State Department Visa Freeze Could Further Stress Nursing Industry

• The United States Department of State has issued a visa freeze for work visas that allow international nurses to work stateside.
• As a result, some healthcare groups are renewing their push for Congress to take action on the Healthcare Workforce Resilience Act.
• The measure would allow for 25,000 professional nurses and 15,000 physicians to receive employment-based visas for the worker and their families.

A freeze on immigrant employment visas could further stress the U.S. healthcare system — and nurses specifically.

The U.S. Department of State won’t issue work visas, at the level nurses would qualify for, for the remainder of the fiscal year because the annual limit has already been met.

As a result, nursing and healthcare organizations are renewing their push for Congress to move on the Healthcare Workforce Resilience Act, which would help address the workforce shortage.

“We’re reaching a dangerous inflection point where acute nurse staffing shortages feed burnout in a force-multiplying cycle that grows worse every day,” Patty Jeffrey, RN, president of the American Association of International Healthcare Recruitment (AAIHR), said in a statement. “Until we can correct capacity issues that force nursing schools to reject thousands of qualified applicants annually, international nurses will remain essential to safe nurse staffing. This latest visa freeze halts the flow of qualified international nurses when American hospitals need them most, and the only way to correct it is through congressional action.” 

What are Employment-Based Immigrant Visas?

Employment-based immigrant visas are offered at five levels to qualified candidates as part of U.S. immigration law: 

• Employment First Preference (E1): Priority Worker and Persons of Extraordinary Ability
• Employment Second Preference (E2): Professionals Holding Advanced Degrees and Persons of Exceptional Ability
• Employment Third Preference (E3): Skilled workers, professionals, and unskilled workers (other workers)
• Employment Fourth Preference (E4): Certain special immigrants
• Employment Fifth Preference (E5): Immigrant investors

Nurses fall under the E3 category.

About 140,000 employment-based visas are issued each fiscal year, according to the State Department. To initiate the visa process, prospective employers obtain labor certification approval from the Department of Labor, then file the Immigrant Petition for Alien Worker, Form I-140 with the U.S. Citizenship and Immigration Services (USCIS), if required.

Visas are issued in the order the petitions were filed, and the filing date is the applicant’s priority date. A visa can’t be issued until the priority date is reached.

“In certain heavily oversubscribed categories, there may be a waiting period of several years before a priority date is reached,” the Department stated on its website.

Nearly 400,000 applicants are still waiting for an interview following the schedule of June 2024 appointments, according to the State Department’s Immigrant Visa Interview-Ready Backlog Report. However, USCIS said in February that its case backlog decreased by 15% in FY 23. 

And as far back as 2021, the American Hospital Association has sought prioritization in processing immigrant visas for eligible nurses. In a letter to U.S. Secretary of State Antony Blinken, AHA President Richard Pollack argued that there has “never been a more urgent need” for the care foreign-trained nurses provide.

“These professionals play critical roles in ensuring the health of the communities we serve. Moreover, they are highly qualified and required to meet our nation’s rigid standards of equivalent education, English fluency, and state licensure, with no disciplinary record,” he wrote. “Foreign-trained nurses do not displace American workers. At the same time, the demand for nurses continues to grow. Many foreign-trained nurses are recruited to rural and inner-city hospitals, locations that find it more difficult to recruit domestically.”

No visas exist for the healthcare industry specifically. 

How Could the Visa Freeze Impact the Nursing Landscape?

Immigrants account for 16% of registered nurses in the U.S. and 21.4% of nursing assistants, according to The Migration Policy Institute’s analysis of the U.S. Census Bureau’s 2021 American Community Survey.

When the State Department issued a similar freeze last May on green cards for foreign workers, Politico reported that the demand for worker visas is higher than the supply, Politico reported, and green card quotas haven’t been updated since 1990, “despite population growth.”

Luke LeBas, an emergency medicine physician in Louisiana, told Politico at the time that it won’t be good if the “pipeline” stops. 

“I’m talking significant holes in the nursing field, which is already on such a razor-thin edge right now,” LeBas said. 

The American Health Care Association/National Center for Assisted Living said at the time that the backlog of international nurses leads to a backlog in access to long-term care for seniors.

“At a time when the Administration plans to propose a federal staffing mandate for nursing homes, Washington should not simultaneously create barriers to recruit the nurses we so urgently need,” Clif Porter, AHCA/NCAL’s senior vice president of government relations, said in a news release. 

Health Care Workforce Resilience Act

The Healthcare Workforce Resilience Act (H.R. 6205), introduced in a bipartisan effort, would amend the American Competitiveness in the Twenty-first Century Act of 2000 to allow for up to 40,000 employment-based immigrants and their families to have visas approved no later than three years following the act’s enactment. Specifically, it would allow for 25,000 professional nurses and 15,000 physicians.

The measure was introduced last November and referred to the House Committee on the Judiciary by the House of Representatives.

The Healthcare Workforce Coalition, an overarching member organization that includes nearly 20 healthcare groups, also has urged passage of the HWRA. In a statement issued last week, the coalition argued that the EB-3 visa category is an “important pathway” for international healthcare workers to join the U.S. workforce and admonished the retrogression of final action dates for “several high-demand countries.”

“Foreign-trained nurses and doctors play critical roles in providing support for our hospitals and health systems,” said Megan Cundari, Senior Director, Federal Relations, American Hospital Association, said in the HWC release. “While we must invest in developing our domestic health care workforce, the HWRA would help ease current shortages so we can continue to serve our patients and communities.”

The Bottom Line

The U.S. Department of State has met the annual limit for certain employment visas, which affect foreign-born nurses who aim to work stateside, with about two-and-a-half months remaining in the current fiscal year. Healthcare organizations and advocacy groups believe the cutoff will further exacerbate industry workforce shortages and are urging Congress to act on the Health Care Workforce Resilience Act. The measure would increase the allotted number of employment-based visas within three years of its enactment. 

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