Foreign nurses face immigration barriers amid U.S. healthcare staffing shortages
The United States is grappling with a critical healthcare staffing shortage. Despite a global pool of skilled nurses and technologists eager to work in the U.S., immigration hurdles continue to prevent a much-needed influx of foreign workers into the healthcare system. Kathleen Campbell Walker, JD, chair of the immigration practice group at Dickinson Wright and past president of the American Immigration Lawyers Association (AILA), sheds light on the legal and bureaucratic obstacles exacerbating this crisis.
According to Walker, the immigration system has not kept pace with the evolving needs of the healthcare industry. Many foreign nurses, who could help address the staffing shortages in hospitals and clinics, face daunting barriers to entry, from outdated visa categories to excessive credentialing requirements.
"Nurses have a long history in U.S. immigration, both as non-immigrants and immigrants," Walker explained. "Historically, programs like the H-1A and H-1C visas allowed many Filipino nurses to come to the United States, but those programs no longer exist."
Today, the most common work visa, the H-1B, is largely inaccessible to foreign nurses, as it typically requires positions that demand a bachelor's degree or higher. Most nursing roles do not meet this criterion, limiting the available visa pathways for these essential workers.
Walker advocates for the creation of a new non-immigrant visa category tailored specifically for nurses and healthcare technologists. Such a visa would recognize the urgent need for these professionals, allowing them to work in the U.S. without unnecessary educational requirements.
"Why can't it be based on a documented need, assessed by state, and facilitate a non-immigrant visa whether the position requires an associate’s degree or a bachelor's degree?" she asked.
Adding to the complexity, foreign nurses must navigate extensive credentialing and certification processes, even if they have equivalent degrees and years of experience in their home countries. "For nurses, there’s an additional requirement for a healthcare worker certificate," Walker noted. "Even if a nurse has licensure in their home country, they still need to pass through extra hurdles to be recognized in the U.S."
These barriers not only delay foreign workers from filling critical roles, but also discourage many from seeking employment in the U.S. altogether. Walker said very experienced nurses in another country may have to get additional training, or basically go back through nursing school again, which many are unwilling to do. But, she said they can take on nonclinical manager and administration roles.
Visa reforms needed to mitigate nursing shortages
Beyond the individual challenges faced by foreign healthcare workers, Walker argues that the broader immigration system is out of sync with reality.
"From an immigrant visa perspective, we need to add exemptions from labor certifications for healthcare workers," she said. This would allow hospitals and clinics to hire foreign nurses more quickly, without making them wait in long visa backlogs.
Walker also highlighted the need for reforms to existing trade agreements, such as Trade NAFTA (now USMCA), which facilitates easier immigration for certain professionals from Mexico and Canada. "If we could add more healthcare occupations to the list of approved NAFTA jobs, we could bring in more nurses and other professionals to alleviate shortages," she suggested.
The need for action is urgent, particularly in the aftermath of the COVID-19 pandemic, which further exposed the fragility of the U.S. healthcare system as a large number of healthcare workers left their jobs. Walker emphasized that unless these immigration barriers are addressed, the healthcare sector will continue to struggle with staffing shortages, hampering patient care and increasing strain on existing healthcare workers.
In a time of increasing demand for healthcare services, the inability to bring in skilled foreign workers is a missed opportunity.
"Putting immigration in paralysis mode doesn’t make economic or security sense," Walker concluded. Addressing these barriers could be a crucial step in solving the U.S. healthcare staffing crisis.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: dfornell@innovatehealthcare.com