International Nurses Could Help Shortage But Are Blocked from Entering the U.S. A New Proposal Could Help.

Matthew Arrojas
Updated November 29, 2023
Edited by
    International nurses play a key role in the U.S. healthcare system, but a freeze on visa processing threatens to worsen staffing woes.
    Confident, smiling nurseCredit: Getty Images
    • 1 in 6 practicing registered nurses in the U.S. is an immigrant.
    • However, a recent visa processing change threatens to slow the inflow of international nurses.
    • This may spell trouble as the country struggles with a nursing shortage.
    • The recently proposed Healthcare Workforce Resilience Act may help address staffing woes.

    Historically, international nurses have been viewed as a key part of addressing the nation’s nurse shortage. However, in spring, a federal decision slowed the flow of international nurses into the U.S. to a trickle.

    However, a new proposal in Congress aims to circumvent that decision by essentially forcing an increase in the number of overseas nurses and other professionals who can work in the U.S.

    The U.S. Department of State (DOS) announced in April that the U.S. will temporarily freeze the processing of green cards as it works through a massive backlog of visa petitions and applications.

    This is particularly important in nursing, as most regions in the U.S. are experiencing a worsening nursing shortage. Historically, nurses coming to the U.S. through workers’ visas have helped support the industry. Yet, the freeze on green card processing has meant U.S. hospitals haven’t been able to bring in any international nurses who filed a green card petition after June 2022.

    According to the DOS, there are approximately 312,000 applicants still pending a visa interview as of November 2023. For context, the DOS said in 2019, there were roughly 61,000 applicants pending an interview each month.

    Soon after the DOS’ notice, the American Association of International Healthcare Recruitment (AAIHR) rang the proverbial alarm.

    “Visa retrogression amounts to a catastrophic interruption of the stable flow of healthcare talent to the bedside, and it will be felt acutely by ordinary patients, from pregnant mothers to dialysis patients,” AAIHR President Patty Jeffrey said in April.

    Impact of the Visa Processing Freeze on U.S. Nursing

    The freeze has impacted all industries that count on international workers, but the nursing shortage ensures the healthcare industry will feel the freeze especially hard.

    According to AAIHR, 1 in 6 practicing registered nurses (RNs) in the U.S. is an immigrant. While that doesn’t mean that all these nurses are in the U.S. on a work visa, it does exemplify how important nurses originating from outside the U.S. are for the nation’s healthcare system.

    According to 2022 data from CGFNS International, which evaluates credentials for international nurses looking to practice in the U.S., 17,000 VisaScreen Service applications occurred from 116 countries in 2022. That was a 44% increase from the prior year and a 109% increase from 2019.

    Those workers primarily rely on employment-based green cards, which is the type of visa impacted by the State Department’s freeze. According to CGFNS, 70% of all VisaScreen Service applicants aimed to come into the U.S. through an employment-based green card.

    The freeze comes at a time when hospitals and other healthcare facilities are itching for more nurses.

    Thirty-two U.S. states have a ratio of fewer than 10 RNs for every 1,000 people in the state, according to a NurseJournal analysis of 2022 government data. Nationally, the ratio is just 9.22 RNs for every 1,000 residents.

    Bringing in more international nurses could potentially offset this nursing shortage. However, those in the industry say the DOS’ freeze on visa processing means hospitals in need of nurses won’t be able to hire the international nurses they sponsored through the visa program. Any international nurses hired after June 2022 won’t be able to immigrate to the U.S. because those visa applications aren’t even being considered.

    Bipartisan Bill Aims to Address Concerns

    The recently introduced Healthcare Workforce Resilience Act aims to boost the number of international nurses working in the U.S.

    Democratic Sen. Richard Durbin of Illinois introduced the bill on Nov. 2. He did so with wide bipartisan support, as eight Republicans, six Democrats, and one Independent cosponsored the proposal.

    Specifically, the Healthcare Workforce Resilience Act would recapture unused employment-based visas and designate those visas specifically for healthcare workers. Under the proposal, it would reserve the following amounts for two professions:

    • 25,000 visas for professional nurses
    • 15,000 visas for physicians

    Visas granted through this act would not be subject to country caps, meaning employers would be able to hire international nurses from any part of the world.

    Additionally, the Healthcare Workforce Resilience Act would require the DOS to expedite visa processing and shipping. The DOS may not charge extra for speedier processing.

    Prospects for the bill are uncertain. The bill’s strong bipartisan support is noteworthy, but it’s also worth noting that previous versions of the bill have died in past legislative sessions. Lawmakers introduced the Healthcare Workforce Resilience Act in May 2020 and again in March 2021, but both bills died in the Senate without a vote.

    [Act] is one of the most urgently needed healthcare proposals I’ve ever seen in thirty years of staffing patient bedsides,” Jeffrey said in the statement. “Passing this bill will save American lives by getting the hospitals the nurses they need to deliver quality health care.”