The Growing Role of Foreign-Educated Nurses in U.S. Hospitals and Implications of Visa Restrictions

Registered Nurses (RNs) play a key role in the health care workforce and contribute to the health and well-being of millions of Americans, working in hospitals, nursing homes, physician’s offices, and home health services. The profession has been experiencing shortages, which were exacerbated by the COVID-19 pandemic and are predicted to continue over the next decade as the 65 and older population in the U.S. grows, increasing health care needs. Demand for nurses will also likely increase to meet new requirements for nurse staffing levels in nursing facilities.

Immigrant workers could help address these needs. As of 2022, there were about 500,000 immigrant nurses in the U.S., accounting for about one in six of the close to 3.2 million RNs.¹ However, immigration remains a hot-button political issue with ongoing anti-immigrant rhetoric and recent actions and proposals to limit immigration and immigrants’ role in the workforce. These actions include the federal government extending its pause on the processing of new visa applications for international nurses in June 2024. The pause has been in place since April 2023 and, at this time, the government is only processing applications submitted on or before December 2021. Legislation has been proposed to increase employment-based visas for nurses, although it has remained stalled since 2023. Visa opportunities for nurses could also potentially be expanded through administrative action, for example via H-1B visas, though they would have limitations.

These visa restrictions could exacerbate existing shortages in the nursing workforce and negatively impact the U.S. labor market and economy more broadly, particularly given the growing role of foreign-educated nurses in U.S. hospitals. KFF analysis of data from the American Hospital Association (AHA) Annual Survey shows that the overall share of hospitals reporting hiring foreign-educated RNs has nearly doubled between 2010 and 2022, and a growing share of hospitals report hiring an increasing number of foreign-educated RNs to fill vacancies over time.

Overall, 32% of hospitals accounting for nearly half (45%) of all hospital beds say they hired foreign-educated RNs in 2022, twice the share in 2010, when 16% of hospitals accounting for about a quarter (23%) of all hospital beds said they hired foreign-educated RNs (Figure 1). In addition, between 2010 and 2022, the share of hospitals saying they hired more foreign-educated nurses to help fill RN vacancies compared to the previous year rose from 2% of hospitals representing 3% of hospital beds to 14% of hospitals representing 22% of hospital beds (Figure 2).