing," he told The New York Times.
Given this climate, hospitals make no apologies for their growing emphasis on overseas recruitment. Next year, 125 Filipinos will begin work at the Cleveland Clinic's main campus; another 100 will start at the system's four East Side hospitals. They also form the majority of University Hospitals' new nurses.
English is native to the Philippines, so language isn't a problem. To ease the cultural transition, hospitals often match recruits with established nurses, as the Clinic pledges to do for its new arrivals.
"Most Filipino nurses can't get jobs in their own country," says Lois Bock, a Clinic recruiter. There are more students than jobs, so "the Philippines treat their nurses as exports. They say, 'Go somewhere and make money. Send it back to your family.'"
But it's not always easy. In some cases, promised jobs don't materialize, or the recruits fail licensing tests. Agencies formed to link Filipinos and U.S. recruiters have swindled some nurses by charging up to $2,000 just to forward a résumé. Those agents have suggested to Cleveland Clinic officials that they cut corners by paying the Filipinos less than Americans. "We basically kick those [agents] out the door," says Bock.
Some Cleveland nurses doubt their employers are that noble. Asked whether she thinks the new nurses will be paid the same wage as Americans, one clinic worker snaps, "Definitely not."
"My understanding is that there's a substantial difference in the amount of pay," says Peggy Maguire of the Ohio Nurses Association.
Reports of exploitation have surfaced elsewhere. According to a study released last month, some foreign nurses in Great Britain were paid less than minimum wage, made to clean cars and do laundry, and live in squalid conditions. Whiners were deported. Last year, The Washington Post caught D.C. hospitals giving nurses only a fraction of credit for the work they did abroad, thus bumping them down the pay scale.
U.S. nursing groups contend hospitals prize Filipinos less for their skills than for their naïveté. They're unlikely to complain about working the graveyard shift alone with 10 patients -- at least in the beginning.
American nurses, on the other hand, have become increasingly vocal. Still, most area nurses aren't unionized.
Cleveland hospitals insist they're working as hard at retaining nurses as they are at recruiting them. Says Bock: "The Clinic does a pretty good job responding to what the staff is mad about."
To which one nurse responds: "Can you print that they're full of shit? They make you think that they're listening, but nothing ever happens. It's incredibly manipulative. I don't know how they sleep at night."
It may be no coincidence that the only big hospital in town not looking abroad for nurses is the MetroHealth System, which offers a "senate" for the airing of grievances and has implemented changes suggested by its nurses.
Lisa Karbon, a MetroHealth nurse for 16 years, believes American health officials should get their own institutions in order before turning to other countries.
"There are some elements of the nursing profession that make people not want to get into it, and [hospitals] need to address those issues first," she says.