The flow of international nurses and other foreign-educated healthcare talent into the US slowed to a trickle amid the pandemic, exacerbating an already critical nurse shortage. Lockdowns and pandemic-related logistical challenges hampered suppliers’ ability to bring in workers, but providers are expecting improvement as the pandemic subsides and embassies and travel open up.
International nurses are typically contracted for two- to three-year assignments at a US facility, allowing for more stable staffing than the 13-week commitment of travel nurse contracts. And after their contract ends, a high percentage of international nurses then transition to full-time, permanent roles.
“There are many benefits to a globally diverse workforce,” said Sinead Carbery, president of O'Grady Peyton International, part of AMN Healthcare Services Inc. (NYSE: AMN). “The international nurses we recruit are very experienced, dependable and steady.” O'Grady Peyton’s nurses average 13 years of post-graduate nursing experience and nine years working in their current specialty. They arrive in the US as permanent residents, typically as mid-career nurses, and 80% of the time will convert to a full-time equivalent at the end of their assignment. And their retention rates are also good; about 35% remain at the facility 10 years later.
Another benefit seen amid the pandemic is more affordable bill rates compared to travel nurses. Pre-Covid, hourly rates for an international nurse could be $5 to $15 less than the average rate for a travel nurse. And skyrocketing rates for travel nurses during the pandemic made the years-long contracts for international nurses an even more affordable option.
This is particularly important for facilities in rural areas, which consistently struggle to recruit and retain healthcare professionals and contract for more than half of the international nurses working in the US.
Covid Obstacles
International nurses typically work in the US with employer-sponsored Permanent Resident Cards, or “Green Cards,” which allow them to live and work permanently in the US and eventually apply for citizenship; physical therapists and medical technologists primarily come in on H-1B visas, temporary work visas for highly skilled foreign workers.
But last year was a tough year for immigration. In addition to the crackdown by the Trump administration, US embassies in foreign countries were often closed or minimally staffed because of the pandemic. Travel restrictions also prevented candidates from even traveling to an embassy.
MedPro Healthcare Staffing keeps a pipeline of thousands of international staff but went almost a full year without being about to deploy any because of embassy closures. Last year, the Sunrise, Florida-based company did not start deploying nurses until November and December, according to CEO Liz Tonkin, who is also one of the founding members of American Association of International Healthcare Recruitment.
Licensing and credentialing have also been “very challenging” amid Covid due to closures overseas and difficulty obtaining official documents and transcripts, Tonkin said.
“It was a million different things,” she explained. “We saw orders like we had never seen before, and here we had nurses waiting to come but we couldn’t get them here. It was so, so frustrating.”
Optimistic Outlook
The situation began improving toward the end of 2020 as embassies started coming back online to schedule Green Card appointments.
“That was a much-needed relief,” Tonkin said. “Now that we have a flow again, we can start filling those voids. Are we back to normal again? No, but we are about 80% there and starting to see significant numbers again.”
In addition to improved access as pandemic restrictions ease, legislation may increase the flow of international healthcare workers into the US. The American Association of international Healthcare Recruitment plans to reintroduce a bill to Congress — the Healthcare Workforce Resilience Act, first introduced last May — that captures unused, employment-based visas for foreign-educated nurses and physicians. Unused visas are visas in the annual quota that were not issued in the fiscal year, explained Shari Dingle Costantini, founder and CEO of Avant Healthcare Professionals, which Jackson Healthcare acquired in December 2017, and president of the AAIHR. The HWRA would make 15,000 immigrant visas available to doctors and 25,000 to nurses. The visas would be issued without regard to per-country restrictions and the processing of petitions and applications would be expedited.
The bill essentially strengthens the healthcare workforce in response to Covid, and some estimate put the number of unused visas as close to 1 million, according to Dingle Costantini. “So, I think you are going to see more international nurses coming in in the future,” she said.
Demand for US healthcare professionals is expected to exceed supply for virtually every major healthcare occupation over the next decade, according to the AAIHR. Analysts predict that as many as one million registered nurses will retire by the end of the decade. At the same time as the nursing workforce ages into retirement, the US population is also aging and requiring more and specialized care for increasing rates of chronic illness.
“Nursing shortages are at an all-time high, and the Covid-19 pandemic has worsened the situation,” said O'Grady Peyton’s Carbery. “It’s imperative to seek nurses domestically and overseas so we can ensure our health system nationwide can continue to provide quality care — today and in the future.”
