Nursing Pipeline Jams With International Visa Cap While Demand Rises

Amanda Loudin

May 10, 2023

During a national nursing shortage, hospitals often fill entry-level positions by hiring international workers. But a recent federal visa cap could delay by as much as 2 years hospitals' ability to hire new immigrant nurses to replenish the nursing pipeline. One in six registered nurses practicing in the US are immigrants, according to the American Association of International Healthcare Recruitment (AAIHR).

The visa restrictions come as US nursing schools struggle with declining enrollment and applications.

Earlier this month, the US Department of State's Bureau of Consular Affairs issued a notice regarding a category of immigrant workers that includes occupations requiring an associate degree, such as entry-level nursing. Demand for nurses in this subcategory remains high, and the annual limit for green cards for the fiscal year has been reached, according to the notice. Only those nurses' petitions that were filed earlier than June 1, 2022, will continue to be processed, so it could be 2025 before new international nurses would be able to enter the country, AAIHR reports.

"Unfortunately for the nursing shortage, the category is largely made up of tech workers," Christopher Musillo, an immigration lawyer with Musillo Unkenholt, told Medscape Medical News. "Those workers are eligible for [certain] visas, and nurses are not. So the tech workers wind up taking most of the spots. With the recent cap, the time for processing new nurse filings has essentially doubled."

American hospitals, particularly those serving rural populations, benefit from having international nurses on staff, AAIHR President Patty Jeffrey, RN, said in a prepared statement following the visa bulletin.

"As COVID burnout and historic Baby Boomer retirements continue to squeeze hospital staffing, the international talent pipeline is more important than ever. However, because international nurses compete for a limited number of employment-based visas within a large applicant pool that includes IT workers, they're now barred from entering the US because of rising demand by other workers," Jeffrey added.

Delaying visas for international nurses "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," she stated.

Prior to the visa cap, Congress tried to address the issue through the bipartisan Healthcare Workforce Resilience Act, which attempts to recapture unused visas that could increase the number of nurses allowed to immigrate to the US. The bill didn't make it to a vote last session, but Musillo expects another version will be proposed in the current session.

Last year, in another effort to jumpstart the nursing pipeline, the Department of Labor offered $80 million in grants for programs to educate new nurses.

The pipeline problems stem from recruitment and retention barriers, according to Cheryl Peterson, MSN, RN, vice president of nursing programs for the American Nurses Association. She said the US lacks a plan for a self-sufficient nursing workforce. "Our default is to go to other countries. But many of those same countries are also facing a shortage and are recruiting from other nations. It's kind of like moving chess pieces."

US hospitals also struggle to recruit and retain domestic nurses, Peterson added. "We need to fix the reason so many nurses want to leave the profession." She suggests that hospitals and other medical facilities examine pay, work environments, scheduling flexibility, and other factors. "We have a pipeline of new nurses that's pretty robust, but they have to want to work where we need them," she added.

Peterson said that hospitals and the federal government should continue to encourage international nurses to immigrate and better themselves financially and professionally. "But that shouldn't be the only answer to the nursing shortage. If we fail to plan and create a good work environment, we are contributing to a global problem."

For more news, follow Medscape on Facebook, Twitter, Instagram, and YouTube.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.