How a green card freeze will exacerbate the nursing crisis (2023)

And emergency room doctors say not having enough nurses is a top concern coming out of the pandemic.

“If that pipeline stops, it ain’t gonna be good — and I’m talking significant holes in the nursing field, which is already on such a razor-thin edge right now,” said Luke LeBas, an emergency medicine physician in Louisiana, who added that an “incredible number” of nurses have come to the U.S. from the Philippines to backstop hospitals on the West Coast.

The shrinking labor pool has ripple effects beyond the hospital walls. The reduction in foreign visas will affect nursing homes, assisted living facilities and hospice care, which could increase costs and delay care for the elderly and the dying.

An estimated 100,000 registered nurses in the U.S. left the workforce during Covid because of stress, burnout and retirements. About another 600,000 have reported “intent to leave” the workforce by 2027 because of the same issues. The U.S. is now facing a projected shortage of more than 200,000 nurses in the next few years.

International nurses have proven for many hospitals and health systems to be a useful tool at combating those staffing shortages — with foreign workers comprising about 15 percent of the workforce, a number that’s nearly doubled in the last decade.

But with the State Department’s freeze on green card petitions filed in the past year, health systems — already crushed under the weight of a workforce crisis that is crimping margins and hurting patient care — will be short one of their most effective hiring tools. The American Association of International Healthcare Recruitment estimated at least two-thirds of the thousands of international nurses on their pipeline to enter the U.S. this year won’t be able to immigrate because of the State Department’s freeze.

“You already have nurses who are over-stressed, overworked, burnt-out because of the last few years,” said Lesley Hamilton-Powers, vice chair of the AAIHR. “… About 15 percent of nurses are international, working in the U.S. today, and so you take those nurses away from the bedside and the nurses who are left continue to be overworked and delivering care in a vacuum of enough personnel.”

The State Department’s freeze is a result of higher-than-anticipated demand for employment-based visas in the EB-3 subcategory, a massive professional pool that includes all occupations that require at least an associate’s degree, but not a master’s degree.

That means nurses are in the same processing queue for green card applications as IT workers and engineers. Because the demand for work visas is greater than supply, the State Department prioritizes the oldest applications first, not the industry in which there is the greatest need.

The department has nearly exhausted the 40,000 green card annual limit for this fiscal year, ending Sept. 30. The annual limit will reset in October, but because of such high demand for green cards coming out of the pandemic, there will likely still be a cut-off date for eligibility come the fall, said Chris Musillo, an AAIHR-affiliated immigration lawyer.

If the cut-off for eligibility continues past October, international nurses who petition for green cards this summer might not be able to enter the U.S. until at least 2025, Musillo predicts.

A State Department spokesperson told POLITICO that “people from most countries who are seeking to immigrate to the United States” on an EB-3 visa “should expect to wait longer for a visa to become available than in prior bulletins.”

“We recognize the importance of health care workers to the U.S. economy and are continually monitoring the situation,” the spokesperson said.

The EB-3 category is numerically limited by the Immigration and Nationality Act, and Congress hasn’t updated the quotas for the green cards since 1990 despite population growth. This is one fundamental problem leading to the backlog, along with Congress’ decision to lump different professions into the same visa categories, “regardless of the benefit to the American public,” said Musillo.

“And we would submit that bringing in nurses is maybe more important than some of the other occupations,” he said.

‘A catastrophic interruption’

Paula Butts, the chief nursing officer at Piedmont Henry Hospital, outside Atlanta, said that since the pandemic, she has had about three to four international nurses join her staff per month. Butts contracts out about 20 percent of her workforce to nursing recruitment agencies to meet patient needs.

With 52 international nurses on staff and a pipeline of 20 coming in, she still needs about 50 more foreign nurses. The State Department’s green card freeze “is going to slow me down greatly,” she said.

“We have to have every tool in the toolbox in order to meet this crisis, and it’s just very disappointing when you have such a useful tool taken away from you,” Butts said.

The effects of the pause will expand beyond hospitals. Nursing homes and assisted living facilities have also heavily relied on a pipeline of international nurses in the last couple of years, as they’ve lost an estimated 200,000 workers since the pandemic began.

