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U.S. RuNning out of RNs, but not RuNning after Nurses Overseas. Why?

The U.S. Bureau of Labor Statistics warns that less than 3 year from now, the U.S would be needing an additional 1.2 million RNs to meet the demands of the workforce and the $2.9 trillion healthcare industry. Yet, there has been no action to actively recruit nurses from overseas.

Crispin ArandaOriginally posted on July 8, 2016; updated July 13, 2016

U.S. RuNning out of RNs, but not RuNning after Nurses Overseas. Why?

In October 2014, President Barack Obama welcomed RN Nina Pham who was declared free of the Ebola virus.  Pham does not need a visa or green card, but tens of thousands of RNs needed by the U.S. do. Yet, there has been no nurse-issue hugging legislation or executive order.

With the increased need for RNs and healthcare workers, there has been a dramatic increase in the aging, elderly population of the US and the percentage of practicing RNs who are over age 50 and are going into retirement as well.

Yet, the U.S. Congress has not created special for-nurse-only-visas such as the H-1A in 1990.  Nor has the U.S. government allocated a certain number of visas exempted from the 65,000 yearly allocations from the H-1B working visas.  Then, on the immigrant visa front, the quota for the EB3 category for professionals and skilled workers (RNs) has not been increased from 40,000 a year.

Finally the passage of the Affordable Healthcare (Obama Care) Act increased the number of Americans eligible for healthcare services thereby further exacerbating the need for additional qualified, competent nurses.

The result of the inaction is a long line of Filipino nurses waiting for the issuance of their immigrant visas, and disappointment from nurses who continuously fail to get into the H-1 B lottery program year after year.

With the foreign nurses working and immigrant visas at a stand-still in the U.S. what options are there for Filipino RNs?

USCIS Policy Allowing Employers to File H-1B Petitions for RNs

In February 2015, the U.S. Citizenship and Immigration Services issued a policy memorandum allowing foreign RNs to be sponsored through the H-1B visas provided the employer can prove that a bachelor or higher degree is a requirement for the position.

While this policy memorandum sparked a glimmer of hope among potential H-1B applicants, the fact is that sponsorship filed by employers are selected at random by computers. Hence it is commonly known as the April 1 visa lottery.  Even if an RN has an employer that submitted a completed application right after midnight of March 31 of every year, the applicant would still have be lucky, pray a lot and hope to be selected.

The most viable option is pursuing an advanced degree in the U.S., either Masters or PhD in Nursing.

Advance Degree Holders Exempt from the 65,000 Annual Cap

In addition to the 65,000 yearly quota, 20,000 H-1B visas are exempt from this cap for visa applicant who “has obtained a U.S. master’s degree or higher (commonly known as the “advanced degree exemption”).

However, if the USCIS receives more than 20,000 petitions requesting an advanced degree exemption during the first five business days, a lottery will be conducted to select 20,000 petitions.  Those not selected for the advanced degree exemption will be entered into a second (the general H-1B lottery) for the regular 65,000 cap.

The advanced degree (Masters or PhD) must have been obtained in a recognized U.S. educational institution.

Nursing graduates in the US

According to the American Association of Colleges of Nursing (AACN), “nearly 155,000 new nursing graduates entered the workforce in 2015.”  Assuming the number of nursing graduates remains the same, there would be 775,000 new nurses.

Despite a 69.87% passing rate for those who passed the 2015 National Council Licensure Examination (NCLEX) was 229,459 for the entire year. This number includes the first time U.S.–educated applicants, the repeat U.S. educated as well as the internationally-educated RNs, first timers and repeaters.

If the passing rate remains the same, there should be 1,147,295 licensed RNs in the U.S., more than the 1 million projected shortages. 

Shortage remains despite increase in nursing graduates and NCLEX passers

The AACN explains that while the number of new nursing students and graduates is growing, the nursing-education system hasn’t kept pace, effectively creating a bottleneck in which only so many aspiring nurses can access the training they need.” 

In short, America’s healthcare industry may have sufficient licensed nurses but lack academic qualifications and further training that come with advance degree programs that incorporate actual workplace experience.

Then there’s the cost and lack of nursing faculty especially for undergraduate and graduate programs.

The AACN’s report on 2014-2015 Enrollment and Graduations in Baccalaureate and Graduate Programs in Nursing shows that “U.S. nursing schools turned away 68,938 qualified applicants from baccalaureate and graduate nursing programs in 2014 due to an insufficient number of faculty, clinical sites, classroom space, clinical preceptors, and budget constraints. Almost two-thirds of the nursing schools responding to the survey pointed to faculty shortages as a reason for not accepting all qualified applicants into baccalaureate programs.”

As for the cost, most masters and PhD programs in the U.S. could go up to $120,000, according to FinAid.org.

The cost varies depending on the university and the master’s program itself. The cost varies by program as well. The average cost of an MBA, for example, is $40,000. At most universities, this is what master’s degree graduates will pay. Some institutions have programs for less, and MBA programs at Harvard or Stanford could cost in excess of $120,000

The bestmastersdegrees.com reports that the cost of full-time graduate tuition, at nine or more credit hours, per year at the University of Michigan for engineering students is $10,957 while out of state students will pay $20,616 per year.

Saginaw Valley State University, Michigan

Internationally-educated RNs intending to complete an advance degree with Saginaw Valley State University (SVSU) in Michigan, enhance their career earning potential or have a viable pathway to employment and permanent residency in the U.S. could take up the Master of Science Health Administration  & Leadership (MSHAL) For complete details of MSHAL, click here - https://www.visacenter.org/course/5/health-administration-and-leadership-master-of-science

The MSHAL program includes theoretical and experiential learning opportunities, equipping regional health care leaders with the knowledge required to fill more advanced positions within their respective agencies.  SVSU has the lowest tuition of all public institutions in Michigan – an affordable price for the grand prize of a suitable career progression and permanent residency as a healthcare professional.

Healthcare is the largest industry in the United States, and the second largest employer.  An SVSU MSHAL graduate can look forward to a career in a healthcare setting which includes

  • Hospitals
  • Government facilities
  • Ambulatory facilities
  • Outpatient care centers
  • Healthcare Organizations
  • Public health departments
  • Social services agencies
  • Insurance carriers
  • In-home healthcare providers
  • Group medical practices
  • Managed care facilities

How do nurse practitioner salaries compare?

Nursing Career

Median Annual Salary*

Registered Nurse


Licensed Practical or Vocational Nurse


Physician Assistant


Nurse Midwife


Sources: U.S. Bureau of Labor Statistics' Occupational Outlook Handbook, 2016-17 Editions,

Nursing educators on the other hand, could expect a “19 percent job growth by 2020, similar to the growth in the demand for registered nurses and other medical departments, but still much higher than the average rate of growth of other professions across the United States,” according to nursejournal.org.

The report continues that the “average income for this position ranges from $45,040 to $94,720 depending on the level of academics achieved and how much experience in the field has been accomplished.”

Getting an advanced degree, therefore, provides a common and viable route if an international nurse with a bachelor’s degree from his or her country or origin wish to have a successful, good-paying job in the U.S. and get a green card as well.

This is surely not the typical example for nurses that those who can do; those who can’t, teach.

In this case, teaching gets nurses to get better in what they can.

And that’s the prescription for having the best of both worlds, keeping both the U.S. government and international nursing students from running around in circles.


Authors & Contributors

Crispin Aranda

Crispin Aranda

Crispin R. Aranda is an established International Visa Conselor and Immigrant Advocate. He is the president of IVC and is in several migration radio programs.

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