Worldwide shortages require action to shore up the U.S. workforce.


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Demand for nurses in the United States is expected to grow to 3.3 million within this decade. But without quick action to replenish the nursing workforce, analysts project a potential shortfall by 2025 of 10% to 20% or as many as 450,000 RNs. To close this gap, the United States would need to more than double the number of new graduates entering and staying in the nursing workforce every year for the next three years.

Figure. CGFNS VisaSc... - Click to enlarge in new windowFigure. CGFNS VisaScreen Applications by Country of Education, 2022. Reprinted from CGFNS International.

An immediate solution would be for the United States to authorize increased migration of qualified nurses from other countries. But faced with growing shortages of their own, countries that historically have exported nurses could impose restrictions, as the Philippines did during the COVID-19 pandemic. Nevertheless, surveys show that foreign-educated nurses, especially from poor countries, continue to seek employment and legal resident status in wealthier countries, especially the United States.


A 2022 report from CGFNS International (http://www.cgfns.org/2022nursemigrationreport), a nonprofit credentials evaluation organization that helps foreign-educated health care professionals work in the country of their choice, documents a dramatic increase since 2018 in migration applicants, the majority of them RNs. Almost half (200,000) of the estimated 550,000 foreign-educated nurses opted to emigrate to the United States, eager to take advantage of opportunities for higher wages, improved nurse-to-patient ratios, and better lifestyle.


CGFNS received over 17,000 visa screening applications from 116 countries in fiscal year 2022, a 44% increase from 2021 and a 109% increase from 2018. These increases in applications do not necessarily indicate a trend, authors of the CGFNS report acknowledge, since the years surveyed were ones of elevated global turmoil coupled with the COVID-19 pandemic, which created both demand for health care workers and bottlenecks in the processing of visa applicants due to immigration and travel restrictions.


Foreign nationals wishing to work in the United States must obtain a temporary or permanent occupational visa. Applicants who successfully complete the credentials assessment receive a certificate that satisfies U.S. requirements for professional competence, necessary for visa eligibility. A majority of these applicants (60%) come from the Philippines. Most (81%) are RNs, possess a bachelor's degree or higher, and hope to migrate on permanent, employment-based green cards, according to CGFNS survey data. The Philippines is one of the largest suppliers of health care workers worldwide, but applications also come from nurses in India, Haiti, Jamaica, and English-speaking Caribbean nations.


The shortfall of domestic nurses in the United States and other high-income nations results in quick application approval for this cohort. Migration, however, has downsides. It can leave foreign-educated workers open to exploitation, and also create workforce shortages in the workers' home countries and in those that do not have the resources to compete with wealthier nations. Health worker shortages already exist in numerous low- and middle-income countries and the pandemic has only worsened the situation. This, in turn, affects patient outcomes, public health efforts, and local responses to disease outbreaks.


Globally, one in eight nurses are migrants, with some 550,000 working in 36 high-income countries, including those most dependent on foreign-educated nurses: United States (200,000), the United Kingdom (100,000), Germany (71,000), and Australia (53,000). However, a report from the International Centre on Nursing Migration (ICNM; http://www.intlnursemigration.org/wp-content/uploads/2022/01/Sustain-and-Retain-) estimates that more than three times that number will be needed by 2030. Globally, the World Health Organization projects a shortage of 7 million nurses and midwives by 2030.


Addressing this global workforce imbalance will require efforts by governments, employers, and nursing organizations to improve working conditions in home countries, including safeguarding workers from harm and burnout, and better pay and career opportunities, according to the ICNM report. And, rather than relying on importing foreign-educated nurses, high-income countries should aim to insure an adequate domestic supply of new nurses as well as retention of those already in the workforce. "There is an urgent need for effective and coordinated policy responses both at the national level, and internationally," the ICNM report concludes. "This response must include both immediate action . . . and the development of a shared longer-term vision and plan for the global nursing workforce, to ensure that the world is better placed in the future to meet major health shocks."-Liz Seegert