The American Health Care Association and National Center for Assisted Living have seen hundreds of facilities close in the aftermath of the pandemic, “related directly to the inability to staff the building,” said Clif Porter, the senior vice president of government relations for AHCA/NCAL.

International recruitment has “been a really important solution” to address nursing home staffing numbers that are still significantly below pre-Covid levels, Porter added. One nonprofit that works with AHCA/NCAL had recruited about 300 international nurses to come into the U.S. this year, but with the freeze, about 45 percent of those nurses likely won’t be able to enter until 2024, he said.

“Particularly in senior services, the demand for our services is exploding, in home care and institutional care and acute care, and we don’t have enough people,” Porter said. “And if we don’t do something about it soon, we’re going to be in a real, real bad situation.”

Erica DeBoer, chief nursing officer for Sanford Health, the nation’s largest rural health system, said the State Department’s visa freeze will likely affect 44 percent of the 800 international nurses they expected to join their health system over the next two to three years. The health system currently has about 200 international nurses working at its main medical centers, critical care hospitals, long-term care facilities and Good Samaritan locations — which provide housing and health services to seniors, DeBoer said.

“In the rural setting, probably one of our biggest challenges is, when we think about critical access hospitals and then the amount of staff they need to keep those hospitals open, our international nurses are key to that strategy,” DeBoer said. “Whereas in urban settings, we’ve got more flexibility, so I’d say it’s more catastrophic in our critical access hospitals and our Good Sam locations.”

All eyes on Congress

The executive branch can’t increase the quota for green cards, Musillo said, so health groups are pushing for change through congressional action.

They’re asking for the reintroduction of The Health Care Workforce Resilience Act, a bipartisan bill that would recapture visas that were issued but unused from the previous year for the express use of nurses and doctors. The bill didn’t make it out of the Senate Judiciary Committee last Congress, but Musillo is hopeful it’ll be reintroduced before the summer recess.

Several Senate offices that were supportive of the bill last Congress told POLITICO they had no updates.

AHCA/NCAL also proposed in a recent letter that Congress create a temporary visa option specifically for registered nurses and other health care occupations, where they’d be able to come to the U.S. and start working while waiting for permanent residency approval.

“The future is we have an aging population that’s exploding, and the need for nurses is going to explode,” said Porter. “So ultimately, we’re proposing that we ought to be looking at policies that essentially treat health care workers identically to how tech workers are treated, and that would absolutely help stimulate, supply and ultimately get more nurses here, ready to work.”

Daniel Payne contributed to this report.


How do you solve a nursing crisis? ›

  1. 1 | Listening to Nurses Concerns. ...
  2. 2 | Prioritizing Workplace Culture Increases Retention. ...
  3. 3 | Prioritizing Nurse Retention Levels. ...
  4. 4 | Increasing Diversity in the Nursing Student Body. ...
  5. 5 | Addressing the Need for More Nurse Educators. ...
  6. 6 | Using Innovation to Address the Nursing Shortage.

How does nursing shortage affect evidence based practice? ›

Inadequate or insufficient nurse staffing levels increase the risk of care being compromised, adverse events for patients, inferior clinical outcomes, in-patient death in hospitals and poorer patient experience of care.

Which factor contributes to the nursing shortage in the US quizlet? ›

Downsizing for cost containment by hospitals contributed to the shortage.

What should the US do to end the nursing shortage? ›

Low or no pay is a primary challenge. Congress should expand funding for tuition reimbursement for nurses who teach and those who commit to work in shortage areas. Public-private partnerships, meanwhile, would better integrate schools and workplaces to facilitate clinical training.

What is an example of crisis in nursing? ›

Common examples of situational crises include severe illness, job loss, unwanted pregnancy, divorce, and the death of a loved one. Finally, existential crises are usually related to one's life's meaning, purpose, and freedom.

What are the three types of crisis nursing? ›

There are three basic types of crisis situations: (1) maturational (or developmental) crises, (2) situational crises, and (3) adventitious crises. Identifying which type of crisis the individual is experiencing or has experienced helps in the development of a patient-centered plan of care.

What are five barriers to evidence-based nursing? ›

More specifically, research has shown that factors limiting the extent of EBP include lack of knowledge and skills, insufficient time to find research reports, difficulty in understanding research reports, lack of resources, limited support, lack of financial, material and human resources and inadequate training in ...

