Immigration, always a strength for the U.S. economy, has the potential to fill a dangerous and growing labor shortage of skilled nurses. According to nurse.org’s 2023 State of Nursing report, “91% of nurses believe the nursing shortage is getting worse, and 79% report that their units are inadequately staffed.” And it’s not just nurses who recognize this problem. 90% of hospital CEOs report that nursing shortages are their most pressing workplace issue.
Burnout from Covid-19 is an important contributor to this problem. A survey by NCSBN (an organization of nursing regulatory bodies) found that approximately 100,000 registered nurses (RNs) quit in the two years following the COVID-19 outbreak “due to stress, burnout and retirements.” By 2027, “another 610,388 RNs reported an ‘intent to leave’ the workforce.” Over the next couple of years, approximately 20% of RNs are projected to retire or pursue other opportunities.
Despite all these people choosing to retire or leave nursing, the U.S. Bureau of Labor Statistics projects that there will be “about 203,200 openings for registered nurses” each year, on average, over the next decade.
The combination of these trends indicates that, despite how bad the current nursing shortages are, they are likely to worsen in the future. In the near-term, McKinsey estimates that by 2025, “the United States may have a gap of between 200,000 to 450,000 nurses available for direct patient care, equating to a 10 to 20 percent gap.”
Longer-term, the situation will likely continue to deteriorate due to the aging of the baby boom generation. By 2030, over 73 million people (21% of the U.S. population) will be 65 or older; people 65 and older require more healthcare services, indicating that the demand for nursing services will be growing while the supply of nurses is stagnating at best. The implications for healthcare quality are daunting.
Studies consistently find that patients face significantly higher mortality rates when there are fewer nurses per patient. Inadequate nurse staff levels have also been associated with a large number of other adverse outcomes such as more medication errors, greater numbers of infections, and increased pneumonia rates. Inadequate staffing levels also impose greater stress on those nurses who are helping patients, creating a vicious circle where inadequate staffing levels contribute to greater rates of nursing burnout, which then worsens the nursing shortage.
It is not feasible to alleviate the shortage solely by educating more nurses domestically – at least in the short term. As the American Association of Colleges of Nursing has noted, “U.S. nursing schools turned away 91,938 qualified applications (not applicants) from baccalaureate and graduate nursing programs in 2021 due to insufficient number of faculty, clinical sites, classroom space, and clinical preceptors, as well as budget constraints.”
Encouraging greater immigration of skilled nurses offers a solution to this otherwise intractable problem. Foreign-educated nurses are highly trained professionals who are qualified to staff medical facilities throughout the nation and can help fill the growing gaps in care. Countries, including the Philippines and India, train a surplus of nurses with the expectation that they will work in other nations and send remittances back home. It’s a win-win opportunity for all.
Hospitals are already increasingly turning toward foreign-educated nurses to staff their organizations. Without these professionals, the current nursing shortage would be more acute leading to additional adverse outcomes for patients.
There is a catch, however, because the U.S. State Department has halted access to work visas. Only those nurses who filed for a green card prior to June 2022 are eligible for visa interviews. This rule all but guarantees that the demand for experienced nurses will fail to keep up with the needs of the healthcare system.
Worse, as a Staffing Industry Analysts’ piece explains, “today’s 10-month [processing] timeline will increase dramatically, likely meaning nurses who petition this summer [summer of 2023] will not be able to enter the US until 2025 at the earliest. According to the American Bar Association, healthcare providers and industry groups have reported that this backlog will exacerbate the current nurse staffing shortage in the US.”
Unless this visa backlog is alleviated, the current nursing shortage is all but guaranteed to worsen. And patients will bear the brunt of these costs. Before the problem gets any worse, Congress needs to act, and the answer is clear: The current limit on the number of green cards is too stringent. Currently only 140,000 employment-based green cards are available each year. This is insufficient even if every one of these green cards went to a skilled nurse, which, of course, they don’t. Increasing this number and streamlining the processing to alleviate the current backlog are essential if we are going to avoid a devastating nurse shortage in the not-too-distant future.