Researchers on Thursday likened long-term care organizations’ quest to entice immigrant nurses to using a Band-Aid to stop a hemorrhaging workforce wound.
“It may provide temporary relief, but it will not work in the long run,” nursing researchers from the University of Missouri, George Washington University and New York University wrote in Health Affairs commentary. “Instead, it would be more beneficial to focus on retaining the existing workforce while also creating more equitable and accessible pathways to employment for IENs [internationally educated nurses]. By doing so, we can address the staffing crisis in a more comprehensive and sustainable manner.”
The researchers noted that there are far fewer nurses than providers realize available to work in the US, and most need a bachelor’s degree to obtain a visa. While degree-holding workers may appeal to hospitals and other higher-paying settings, nursing homes have a far greater overall need for entry-level certified nurse aides and licensed practical nurses.
Nursing exam pass rates in many countries lag below 50%, including in the Philippines, which provides the most international nursing candidates. And once an international nurse passes the NCLEX, the next step is to obtain a work visa or an employer-based green card, most often requiring a bachelor’s degree.
“As a result, the number of annual potential applicants available for recruitment is only about 8,663,” the researchers wrote. “This is a very small pool, and it is insufficient to address the estimated 203,200 nursing vacancies that currently exist throughout the nation.”
LeadingAge and the American Health Care Association both signed on to a coalition letter this week asking Congress to enact immigration reforms that significantly increase annual quotas for employment-based immigrant and nonimmigrant visas; expand essential worker programs; and creating new visa options for international students, entrepreneurs, and other high-demand workers.
Immigration changes will be needed to address long-term care shortages in any meaningful way, Health Affairs co-author Allison Squires, PhD, RN, told McKnight’s Long-Term Care News on Thursday.
“There’s virtually no option for any health worker without a professional degree to obtain a legal work permit in the US if they are not already here legally,” said Squires, associate professor at NYU Rory Meyers College of Nursing. “If they go through a formal nursing assistant training program as an international student, they might be eligible for Optional Practical Training but that would require the employer to sponsor the work visa after OPT runs out.”
Relying on international LPN applicants won’t help either, Squires added, because only 408 took the exam in 2022, with a 50% pass rate.
Beyond the numbers, the researchers noted that assuming foreign-born nurses want to work in entry level jobs or stress-laden environments “has deep roots in racism, xenophobia and sexism.”
“The assumption, on the part of hospital and other healthcare facility/system administrators or policy makers, that internationally educated nurses would accept the same subpar working conditions that are causing US-trained nurses to leave clinical practice in US health systems is offensive,” they wrote. “The real issue is that nurses do not want to work in places where they are undervalued and underappreciated, driving an inequitable distribution of nurses across the country.”
Instead, the team emphasized the need to make healthcare jobs more attractive and retain the more than 150,000 new US nurses who pass the NCLEX exam each year.
They also urged immigration policymakers to designate nursing as a Science, Technology, Engineering and Mathematics, or STEM field. That could create additional work visa options for internationally educated nurses, such as making it easier to qualify for H-1B visa.
Providers who continue to recruit internationally educated nurses should prioritize those efforts by aligning hiring with the needs of their patients, including hiring nurses who speak languages other than English to match local demographics.
Squires also said skilled nursing operators might be wise to watch how international nurses fare in local hospitals after being recruited.
“People may appreciate the slower pace and lower acuity in LTC/SNF facilities,” she told McKnight’s. “Of course, they may have to raise salaries, improve benefits and create more positive work environments to attract folks.”
