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Visa Backlog Blocks Nursing Help in U.S., but Progress Seen

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Visa Backlog Blocks Nursing Help in U.S., but Progress Seen

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https://www.usnews.com/news/health-news/articles/2021-12-08/immigrant-visa-backlog-blocks-covid-nursing-help-in-u-s

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Observers say they've started to see progress on efforts to streamline the immigration visa process to allow more internationally trained health professionals to work in the U.S. and help address widespread nursing shortages amid the COVID-19 pandemic. But they also say more needs to be done.

The pandemic has slowed the pace at which U.S. officials have conducted interviews with visa seekers, which is one of the final steps needed to gain permanent residency. As of November, only 28,964 out of more than 490,000 qualified immigrant visa applicants were scheduled for interview, according to figures from the Department of State's Bureau of Consular Affairs.

An estimated 10,000 foreign-trained nurses have been on the waiting list for an interview, with the average wait time anywhere from 12 to 18 months, according to Sinead Carbery, brand president of O'Grady Peyton International, the international division of leading health care staffing recruitment firm AMN Healthcare.

Carbery and others contend a contributing factor to the delays in processing immigration visas for nurses has been a four-tier system the U.S. Department of State established late last year to prioritize cases. While the system was intended to work through the backlog by granting higher priority to petitions filed by immediate family members, for example, it placed employment-based visa petitions, which includes visas sought by health care professionals, among the last in line to be processed.

Photos: COVID Nurses Recount Traumatic Experiences

"These health care workers already have an employer that needs them who is ready to hire them as soon as they enter into the U.S.," says Sherry Neal, an immigration attorney with the law firm Hammond Neal Moore in Cincinnati. Neal says nurses waiting for visa interviews have already been matched with an employer, and have met both nurse licensing and English-language proficiency requirements.

"That's why employers are screaming because they're saying, 'We have these people who are willing to come and work, we have already identified them and we have already interviewed them - these are the people we have selected,'" Neal says. "Yet the only thing that's preventing them from coming in is this hurdle of the consulate interviews."

Health care trade groups have called on the State Department to expedite the visa application process for foreign-trained nurses in light of the ongoing public health crisis caused by the pandemic. In June, the American Hospital Association sent a letter to Secretary of State Antony Blinken requesting higher priority for the processing of visa applications by international nurses.

"There has never been a more urgent need for the care that foreign-trained nurses provide than during the current COVID-19 pandemic and its looming aftermath," AHA President and CEO Richard J. Pollack wrote. "These professionals play critical roles in ensuring the health of the communities we serve."

In August, a coalition of about a dozen long-term care organizations led by the American Health Care Association and the National Center for Assisted Living sent a letter to Blinken asking that the immigrant visas of international nurses and health care workers be given higher prioritization. Also in August, the State Department announced it would allow consulates to choose whether to expedite visa cases involving certain health care workers who would be working directly in the COVID-19 relief effort.

"The problem with that is that when they did that, it basically was a permissive situation," Neal says. "So everybody started asking for expedites, but the consulates were saying no."

The coalition sent a second letter to Blinken on Nov. 10, recommending that the department allow for virtual interviews and waive the immigrant visa interview process for nurses altogether.

"We need to prioritize health care workers who wish to live and work in the United States, especially those who are willing to care for our nation's most vulnerable," the American Health Care Association/National Center for Assisted Living tells U.S. News in an email. "Expediting the visa authorization process for these heroes would help us build back our workforce and expand the number of seniors we can serve."

On Nov. 19, the State Department announced it was effectively rescinding the tier-based prioritization system, stating embassies and consulates have "broad discretion" to determine how to prioritize visa appointments. And Neal, the immigration attorney, says she has started to see some progress in the processing of visas for nurses in recent weeks.

Carbery, at O'Grady Peyton, says she also has become more optimistic. She says several U.S. embassies located in the countries of origin for a majority of international nurses who come to the U.S., such as the Philippines, have begun to put nurses higher up on the prioritization list for interviews.

Both Carbery and Neal contend, however, more can and should be done to expedite the visa process.

"It's a good sign that they have started to move," Carbery says. "They need to continue the momentum because the shortage is almost feeling like a crisis at this point."

A State Department official tells U.S. News that the department remains focused on "reducing wait times for all consular services at our embassies and consulates overseas while also protecting the health and safety of our staff and applicants."

Some 500,000 immigrant nurses are believed to have worked in the U.S. in 2018, making up 15.5% of the country's nursing workforce, according to data tabulated by the Migration Policy Institute. Approximately 86% of international nurses providing care in the United States have treated COVID-19 patients, based on a recent survey of nearly 600 nurses conducted by O'Grady Peyton International. The survey also found 17% of respondents reported having contracted COVID-19.

Carbery warns solving the country's nursing woes will take more than bringing in more international nurses. What the pandemic has helped make clear, she says, is that such an approach is unsustainable to meet both current demand and the need for health care professionals moving forward.

