International nurses bring skills and experience to areas in dire need of nurses. Healthcare leaders need to articulate the value of these RNs to ensure they continue to flow into the nursing workforce pool.
For decades, healthcare organizations have been turning to international nurses as a way to address nurse staffing challenges.
"I've been a CNO since 2004, in various locations, and in every location I've had international nurses. For 13 years there has been a steady supply for healthcare organizations across the country, not just my hospital," says Pam Bradshaw, DNP, MBA, RN, NEA-BC, CCRN-K.
Bradshaw is chief operating officer and chief nursing officer at Shannon Medical Center, a 409-bed medical center in San Angelo, TX. The community of 100,000 people is located in the western part of the state.
"We've seen a dramatic uptick in demand [in international nurses]. We're getting a lot of inbound leads and people calling us. We're adding new clients all the time," says Shari Dingle Costantini, RN, MBA.
"Hospitals and health systems are really looking at international nurses and asking, 'How do we plug them in and how do we make them part of our solution?'" Costantini is CEO of Avant Healthcare Professionals, an Orlando-based staffing firm specializing in international recruitment of healthcare professionals.
But, just as the desire to employ international nurses has been on the rise, so too has political rhetoric regarding immigration.
"That's been something that we feel we've had to combat around the world," says Costantini, who is also vice president and chair of regulatory affairs for the American Association of International Healthcare recruitment.
A Brief History of Visa Policy Confusion
Even before he was elected president, Donald J. Trump was talking tough on immigration by calling for a wall along the U.S.-Mexico border and pledging to find and deport those without legal immigration status.
Once he moved into the Oval Office, his talk became action. In January, Trump issued a chaotically implemented travel ban that caught some international physicians, including a Cleveland Clinic physician with a valid H-1B visa, in its web.
That ban was blocked in court and a revised version is currently being scrutinized in a U.S Circuit Court of Appeals with speculation that it will ultimately end up before the U.S. Supreme Court.
In March, confusion over U.S. visa policy led to some Canadian advanced practice registered nurses working in Michigan healthcare systems to be turned away at the U.S.-Canada border. These nurses typically hold non-immigrant NAFTA professional visas called TN-1 visas.
Fortunately for them and for their US employers, the travel ban and policy confusion has not had a huge effect.
"The seven countries that were listed on the travel ban… represent a very small number of nurses, primarily because many of those countries just, from a cultural perspective, don't educate their own nurses," she says.
Because RNs in the U.S. are not required to have a baccalaureate degree to work at the bedside, they have managed to steer clear of issues that may arise from changes to the H-1B visa program, which allows highly skilled international workers such as physicians and technology industry workers into the U.S. in order to fill employment gaps.
"The H1-B visa that we hear a lot about in the news is for specialty professions that require a bachelor's degree or higher. So most nurses don't qualify, unless, say I'm bringing a clinical nurse specialist over and that position requires a masters' [degree]. That's why nursing has to go with this EB-3 visa (employment-based immigrant)," Costantini says.
Under current visa regulations, between 5,000 to 7,000 international nurses travel to the U.S. for work annually. Costantini estimates the total number of international nurses in the U.S. is around 400,000 to 460,000.
"That's not a huge number. It's not going to cure the shortage, but it's certainly going to help a lot in rural areas or areas or specialties where there's critical shortages," she says.
"Our nurses are filling an experience gap. Our average nurse has 6 to 11 years of experience. They're coming in and within a year of acclimating to a new environment, they become a preceptor. The other big benefit is that we put people on two- to two-and-half-year assignments, and at least in my company's experience, 75% of those nurses convert onto the staff of the hospital."
Rural Healthcare Needs International RNs
Like many healthcare organizations in rural areas, Shannon Medical Center has had challenges recruiting RNs.
"We do have two nursing schools here, which is great, but… when younger nurses graduate, they want to go to Dallas, Ft. Worth, Austin, San Antonio—those places where they can get that big city experience," Bradshaw says.
"From a complexity and acuity perspective, we provide that same level of care, but it's the appeal of the nightlife and the restaurants and the shopping that we battle as well."
About two years ago, just after Bradshaw came to Shannon, the organization had begun to look at international nurses as a workforce solution.
"We were forced into the position because our local university went from an associates' degree program to a BSN program so there was a lag of supply and increased demand with retirements and everything else that's going on in healthcare," she says.
About a year and a half ago, 15 international nurses came onboard at the organization.
"We quickly realized that in order to accommodate growth, we really needed more [international nurses] than that," Bradshaw says. Presently, the medical center has between 600 and 700 RNs. Ten percent of those (60) are international nurses. They come from variety of places including the Philippines, Nigeria, and the Caribbean.
"We have had great success with [the international] nurses. Last month, our Daisy award nurse was one of our international nurses and she is from the Caribbean. We're only about year in, but so far they're doing well," she says.
Bradshaw hopes once their contracts are up, the international nurses will choose to stay. "I'm optimistic that by the time our current contracts are done, we'll either retain those nurses or we'll have improved our local supply, which is something we're also working on," Bradshaw says.
A Multi-pronged Workforce Development Approach
"As you know, there's no magic bullet. You have to have multiple options or multiple solutions to really make sure you're addressing staffing in a comprehensive way," Costantini says.
To ensure international RN remain a viable component of the workforce pool, Costantini advises healthcare leaders to advocate for the value of international nurses.
"Our biggest challenge is getting the message out to lawmakers. If international healthcare professionals are important in their [healthcare leaders'] organizations, they [need to be] sharing that," she says.
"Although the U.S. wants to hire Americans, we also want to care for Americans. We won't be able to deliver patient care to Americans if we don't have enough healthcare professionals."
Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.