Hospitals are Turning to Foreign-Educated Nurses Fix The U.S. Staffing Crisis

As the United States continues to deal with staffing shortages in hospitals and nursing homes, some administrators are turning to hire foreign-educated nurses to fill those critical roles. According to ABC News, there are twice as many green cards this year than last year for foreign professionals working in the U.S., including, of course, nurses. 

In fact, one immigration attorney told the news outlet that she has seen more demand for foreign nurses over the course of the past two years than in the entirety of her 18-year career. And she doesn’t expect it to slow down anytime soon. 

With staff nurses leaving their positions because of burnout, childcare issues, or to the allure of the lucrative travel nursing industry, more positions are left unfilled—meaning someone is needed to fill those gaps. 

And with a push towards capping travel nurse pay, there may be even less opportunity for travel nurses to help with staffing issues, meaning foreign-educated nurses could have more opportunities than ever. 

What’s Behind More Foreign-Educated Nurses

The reason that there are more foreign-educated nurses vying for nursing positions this year is that, because of the pandemic, visas that normally would have been issued to relatives of American citizens went unused, freeing up a total of 280,000 visas that can be given to professionals looking to work in the U.S. That includes other professionals besides nurses, of course, but with the staffing crisis a priority, many slots will go to nurses who can help alleviate the strain hospitals (and thus, patients) are feeling right now. 

In fact, the Biden administration instructed that any applications from nurses willing to work in hard-hit areas should be prioritized. New applicants have until September 2022 to apply before the fiscal year ends, so many foreign-educated nurses are rushing to get in before the deadline ends. 

According to the American Association of International Healthcare Recruitment (AAIHR), 5,000 international nurse visas were waiting to be approved as of September 2021. Back in August of 2021, when COVID numbers began creeping up again, the American Hospital Association (AHA), the American Association of International Healthcare Recruitment (AAIHR), and healthcare staffing firm Avant Healthcare Professionals also pushed for more action from the government to help speed up the process of getting more international nurses to work, reported MedPage Today. 

The pushes have seemed to work. According to the Institute for Nursing, there are about 1,000 nurses currently being hired each month, with 10,000 more on waiting lists. 

According to AAIHR, New York Governor Cathy Hochul said the state was looking to recruit qualified foreign nurses to backfill its shortage. “This is something we have to work with the Department of State on first,” the governor said. “This is a conversation we have already been having to talk about the opportunity we might have in freeing up the visa system.”

Additionally, the CEO of Michigan’s Henry Ford Health, which recently closed beds over an inability to staff them, said the system is working to hire hundreds of nurses from the Philippines.

The president of Nurse Staffing Solutions for AMN Healthcare Sinead Carbery told ABC News that demand for international nurses is as high as 400% more than it was at the beginning of the pandemic and even with the increase of available visas, there still won’t be enough nurses to fill all of the available slots. But nursing recruiters are actively seeking to hire more nurses from overseas due to both demand and eagerness of those nurses to come to the US for work. The BLS reports that it’s projected that there will be 194,500 nurse positions open every year on average.

Furthermore, Sinead Carbery said about 1,000 nurses are arriving in the United States each month from African nations, the Philippines and the Caribbean. Currently, there are an estimated 10,000 foreign nurses with U.S. job offers on waiting lists for interviews at American embassies around the world for the required visas. The reality is - that other “wealthy” countries, including Canada and Great Britain, are also attracting foreign-educated nurses. 

What are the Impacts of Foreign-Educated Nurses Working in the U.S.?

While we can all certainly agree that more nurses are always a good thing, there is some concern that in pushing to hire more foreign-educated nurses—who may be hired in at lower rates—ignores the systemic issues facing staff nurses at hospitals across the country. It may be a band-aid solution when the real issues at hand plaguing staff nurses, including patient-nurse ratios, better wages, safety in the workplace, and mental health crises, are being ignored. 

Additionally, there is the very real fact that the nursing shortage doesn’t just exist here in the U.S., so international nurses leaving their homes to work in the U.S. could have an impact on healthcare internationally as well. For instance, a January 2022 report by the International Centre for Nurse Migration (ICNM) in partnership with CGFNS International, Inc. (CGFNS) and ICN, warned of the importance of addressing nursing shortages worldwide. 

CGFNS President and Chief Executive Officer Dr. Franklin A. Shaffer, a co-author of the report, stated: 

“We can anticipate that there will be a migration tsunami as more than ever before, countries around the world turn to the international nursing supply to meet their workforce needs. The pre-existing unequal distribution of nurses around the world will be exacerbated by large-scale international recruitment to high-income countries as they look for a ‘quick fix’ solution to solving their nursing shortages, which will only widen inequalities in access to healthcare globally.”

There are also hurdles to consider when relying on foreign-born nurses. For one, the process of applying and getting a visa accepted can be a time-consuming one, even when expedited. Additionally, there can be huge cultural components to nurses coming to the U.S. to work. One nurse described it as coming to work on a “different planet,” and staffing agencies must not only help place nurses in positions but help them navigate cultural training as well. 

Still, one survey by a staffing agency for international nurses found that hospitals that sponsor international nurses actually report less turnover and higher rates of patient satisfaction and safety. The National Council of State Boards of Nursing, Inc. also states that “it has been noted there is no comparative outcomes research on FENs and U.S.-educated nurses.” Leading nursing organizations haven’t formally issued statements regarding the employment of foreign-educated nurses, but the ANA did release an ethical code of conduct for foreign-educated nurses back in 2009. 

How Do U.S. Trained Nurses Feel? 

The reaction among nurses may be best described as cautious. The very real opportunities for help on the floor, for individuals who desire to come to the U.S. for personal and/or professional reasons, and the diversity that can only strengthen the nursing industry, can’t be understated. 

But there are some who worry that the push to flood the workforce with foreign-educated nurses is another attempt to “solve” the nursing staffing shortage crisis without real and systematic change—and that it may take advantage of international nurses who may be using U.S. visas to leave less-than-desirable conditions in their home countries, along with leaving dire shortages in international areas too.

“Big medicine and the politicians they pay for are pushing to flood the U. S. with foreign nurses,” wrote one commenter on MedPage Today. “They know that foreign nurses are desperate to escape their own lousy countries and poor living conditions. They will labor longer hours, with more patients, and for less money than American nurses, who want to improve their profession's work conditions and compensation here at home….A sadly fitting article so close to Labor Day, showing that U.S. capitalists are still happily, greedily finding innovative ways to oppress America's core Healthcare workers - its nurses - of which there is no true numerical shortage, just a shortage of those willing to work for the hours, pay, staffing, and equipment offered.”