"A hidden system of exploitation underpins US hospitals' employment of foreign nurses,"

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A slight, soft-spoken Filipino woman, Rachel, 31, had spent her career working in hospitals across the Philippines, struggling to care for patients in the country’s under-resourced healthcare system...

She and her colleagues would regularly juggle as many as five patients at one time, straining them to their limits...

Soon, Rachel found herself spinning through the cycle of anxiety, burnout, and guilt about a job hastily done that has plagued nurses across the US and accelerated during the covid-19 pandemic...

But Rachel couldn’t quit so easily. Her employment contract with Tallahassee Memorial committed her to working for the hospital for at least three years and barred her from changing departments for at least one year...

Moreover, Rachel had also signed a contract with a Florida-based recruitment agency, Professionals to USA (PTU)... [it] had charged her a $2,500 fee as part of the application process, she said, and she had to shoulder thousands of dollars in additional costs, such as a job offer letter and a medical clearance exam. Rachel also said her PTU contract included a $30,000 breach fee, a common practice among agencies that recruit nurses to work in the United States...

The agency’s CEO also suggested in social media posts that he would report nurses who didn’t fulfill their contracts to immigration authorities...

In some cases, high contract breach fees and threatening disobedient workers with deportation may violate laws against human trafficking and forced labor. But the work of recruitment and staffing agencies often falls into a regulatory gray area...

Such practices can impact not just nurses, but patients as well. Rachel said she feared that understaffing in her unit at Tallahassee Memorial put her at risk of making a serious error...

In a statement to Quartz and Type Investigations, PTU’s founder and CEO Raymund Raval denied threatening to report nurses to immigration authorities and defended the agency’s inclusion of breach fees in its contracts. “Some of our contracts do include a ‘liquidated damages’ amount.  That is not a ‘breach fee’ and is not illegal in the case of permanent visa immigrants,” Raval said. “The liquidated damages provision is not intended as a penalty, but is a normal way of agreeing to damages in the case of breach when damages cannot be reasonably calculated.”...

A spokesperson for Tallahassee Memorial said in a statement that its priority is “creating an environment of engagement and support for everyone who comes through our doors,” and that all employees are treated with dignity and respect. “For many years, TMH has recruited nurses and other medical professionals from the Philippines,” the spokesperson said. “These colleagues are valued members of our TMH family, and many have been with us for years and are leaders in our organization.”...