International Nurses, Visa Implications, and the Labor Shortage

The nursing shortage continues to sound a growing alarm. To support their healthcare clients, the staffing industry and contingent labor firms are pulling out all the stops to reach new nursing talent, develop nursing candidate pools, and increase the speed to hire. International nurses have been one means to fill the gap. For foreign nurses, joining the U.S. workforce via an EB-3 enables them to file for a green card that grants them lawful permanent residence (LPR). Today we explore how the current decision to pause visa applications and a visa backlog adds to concerns about how healthcare systems will sustain services in the foreseeable future.

International Nurse Recruitment Makes an Impact

Immigrants, including foreign nurses, play a critical role in the U.S. healthcare system. They help meet the growing demand for healthcare services, particularly in underserved areas, and contribute to the diversity and effectiveness of patient care. Their impact is multi-dimensional:

  • Filling the Gap: The U.S. continues to face a nursing shortage. This problem is growing more acute as the population ages and more people need medical care. Foreign nurses help to fill this gap. They bring their skills and experience to hospitals, clinics, and nursing homes nationwide. According to Patty Jeffrey, president of the American Association of International Healthcare Recruitment, one in six registered nurses practicing medicine in the U.S. is an immigrant. 
  • Diversity and Multicultural Understanding: Nurses from different cultures bring a unique perspective to patient care. They can help provide culturally sensitive care to diverse patient populations, improving patient outcomes and satisfaction.
  • Expertise and Specializations: Some foreign nurses come with specializations and skills in high demand in the U.S. healthcare system.
  • Rural Healthcare: Many rural areas in the U.S. need help attracting healthcare professionals. Foreign nurses often work in these underserved areas, ensuring patients in rural communities can access healthcare services.
  • 24/7 Care: Hospitals and healthcare facilities operate around the clock. Immigrant nurses often work in shifts that are hard to fill, ensuring that patients always receive care.
  • Economic Contribution: Foreign nurses contribute to the U.S. economy. They pay taxes, rent, and buy goods and services. Their work also supports other jobs in the healthcare industry.

A Pause on EB-3 Visas

EB-3 visas, issued to people filling in-demand roles for professional, skilled, and unskilled workers, are the means for foreign nurses to gain employment and legal entry to the United States. Every year, the U.S. sets aside a specific number of available green cards for individuals worldwide. In addition, there are per-country caps on green cards so that every country can stay within 7% of the total number of green cards annually. Due to numerical limits, per-country caps, and administrative delays, the employment-based green card backlog reached 1.6 million by the end of Fiscal Year 2022.

To put this backlog in perspective, nurses entering the U.S. with an EB-3 visa are within a green card limit of 40,000 per fiscal year. According to a June report from the National Visa Center, over 350,000 applicants are waiting for visa interviews to be scheduled.

The U.S. State Department recently announced its decision not to accept further visa applications for foreign nurses in 2023. Only those individuals who submitted applications before June 1, 2022, are eligible for visa interviews. Staffing Industry Analysts (SIA) reports concerns from the staffing industry, as legal experts anticipate the already backlogged queue of applications will push nurse applicants through a process that will delay their entry into the U.S. to 2025 at the earliest.

Is Some Relief Pending?

A strategy that previously received bipartisan support in Congress (in 2000 and 2005) is to recapture unused green cards lost to bureaucratic delays since 1992. On March 10, 2023, a bill was introduced in the House to make additional visas available. While the impact of this bill, if it passes, would not impact the current stoppage on visas for international nurses, it does point to some potential relief to come in 2024.

The Eliminating Backlogs Act of 2023, or H.R. 1535, is a bipartisan bill that would recapture the unused employment-based green cards accumulated since 1992. In addition, the bill would exempt these recaptured green cards from the 7% per-country cap. In addition, some individuals waiting in lengthy backlogs from “capped-out” high immigration countries like India, China, the Philippines, and Mexico would immediately be eligible for green cards.

This bill is a step towards tackling the green card backlog and alleviating the pressing labor shortages in the United States, while helping reunite separated families.

Broader Thinking to Open Doors and Better Serve

As we face an increasingly globalized world, we should consider resources, talent, and solutions from a broader perspective. Foreign nurses have proven invaluable resources in the U.S. healthcare system, stepping in to fill gaps in care, offering their diverse perspectives and specialized skills, and contributing positively to our economy. With a deepening nursing shortage, this international talent pool is essential. However, current barriers, such as the visa backlog and the decision to halt further visa applications for foreign nurses in 2023, are impacting these dedicated professionals and affecting healthcare facilities, patients, and the broader economy.

Initiatives like the Eliminating Backlogs Act of 2023, which aims to recapture unused employment-based green cards, show promise in tackling these issues. In fostering diverse, inclusive communities, we must avoid imposing barriers that ultimately harm the individuals who wish to contribute to our society and the industries that greatly need their skills. Thinking globally, we can devise solutions that address the current healthcare challenges and help us build a robust and resilient healthcare system.


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