"The root of the problem is we're not producing enough U.S. domestic supply," Carbery says. "As long as we're not paying nursing educators enough money to be able to produce U.S. domestic supply, we're going to continue to be in this crisis."

Meanwhile, the pandemic has fueled an exodus of nursing professionals. An estimated 30% of nurses have either quit or been laid off from their jobs since February 2020, according to a poll in September by Morning Consult of 1,000 workers, with 54% reporting COVID-19 as the primary reason for their departure.

Such issues have prompted calls and efforts to increase the capacity of nursing schools so they can train more students.

Bob Riney, president of health care operations and chief operating officer for Detroit-based Henry Ford Health System, says part of his organization's recruiting strategy includes recruiting international nurses. He says the health system has begun to file work visa applications for nurses from the Philippines, with the hope of adding the first group of approximately 100 nurses to their staff within a year.

Riney says Henry Ford is also working to increase the number of students that can be trained and potentially enter the workforce. In January, Henry Ford launched a 30-year partnership with Michigan State University that's to include efforts aimed at removing barriers to medical education for members of marginalized communities, in the hope of improving diversity among health care providers.

"We have an aggressive short- and long-term recruitment strategy in place to navigate the ongoing national nursing shortage," Riney says.

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u.s. citizenship and immigration services

# data[].attributes.attachment_link.title
Visa Backlog Blocks Nursing Help in U.S., but Progress Seen

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Observers say they've started to see progress on efforts to streamline the immigration visa process to allow more internationally trained health professionals to work in the U.S. and help address widespread nursing shortages amid the COVID-19 pandemic. But they also say more needs to be done.

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Nation Campaign for Safe RN-Patient Staffing Ratio

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Nation Campaign for Safe RN-Patient Staffing Ratio

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https://www.nationalnursesunited.org/ratios

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NNU's proposal for minimum, mandated, nurse-to-patient staffing ratios protects our patients' right to nursing care.

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California bypasses nurse staffing ratio rules amid virus surge

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California bypasses nurse staffing ratio rules amid virus surge

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https://www.modernhealthcare.com/providers/california-bypasses-nurse-staffing-ratio-rules-amid-virus-surge

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SAN FRANCISCO (AP) - Nerissa Black was already having a hard time tending to four COVID-19 patients who need constant heart monitoring. But because of staffing shortages affecting hospitals throughout California, her workload recently increased to six people infected with the coronavirus.

Black, a registered nurse at the telemetry cardiac unit of the Henry Mayo Hospital in Valencia, just north of Los Angeles, barely has time to take a break or eat a meal. But what really worries her is not having enough time to spend with each of her patients.

Black said she rarely has time to help patients brush their teeth or go to the bathroom because she must prioritize making sure they get the medicine they need and don't develop bedsores.

"We have had more patients falling (in December) compared to last year because we don't have enough staff to take care of everybody," Black said.

Overwhelmed with COVID-19 patients in the nation's most populous state, Black and many other nurses already stretched thin are now caring for more patients than typically allowed under state law after the state began issuing waivers that allow hospitals to temporarily bypass a strict nurse-to-patient ratios law - a move they say is pushing them to the brink of burnout and affecting patient care.

California is the only state in the country to require by law specific number of nurses to patients in every hospital unit. It requires hospitals to provide one nurse for every two patients in intensive care and one nurse for every four patients in emergency rooms, for example. Those ratios, nurses say, have helped reduce errors and protect the safety of patients and nurses.

Nurses overwhelmed with patients because of the pandemic in other states are demanding law-mandated ratios. But so far, they have failed to get them. In Massachusetts, Pennsylvania and New York, the country's first pandemic hotspot, nurses have been demanding state-mandated minimum staffing standards for months. Voters in Massachusetts rejected in 2018 mandated nurse-to-patient ratios.

In the 10 minutes Black gets with each person every hour, she has to look at lab work reports, imaging reports, communicate any abnormalities to the doctor, document her interventions, coordinate with case workers, and in many cases, arrange for the hospital's chaplain, she said.

"It's very busy, the nurses and not just the nurses but the assistants, we are all exhausted. Morale is pretty low," she said.

Gov. Gavin Newsom's Department of Public Health began issuing temporary waivers of the law for a second time in December after another surge left hospitals in Southern California and the agricultural San Joaquin Valley with what is considered no intensive care capacity because of a lack of staffing. The department had ordered all non-urgent and elective surgeries and issued a blanket 90-day waiver of the patient ratio last spring.

So far, at least 250 of California's about 400 hospitals have been granted 60-day waivers that allow for ICU nurses to care for three people and emergency room nurses to oversee six patients. The waivers only apply to intensive care, observation units, cardiac monitoring, emergency and surgical care units. But Newsom so far has not canceled elective surgeries during the recent surge.

Kaiser Permanente, which has 36 hospitals in California, applied for waivers at 15 of them to plan for surge needs, spokesman Marc Brown said. He said the health care giant avoided asking for more waivers by canceling elective and non-urgent surgeries, paying nurses overtime and working with the nurses to move their shifts and locations.