What are three barriers to the use of evidence-based practices by nurses? ›

The literature indicates that nurses value EBP; however, its implementation is inconsistent because it is often obstructed by many factors, such as paucity of facilities, time, resources, support, knowledge and skills, autonomy, and funding, as well as access limitations, which have been reported in several studies ...

What workplace factor has been found to contribute to the nursing shortage? ›

Aging Nurse Population

Nurses retire at a higher rate as they get older. This causes a nursing shortage and makes it difficult for hospitals to find replacements. The average age of nurses in the United States is 52, implying that many will retire soon.

What are the two main reasons for the nurse shortage? ›

Burnout and high-stress work environments are the no. 1 factor causing nurses to quit their jobs. Nurses are also getting offered higher salaries in other companies, which motivates them to leave their jobs.

What's really behind the nursing shortage? ›

Facts About the U.S. Nursing Shortage

More than half of current RNs are over the age of 50. In 2021, U.S. nursing schools turned away more than 91,000 qualified applicants due to a lack of faculty, education space, and resources.

What problems are caused by nursing shortage? ›

Nursing shortages lead to errors, higher morbidity, and mortality rates. In hospitals with high patient-to-nurse ratios, nurses experience burnout, dissatisfaction, and the patients experienced higher mortality and failure-to-rescue rates than facilities with lower patient-to-nurse ratios.

How long will the nursing shortage last? ›

According to the United States Registered Nurse Workforce Report Card and Shortage Forecast published in the September/October 2019 issue of the American Journal of Medical Quality, a shortage of registered nurses is projected to spread across the country through 2030.

How bad is the nursing shortage in the United States? ›

The national nursing shortage dates back decades, but the COVID-19 pandemic pushed it to crisis levels. One study predicts that, in the next two years, there will be a shortage of up to 450,000 bedside nurses in the U.S. In countries around the world, medical workers are pleading for more support.

Why is there a nurse shortage 2023? ›

There are a number of reasons for the nursing shortage, extending from education to burnout to early retirement. With an increased demand for healthcare services, nurses need more support than ever to guarantee a better future in nursing.

What are 5 examples of crisis? ›

Family crises, natural disasters, suicide, sudden financial disruption, community-driven events, and impactful life events are some of the most common crisis examples and types that enforcement professionals must respond to.

What are the 5 types of crisis? ›

Following are the types of crisis:
  • Natural Crisis. Disturbances in the environment and nature lead to natural crisis. ...
  • Technological Crisis. ...
  • Confrontation Crisis. ...
  • Crisis of Malevolence. ...
  • Crisis of Organizational Misdeeds. ...
  • Crisis due to Workplace Violence. ...
  • Crisis Due to Rumours. ...
  • Bankruptcy.

What is the first thing a nurse should do in a crisis situation? ›

Identifying the Client in Crisis

The first step of the nursing process, assessment, is done by collecting primary and secondary data, objective and subjective data about the client and their possible potential for violence.

What are the 6 stages of crisis? ›

According to Robert C. Chandler, Ph. D., internationally renowned crisis communication expert, a crisis has six stages: 1) warning, 2) risk assessment, 3) response, 4) management, 5) resolution, and 6) recovery.

What are the 4 phases of crisis response? ›

With a deeper understanding of the four stages of a crisis—pre-crisis, crisis, response, and recovery— you'll be able to identify which stage you are in at any moment.

What is an example of patient crisis? ›

Examples of a situational crisis include the sudden death of a loved one, domestic violence, new job, or financial losses. An internal or maturational or developmental crisis occurs with the inability to cope with transitional changes such as achieving new developmental stages.

What are the two types of barrier nursing? ›

aimed at controlling and preventing the spread of infection. There are two types of isolation – Source Isolation (barrier nursing) where the patient is the source of infection and Protective Isolation (reverse barrier nursing) where the patient requires protection i.e. they are immunocompromised.

What are the 4 major components of evidence-based nursing? ›

Components of Evidence-Based Practice
  • Best Available Evidence. ...
  • Clinician's Knowledge and Skills. ...
  • Patient's Wants and Needs.

