In many U.S. hospitals, nurses from other countries help keep emergency rooms and inpatient units running. From the AIDS epidemic of the 1980s and 1990s to currently understaffed hospitals, foreign nurses continue to ease shortages in parts of the nation. As the U.S. braces for a wave of aging patients, and an exodus of retiring nurses, foreign nurses are expected to be needed as much as ever.
"Nurses that migrate to this country have made a significant impact on helping to improve health outcomes, particularly for hospitals that tend to have challenges in terms of building their own nurse capacity," says Yolanda Ogbolu, a neonatal nurse practitioner and director of the University of Maryland School of Nursing Office of Global Health.
Foreign-born nurses make up about 15 percent of registered nurses in the U.S., according to a June 2016 report by the Institute for Immigration Research at George Mason University and the Immigrant Learning Center. California, New York, Florida, Texas and New Jersey employ more than half of these nurses, but they are needed in other parts of the country, too, particularly in rural pockets.
Foreign nurses who want to work in the U.S. can be frustrated by the visa process. H-1B visas, for instance (which allow U.S. employers to temporarily employ specialized workers in hard-to-fill positions), require these RNs to have earned at least a bachelor's degree to qualify, attorney Sarah Peterson, head of the SPS Immigration law firm in Minneapolis, writes in an email. It can be done, she says, but employers are often met with requests for additional documentation, and even then, there's no guarantee the government will greenlight the application.
State licensure requirements may create another hurdle, Peterson says: "For example, in California, a nurse can't get a license without immigration status and [U.S. Citizenship and Immigration Services] won't give immigration status without the license." Workarounds exist, she adds, but they cost additional time and money for the sponsoring employer.
Time lags cause many foreign nurses in countries with insufficient visa numbers, primarily the Philippines and India, to give up and resettle in other countries, says Gary Ilagan, who practices immigration and nationality law with a focus on the health care industry in the Houston office of Munsch Hardt. "In other cases, employers go out of business or are sold, or they abandon the nurses because they are no longer interested in continuing the immigrant visa process after years of waiting."
Nurses who are hired in the U.S. can run into legal issues as well. "Sometimes nurses become unhappy with the working conditions and try to get out of their contracts early by buying out the contract," Ilagan says. "Or they just flat out leave, thinking there won't be any repercussion, and they get sued for breach of contract."
Just Doing Their Jobs
Lobel Lurie, a nursing professional development specialist with Cone Health in Greensboro, North Carolina, has reinvented her nursing career several times over since arriving to the U.S. from the Philippines. She's worked as a psychiatric nurse and prison nurse in Manhattan, and in education and recruiting roles.
In 1992, Lurie was one of 22 Filipino nurses aboard a Northwest Airlines flight from Manila to JFK Airport in New York City. A representative from Bronx Lebanon Hospital met the new arrivals at the airport. Lurie and her peers were recruited to work with patients with medical conditions including AIDS. Lingering uncertainty about possible viral contagion with AIDS, which became epidemic in the 1980s, contributed to local staffing shortages.
"There was really a need for nurses to take care of these patients," she says. "So they recruited nurses from other countries." To Lurie, it was all in a day's work and what she had trained for. "Really, it's just being sympathetic to your patients and empathetic to what they're going through."
Now, Lurie is creating competency programs for foreign-educated nurses, hospital leadership and hiring organizations to improve the transition for these nurses to U.S. health care.
Nearly 690,000 nurses are projected to leave the labor force through 2024, through retirement and other reasons, with additional nursing job openings putting net nurse vacancies at an estimated 1.2 million, according to statistics provided by the American Nurses Association. However, the ANA suggests that a focused effort to increase the U.S. nurse population, enhance nursing education and maintain a steady supply of newly licensed graduates, with hospital and health employers willing to hire them, could stave off a shortage.
In some areas of the country, the supply of new nurses will actually catch up and outpace demand, according to a 2014 U.S. Health Resources and Services Administration report. But other communities won't have enough. By 2025, Arizona, Colorado and North Carolina are expected to be hit by the biggest nursing shortfalls.
"In our country, we have a great need because the nursing profession is aging, with the average age of a nurse being 47," Ogbolu says. "We anticipate a lot of retirements in the future."
Proud Career Nurses
For Beth Cuento Reyes, a registered nurse in the pediatric intensive care unit at Children's National Medical Center in the District of Columbia, it's all about the kids. Born in the Philippines, she was recruited to the U.S. in 1984 and became a citizen three years later. Reyes is proud of her varied career taking care of the sickest children. "With children, they don't ask questions," she says. "But you learn how to know what they feel and need from you."
Initially, along with five other nurses, Reyes was recruited by the Hospital Corporation of America to work at Children's Hospital of the King's Daughters in Norfolk, Virginia. There for more than a decade, she took care of critically ill children recovering from procedures including open heart surgery and heart transplant -- work she feels fortunate to have been part of.
Hannah Hillis, working night shifts, takes care of medical telemetry patients at the Cape Fear Valley Medical Center in Fayetteville, North Carolina. Hillis, who is a travel nurse working on a contract basis, is also pursuing her master's degree in a nursing leadership program -- the career goal that drew her to the U.S. from the Philippines in 2008.
Unlike many foreign nurses who arrange visas and U.S. jobs through an agency, Hillis had independently searched online for opportunities for temporary H1-C visas, a now-expired program that fast-tracked foreign nurses coming to work in U.S. communities experiencing nursing shortages. That visa took her to Southeastern Regional Medical Center in Lumberton, North Carolina.
Patients in the U.S. have a different attitude toward hospital staff, Hillis found. "Here, patients are very upfront. They're very frank. They'll tell you what they want and they're not going to hesitate."
Cultural differences pose no barrier to good patient care, Hillis adds: "We love what we do," she says. "It doesn't matter where we go -- we're going to give the best care we can. We're happy to be nurses. We're grateful for the opportunity that's given to us."
Lisa Esposito is a Patient Advice reporter at U.S. News. She covers health conditions, drawing on experience as an RN in oncology and other areas and as a research coordinator at the National Institutes of Health. Esposito previously reported on health care with Gannett, and she received her journalism master's degree at Georgetown University. You can follow her on Twitter, connect with her on LinkedIn or email her at firstname.lastname@example.org.