Filling Nursing Shortages via Global Talent: Visa Backlogs and Policy Fixes
U.S. hospitals continue to face nurse recruitment and retention pressures, but workforce conditions differ by region, employer and specialty. International recruitment can expand the available candidate pool, although licensing, credential screening and immigration requirements make it a long-term workforce strategy rather than an immediate staffing fix. Nurse shortages are straining care delivery, pushing labor costs higher, and driving staff burnout to record levels. For some healthcare systems, internationally educated nurses form one part of a broader workforce strategy. Employment-based visa availability continues to delay some international nurse cases, particularly when an applicant’s priority date is not current under the Department of State’s monthly Visa Bulletin.
The U.S. Nursing Shortage: Critical and Growing
- The U.S. could lose 800,000 more RNs by 2027 due to retirements and burnout.
- NCSBN reported in 2025 that more than 138,000 nurses had left the workforce since 2022. In the same national study, 39.9% of registered nurses surveyed reported an intention to leave nursing or retire within five years.
- The 2026 NSI National Health Care Retention & RN Staffing Report placed the hospital RN vacancy rate at 8.6% and RN turnover at 17.6%.
- Recruitment conditions vary considerably by geography, specialty, shift, employer and local labor market. Rural employers can face added recruitment constraints when candidate relocation, housing and community integration are difficult.
Why Hospitals Turn to International Nurses
- KFF estimated that immigrants accounted for approximately one in six registered nurses working in the United States in 2022.
- In 2022, 32% of U.S. hospitals reported hiring foreign-educated registered nurses, compared with 16% in 2010, according to KFF’s analysis of American Hospital Association survey data.
- International recruitment can supplement domestic hiring and, when positions are filled, reduce dependence on temporary staffing. Retention still depends on compensation, working conditions, contractual terms, onboarding, workplace support and community integration.
Some internationally educated nurses have completed substantial education, examination or credential-screening requirements. They still cannot begin employment until all applicable state-licensure, federal health-worker certification, immigration, work-authorization and employer requirements have been satisfied.
Visa Retrogression: The Bottleneck Explained
Visa retrogression occurs when demand for immigrant visas in a particular employment category or country exceeds the number available. The Department of State publishes cutoff dates in its monthly Visa Bulletin. An applicant generally cannot receive final approval or be scheduled for an immigrant-visa interview unless the applicant’s priority date is earlier than the applicable final-action date.
Professional nurses are included in Schedule A, Group I. Employers can still file qualifying EB-3 petitions, and Schedule A occupations do not require the standard Department of Labor labor-certification process. Petition approval, however, does not guarantee that an immigrant visa is immediately available.
Visa availability depends on the applicant’s employment category, country of chargeability, priority date and the current Visa Bulletin. Employers should therefore track each case individually rather than relying on a static backlog estimate.
The Cost of Delays
- Persistent vacancies can increase overtime, contract-labor and recruitment costs while placing additional pressure on existing staff. Employers should calculate these costs using their own vacancy duration, overtime, agency-spend and lost-capacity data.
- Staffing constraints can affect scheduling, capacity and workload. Any claimed effect on patient throughput or satisfaction should be supported by the employer’s own operational data or a cited study.
- The interval between recruitment and employment varies according to state licensure, credential screening, visa category, priority date, consular or adjustment processing, work authorization and employer onboarding.
Extended or uncertain timelines can increase candidate attrition, particularly when expectations, milestones and communication are poorly managed.
Proposed Policy Fixes
Several bipartisan and industry-supported bills could ease the crisis:
- Healthcare Workforce Resilience Act –
The Healthcare Workforce Resilience Act, introduced as H.R. 5283 and S. 2759 in September 2025, would recapture up to 25,000 previously authorized but unused immigrant visas for nurses and 15,000 for physicians. As of this article’s July 2026 review, the proposal had not been enacted.
Proposed legislation should not be treated as part of a current hiring pathway unless and until it is enacted. Employers must plan around the immigration options and visa availability in effect for each candidate.
What Can Hospitals Do Now?
U.S. hospitals can’t wait for Congress. Here’s what works now:
- Begin workforce planning early and build candidate-specific ranges around state licensure, credential screening, visa availability, work authorization and employer onboarding. Do not promise a start date based on a generic national timeline.
- Use alternative visa categories where possible:
- TN status: Qualified Canadian or Mexican citizens seeking temporary U.S. employment as registered nurses may qualify if the position, applicant, state licensure and supporting documentation satisfy the applicable USMCA and immigration requirements.
- H-1B Status: Certain nursing positions may qualify when the specific job satisfies the specialty-occupation standard and the applicant meets the position’s educational and professional requirements. Eligibility must be assessed for the actual position and applicant; advanced-practice status alone does not guarantee approval.
- Work with recruitment partners and qualified advisers that can:
- Assess candidates against agreed clinical and experience criteria
- Review available documentation and stated licensure progress
- Identify known credential-screening, licensure and immigration dependencies
- Coordinate communication among candidates, employers and qualified immigration advisers
- Support relocation and workplace-integration planning where included in the assignment
International nurse recruitment should begin with the destination state and position. Employers and recruitment partners should identify the state board’s licensure requirements, the federal health-worker certification requirements, the likely immigration pathway and the employer’s onboarding capacity before setting recruitment targets.
Completing one milestone does not satisfy the others. Passing the NCLEX-RN does not itself grant state licensure, immigration status or work authorization. Likewise, an approved immigrant petition does not establish that a visa number is immediately available.
Why Global Recruitment Experts?
GRE helps U.S. healthcare providers:
- Source candidates in agreed markets and assess them against the employer’s defined clinical, education and experience criteria.
- Track known recruitment dependencies and coordinate with the employer’s qualified immigration advisers.
- Incorporate ethical-sourcing considerations and identify any applicable national, contractual or procurement requirements.
- Coordinate candidate communication, documentation tracking and relocation support within the agreed recruitment scope.
GRE helps healthcare employers define role requirements, source and assess candidates, review available recruitment documentation and coordinate communication around known licensure and immigration dependencies.
Can employers still file EB-3 petitions for professional nurses?
Employers can file qualifying EB-3 petitions for professional nurses under the Schedule A process. Filing or approval does not mean an immigrant visa is immediately available. Progress depends on the applicant’s priority date, country of chargeability and the Department of State’s current Visa Bulletin. Employers should obtain case-specific guidance from qualified immigration counsel.
Which U.S. immigration pathways apply to internationally educated nurses?
The applicable pathway depends on the position, employer, applicant, citizenship, qualifications, intended duration of employment and current immigration rules. Some Canadian and Mexican citizens may qualify for TN status as registered nurses. Certain positions may satisfy H-1B requirements. Professional nurses can also be sponsored through the EB-3 Schedule A process. Employers should obtain case-specific immigration advice before selecting or sequencing a pathway.
How long does full onboarding take?
There is no reliable universal timeline. State licensure, credential screening, examination status, visa availability, priority date, consular or adjustment processing, work authorization and employer onboarding all affect when employment can begin.
Nursing workforce needs and immigration conditions change over time. Employers should base international recruitment plans on current workforce data, the destination state’s licensing requirements and the immigration pathway applicable to each candidate.
Global Recruitment Experts helps healthcare employers define role requirements, source and assess candidates, review available documentation and coordinate international recruitment around known licensing and immigration dependencies. Formal credential evaluation, professional licensure, immigration advice, work authorization and employment decisions remain with the responsible organizations, authorities, employers and qualified advisers.
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