Reuben S. Seguritan

Immigration Reform Needed to Address Nursing Shortage

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The nursing profession is one of the fastest growing careers in the United States. The number of employed registered nurses is expected to grow 26% from 2010 to 2020, making it the top occupation in terms of job growth. Licensed practical nurses and licensed vocational nurses are expected to increase 22%. Even during the economic downturn, 182,000 RNs were employed.



The high demand for nurses and healthcare workers in general can be attributed to the growing and aging population. By 2025, there will have been 50 million more Americans than there were in 2006, and every day for the next twenty years 10,000 Americans will reach 65 years. By year 2020, four out of every ten patient visits will be by baby boomers.


Because of the aging baby boom generation, the demand for healthcare will continue to grow at a high rate, so much so that by 2030 the U.S. is projected to have a shortage of more than 900,000 nurses. The Affordable Care Act law will further raise the demand as the law expands insurance coverage to more than 30 million Americans by 2014.


The increase in nursing school enrolment is at best only modest and far from sufficient to meet the demand. In 2011, the increase was only a little over 5%. At the same time, however, the average age of nurses has gone up and more and more nurses are nearing retirement age. It is predicted that nurses over 50 years old will soon comprise about a quarter of the entire RN population.


Given the magnitude of the shortfall and the imminence of the surge in demand, domestic measures will no longer be sufficient to avert the shortage. Immigration rules that have been in place specifically to restrict the entry of foreign-educated nurses must be changed in order to ensure that patient care is not compromised.


For instance, most RNs do not qualify for the H-1B visa for “specialty occupations” because employers generally do not require a bachelor’s degree for the position. To be eligible for H-1B classification, an RN would have to be in a supervisory or very specialized position.


The limited number of immigrant visas and long waiting times have also contributed to the deficit of qualified nurses. Most foreign nurses are eligible for classification under the employment-based third preference (EB-3) category for skilled workers. However, under EB-3 an employer would have to wait between five to more than ten years before a visa becomes available to its sponsored nurse. 


The visa retrogression has undeniably hampered the recruitment of much needed healthcare workers from foreign countries, including the Philippines. For the past six years since the retrogression began, thousands of qualified nurses have simply been waiting for their priority dates to reach the cut-off for visa availability under the EB-3 category.


Unsurprisingly, not all of them end up pursuing their visa application. Some of them have simply been discouraged by the delay, while some are lured by equally promising professional opportunities in other countries. The U.S. therefore loses the benefit of their skills and talent.


While immigration rules remain restrictive and recruitment of foreign nurses is sought to be kept at a minimum, patients face increasingly longer wait times in understaffed hospitals or are placed in the care of overworked nurses. Urgent action in reforming immigration law is needed to ensure that the health of millions of Americans is not endangered.



(Editor’s Note: REUBEN S. SEGURITAN has been practicing law for over 30 years. For more information, you may log on to his website at or call (212) 695-5281.)

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