The U.S. nursing workforce is shedding workers. About 100,000 nurses quit or retired during the pandemic, while another 800,000 have signaled an “intent to leave” by 2027. And yet, the country is failing to tap an available group of qualified health-care workers: immigrants. While there’s no single fix for the U.S.’s nursing shortage, a more efficient system to bring in foreign-trained professionals would go a long way toward easing it.
Immigrants comprise about 16% of registered nurses and have been a crucial part of the health-care workforce for decades. Even so, the U.S. lacks a dedicated pathway for foreign-trained nurses to work in the country. Most come through the employment-based immigration system, which is capped at 140,000 green cards per year for all applicants and their family members. Of that number, roughly 40,000 are allocated to “skilled workers, professionals and other workers,” a category that includes nurses. Because most of those green cards are awarded to workers already in the country, only 10,000 to 12,000 visas are available each year for new foreign-trained nurses.
That’s insufficient to meet America’s health-care needs. Roughly 60% of the population has a chronic disease and a fifth will be above the age of 65 by 2030. According to the Bureau of Labor Statistics, the U.S. will need to fill more than 200,000 vacancies for RNs each year, on average, through 2031. Far from allowing more nurses to come to the U.S., however, the government is making it even harder. Last month, the State Department said it would delay visa processing amid surging demand, leaving thousands of nurses in limbo.
For years, lawmakers have resisted efforts to expand the pipeline of skilled foreign workers, partly out of fear that increased immigration will drive down wages and compromise working conditions. Such concerns are understandable but are ultimately self-defeating. Severe nursing shortages during the pandemic pushed hospitals toward contract nurses and sent costs soaring. Higher immigration could help restore some balance while benefitting the economy more broadly.
In the absence of comprehensive immigration reform, lawmakers should pursue targeted steps to bring in more foreign nurses. One bipartisan pandemic-era proposal in Congress should be revived. It aimed to “recapture” unused employment-based visas for doctors and nurses from years past and give them priority for green-card processing — which would yield 15,000 additional visas for doctors and 25,000 for nurses. As a one-time visa allotment, it would have only a limited impact on the domestic labor market, while reinforcing a depleted workforce. It’s an example of compromise that’s eluded the immigration debate for more than three decades.
Another option is tapping foreign-trained nurses already in the U.S. More than 115,000 immigrants with undergraduate degrees in nursing are working below their skill level, many as low-paid assistants, home health aides and domestic help. In September, Congress passed a law requiring the Labor Department to study barriers to employment for immigrants with foreign credentials and to issue recommendations for reform. These should include streamlined re-credentialing, grants to support test preparation for licensing exams, and more efficient pathways for immigrants to pursue advanced degrees.
At a time of unprecedented demand on the U.S. health-care system, keeping qualified foreign-trained nurses out of the workforce is shortsighted. Smarter immigration policy can get health workers where they’re needed.