The U.S. healthcare system is broken. For those working in healthcare, and patients who struggle with the system, this is not a shocking statement. Even before the pandemic, resource constraints, rising patient demands, and tremendous inefficiencies plagued healthcare. COVID-19 simply exposed a system already pushed beyond its limits along with those providing care. Among these providers most affected were nurses on the front lines. And as stressors mounted, many chose to leave the profession, creating a major nursing shortage problem in the U.S. That crisis still exists today and is growing worse each year. While many things are to blame, America’s broken immigration system plays a significant role. And it doesn’t look like this is about to change anytime soon.
When one comments about the broken immigration system in the U.S., the focus immediately goes toward illegal immigrants. But when it comes to the tremendous nursing shortage problem in the U.S., it is the legal immigration system that is the issue. Bipartisan gridlock in Congress over illegal immigration policies has spilled over to the entire immigration system. As a result, even highly qualified nurses from abroad have little chance of receiving immigration work visas. Ultimately, this hurts healthcare employers that must pay significant sums to temp nurses who have little organizational loyalty. And of course, this undermines patient quality and safety of care due to a lack of staffing. This is the current state of affairs when it comes to healthcare in the U.S. today.
The Nursing Shortage
When it comes to the current nursing crisis in the U.S., several factors have contributed. In past decades, state laws limited what nurse practitioners could do within healthcare settings. This has improved greatly in many regions. However, insufficient general nurses now exist to meet rising patient demand. As Baby Boomers age, they experience a higher number of chronic diseases and demand higher amounts of healthcare resources. At the same time, fewer nurses are choosing to go into the profession. Limited pay, excessive caseloads and hours, and high-stress assignments have deterred many. And even those in the field are choosing to retire early or simply walk away into other careers. In this regard, it’s not the broken immigration system at fault. Instead, it’s a lack of nurse supply compared to rising care demands.
That doesn’t mean the broken immigration system in the U.S. isn’t playing a role. The initial solution to the nursing shortage problem in the U.S. was to recruit temporary and traveling nurses. However, this solution is hardly sustainable. Given the supply-demand curve described, temp and travel nurses require three times the wage as routine nursing hires on average. This means healthcare systems able to pay the higher wage wins out on the limited number of nurses available. Left out in the cold are the small hospitals and rural healthcare systems unable to compete at this level. These are the organizations feeling the most constrained, and likewise, the ones with the highest nursing turnover. For them, foreign nurse recruits and even virtual talent offer solutions both feasible and promising.
The Broken Immigration System in the U.S.
The current issues with legal immigration date back many decades. In essence, the system continues to work off a framework developed in 1965. Some aspects were revamped in 1990 by Congress. However, the impact of these changes has not even come close to keeping pace with changes in the labor market. Under these laws, the set cap for skilled workers annually into the U.S. is 140,000. However, legal immigrants from a specific country cannot exceed 7% of this total. This naturally limits sizable countries like India. But this isn’t the issue when it comes to the nursing shortage problem in the U.S. Instead, it’s the high level of bureaucracy bogging down the system and a grossly inadequate quota limit. Nursing demand as well as the demand for other labor markets have grown exponentially since the 1990s. But the limit for legal immigrants has hardly budged.
When it comes to bureaucracy, major delays interfere with legalized immigrants from gaining access to the country. The first step of processing involves the Labor Department, which must ensure foreign workers won’t negatively impact domestic opportunities. This doesn’t apply to the nursing shortage problem in the U.S. since domestic supply is quite scarce. Regardless, due to staffing and budget shortages, this step still takes several months. Once this is completed, application processing then takes place at the Department of Homeland Security. Delays here can extend up to 2-3 years with many green card applications never reaching processing. Finally, if one is lucky enough to get this far, an interview with the U.S. Consulate must occur. Though the interview usually takes less than an hour, getting an interview can also take over a year. In essence, there is evidence of a broken immigration system every step of the way.
An Urgent Call to Action
In terms of the nursing shortage problem in the U.S., there is little hope for immediate relief. In 2023, the State Department reported that the 140,000 cap for legal immigrants was nearly reached. For nurses, there is roughly about 40,000 slots of this that might be available. They must compete with other labor markets in software development, engineering, and law. As such, only about 5,000 nurses reach the U.S. from abroad due to this broken immigration system. That means that hospitals and other healthcare systems will have to continue to deal with nursing shortages and excessive pay. Ultimately, this will negatively affect healthcare overall and undermine patient safety.
It’s not like rural and smaller healthcare systems aren’t trying to resolve the nursing shortage problem in the U.S. Many have invested millions to recruit foreign nursing talent that include expert consultants, fees to expedite the process, and more. But the broken immigration system is beyond these types of feasible solutions. The immigration problem in the U.S. needs to be resolved, and it goes well beyond illegal immigration. A combined effort is desperately needed among employers, policymakers, and agencies is needed to turn things around. And if legal immigration of foreign nurses isn’t part of this pursuit, the further decline of the U.S. healthcare system is inevitable.