As policymakers, special interest groups, health care professionals and others discuss the need for health care reform in the US and debate how this reform should take place, one of the most important issues to health care is being left out of the debate: the national nursing shortage. So far, the debate over health care has hinged around whether there should be a “public option,” creating room for divisive ideological debate at the expense of any real progress toward improvements to the current broken system. The nursing shortage continues to exacerbate the health care crisis, such that no true healthcare reform can occur without immigration law reform.
The health care industry has and continues to face a crisis in filling current open positions with trained, skilled nurses. As the baby boomers enter their golden years, an increasing strain is put on the health care system to provide care for this large, aging population. Further compounding the problem is the fact that the current nursing population is aging as well.
For example, the average age of nurses in California is 47. The California Institute for Nursing and Health Care estimates that the state will need 108,000 new nurses by 2020 to fill the vacancies left by retiring nurses and to fill the new positions opened up to meet the increased demands for health care. Nationally, the US Bureau of Labor Statistics estimates that 1 million new and replacement nurses will be needed by 2016 to meet staffing needs.
Individual states have ramped up their efforts to tackle their individual nursing shortages by offering more grants and scholarships to nursing students and trying to increase enrollments at nursing schools. While these efforts may help meet some of the future nursing needs, they do little to nothing to meet current staffing demands — including the 135,000 open positions across the country for registered nurses. What makes this shortage all the more difficult to understand is the fact that there are hundreds of qualified, available nurses from other countries who are willing to immigrate to the United States but, because of the immigration system, cannot get a visa to enter the country.
There are two different categories of visas foreign nurses can apply for to enter the US to work: nonimmigrant visas and immigrant visas. Nonimmigrant visas are temporary visas that allow them to enter the US for a limited amount of time. There are three types of nonimmigrant visas nurses may be eligible for: H1-B visas, TN visas and H-1C visas.
Nonimmigrant visas present a couple of difficulties. First, they are valid for a limited amount of time, whereas the nursing crisis is an ongoing problem. Second, there are very few available nonimmigrant visas for which nurses can apply. For example, H1-B visas are only available to those who have a bachelor’s degree or higher and many nurses do not have the required educational degree. TN visas, on the other hand, are only available to qualified nurses from Canada and Mexico. Lastly, H1-C visas, which were created specifically to address the nursing shortage, are limited to only 500 per year and currently only 14 hospitals have the required certification to qualify for the visas!
The second option, immigrant visas, allows foreign nurses to receive permanent residence in the US, otherwise known as a “green card.” Nurses typically are eligible for EB-3 visas, or a “third priority employment-based visa.” In order to apply for an immigrant visa, the foreign nurse must be sponsored by a US employer, like a hospital. The employer then must enter a lengthy application process before the foreign nurse can become eligible to apply for a visa. The process includes filing an I-140 petition and labor certification with the US Citizenship and Immigration Services (USCIS) office.
Generally, employers seeking to sponsor workers for EB-3 visas also must complete a lengthy application process with the US Department of Labor (DOL) to certify that there is a shortage of US workers for the position and that hiring a foreign worker will not have an adverse affect on the wages or working conditions of US workers.
However, nursing is considered a “Schedule A” occupation. This means that the DOL has pre-certified that there is a documented shortage of nurses and that hiring foreign nurses will not displace or adversely affect US nurses.
The Schedule A designation is supposed to speed up the application process for employers trying to sponsor foreign nurses by allowing them to bypass the DOL process and skip ahead to filing the petition and labor certification with the USCIS. But even with this designation, it still takes the USCIS an estimated 15 months to process an I-140 Immigrant Visa Petition for a Schedule A nurse.
The biggest barrier, however, to bringing more foreign nurses to work in the US is not the application processing time, but how long it takes after the application has been processed until a nurse receives a visa.
Once the USCIS has approved the application for the foreign nurse, the nurse then is given a priority date and placed in line for a visa with all of the other approved EB-3 applicants. The current wait time for an available EB-3 visa number is 3-7 years. So this means that hospitals who filed successful petitions for foreign nurses as far back as 2002 still may be waiting for the nurse to begin work. Once the visa number becomes available, then the foreign nurse must either apply for a visa at the US consulate or embassy in his or her home country. If the nurse currently is in the US on a different type of visa, he or she then must apply for a change of immigrant status. Either one of these processes may take months more to process.
Waiting 7 or more years for a foreign nurse’s immigration process to be fully completed is not helping any hospital with its nursing staff shortages. If anything, the length and complexity of the process serves as a deterrent to hospitals and other health care institutions who may be considering employing foreign nurses. One of the easiest ways to increase the number of nurses and decrease the waiting time in the immigration process is to create a special priority category just for nurses. Under US immigration law, only an act of Congress amending the Immigration and Nationality Act (INA) or an executive order issued by the President can create this new category for immigrant visas.
Additionally, the federal government could take action to increase the number of immigrant and nonimmigrant visas available to nurses. This number is set each year by Congress. Currently, there only are 140,000 eligible visas for all five of the EB categories. By increasing the number of available visas and providing nurses with a special priority category for attaining a visa number, the federal government can take significant steps towards addressing the nursing shortage.
Meaningful health care reform cannot occur without tackling the nursing shortage. No matter what shape the US health care system takes in the future, there will always be a need for well-trained nurses. Without them, hospital care cannot be expected to improve. Individuals, health care providers and the public must urge their Congressmen to support immigration reform as important means through which to reform the broken US health care system.