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A new report from the American Immigration Council says more immigrants make up Iowa's health care workforce — and yet barriers to hiring remain constant roadblocks. Those hurdles, the council added, pose a problem for states like Iowa to grapple with a growing labor shortage.

The council said many immigrant workers are educated, trained and licensed to practice medicine in another country but face different hurdles once they arrive in the U.S. such as language barriers and a re-credentialing process. Their skills often are overlooked or underused.

According to the report, there were about 5,000 immigrant health care practitioners in Iowa between 2015 and 2019, their occupations ranging from nurses and dentists to medical technicians. Of that figure, roughly 21% — or close to 1,000 — were physicians and surgeons.

In the lead-up to the 2020 election, all eyes are on Iowa. Get updates of all things Iowa politics delivered to your inbox.

The council said Iowa has struggled to employ physicians long before the COVID-19 pandemic, with some counties only having 10 physicians per 100,000 residents. The state may need an additional 119 primary care physicians by 2030, especially in rural communities, the council reported. It also needs more registered nurses, licensed practical and licensed vocational nurses, medical records specialists and clinical laboratory technicians.

"For Iowa to remain competitive and address critical shortages of physicians and other health care practitioners, itwill be crucial to implement policies that not only attract and retain global talent that is complementary to the U.S.-born workforce, but that also builds career pathways for immigrants who already call the state home," the council said in a news release.

More:Iowa farmers need workers. But will US Senate pass visa changes amid immigration concerns?

With most health care jobs seeking employees who are multilingual and culturally competent, Iowa could be missing out on a whole host of people who could provide that support, the council said. From 2017 to 2021, the number of health care jobs that required bilingual skills in Iowa increased 13%, it found.

F. Amanda Tugade covers social justice issues for the Des Moines Register. Email her at ftugade@dmreg.com or follow her on Twitter @writefelissa.

This article originally appeared on Des Moines Register: Group says immigrants could be the answer to Iowa's health care workforce shortage

LINCOLN — COVID-19 placed an immense strain on hospitals and the medical field with thousands of cases and deaths in the nearly three years of the pandemic in Nebraska.

Public health directors as well as state and local governments issued directed health measures to mitigate the spread of the coronavirus, action that helped “save” local hospitals according to one registered nurse in Lincoln.

“When DHMs [directed health measures] were announced, there would be a collective sigh of relief amongst bedside clinicians, myself included,” nurse Julia Keown told the Health and Human Services Committee on Wednesday. “We would actually cheer because we knew it was going to work, and it did.”

Keown explained that the measures led to fewer patients dying from COVID-19 and fewer times health care professionals had to tell family over Zoom that their loved ones had died.

One legislative proposal seeks to change who can issue these measures, taking the authority away from public health directors and changing their roles to one of advisement.

Legislative Bill 421, proposed by State Sen. Kathleen Kauth of Omaha, would require county boards or city councils to vote to adopt directed health measures, alongside state officials’ approval.

“It maintains the importance of the education and experience brought by public health directors but redirects the responsibility of restricting liberties,” Kauth said. “This should also serve to redirect the ire of the public from the public health director to the elected officials where it belongs.”

Keown was one of five medical professionals who testified against the legislative proposal Wednesday. Two private citizens testified in support of the bill.

‘Maintain our rights’

Kauth said her bill is a direct response to actions taken during the pandemic that she said restricted individual freedoms. She said this included mask mandates and restrictions on public gatherings.

“It is critically important, especially in what may be an emergency, to maintain our rights,” Kauth said. “Elections have consequences, and the responsibility for decisions regarding citizen freedoms must live with those elected officials.”

The bill mirrors backlash in Lincoln and Omaha over health measures that led to a failed recall campaign against the mayor and city council members in Lincoln and lawsuits against the health director in Omaha for issuing a mask mandate without the city council’s approval.

Then-Attorney General Doug Peterson dropped his lawsuit after the Omaha City Council approved an ordinance allowing the council to veto public health measures.

Dr. James Lawler, who is a professor in the division of infectious diseases at the University of Nebraska Medical Center, said the bill would make Nebraska less safe because it could delay health decisions.

In all of his experiences, Lawler said, critical and effective public health responses rely on speed, technical expertise and professional courage.

“LB 421 would undermine all of these in Nebraska,” Lawler said, adding that speed is the most important principle.

Day-to-day operations

The health departments in Douglas and Lancaster Counties issue about 120 work restrictions and isolation or quarantine orders every year, Lawler explained, excluding COVID-19. 

This includes action on diseases or pathogens such as hepatitis, salmonella, norovirus or tuberculosis, which all would need to be approved by elected officials.

“Most of the time, these orders are executed quietly. The emergency is contained and we never hear about it,” Lawler said. “But I, for one, am certainly glad these unsung heroes are working tirelessly behind the scenes every day.”

This means any directed health measure would require county or city as well as state approval.

