The Nursing Shortage and its Effects on Health Care and the Economy
The nursing shortage in the United States is becoming increasingly problematic and may adversely affect the health care industry. Congress has passed legislation that recognizes the labor shortage for nurses.

According to an HHS study, 2006 estimates from the Bureau of Labor Statistics suggest that the United States will require 1.2 million new RNs by 2014 to meet the nursing demand: 500,000 RNs to replace RNs leaving the field, and another 700,000 to meet growing demand. The current vacancy of RNs at the U.S. Department of Veteran Affairs is ten percent. Notably, the demand for nurses will continue to grow by two to three percent each year. Reports have indicated that this estimate will increase given inadequate domestic facilities to educate and train nurses, the low number of nursing students, the existing aging workforce, and the barriers in the immigration process for foreign nurses.

The shortage of RNs and an increased workload for current nurses is a threat to the quality of patient care. Looking at the impact of nurse staffing and how it relates to patient care, the American Association of Colleges of Nurses reported that an increase in RNs contributed to a decrease in hospital-related mortality and reduced lengths of patient stays, whereas inadequate staffing was reported to compromise patient safety. Furthermore, most RNs have voiced concerns that there is not enough time to ¡??maintain patient safety, detect complications early, and collaborate with team members.à Americans for Nursing Shortage Relief presented testimony before a House Subcommittee on the nursing crisis warning that the shortage could result in serious national security and health concerns if there is a pandemic flu or other man-made or natural disaster, and the United States does not have adequate health care resources to respond.

The shortage also makes it difficult for facilities to expand services or prepare for an emergency response. One hospital representative reported to the CIS Ombudsman that hospitals have been forced to close beds and wings to their hospitals due to the shortage.

The nursing shortage is credited to a variety of factors, including the growth of the aging U.S. population and their associated health care needs, an inadequate supply of nursing educators, and an aging nurse workforce leaving the profession. The American Nurses Association (ANA), indicates that the nursing shortage is caused in part by high turnover rates, ¡dissatisfaction with the current work environment,¡à and a lack of funding for domestic nursing schools to educate U.S. workers.

Barriers to the Immigration Process
Many hospitals, organizations, and stakeholders have expressed frustration with the immigration process for nurses. Non-immigrant visa options are very restricted and do not adequately address the nursing shortage. The most common route for foreign nurses, the green card option, is hampered by the limited number of immigrant visas and long wait times. Generally, RNs qualify for immigrant status under the employment-based third preference (EB-3) visa category. For many months, no visas were available for any professions that qualified under the EB-3 category for any nationality. Recently, visa numbers for the EB-3 category became available, and limited numbers will become available throughout the fiscal year. Stakeholders have indicated that it can take many years to complete the entire immigration process Nursing organizations advised the CIS Ombudsman that, as a result of the delays, many nurses choose to work in countries that offer shorter waiting times to obtain their permanent residency, such as Australia, Canada, and the United Kingdom. Proposed legislation in Congress has suggested recapturing previously unused employment-based visa numbers, including EB-3 numbers.

Apart from visa limitation issues, procedural concerns include inconsistencies in processing times and adjudications at USCIS service centers. For example, in September 2008, USCIS¡¯ posted processing times for the Nebraska and Texas Service Centers differed by four months. According to participants in a recent CIS Ombudsman teleconference, another concern in the adjudication of nurse applications is the disparity in the number of Requests for Evidence (RFEs) issued at the two different USCIS service centers.