A National Crisis Deserves a National Response

A National Crisis Deserves a National Response

The Department of State last week updated its visa processing protocols to provide a possible pathway for emergency visa processing of foreign healthcare workers.

The move comes as American hospitals are being crushed and the weight of the delta variant. At the same time, U.S. embassies and consulates worldwide have failed to schedule green card interview appointments with thousands of qualified international nurses, who have sterling clinical records and have passed background checks, US licensure exams, and English language proficiency tests. 

The Department’s existing priority schedule provides four applicant processing tiers into which nurses inexplicably qualify dead last. The agency’s updated guidance doesn’t replace that framework but advised U.S. embassies and consulates that they may classify healthcare professionals’ immigrant visa applications as emergencies.

  • YES BUT: Embassies and consulates have long had the discretionary authority to grant emergency appointments. 
  • Before State’s updated guidance, there were already some 1,500 healthcare workers who had been approved for emergency appointments but still had not been granted an immigrant visa, according to a survey by the American Association of International Healthcare Recruitment. In one extreme case, reported by a member of the AAIHR, one nurse had to wait twelve months before an exit interview could be conducted. 

American hospitals cannot wait twelve months for “emergency appointments.” This solution is an incomplete one.


A national crisis: The American Nurses Association has called on the Department of Health and Human Services to declare America’s nursing shortage a national crisis and to convene a stakeholder task force to develop both short- and long-term solutions.

“The nation’s health care delivery systems are overwhelmed, and nurses are tired and frustrated as this persistent pandemic rages on with no end in sight. Nurses alone cannot solve this longstanding issue and it is not our burden to carry,” ANA President Ernest Grant said in a letter to HHS Secretary Xavier Becerra.


Quote of the pandemic: “Every shift is the worst shift I’ve ever worked. I cried the whole way home from work every day“—nurse quoted in a new healthcare worker survey.


By the numbersCalifornia’s most experienced nurses are eyeing the exits in historic numbers, according to a new survey by UCSF’s Health Workforce Research Center on Long-Term CareFrom the report:

  • In 2020, 26 percent of registered nurses between the ages of 55 and 64 said they plan to leave the field in the next two years, up from 12 percent in 2018.
  • The authors estimate a current shortage of 40,567 full-time equivalent registered nurses—a 13.6 percent gap that is projected to persist until 2026.

Other trends driving the shortage, per UCSF:

  • Employers have been reluctant to hire less experienced RNs, possibly because of the difficulty in onboarding them during the pandemic. 
  • California is also producing fewer nurses. Public registered nursing education programs, including city colleges and the California state system, had to decrease enrollments, skip cohorts, and reduce class sizes during the pandemic, in part because of their inability to place students in clinical environments.

NOT TO PUT TOO FINE OF A POINT ON IT: California and others struggle to retain experienced nurses or train new ones while thousands of qualified, highly skilled nurses are waiting for their visa processing appointments at U.S. embassies worldwide.


Boomerang effect: Some trade groups and healthcare worker unions have begun warning that the Biden Administration’s vaccine mandate for nursing home staff could drive roughly one-third of the sector’s workforce out.

  • In a letter to Secretary Becerra, American Health Care Association CEO Mark Parkinson wrote, “If a significant portion of the approximately 38 percent of unvaccinated nursing home staff leave, the net impact will be worse care for the residents. While the loss of just half of the unvaccinated staff would be devastating to care, the loss of even one or two staff in a nursing home impacts care on certain shifts and units.”
  • Others, meanwhile, say vaccine mandates are critical to protecting America’s vulnerable seniors: “It was a small price to pay to keep our elders safe. I think we did well,” the president of New Jersey-based Jewish Home Family told The Hill.
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