Recruiting International Nurses Typically Requires Time and Patience

In most cases, expect a bit of competition and a lengthy wait, immigration attorney says.

As U.S. hospitals labor to keep nurse staffing at safe levels amidst a nursing shortage intensified by the COVID-19 pandemic, many are seeking a solution beyond American borders.

Henry Ford Health in Michigan, for example, is working to hire hundreds of nurses from the Philippines, according to its CEO, and New York Gov. Cathy Hochul said the state is recruiting qualified foreign nurses to boost its staffing.

"I'm definitely seeing an increase, and not just an increase in hiring right now but also anticipating the future shortage," says Yova A. Borovska, an attorney with Pittsburgh-based Buchanan Ingersoll & Rooney PC who specializes in immigration and nationality.

"Some of my clients are already planning to ramp up recruitment of international nurses in the near future, and that really emphasizes the need for all healthcare organizations that anticipate such needs to start thinking about that as well, because it can get quite competitive," she says.

More than 500,000 seasoned RNs are anticipated to retire by the end of 2022 and the U.S. Bureau of Labor Statistics is projecting the need for 1.1 million new RNs for expansion and replacement of retirees, according to the American Nurses Association.

Nurse leaders should consider hiring internationally if recruitment isn't resulting in enough applicants, as well as for long-term nurse staffing strategy, Borovska says.

The hiring process is a bit more complicated, however, she says, so nurse leaders interested in hiring international nurses should be aware of the challenges involved.

Some countries, for example, are easier to hire from than others.

"The country of citizenship matters … so [nurse leaders] should think about targeting a certain geographic area," Borovska says.

Citizens of Canada and Mexico, for example, have the TN Visa, which offers expedited work authorization under the United States-Mexico-Canada Agreement (formerly the North American Free Trade Agreement).

Canadian nurses who have their VisaScreen—a credentials assessment from the Commission on Graduates of Foreign Nursing Schools (CGFNS) that proves a nurse has the necessary education, licenses, exam scores, and English language proficiency—can go to work in the U.S. nearly instantly, Borovska says.

For Mexican citizens, the process may take two or more months because they need to apply for a visa stamp, and the backlog of visa applicants can delay the process, she says.

"It makes it much easier for employers that recruit citizens of those countries to recruit international applicants because of the visa options that are available to them," Borovska says.

Many U.S. hospitals hire nurses trained in India, but "but their visa options are a bit more limited, so it gets a little more challenging with them," she says.

The Philippines is the major source country, accounting for more than 30% of U.S. foreign-educated nurses, but acquiring Filipino nurses typically takes between six to 12 months, and perhaps longer, depending on the backlog at the consulate, Borovska says.

Indeed, the demand for nurses is so great that it’s created a backlog of more than 5,000 international nurses who are awaiting final visa clearance to work in the United States, according to the American Association of International Healthcare Recruitment.

The snag causing that backlog is that, after jobs are offered and accepted, foreign-born nurses require a final interview to obtain a visa from the U.S. State Department, according to Kaiser Health News (KHN).

Those interviews are piling up because of the pandemic, as many of the U.S. embassies where those interviews take place remain closed or are operating on fewer hours, KHN reports.

Agencies can help

If a hospital doesn't already have a team to handle immigration work, specialized hiring agencies can complete the legwork, Borovska says.

"Some agencies will do the recruitment, and some also offer immigration services," she says.

"It depends on what options are available to the particular candidates," she says. "But there certainly are agencies that provide kind of a full service in that respect, because they do the recruitment, and they also ensure the fact that candidates are qualified with all their certificates and then they perhaps either will handle the visa process or refer it to somebody to handle."

Looking ahead

While international nurses can help stabilize staffing challenges in the short term, they also can be a solution for long-term planning, particularly for a nursing shortage that isn't going away anytime soon.

"[Nurse leaders] should start thinking about the big picture—what are their recruitment needs in the next five years—and come up with a strategy have a steady supply of international talent in the next five years," Borovska says.

"Some (international hiring) options can take a long time, sometimes even over a year," she says, "so it's important to have a strategy in place for recruitment of international nurses."