Flatlining: How the Reluctance to Embrace Immigrant Nurses is Mortally Wounding the U.S. Healthcare System

Abstract:     
Understaffing of nurses in U.S. hospitals is severely impacting the quality of healthcare and is predicted to worsen in future years. By the year 2020, the nursing workforce is projected to be nearly a million nurses short. The current nurse pool is retiring, and the number of new nurses entering the profession is inadequate. At the same time, an aging baby boomer population will need to be cared for as they reach old age. The nationwide shortage is related to another issue, inadequate staffing. There is a strong relationship between inadequate staffing and adverse patient outcomes, including mortality. Proposed domestic solutions to this problem include mandating the minimum number of nurses per patient, increasing nurse education investment, augmenting existing outreach programs that target young people, and increasing nurse wages. One possible solution is the use of foreign nurses to alleviate the burgeoning shortage. This solution is circumscribed by immigration law, which still remains far behind in terms of meeting the need. Immigration law only authorizes 500 H-1C visas per year. Attempts to expand immigration have been met with a cold response from nurse unions and trade associations. This Article argues for the increased use of foreign nurses in U.S. hospitals as a complement to proposed domestic policy solutions, in order to fully alleviate the shortage and to adequately ensure patient safety. This Article analyzes past and current efforts in the U.S. to use immigrant nurses in times of nurse shortage. The Article concludes by analyzing the challenges associated with the continued nurse migration and also calls for an expansion of the H-1C program, as well as further global investment in nursing care.

Number of Pages in PDF File: 41

Keywords: Nurses, Immigration Law, health care

JEL Classification: L18, J19, J29, J39

working papers series