JULY 2nd, 2022

A recent news article does a disservice to all those working selflessly to care for Americans during a time of unprecedented need. Ethically and capably connecting critically needed nurses and other healthcare professionals to U.S. hospitals is both a privilege and a responsibility – one that Health Carousel takes very seriously and does with great pride.

Nurses are the heart of our operation. Their skill, compassion and dedication are the engine that runs the U.S. health system. For our part, ensuring the health, safety and well-being of every one of our nurses is the core of our business. To imply otherwise, based on activists intent on exploiting and twisting the experiences of a few, is disheartening and damaging. But more than that, it is simply inaccurate and a grave insult to the millions of people worldwide who continue to be victimized by traffickers.

Health Carousel goes to great lengths to create an experience for our nurses that is fulfilling, ethical and responsible. At every step of the journey to help international nurses fulfill their dream to work in the U.S., we emphasize transparency and empowerment. We build into our process many avenues for open communication, including various feedback mechanisms. We encourage nurses to question any step of the process, alone or with the support of outside advisers and counsel. Our business works best when our nurses feel heard and valued. A recent news article in the media tries to establish a narrative that is simply untrue.

We are committed to policies and practices that prevent labor trafficking. Our healthcare professionals’ employment is voluntary. As employees-at-will, they can resign at any time, for any reason or for no reason at all. We follow the American Association of International Healthcare Recruitment (AAIHR) Code of Ethics and are a Certified Ethical International Recruitment Firm. Every day, we strive to live up to our commitment to fair practices in contracting, freedom from discrimination, fairness in compensation, and the freedom of movement.

We will continue to do the important and crucial work of preparing and supporting foreign-born healthcare professionals so that they may work in the U.S. – fulfilling their American dreams and providing critically needed care. A misguided attempt to malign our company and, indeed, our entire industry, will not divert us from our mission.

Frequently Asked Questions

Are healthcare professionals forced to sign a lengthy new contract when they arrive in the U.S.?

At no point is an employee “forced” to sign anything. Healthcare professionals who wish to become employed by Health Carousel sign one employment agreement with Health Carousel.

During the on-boarding process following arrival in the United States, all new employees are required to acknowledge receipt of our Employee Handbook that spells out a variety of our policies and practices. The documents accompanying the Employee Handbook are comprehensive, as they include plan descriptions for platinum-level medical, dental, and vision insurance and related enrollment materials, a safety handbook, and other customary employment commencement documents that would be applicable to any new employees at any company in the United States (e.g., Form I-9, Form W-4, and a direct deposit enrollment form). None of these documents constitute a new contract.

Why don’t overtime and orientation work count toward contractual commitment periods?

Contract staffing assignments in the United States are generally “fixed term” assignments, meaning that they have a start date and an end date. Clients sign up with companies like Health Carousel to ensure that they have coverage during specified periods. Healthcare professionals are paid for all hours worked in accordance with applicable laws regardless of whether overtime and orientation count towards completing the contractual commitment period.  

Foreign trained healthcare professionals are usually not immediately ready to practice in the United States without orientation to the facility and its policies and procedures, to the assigned nursing unit, to the equipment, etc. Most foreign trained healthcare professionals are required to work with a clinical preceptor for a period before they are eligible to practice independently. This orientation requires investment of significant resources by the client facility.  So, clients expect healthcare professionals to be available to practice independently for a fixed period after the completion of orientation. Regardless of the duration of orientation, healthcare professionals are paid for hours worked.

Overtime hours are not counted against the commitment period calculation because hospitals are relying on the availability of the healthcare professional to provide coverage for a minimum number of hours during a particular period. It is a customary practice for healthcare professionals in the United States working on a contract basis to commit to a specified period of employment and a minimum number of weekly hours. Clients are not looking for healthcare professionals to accelerate the completion of their assignment period by working overtime, so we commit to making the healthcare professional available for the fixed period of time after completion of orientation.

Are healthcare professionals required to work overtime?

Health Carousel does not require healthcare professionals to work any overtime hours. Some hospitals may request that their staff healthcare professionals working in particular units to work overtime during busy times, as the existing nursing shortage has only been exacerbated by the continuing pandemic. In those circumstances, healthcare professionals may be expected by the client to work under the same policies and conditions as their regular staff members.

Do you monitor and restrict travel once healthcare professionals are in the U.S.?

If healthcare professionals are working in the United States on an EB-3 permanent resident visa, they are free to travel throughout the United States. If healthcare professionals are working in the United States on an H-1B temporary visa, there may be restrictions on their travel. Paid time off must be approved in advance by Health Carousel and the client. Therefore, we request that healthcare professionals notify us if they are planning to take time away from work to travel so that we can assess what limitations may be applicable.  

If a hospital has poor working conditions, do you force the healthcare professionals to stay there?

No. Our goal is to attract and retain top talent and healthcare professionals’ satisfaction is important to us. So, if a healthcare professional has issues or complaints about their working conditions, they should raise them with their employee liaison who can engage the right people in our organization and the client to address whatever the issue may be. We may work to find another client facility that is more appropriate.

Why do nurses have to reimburse expenses when they break their contract?

Requiring repayment of invested expenses and other damages if an employee does not fulfill a service obligation is not a “quitting fee” or a penalty.  Rather, it is a customary, reasonable and fair practice that many employers use in a range of industries and occupations to recoup investment in tuition reimbursement, relocation expenses, signing bonuses and more. In today’s severe nursing shortage, nurses in some high demand specialties and geographies can often receive signing bonuses ranging from $10,000 to as much as $40,000. These arrangements generally come with service period obligations ranging from 2 to 5 years and require repayment if the nurse fails to fulfill the service period they agreed to in exchange for the financial benefit they received. Indeed, hospitals that recruit, sponsor, and employ foreign trained healthcare professionals directly, also routinely pursue expense repayment when those healthcare professionals fail to fulfill their agreed upon service term.

If anything, the service obligation provision in Health Carousel’s contracts with healthcare professionals typically understates Health Carousel’s actual damages in the event of an early termination.  Health Carousel spends a great deal of time arranging for international healthcare professionals to come to the United States and work in hospitals in the United States and incurs a wide range of actual direct expenses, typically averaging between $20,000 to $30,000, in connection with the recruitment, sponsorship and employment of international healthcare professionals, including visa processing, licensing and credentialing costs, travel-related expenses and many more. The expenses that Health Carousel expects healthcare professionals to reimburse if they do not complete their contracts approximates or underestimates the cost of its up-front investment on their behalf.

For example, when healthcare professionals do not complete the commitment period in the contract, the nurse retains his or her permanent resident visa to work in the United States, but Health Carousel suffers a financial loss because it cannot earn back the money it had advanced for their recruitment, credentialing, sponsorship, relocation and resettlement, and employment. The service obligation provision allows Health Carousel to recover some (but not all) of the up-front costs when a healthcare professional does not complete the assignment. Aside from the direct costs described above, there are difficult to quantify damages in the form of lost profits, and the reputational damage that Health Carousel suffers when it places a healthcare professional in a facility and the individual does not complete his or her commitment period.

For a full summary of the many up-front investments Health Carousel makes in its international healthcare professionals, please refer to this page on our website:

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