The United States is facing a nursing shortage, and while there may not be a single solution, the path to short-term relief is clear−the U.S. needs more foreign-educated nurses. Hospitals, clinics, and long-term care facilities are all feeling the impact after the COVID-19 pandemic exacerbated an existing national healthcare workforce challenge. The U.S. Bureau of Labor Statistics predicts an additional 276,800 registered nurses positions by 2030 as the general population grows older and rates of chronic illness such as heart disease and diabetes increase.
A recent McKinsey & Company survey, “Assessing the lingering impact of COVID-19 on the nursing workforce,” estimated a supply and demand gap of 10 to 20 percent for registered nurses by 2025. The situation is so dire that the American Nurses Association urged the U.S. Department of Health and Human Services to declare the nursing shortage a national crisis last September. Educating and placing more U.S. nurses is integral to a long-term solution. Still, many inside and out of the healthcare industry believe the U.S. must bring in more foreign-educated nurses to maintain current healthcare standards.
Foreign-Educated Nurse Workforce
Foreign-educated registered nurses make up approximately 5.4 percent of the total number of registered nurses in the U.S., according to the American Association of International Healthcare Recruitment (AAIHR). These nurses and other healthcare professionals come from the Philippines, India, the United Kingdom, the Middle East, and other countries for the opportunity to advance their education and careers and earn more money. “Many of these professionals worked in Joint Commission International-accredited hospitals, and they are open to taking jobs in geographic locations and clinical settings that can be difficult to fill with American workers,” said Patty Jeffrey, President and Regulatory Chair at AAIHR and Executive Vice President, International Operations at MedPro International, the industry leader for placing foreign-educated healthcare workers in the U.S. “There are challenges to adapting to a different culture, but through education and assistance, we have been able to help foreign-educated healthcare professionals assimilate to working and living in the U.S.”
According to the U.S. Bureau of Labor Statistics, 194,500 openings for registered nurses are projected each year through 2030. Many immigrants, including those with international medical degrees, want to start a career in the U.S. but face significant costs and obstacles. “We’re seeing a huge increase in demand for foreign-educated nurses,” said Jeffrey. “Our biggest challenge is expediting those nurses through the immigration process.”
Like many areas of business, immigration is still playing catch up after pandemic-related shutdowns. The U.S. typically offers 140,000 green cards annually to immigrants in five employment-based categories, including nursing, per the Migration Policy Institute. But this year, 280,000 green cards were available, according to a July 2022 Bloomberg Law report. The U.S. consulate temporarily suspended visa services worldwide in March 2020 to relatives of American citizens. By law, these unused slots are now available to eligible workers. Agencies such as MedPro International hope to use those visas to place more foreign-educated nurses into positions at U.S. acute care facilities, but the process of getting those nurses into the U.S. and on the job is still slow.
U.S. Citizenship and Immigration Services announced it would increase the extension period for employment authorization, which could help keep some foreign citizens already in the United States on the job, and the State Department told consulates last year to prioritize applications for workers at facilities that are responding to the pandemic. However, industry leaders are now looking toward new legislation to meet healthcare staffing needs.
In June, Representatives Adam Smith (D-WA) and Lucille Roybal-Allard (D-CA) introduced three bills to address healthcare workforce shortages in the U.S. and reduce barriers keeping or delaying immigrants from entering the U.S. healthcare field. “Our country is in desperate need of more primary care physicians, nurses, behavioral health professionals, technicians, and other critical workers who care for our communities,” said Rep. Smith in a June 9, 2022, press release.
The bills help immigrants interested in joining the U.S. healthcare workforce by creating grants for programs providing training, licensing, certification, and case management in the healthcare field, but they don’t address actual immigration law. “These bills are encouraging,” said Jeffrey, “but the U.S. is facing an unprecedented nursing shortage. Bringing in foreign-educated healthcare professionals is key to sustaining the country’s healthcare demands and maintaining quality care.
Future of Healthcare
The United States healthcare system is in the midst of a crisis. Nursing shortages lead to “errors, higher morbidity, and morbidity rates,” and nurse “burnout and dissatisfaction,” according to a recent study in the National Library of Medicine. The U.S. Bureau of Labor Statistics is predicting a nine percent increase in registered nursing openings over the next decade. Hospitals are filling some of the gap by hiring traveling nurses, but McKinsey estimates that the number of new graduates and those staying in the workforce will have to double in the next three years for supply to meet demand. The likelihood of achieving that goal is slim, considering nursing schools don’t have enough academic or clinical open spots and educators to accommodate more students, per McKinsey. That inconvenient fact is leading many experts to look outside of the U.S. A pool of foreign-educated talent is available to assist healthcare facilities across the U.S. and ensure patient quality of care, but the process will have to be expedited for those healthcare professionals to enter and start working in the U.S. and begin to have an impact on the shortage.