What are nurse barrier methods? ›

Simple barrier nursing consists of utilizing sterile: gloves, masks, gowns, head-covers and eye protection. Nurses also wear personal protective equipment (PPE) to protect their bodies from infectious agents.

What are 3 barriers that might impact patient understanding? ›

Obstacles that prevent easy delivery of health care information include literacy, culture, language, and physiological barriers. It is up to the nurse to assess and evaluate the patient's learning needs and readiness to learn because everyone learns differently.

What are three common barriers to healthcare? ›

The challenges are myriad, but five are especially concerning for the years ahead.
  • Insufficient insurance coverage. A lack of insurance often contributes to a lack of healthcare. ...
  • Healthcare staffing shortages. ...
  • Stigma and bias among the medical community. ...
  • Transportation and work-related barriers. ...
  • Patient language barriers.
Jul 27, 2022

Which of the barriers to evidence-based nursing practice is the greatest? ›

Lack of time considered as the main barrier in the implementation of evidence-based practice in nursing [1-12]. In Azmoude et al. study, the results showed that the nurse does not have time to read research (mean = 2.70) [12].

What are the four challenges facing the nursing workforce in the United States? ›

Four challenges face the nursing workforce of today and tomorrow: the aging of the baby boom generation, the shortage and uneven distribution of physicians, the accelerating rate of registered nurse retirements, and the uncertainty of health care reform.

What are the four challenges facing the nursing workforce? ›

5 Issues Nurses Face in Their Career
  • Inadequate Staffing. Being short-staffed for brief periods of time is common in most professions, and in many of those situations, it is a minor inconvenience. ...
  • Stress. ...
  • Safety on the Job. ...
  • Workplace Violence. ...
  • Improving Self-Care.

How can we fix the shortage of healthcare workers? ›

The single most important way to reverse that is to support and expand partnerships between universities and community health care settings to develop additional residencies for graduating medical students as well as clinical training opportunities for nurses, respiratory therapists, radiology technicians, and others.

Where is the highest nursing shortage? ›

California has the worst nursing shortage in the United States. It's predicted that by 2030, California will be in need of over 44,000 nurses. Other states with major hospital staff shortages include New Mexico, Vermont, Rhode Island, West Virginia, and Arizona.

How do you solve short staffing in nursing? ›

Hire more nurses: If possible, hire more nurses to provide adequate cover for each shift. Another option is to work with a staffing agency to bring on nurses as needed. If your facility has a large enough pool, it's unlikely you'll have difficulty getting enough people to work each shift.

Will there be a nursing shortage in 2030? ›

Without sufficient recruitment and retention, the world could face a shortage of up to 13 million nurses by 2030, according to a new report.

How does nursing shortage affect people? ›

The nursing shortage affects patients, which has long been a problem for medical facilities. Patient care is frequently compromised due to nurse shortages and increased workloads. This can result in treatment delays, longer appointment wait times, and other issues with patient satisfaction.

Is the nursing shortage a global problem? ›

However, there is an estimated shortage of up to 13 million nurses around the world. The world would need millions more nurses to achieve Sustainable Development Goal (SDG) target 3.

How does nursing shortage affect care? ›

There's a direct link between patient mortality, or risk of death, and a shortage of nurses. Facilities with fewer nurses tend to witness a 2-7% increase in mortality. When there are fewer nurses caring for patients, there's reduced patient safety, more medical errors, and failure-to-rescue situations.

What is the nurse update for 2023? ›

2023 nursing healthcare trends will be led by the fallout of a momentous nursing shortage and growing technological changes. 2023 should also bring a renewed focus on nurses' mental health, wearable medical devices, and a rise in virtual medicine.

Will nurse pay increase in 2023? ›

The amount of increase depends on the facility, but a 3-5% raise is standard. In addition to annual pay increases, more hospitals and employers are offering sign-on bonuses to nurses, particularly in areas experiencing acute shortages.

Is nursing worth it 2023? ›

Yes, becoming a nurse is worth it for many students. Nursing is a popular career path because nursing skills are needed in a variety of settings.

Is there a nursing shortage in the US 2023? ›

The percentage of nurses who said they were satisfied with the quality of care they provide also decreased from 75% in 2021 to 64% in 2023. About 94% of those surveyed said there was a severe or moderate shortage of nurses in their area, with half saying the shortage was severe, per the survey.

