San José, Costa Rica, since 1956

Lack of Opportunities Sends Nurses To U.S.

Low salaries, exhausting hours and a lack of job openings for professional nurses in the country’s public health-care system has made recruiting offers from the United States attractive and could leave Costa Rica with a shortage of nurses, according to representatives from the sector.

“We are worried about in whose hands Costa Rica’s health will be,” said Virian Mejías, president of the Costa Rican Nurses Association. According to Mejías, public health care is already short more than 850 nurses, “just to cover Costa Rica’s minimum needs.”

The shortage, she explained, is because Costa Rica’s Social Security System (Caja), which administers the nation’s socialized health-care system, does not authorize enough nursing positions in public hospitals and clinics. The Caja provides health care to approximately 88% of Costa Rica’s 4 million inhabitants.

Meanwhile, she added, a U.S. company called Americus Nursing International wants to recruit at least 500 Costa Rican nurses to work and live in the United States, where the company says there is a need for an additional 20,000 nurses, she said.

The company, which Mejías said would begin recruiting in October, has said it will take care of the visas and necessary work permits for the selected nurses, who would be contracted for at least two years and earn between $3,000-8,000 a month, depending on their qualifications.

Neither The Tico Times nor the U.S. Embassy in San José was able to confirm the existence of Americus Nursing International.

A Google Internet search found no reference to the name, and messages left at a phone number for the representative of the company, James Craig, whose name was obtained from the daily Al Día, went unreturned.

In Costa Rica, the base monthly salary for a nurse in the public health sector, set by the Caja, is ¢290,000 ($566). Private hospitals would not divulge nurses’ salaries or did not return Tico Times’ calls.

The Nurses Association, to which nurses must belong to work in either public or private health care in Costa Rica, has promoted raising nursing salaries; however, the Caja has dismissed their efforts, Mejías said. In addition, many nurses are contracted by the Caja for positions they are overqualified for and paid a lesser salary, yet do the work of professional nurses, she alleged.

The Tico Times asked the Caja about this, but received no response in the past several weeks.

In the past year, 76 nurses have emigrated to work in other countries, independently of Americus Nursing International’s recruiting efforts,Mejías added.

Not Enough Openings

Johany María Romero, nursing director at the San Juan de Dios Hospital, explained not only low salaries, but also a lack of professional nursing positions hurt Costa Rican health care.

San Juan de Dios, one the nation’s largest public hospitals, is already handicapped by a shortage of doctors that has patients waiting months or years for surgery or specialized medical appointments (TT, July 7).

“What happens is we estimate (how many nursing positions) we need and give it to Caja,” Romero said. “But, probably for budget reasons they do not give us (all) the positions.”

At San Juan de Dios, Romero said, she deals with this shortage by having nurses under her charge work overtime hours. She would have to hire 38 more nurses just to cover those hours if her nursing staff worked normal workdays, according to a study she recently conducted. According to Mejías, it would cost the Caja less to hire 38 more nurses than pay these overtime wages. It would also mean a better-rested nursing staff.

Romero was quick to point out the patients at San Juan de Dios receive the attention they need.

“I can show you that our patients are really happy. It is the personnel who aren’t happy,” Romero said. “The exhaustion is really immense. But we do it by sacrificing, by skipping lunch, doing what we have to do to attend to the patients.”

Both Romero and Mejías say many professional nurses accept jobs as nursing assistants in hopes higher positions will open up.

“They come out of the universities expecting nursing positions, but we don’t have openings for them,” Romero said.

The Caja used to offer nursing scholarships, she continued, that required nursing students to stay and work in Costa Rica for at least five years after graduation, but they have been discontinued for reasons not clear.

Greener Grass?

Romero said she understands why nurses would follow attractive offers to the United States. She added that the recruiting could even be beneficial if the Caja responds to this competition by raising salaries and opening more positions.

“But it is a double-edged blade,” she said, because if the Caja doesn’t make nursing more attractive in Costa Rica, the result could be the flight of Costa Rica’s best nurses to other countries.

In addition to the United States, she added, countries such as Italy and France also are experiencing serious shortages of nurses.

According to U.S. citizen and former nurse Carol Veloso, the director of the private CIMAHospital, in Escazú, west of San José, the shortage of nurses in the United States has multiple causes. Principally, she said, there is a lack of nursing professors, because nursing professionals earn a lot more money working as nurses than as a university professors.

Because nursing schools must have a student-to-professor ratio of no more than 10-to-one, she continued, they are limited in the number of students they can accept.

In addition, nursing has traditionally been a woman’s job, but because women in the United States have a much broader choice of professions, fewer are going into nursing, she said. Nurses also have more options, such as opening their own practices as nurse practitioners.

“There are a lot more opportunities for nurses outside the hospital, leaving a huge gap in bedside care,” Veloso said. “So you have companies rise up and go to foreign countries that have nurses.”

Caution Urged

Veloso warned not all nursing offers are what they seem. In some circumstances, a U.S. hospital beginning labor negotations with its nursing staff could recruit nurses from another country to cover a possible strike, Veloso said.

Veloso said the salaries being offered by the Americus Nursing International, though high for Costa Rican standards, dip into the low side for U.S. standards.

“If they are paying $3,000 a month, they are underpaying. That’s about $36,000 a year, way below what a nurse would make in the United States.Veloso said. “On the East Coast, and on the West Coast in California, nurses (make) closer to $60,000 a year. The dollar amount will look outstanding to nurses here, but it’s not how much they should be getting.”

According to Evelyn Ardón, an Information Specialist with the U.S. Embassy in San José, U.S. work visas for foreign health professionals, such as nurses, are available through a temporary-workers program that requires the sponsorship of a U.S. employer and passing a set of exams (in English) conducted by the Educational Commission for Foreign Medical Graduates. More information on the program can be found at


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