CHCC: Almost half of CHC’s nurses capped out by 2018

The Commonwealth Healthcare Corp. is staring at a potential crisis when the CW1 visas of 47 percent of its nursing workforce expire by 2018. That means that, among nurses alone, 85 of about 180 are expected to exit the CNMI.

CHCC chief executive officer Esther Muña said a total of 114 CW1 workers from various areas of the Commonwealth Health Center, Tinian Health Center, and the Rota Health Center will be “potentially capped out” in November and December of 2017.

The CNMI is only allowed a total of 12,998 CW1 slots this fiscal year. Being “capped out” means there would no longer be any slots for these nurses, which means they will have to leave the CNMI.

An immediate solution would be to pay extra overtime for the remaining nurses, which would not only be a financial blow to CHCC, but also be extremely taxing to the nurses themselves, said Muña.

“We are worried,” said Muña. “How do we make sure that [CHCC] has enough nurses for the patients? How can we expand our hospital if we do not have the workforce?”

Muña said that CHC’s perennial workforce problem could be solved by providing a competitive salary to entice nurses, both local and from the U.S. mainland, and encourage more to pursue a nursing career.

Muña concedes that local nurses do finish a nursing course at the Northern Marianas College but opt not to push through in becoming a registered nurse, RN.

“You produce enough graduate nurses but the problem is, they don’t become nurses. The percentage of how many people pass the National Council Licensure Examination, or NCLEX, is small,” said Muña.

“We want to provide more incentive for people to take the exam, to pass the exam, and to actually become a nurse. We know that the rate of RNs being produced out of the graduate nurses is small. How do we address that? We have to look at competition,” said Muña.

Muña said that recruiting from the U.S. mainland is also tricky due to the islands’ less competitive salary.

“Even if we recruit in the U.S., nobody wants to come because of the salary. We have nurses who have graduated here in the CNMI who are locals, but go to the mainland because the salary is not that competitive [here],” said Muña.

The third problem, according to Muña, is that other industries that also utilize CW workers are competing with CHCC for CW slots.

Muña believes making salaries competitive would benefit CNMI healthcare in general.

“[With a competitive salary], the nurses you are trying to recruit is convinced to come here and the nurses that you are getting out of the college is enticed to pursue and pass the NCLEX to come and work for CHCC as a nurses,” she said.

In California, RNs make as much as $100,000 per annum, while $40,000 to $50,0000 is the average for Guam. On Saipan, RNs arn about $20,000 to $30,000 only.

Long-term solutions may include an employment-based visa, but that itself comes with its own set of problems.

“We are talking about removing and getting away from the CW, [switching to] an employer-based visa. One of the concerns that people have is [retention],” said Muña.

“Nobody can be deprived of their right to choose, so you can’t demand that they stay here. You can demand a payback in the contract, but how do you make them stay?”

By providing a competitive salary, along with an employment-based visa, Muña believes majority of the nursing workforce would be retained.

According to Muña, nine employees would be going home in April due to the expiry of their CW1 visa.

Muña reminded that it is a Center for Medicaid and Medicare Services, or CMS, requirement that there should be at least one RN on duty at all times for each health center.

“We will not remove that,” said Muña, referring to both CMS compliance and the placement of at least one RN in the hospital at any given time.

CMS is an invaluable source of funding for CHCC.

“You can’t practice healthcare with uncertainty,” said Muña.