Immigration Restriction Cuts Nurse Supply

​Americans consistently rate nursing as the most trusted profession, yet health care providers continue to struggle mightily when it comes to recruiting people to fill thousands of open nursing positions.

Now, that struggle promises to get worse. The U.S. State Department has halted access to green cards for foreign workers—a move that cuts off an important pipeline for U.S. health care providers to hire nurses from other countries. A government-issued green card enables citizens of other nations to permanently live and work in the U.S.

The American Association of International Healthcare Recruitment (AAIHR) says the government-imposed freeze means that only those nurses who filed a green card petition before June 2022 can proceed with the green card process. A petition is a precursor to a formal application. Nurses who submitted a petition after June 2022 are now stuck in a holding pattern.

"American hospitals, particularly those serving rural populations, would have collapsed long ago without the contributions of international nurses," registered nurse Patty Jeffrey, president of AAIHR, said in a news release.

Because of the freeze, nurses who submit green card petitions this summer likely won't be able to come to the U.S. until at least 2025, according to the AAIHR.

The green card freeze will likely complicate an already dire situation.

A 2022 study from consulting giant McKinsey & Co. predicts the U.S. could experience a shortage of 200,000 to 450,000 nurses by 2025. Much of that projected shortage is being driven by a departure of many nurses from the profession; an estimated 100,000 nurses left the workforce during the pandemic, found the National Council of State Boards of Nursing. Going forward, 30 percent of nurses say they're likely to leave their career due to the pandemic, according to a survey from health care staffing agency AMN Healthcare, and 18 percent indicate they're inclined to retire due to the pandemic.

To make matters worse, the number of students enrolled in U.S. nursing programs that award bachelor's degrees fell 1.4 percent in 2022, ending a 20-year streak of enrollment growth in programs to train registered nurses, according to the American Association of Colleges of Nursing. Enrollment also declined in master's degree and doctoral programs for nurses.

To help shore up the supply of nurses, many U.S. health care providers have relied on nurses from other countries. Foreign-born nurses make up about 15 percent of the U.S. nursing workforce. They're able to permanently live and work in the U.S. if they're approved for an EB-3 visa, an employment-based green card.

Detroit-based Henry Ford Health is recruiting nurses from the Philippines to help fill open positions. The health care system employs about 6,500 registered nurses and has about 400 openings for nurses.

Henry Ford Health expects to bring aboard about 500 to 600 nurses from the Philippines by the end of 2025. However, the State Department's move could stymie those efforts.

"The State Department freeze on visas for international nurses is not unexpected, but it is painful to Henry Ford Health and organizations across the country who are trying to stabilize their nursing workforce," said Eric Wallis, senior vice president and chief nursing officer at Henry Ford Health. "We had hoped to begin welcoming groups of international recruits this summer. Right now we're concerned that the process could be on hold until at least October."

An estimated one-third of foreign-born nurses in the U.S. are from the Philippines. Why does the U.S. attract so many Filipino nurses? Substantially better pay and benefits. Other drivers include unsafe working conditions and chronic understaffing in their home country, according to the Journal of Public Health.

Andrew Limouris is founder, president and CEO of Medix, an international staffing organization that recruits skilled workers in the health care, science and IT industries. He said the green card freeze will only worsen a nursing shortage prompted by a lack of nursing faculty, along with burnout and retirements.

"From my lens of the world, there are so many pressures on the nursing community, and the ability to bring in foreign nurses to support some of these areas of pressure would only prove advantageous," Limouris said.

The freeze also could push foreign-born nurses toward opportunities outside the U.S., he said.

"If these nurses are determined and want to make a living, they can and will find another way to do it, and that might mean taking their talents to other countries," Limouris said.

Amid the green card restrictions, how can health care employers recruit more nurses? Limouris and others offer these suggestions:

• Double down on tapping into local talent pools.
• Commit to robust benefits.
• Provide flexible schedules.
• Offer hiring bonuses.
• Speed up the time it takes to pay nurses.
• Encourage partnerships to beef up the faculty ranks in nursing programs.
• Accelerate the time it takes to earn a nursing degree.
• Support apprenticeships for nursing assistants.
• Recruit more men to the nursing profession. Men represent roughly 10 percent of nurses in the U.S.
• Embrace technology that eases the workload of nurses.
• Consider using "nurse on demand" apps to ensure adequate staffing.
  

"Health care employers and recruiters need to lock arms and work together to create job opportunities that are attractive to a diverse population of providers, clinicians and technicians," Limouris said.

John Egan is a freelance writer based in Austin, Texas.