Is USA good for nurses? ›

Living in the United States can be rewarding and the salary is great too. The median salary of a US RN is $60,000 annually. Furthermore, a nurse's salary can be influenced by training, experience, education, and other certifications.

How many nurses are needed by 2025? ›

The health care industry could be short 2.1 million nurses by 2025, according to an analysis from The Josh Bersin Co. and Eightfold, in today's bite-sized hospital and health industry news from California, Minnesota, and Mississippi.

Will nurses strike in 2023? ›

The Royal College of Nursing (RCN) have announced that nurses will be striking from 8pm on 30 April to 8pm on 2 May 2023.

How many nurses do we need by 2030? ›

According to the report, as many as 13 million more nurses may be needed by 2030; the world's current nursing workforce totals approximately 28 million. The report explains that taking action to sustain and retain workers could minimize the shortage.

How to retain nurses 2023? ›

Healthcare leaders should focus on six priority areas to relieve the nursing workforce's challenges next year.
  1. Listen to Your Nurses. ...
  2. Prioritize a Diverse Culture in the Workplace. ...
  3. Offer flexibility. ...
  4. Provide Training for Your Nurses. ...
  5. Focus On Mental Health. ...
  6. Introducing International Nurses.
Oct 26, 2022

What are the 5 steps of problem solving in nursing process? ›

The nursing process functions as a systematic guide to client-centered care with 5 sequential steps. These are assessment, diagnosis, planning, implementation, and evaluation.

What are the 4 problem solving approach in nursing? ›

The problem process involves: 1) The systematic identification of a problem 2) Determination of goals related to the problem 3) Identification of possible solutions to achieve these goals 4) Implementation of selected solutions 5) Evaluation of goal achievement.

What is crisis response in nursing? ›

A crisis nurse is a nurse that responds to natural disasters or healthcare emergencies and staffs hard-hit areas. Think New Orleans during Hurricane Katrina, New Jersey during Hurricane Sandy, and New York City during COVID-19. Crisis nurses are usually travel nurse positions.

What is the first priority in a crisis situation? ›

The most important steps any organization can take during any emergency or crisis are to: Take conclusive action to quickly resolve or stabilize victim issues, problems, or situations being caused by the crisis.

What should be your first priority during a crisis? ›

From the outset of a crisis you must ensure your people's safety. Prioritise action and allocate resources to get them out of harm's way and to care for those who've been harmed. Even when it hits your bottom line, secure the safety of your people. No exceptions.

What are the 3 main steps of problem-solving? ›

Six step guide to help you solve problems
  • Step 1: Identify and define the problem. State the problem as clearly as possible. ...
  • Step 2: Generate possible solutions. ...
  • Step 3: Evaluate alternatives. ...
  • Step 4: Decide on a solution. ...
  • Step 5: Implement the solution. ...
  • Step 6: Evaluate the outcome.

What are the three step problem-solving techniques? ›

Those steps are: Define the problem. List all the possible solutions. Evaluate the options.

What is a four step problem-solving plan? ›

This problem-solving plan consists of four steps: details, main idea, strategy, and how. As students work through each step, they may use “graphic representations” to organize their ideas, to provide evidence of their mathematical thinking, and to show their strategy for arriving at a solution.

What is a good example of the problem-solving process? ›

72 Examples of Problem Solving
A business unit builds new revenue after losing a major customer.A carpenter fixes a flaw in a wall without having to tear it down and reconstruct it.
Designing an approval process to reduce invalid expenses.Developing a new product to recover from declining sales.
34 more rows
Feb 13, 2023

What is a main goal of the nurse during crisis intervention? ›

The focus of crisis intervention is on the present problem. The two initial goals are to ensure patient safety and take measures to reduce patient anxiety. Anxiety reduction and coping is important; however, safety is a priority need.

What is a crisis response plan? ›

The Crisis Response Plan (CRP) is a brief procedure used to reduce an individual's risk for suicidal behavior. The CRP is created collaboratively between a suicidal individual and a trained individual, and is typically handwritten on an index card for easy, convenient access during times of need.


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