Dr. Jim Nora, an infectious disease physician in Lincoln, testified against the bill and said medical professionals also want to uphold liberties and values. He said it should never be the intent of health policies to be arbitrary or discriminatory.

Jon Cannon, executive director of the Nebraska Association of County Officials, also testified in opposition. 

He said that gathering a quorum of city council members or county board members could be difficult, in addition to needing to abide by the open meetings act.

‘Arbitrary, wide-sweeping’ overreach

David Splonskowski of Omaha testified in support of Kauth’s bill because he said his family was hurt in the spring of 2020, mainly because of restrictions placed on church gatherings.

This placed an “undue burden” on his worship, he said, but these concerns fell on “deaf ears” when he contacted his county health director.

“It doesn’t necessarily prevent poor decisions being made,” Splonskowski said of the bill. “But at least it does allow residents to petition their local elected officials regarding the limitation of certain health directives.”

Stacey Skold of Malcolm, who has a Ph.D. in human sciences, said unelected officials ordered “arbitrary, wide-sweeping” mandates over the past three years that have eroded democracy.

Passing Kauth’s bill would close the loophole in medical directives, Skold said, arguing the bill needs additional language to prohibit injections as part of health measures. 

Ultimately, Skold said the Legislature should also develop a medical bill of rights.

‘Very scary time’

State Sen. Lynne Walz of Fremont, a committee member, expressed concern over how the bill would have affected her community during significant flooding in 2019.

Fremont became an island, Walz said, and if the health director’s actions involving  contaminated water quality had required additional approval, she questioned how that would have worked.

“It was a very, very scary time for the members of our community,” Walz said.

State Sen. Brian Hardin of Gering, committee vice chair, said Kauth’s bill would act as a check and balance on health directors. He pushed back against opponents’ testimony throughout the hearing. State Sen. Ben Hansen of Blair, committee chair, said the bill seemed reasonable due to the unprecedented action taken in response to COVID-19.

Dr. Echo Koehler, testifying in opposition for the Nebraska Nurses Association, said the bill would add “bureaucratic red tape” and undermine public health.

State Sen. Machaela Cavanaugh of Omaha, another committee member, repeatedly thanked medical professionals for their time in testifying and said openly she would not vote for the bill.

“You can thank me by not passing this bill,” Keown, the registered nurse, told Cavanaugh.

The committee took no immediate action on the legislation.

Feb. 18—ALBANY — With a projected shortage of registered nurses nationally of as many as 450,000 by 2025, the opportunities in the field would seem to be wide open, and one potentially untapped resource to help fill the gap is males.

As Baby Boomers age and retire and also join the ranks of those needing nursing care themselves, the demand for licensed practical nurses and nurse aides for home and nursing home jobs also will increase.

Closer to home, the number of males looking to enter health care professions at Albany Technical College total 54 out of 1,021 currently enrolled.

"In health care, 5.2% of our population of males has actually chosen a health care track," Lisa Stephens, the dean of business and health care technology at Albany Tech, said. "Among African American males, 5.6% have chosen health care."

The technical college has three nursing programs: an associate's degree in science in nursing to train RNs, a practical nursing program for future LPNs, and a nursing aide certificate program.

Other associate's degree programs include pharmacy technology, surgical technology and radiologic technology, as well as paramedicine technology and health information management technology.

Diploma programs are available in dental assisting, pharmacy technology, health information coding, EMS professions and medical assisting.

Certificate programs, which are shorter and mainly for entry-level positions, include phlebotomy and pharmacy.

Last week, Albany Tech presented a panel discussion sponsored by the Student Wellness: Mental, Academic and Physical Preparedness PBI Grant program aimed at dispelling some of the stereotypes about males who work in medical jobs. One of the goals of the grant program is to increase the number of African American males enrolling and completing degree or certificate programs.

"One group we are focusing on is in health care, our most underrepresented group," Stephens said. "For MAPP, health care is a focus. Our overall goal is to get more males in to health care."

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While the trend of women moving into more male-dominated professions has been ongoing, the movement in the other direction — males into jobs traditionally held by women — has not, she said.

"While there are increases, it's just not at the same rate," Stephens said. "One of the things we learned from our panel last night is there is a need in health care. We're trying to overcome this stigma or stereotypes."

For nurses, area salaries can range from about $26,530 for nurse aides to $69,600 for registered nurses, she said.

Other certificate and degree programs in medicine have salaries ranging from about $33,000 to $46,800.

"One of the stereotypes is they're low-paying," Stephens said. "These are really good-paying salaries. And it's better for (medical) outcomes."

