The headlines and warnings have been relentless: there are not enough nurses – or people studying to be nurses – in the United States.
To solve life-threatening shortages, hospitals, nursing schools, and healthcare leaders must work to expand the talent pool, address longstanding biases and misunderstandings about who can succeed in the nursing field, and embrace the benefits that diverse, international nurses with degrees from U.S. universities can bring to the healthcare sector.
Today, outdated, ineffective systems and conceptions about international talent result in nursing schools and hospitals overlooking the eager, skilled pipeline of prospective international nurses.
Academic Progression. International students aspiring to pursue nursing education in the U.S. face numerous barriers to enrollment, including false misconceptions of lower predicted academic performance, as well as cultural and linguistic competency. Further hindering international students, academic nursing leadership frequently rationalize their hesitation to consider increasing international student enrollment upon the pressure to maintain program accreditation and licensure exam pass scores. At the same time, these instituions are trying to educate the next generation of nurses with limited faculty and staff.
In reality, international students graduate at roughly equivalent rates to their U.S. domestic peers. And far from being “fish out of water,” many international nursing students come to the U.S. already having healthcare experience, making it easier for them to become proficient with U.S. standards for healthcare delivery and helping them become gainfully employed at a hospital or nursing school – two workplaces that can benefit tremendously from increased diversity.
Visa Challenges. Along with barriers to relevant education, the complex U.S. visa system – perpetually in a state of flux – along with the time-consuming sponsorship process makes it intimidating for employers to hire highly qualified international candidates, even if they already reside in the U.S.
These barriers are particularly damaging given the evidence showing the many benefits of skilled immigration and the urgent need to address the nursing workforce crisis. Not only is international talent more mobile and more likely to work in geographies where they’re needed most, they have the unique ability to close the linguistic and cultural trust gaps that exist in underserved communities. With more than 40 percent of the U.S. population identifying as people of color, it’s imperative to increase diversity in hiring and recruitment within the healthcare field, especially when only 15 percent of currently registered nurses and 29 percent of physicians are foreign-born.
Staffing Agencies. Given the ongoing staffing crisis, many health care organizations (HCOs) are increasingly relying upon staffing agencies to help fill open nursing shifts. Once seen as a part of the solution, reliance on agencies has become expensive and inefficient. What’s more, reports of questionable practices and poor treatment of foreign-born nurses (forced into low-pay, high-patient-load jobs under unfair contracts) have cast a shadow that has likely further depressed the number of otherwise highly-qualified nurses and prevented hospitals from both recruiting and retaining top-tier talent.
As these challenges continue to restrict the flow of international talent into nursing positions, the U.S. lost 100,000 nurses since the COVID-19 pandemic. Retirements, turnover, stress, and burnout in the nursing workforce have accelerated, with expensive and life-threatening implications for providers, patients, and insurers alike. Meanwhile, after years of growth, 2022 was the first time since 2000 in which U.S. nursing school enrollments declined, according to the American Association of Colleges of Nursing.
Given the scope and urgency of the crisis, there’s never been a more critical time to streamline pathways for skilled international nursing students through intentional collaboration between both public and private sector institutions.
Firstly, end-to-end partnerships between HCOs and academic nursing programs are essential to establishing supportive pipelines that connect international talent with nursing programs and, subsequently, the U.S. professional nursing workforce. Enhanced collaboration between HCOs and nursing programs provide more sustainable, skilled nursing pipelines, accomplish shared diversity, equity, and inclusion initiatives,and improve patient outcomes. Strong academic-practice partnerships cultivate support systems for workers and promote career longevity and success.
Second, policymakers and immigration officials must collaborate to ease pathways for international talent to enter the healthcare sector by adding nursing to the STEM fields eligible for the Occupational Practice Training (OPT) program extension. Establishing this eligibility clearly for Registered Nurses would allow visa-holding students becoming nurses to stay and work in the U.S. for up to three years following their graduation, making it easier for employers to staff hospitals and signaling to students across the globe that nursing is a viable career to pursue in the U.S.
Solving the nursing shortage and addressing long-standing diversity gaps in the profession begins with embracing solutions that deal with the systemic barriers and misperceptions that hinder attracting and retaining international talent. By doing so, we can improve nurse retention, patient outcomes, grow faculty pipelines, increase workforce diversity, and advance the nursing profession.
Hospitals and nursing schools are the front lines of determining the future of our healthcare system. We should settle for nothing less than a standard of care envied worldwide, delivered by nurses and healthcare professionals from the U.S. and across the globe.
Ranil Herath, MBA is the President of Emeritus Healthcare and an Advisory Council Member for the National League for Nursing
Jason Garbarino, DNP, RN, GERO-BC, CNL is the Healthcare Talent Director for inSpring, a Boston-based company helping U.S. employers respond to labor shortage challenges in the nursing and tech sector nationwide.