Labor market analysis for the supply of nurses to the future of healthcare is more than a crystal ball prediction. The crisis in the shortage of registered nurses (RNs) has been a topic of discussion for the past several years with the anticipation of 3.6 million nurses needed in the U.S. by the year 2030. As foreign-born nurses comprise an average of 15% of the nursing workforce, have the changes to the immigration laws compounded the nursing shortage?

Reports from the U.S. Bureau of Labor Statistics (BLS) show that of the 12.4 million healthcare workers in the U.S. in 2015, 2.1 million are foreign born. These numbers represent both skilled (physician, therapist, RN) and non-skilled (aid or assistant) workers, of which RNs comprise 15% of the overall immigrant healthcare workforce. States such as New York, California and New Jersey employ the highest shares of immigrant RNs, more than twice the national average.

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Similar to native U.S. workers, immigrant RNs are predominately (80%) female whereas a large majority of foreign-born male healthcare workers are physicians or surgeons. Although characteristics of immigrant healthcare workers vary across all the healthcare fields, as a whole the group was significantly more likely to hold a bachelor's degree or higher than the average U.S. citizen. This is attributed to the requirement of the H1-B and EB-3 visas which require bachelors or graduate-level degrees and specialty occupations.

The US H-1B visa is a non-immigrant visa that hospitals or medical centers can petition for to bring healthcare workers into the U.S. to work for 3 years initially, and up to 6 years total. This visa is capped at 85,000 per year which includes 65,000 new H-1B visas to those with a bachelor's degree and another 20,000 for advanced degrees for specialty workers from U.S. universities. Those holding this visa can bring their spouse and dependents who are under age 21 and can apply for permanent residency (a U.S. Green Card) while working under the visa. The Employment-Based Immigration: Third Preference (EB-3) visa is similar to the H-1B visa regarding skill and education, but is a request for permanent residency in the U.S. While it is less stringent than other visa processes, it is very backlogged and can take 6-12 years, depending on the country of origin.

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In February 2017, under executive order 13769, President Donald Trump enacted a travel ban to bar or restrict entry to immigrants from countries deemed as a national security risk. This order has since been revised, parts of it rescinded, with countries added and deleted. Currently, the ban or bar is effective for North Korea, Libya, Syria, Iran, Yemen, Somalia and select officials in Venezuela. While these countries contribute only a small amount of healthcare professionals to the U.S., mostly on the physician side of the workforce, the impact may be felt in the more rural areas seeking clinicians. The overall affect to nursing is minimal considering the native countries of the immigrant nurses.

Foreign-born nurses in the U.S. are immigrating from Asia (29%) followed by Africa's Nigeria, Ghana, Liberia and Sierra Leone at 28%. Nurses from Somalia would obviously be the most affected by the ban, however, those meeting the visa requirements may still be admitted after a thorough vetting process. The Caribbean contributes 18% of immigrant nurses as well as Latin America (14%) with Europe, North America and Oceania comprising the remaining 24% of the population.

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Immigrant nurses are vital to the future demand of healthcare in the U.S. In spite of changes and controversy with immigration laws, organizations are continuing to seek the maximum resource of the foreign-born nurse to fill the gaping hole of nursing shortages. As the immigration process becomes more streamlined, professional nurses can continue to add to the benefits of cultural diversity in our workforce and our communities.

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