Limited Visas Hinder Hospitals Ability To Curb Nursing Shortfall
Covid-19 burnout and understaffed hospital wards have taken their toll on the nursing profession. An April 2023 study found that overworked nursing professionals and understaffing have driven “an overall 3.3% decline in the U.S. nursing workforce during the past 2 years.”
While some argue that the term shortage is not appropriate because the number of registered nurses has grown, the number of unfilled nursing positions in critical facilities such as hospitals is also growing. The insufficient numbers of nurses working in essential healthcare functions undermine the arguments that the shortage is not real. As a 2022 McKinsey study estimates “the United States may have a gap of between 200,000 to 450,000 nurses available for direct patient care [in 2025], equating to a 10 to 20 percent gap.”
The threat of such shortages threatens the quality of healthcare patients will receive. As I noted back in August,
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.
Sustainably addressing such a multifaceted problem requires a comprehensive approach – there are no silver bullets. Toward this goal, as I previously argued, allowing more legal immigration of skilled nurses would meaningfully lessen the growing shortage and help close the gap of nearly a half million skilled nurses.
Rather than being part of the solution, the broken immigration system is worsening the problem. A Washington Post article published in December 2023 documented the experience of Sanford Medical Center in North Dakota. To expand its heart unit and staff the new wing, the hospital was relying on the immigration of nearly 60 nurses from the Philippines, Kenya, and Nigeria. The U.S. State Department had other plans.
Due to a backlog of applicants, the State Department is only issuing visas to applicants who had applied before December 2021, which does not include the hospital’s nurses. As a result, their arrival has been delayed until the first quarter of 2025, but perhaps even longer. The delays mean that Sanford Medical Center will need to transfer some patients to the hospital’s other facility that is 200 miles away, since the planned expansion is impossible without the additional nurses. The delays reduce patients’ quality of care and increase overall healthcare costs. Worse, these problems are not unique to North Dakota; it is systemic and nationwide.
Undoubtedly, our immigration system is broken, and many reforms are long overdue. Removing the obstacles preventing skilled nurses from immigrating to the U.S. is one of them. Most nurses trying to immigrate to the U.S. compete for one of a limited number of EB-3 visas issued each year, which are not even reserved for nurses. These are the visas offered to all skilled workers, professionals, and unskilled workers. As a result, only a fraction of the total EB-3 visas is offered to nurses each year.
These strict quotas keep thousands of qualified nurses out of the U.S., even though American hospitals and patients desperately need their help. Yet, even for those nurses lucky enough to get a visa, the extensive bureaucratic red tape and understaffed consulates often create years of delays before they are given their final interviews.
Congress has consistently failed to pass legislation that would address this situation, but there is an opportunity for Congress to change that – the Healthcare Workforce Resilience Act. This bipartisan bill was introduced in November 2023 by Sens. Dick Durbin (D-IL) and Kevin Cramer (R-ND).
If passed, the bill would authorize the State Department to issue visas that went unused in previous years. Specifically, the “U.S. Citizenship and Immigration Services (USCIS) would “recapture” up to 25,000 immigrant visas for nurses and 15,000 immigrant visas for physicians.”
As a result, qualified foreign-born nurses would be better positioned to help reduce the nursing shortage, particularly in medically underserved areas. So far, 18 senators are backing the bill – 8 Democrats, 9 Republicans, and independent Sen. Kyrsten Sinema. The House version also has bipartisan support.
Recapturing these visas is an important step that will help alleviate the growing nursing shortage. The reforms address the problem in the short term by closing the current vacancies. Importantly, by closing these short-term vacancies, the burnout pressures on the current nursing staff will also be lessened, creating important benefits for the current nursing professionals. Ultimately, it is patients who will benefit the most through improved care and better health outcomes.
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