"We take the existing ratios seriously," Brown said.

California Hospital Association spokeswoman Jan Emerson-Shea said hospitals are applying for the waivers only after they have no other choice left to care for the patients they have.

"We are literally in the worst crisis of this pandemic so far and are seeing caseloads that we have not seen to date," Emerson-Shea said, adding that hospitals are just trying to get through the crisis. "No one wants to have our staff emotionally and physically exhausted. But we have no choice. People need care."

California hospitals typically turn to staffing agencies and travel nurses during the winter season, when hospitalizations surge and medical staff get sick because of the flu. But California is now among states nationwide vying for medical personnel, particularly trained ICU nurses.

Stephanie Roberson, the California Nurses Association government relations director, criticized hospitals for not preparing better by training registered nurses and failing to hire more staff - including traveling nurses - during a fall lull in COVID-19 cases, despite an expected fall surge in hospitalizations.

"In some of our hospital systems, if they were lucky to have travelers, they shooed the travelers away because they told the travelers they weren't in crisis mode and those travelers went elsewhere because they had better gigs somewhere else," Roberson said.

Black, who has been a nurse for 10 years, said she has been relying on her husband to take care of her family needs so she can rest and sleep as much as possible on her days off. She has also been seeing a therapist to cope with the stress from work.

She said she is doing everything she can to take care of herself because she is committed to helping her patients. But she calls her working conditions increasingly unsafe.

"A lot of people say we signed up for this and no, we didn't. I signed up to help take care of people, not to throw myself into the fire," Black said.

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California bypasses nurse staffing ratio rules amid virus surge

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SAN FRANCISCO (AP) - Nerissa Black was already having a hard time tending to four COVID-19 patients who need constant heart monitoring. But because of staffing shortages affecting hospitals throughout California, her workload recently increased to six people infected with the coronavirus.

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Nursing shortage is a national health issue

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Nursing shortage is a national health issue

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https://www.baltimoresun.com/opinion/op-ed/bs-ed-op-0207-nursing-shortage-20220206-xoh3ddb6mbg4bid63olqgepf4u-story.html

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Nursing shortage is a national health issue | GUEST COMMENTARY

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The nursing shortage is leading hospitals to close units or scale back services, which affects not only high acuity units like the Intensive Care Unit and Emergency Department, but long-term care, labor and delivery, and the operating room.

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Nationwide nursing shortage is leading to big salary boosts

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Nationwide nursing shortage is leading to big salary boosts

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https://fortune.com/2021/11/19/nursing-shortage-salary-increases-average-pay/

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Nursing salaries surge 4% to combat burnout and worker shortages

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To combat burnout and a nursing shortage, some health care providers increase nurse salaries 10%.

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Boyle, P. (2021, September 07). Hospitals innovate amid dire nursing shortages. Retrieved February 07, 2022, from https://www.aamc.org/news-insights/hospitals-innovate-amid-dire-nursing-shortages

Brusie, C. (2022, February 3). This legislation could cap travel nurse pay, staffing agencies accused of "price gouging". Retrieved February 09, 2022, from https://nurse.org/articles/travel-nurse-pay-caps/

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Donahue, A. (2021, May 12). National Campaign for safe RN-to-patient staffing ratios. Retrieved February 07, 2022, from https://www.nationalnursesunited.org/ratios

Johnson, S. R. (2021, December 08). Immigrant Visa backlog blocks COVID nursing help in U.S.: Healthiest Communities Health News. Retrieved February 07, 2022, from https://nthenews.com/2021/12/08/immigrant-visa-backlog-blocks-covid-nursing-help-in-u-s-healthiest-communities-health-news/

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Press, A. (2021, January 08). California bypasses nurse staffing ratio rules amid virus surge. Retrieved February 07, 2022, from https://www.modernhealthcare.com/providers/california-bypasses-nurse-staffing-ratio-rules-amid-virus-surge

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https://www.usnews.com/news/health-news/articles/2021-11-15/us-faces-crisis-of-burned-out-health-care-workers

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Hospitals innovate amid dire nursing shortages

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Hospitals innovate amid dire nursing shortages

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https://www.aamc.org/news-insights/hospitals-innovate-amid-dire-nursing-shortages

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https://www.worldometers.info/coronavirus/country/us/

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United States Coronavirus update with statistics and graphs: total and new cases, deaths per day, mortality and recovery rates, current active cases, recoveries, trends and timeline.

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This Legislation Could Cap Travel Nurse Pay, Staffing Agencies Accused of "Price Gouging"

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This Legislation Could Cap Travel Nurse Pay, Staffing Agencies Accused of "Price Gouging"

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https://nurse.org/articles/travel-nurse-pay-caps/

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This Legislation Could Cap Travel Nurse Pay, Staffing Agencies Accused of “Price Gouging”

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The movement to cap travel nurse and agency staffing pay rates is growing. Many states are introducing legislation to put a cap on travel nurse pay. A letter signed by 200 hospital supporters is urging Congress and the White House to investigate “price gouging” by travel nursing agencies.