In a recent Time Magazine op-ed, former U.S. Health and Human Services Secretaries Kathleen Sebelius (President Obama) and Alex Azar (President Trump) crossed party lines to jointly ring the alarm bells on the country’s healthcare workforce shortage. “The United States is about to learn the hard way what happens when an entire generation of nurses retires without enough new clinicians to fill their shoes at the bedside,” wrote Sebelius and Azar.
The impact is already well documented, with hospitals shutting down maternity services, facilities struggling to treat an influx of respiratory syncytial virus cases among children last fall, and patients traveling extreme distances to receive care. Sebelius and Azar point out this is not a red state vs. blue state, urban vs. rural issue. All Americans are or will feel the impact of the workforce shortage. However, bipartisan efforts to pass legislation could make a profound impact.
Addressing the Problem
Approximately 100,000 nurses left the profession during the COVID-19 pandemic. Another 800,000 are expected to leave by 2027, according to the National Council of State Boards of Nursing and the National Forum of State Nursing Workforce Centers. However, thousands of nurses are ready to come and help.
“One in six registered nurses practicing medicine today in the United States is an immigrant. American hospitals, particularly those serving rural populations, would have collapsed long ago without the contributions of international nurses,” said American Association of International Healthcare Recruitment President and MedPro International Executive Vice President, International Operations Patty Jeffrey, R.N., in a recent AAIHR statement.
Jeffrey and other members of the AAIHR traveled to Washington, D.C., earlier this year to promote the Healthcare Workforce Resilience Act of 2023. HWRA 2023 seeks to allow 25,000 RNs and 15,000 MDs per year to enter the U.S. by recapturing unused visas previously authorized by Congress. “There is no single solution to our workforce shortage,” Jeffrey said. “Still, we had strong bipartisan support for HWRA last year, and lawmakers recognize that foreign-educated nurses are part of a multifaceted approach to solving this crisis,” said Jeffrey.
Unfortunately, the U.S. Department of State’s Bureau of Consular Affairs announced an EB-3 visa retrogression in May, updated in the July visa bulletin, putting a hold on all applications after February 1, 2022, and shutting down relief to overburden nursing staff.
“A steady flow of international nurses is paramount to understaffed hospitals dependent on this workforce to meet patient needs,” said Jeffrey. “The effects of visa retrogression will be felt by hospitals, staff, and patients.”
Domestic Education and Training
More domestic nurses would appear to be the obvious solution. However, there are not enough available educators to train the next generation of bedside clinicians, according to the American Association of Colleges of Nursing. In 2021, nursing schools turned away 91,938 qualified applicants. “Consistent with declines across higher education, nursing programs are enrolling fewer students, which raises serious concerns about how this will impact the nation’s nursing supply,” said Dr. Deborah Trautman, AACN President and Chief Executive Officer, in an AACN press release. The AACN listed clinical placement sites, faculty, preceptors, and classroom space as the primary barriers. “With enrollments trending downward, academic and practice leaders should work together to ensure that schools are able to accommodate all qualified applicants to meet the growing demand for nurses to provide care and serve as faculty, researchers, and leaders.”
HWRA 2023 would boost the domestic supply of nurses by implementing a fee paid by the U.S. employer (expected to generate $350 million over five years) to create a fund to be used directly by U.S. hospitals, health systems, and nursing schools to increase domestic numbers. As Azar and Sebelius pointed out, there is precedent in 2000 and 2005 for revising immigration law to bring foreign workers into the U.S. Immigrants have helped the nation overcome significant challenges in the past, and with lawmakers’ help, they are poised to answer the call once again and help the U.S. take on the healthcare workforce shortage.