One of New Hampshire's largest hospitals said Thursday that the future of the state's rural health care system may be in jeopardy.Dartmouth Health, which serves a large portion of New Hampshire's rural communities, said health care in those areas is at a breaking point, and more needs to be done to address the strain on the system before the situation gets worse. "We are seeing some stress fractures, and we need to attend to it now," said Dr. Joanne Conroy, CEO and president of Dartmouth Health.Conroy is calling on her colleagues to address the strain on New Hampshire's health care system, particularly in rural areas. "So we don't get to that point where people cannot find an institution that can care for them," she said.Conroy said issues from the pandemic still plague hospitals, including high health care costs, supply chain problems and, especially, staff shortages. Some rural hospitals are starting to cut services. Officials said that on average, Dartmouth-Hitchcock Medical Center has 75 patients waiting to be discharged, but there is no post-acute care facility willing to accept them."I can tell when a local facility is closing a unit because my numbers will bump up," Conroy said. "We are working with our providers to see if we can actually buy the bed. Can we buy it to keep it open?"Conroy said it's one of many solutions DHMC is looking into, but she said solving the problem will take a collaborative effort from all partners. "We're going to have to have much better relationships with the state and federal legislators who make decisions on how we pay for care," she said.U.S. Sen. Maggie Hassan, D-New Hampshire, brought the issue to Capitol Hill during a hearing Thursday. "While it's essential that we train more registered nurses, we also need these nurses to practice in rural areas in states like New Hampshire, Maine and Vermont," Hassan said.DHMC recently completed an expansion project to accommodate more beds that are set to open in April.

At Lee Health, we have a multidisciplinary team of registered nurses and exercise physiologists who help patients following heart attacks, heart surgery, coronary artery bypass, heart valve replacement or repair, angioplasty or stenting, and other heart conditions. The team is part of the cardiac rehabilitation program.

“Cardiac rehab is a comprehensive program that includes individualized exercise programs, education and behavioral modification to help patients who have been through a cardiac event reduce their risk factors and recover,” explains Marion Harris-Barter, RN, BSN, M.Ed., CCRP, Lee Health’s system director, cardiac rehabilitation. “Research shows that patients who attend the program have better health outcomes, including reduced re-hospitalizations, better long-term survival, improved endurance and strength and a better quality of life.”

If your heart condition requires a hospital stay, your rehabilitation starts while you are there. “One of our registered nurses’ visits and educates you on your diagnosis, risk factors and the importance of attending cardiac rehab,” Marion explains. “Your physician will usually make a referral to outpatient cardiac rehab when you are discharged from the hospital.”

Outpatient cardiac rehabilitation starts with an orientation and a one-on-one evaluation to determine individualized goals and an exercise prescription. “This phase of cardiac rehab is medically supervised, includes education, support and exercise, and is typically completed in 36 sessions. Our patients can attend cardiac rehab two or three times a week,” Marion says. “We have three locations for our outpatient cardiac rehab: Cape Coral Hospital, Lee Health Coconut Point and Medical Plaza One (near HealthPark Medical Center). Our Medical Plaza One location sustained damage from flooding from Hurricane Ian, so it is closed for renovations and repairs. We set up a small satellite program at HealthPark Medical Center until we can reopen – which we hope to be able to do this month.”

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Cape Coral resident Bill Ruggles can attest to the value of the cardiac rehabilitation program. He had his first open-heart surgery in New Jersey in 2012 – an aortic valve replacement and an ascending aortic aneurysm repaired. Then, in 2021, as he was moving to Southwest Florida, sepsis following dental work damaged his replacement valve and another valve, so he was referred to Michael DeFrain, M.D., a cardiothoracic surgeon with Lee Health’s Shipley Cardiothoracic Center.

“Dr. DeFrain told me the surgery would be very high risk because it would be my second open-heart surgery,” Bill explains. “But he said he had a plan to do it safely so I could continue a life of health and happiness. He said he had the team and the facility to do it, so my wife and I said, ‘yes.’ We are people of faith and had a lot of people praying for us.”

Bill had the surgery. “I was on the operating table for 10 hours, in an induced coma for three days, and then I spent two weeks in intensive care,” he says.

When Bill was ready to start cardiac rehabilitation at Cape Coral Hospital, he did so using a walker. “I went through it in stages,” he explains. “At first, I was monitored with a device. Then, I did the rehab on my own. I’m a former athlete, so I pushed myself – within reason, and before I knew it, I was ready to go.”

Bill was motivated and pushed himself but said the team’s positive attitudes helped, too. “The attitudes, bedside manner, sense of humor, professionalism – it was all fabulous,” he says. “I was facing a lot of challenges when I started cardiac rehab, but I felt positive. I looked forward to my sessions. I worked hard and had fun, too.”

Feb. 13-19 is Cardiac Rehabilitation Week, which is meant to raise awareness of the program and its positive effect on outcomes on heart health. I am proud of our talented and caring team and their efforts in motivating, inspiring and supporting healthier hearts and lives, like Bill’s.

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Larry Antonucci, M.D., MBA is the president & CEO of Lee Health, Southwest Florida’s major destination for health care offering acute care, emergency care, rehabilitation and diagnostic services, health and wellness education, and community outreach and advocacy programs. Visit www.LeeHealth.org to learn more.

This article originally appeared on Naples Daily News: Lee Health: Cardiac rehabilitation helps heart patients recover