By AMY TAX­IN-As­so­ci­at­ed Press

With Amer­i­can hos­pi­tals fac­ing a dire short­age of nurs­es amid a slog­ging pan­dem­ic, many are look­ing abroad for health care work­ers.

And it could be just in time.

There’s an un­usu­al­ly high num­ber of green cards avail­able this year for for­eign pro­fes­sion­als, in­clud­ing nurs­es, who want to move to the Unit­ed States — twice as many as just a few years ago. That’s be­cause U.S. con­sulates shut down dur­ing the coro­n­avirus pan­dem­ic weren’t is­su­ing visas to rel­a­tives of Amer­i­can cit­i­zens, and, by law, these un­used slots now get trans­ferred to el­i­gi­ble work­ers.

Amy L. Erl­bach­er-An­der­son, an im­mi­gra­tion at­tor­ney in Om­a­ha, Ne­bras­ka, said she has seen more de­mand for for­eign nurs­es in two years than the rest of her 18-year ca­reer. And this year, she said, it’s more like­ly they’ll get ap­proved to come, so long as U.S. con­sular of­fices can process all the ap­pli­ca­tions.

“We have dou­ble the num­ber of visas we’ve had avail­able for decades,” she said. “That is kind of tem­porar­i­ly cre­at­ing a very open sit­u­a­tion.”

U.S. hos­pi­tals are strug­gling with a short­age of nurs­es that wors­ened as pan­dem­ic burnout led many to re­tire or leave their jobs. Mean­while, coro­n­avirus cas­es con­tin­ue to rise and fall, plac­ing tremen­dous pres­sure on the health care sys­tem. In Cal­i­for­nia alone, there’s an es­ti­mat­ed gap of 40,000 nurs­es, or 14% of the work­force, ac­cord­ing to a re­cent re­port by the Uni­ver­si­ty of Cal­i­for­nia, San Fran­cis­co.

Hos­pi­tals are fill­ing the gap by hir­ing trav­el­ing nurs­es, but that can be ex­pen­sive. And hos­pi­tal ad­min­is­tra­tors say not enough nurs­es are grad­u­at­ing from U.S. schools each year to meet the de­mand.

Some hos­pi­tals have long brought nurs­es from the Philip­pines, Ja­maica and oth­er Eng­lish-speak­ing coun­tries, and more are now fol­low­ing suit. And both long­time re­cruiters and new­com­ers are try­ing to take ad­van­tage of the green card wind­fall be­fore the fis­cal year ends in Sep­tem­ber.

The U.S. typ­i­cal­ly of­fers at least 140,000 green cards each year to peo­ple mov­ing to the coun­try per­ma­nent­ly for cer­tain pro­fes­sion­al jobs, in­clud­ing nurs­ing. Most are is­sued to peo­ple who are al­ready liv­ing in the Unit­ed States on tem­po­rary visas, though some go to work­ers over­seas. This year, 280,000 of these green cards are avail­able, and re­cruiters hope some of the ex­tras can be snapped up by nurs­es seek­ing to work in pan­dem­ic-weary hos­pi­tals in the Unit­ed States.

The Biden ad­min­is­tra­tion, which has made moves to re­verse Trump-era poli­cies re­strict­ing le­gal im­mi­gra­tion, has tak­en some steps to try to help for­eign health care work­ers so they can as­sist with the pan­dem­ic. U.S. Cit­i­zen­ship and Im­mi­gra­tion Ser­vices said it would speed the re­new­al of work per­mits for health care work­ers, which could help keep some for­eign cit­i­zens al­ready in the Unit­ed States on the job. The State De­part­ment told con­sulates last year to pri­or­i­tize ap­pli­ca­tions for work­ers at fa­cil­i­ties that are re­spond­ing to the pan­dem­ic, an agency of­fi­cial said.

Faith Ak­in­made, a 22-year-old nurse from Nige­ria, is among those hop­ing for a quick so­lu­tion. Af­ter com­plet­ing col­lege in the U.S., Ak­in­made has been work­ing as an ICU nurse for Uni­ver­si­ty of Louisville Hos­pi­tal in Ken­tucky. But her work per­mit is set to ex­pire in March. She said she needs it re­newed, or her green card ap­proved, to stay on the job.

“At this point and time, I just feel like I have faith that at the end of March some­thing is go­ing to show up to con­tin­ue to work,” Ak­in­made said. She said the is­sue af­fects many of her in­ter­na­tion­al col­leagues as well as do­mes­tic ones, who may be pressed to take on shifts for col­leagues if their im­mi­gra­tion pa­per­work doesn’t come through.

Dr. Rox­ie Wells, pres­i­dent of Cape Fear Val­ley Hoke Hos­pi­tal in Rae­ford, North Car­oli­na, said she start­ed try­ing to bring over for­eign nurs­es be­fore the pan­dem­ic, but it wasn’t un­til last year that these re­cruits start­ed get­ting con­sular in­ter­views in larg­er num­bers. So far, about 150 were ap­proved to come work, but Wells said they’re still wait­ing on an­oth­er 75.

“Ob­vi­ous­ly it has be­come more nec­es­sary dur­ing the pan­dem­ic,” she said. “The 150, if we didn’t have them, we would be in a pre­car­i­ous sit­u­a­tion.”

The surge in the omi­cron vari­ant in the Unit­ed States has made the strained staffing sit­u­a­tion even more ap­par­ent in hos­pi­tals as health care work­ers, like so many oth­ers, have been sick­ened by the high­ly con­ta­gious virus and side­lined from work at a time when more pa­tients are com­ing in.

Sinead Car­bery, pres­i­dent of Nurse Staffing So­lu­tions for AMN Health­care, said the de­mand for in­ter­na­tion­al nurs­es has risen be­tween 300% and 400% since the pan­dem­ic be­gan. The num­ber of nurs­es that can be brought in­to the Unit­ed States even with the ad­di­tion­al green cards won’t be enough to meet de­mand, and many more re­cruiters are now seek­ing to hire nurs­es over­seas be­cause there are im­mi­grant visas avail­able, she said.

“This is a win­dow of op­por­tu­ni­ty,” she said. “Be­cause every­thing is flow­ing so well, there’s a lot of com­pe­ti­tion for that tal­ent.”

Na­tion­al Nurs­es Unit­ed, a union rep­re­sent­ing 175,000 reg­is­tered nurs­es, said more scruti­ny should be giv­en to in­ter­na­tion­al re­cruit­ment to en­sure for­eign nurs­es aren’t brought in and sub­ject­ed to un­safe work­ing con­di­tions. The union con­tends hos­pi­tals drove away U.S. nurs­es by keep­ing staffing lev­els so low — and this was well be­fore con­cerns arose about work­er safe­ty and pro­tec­tions dur­ing the COVID-19 pan­dem­ic.

Michelle Ma­hon, the union’s as­sis­tant di­rec­tor of nurs­ing prac­tice, said many for­eign nurs­es sign years­long con­tracts with em­ploy­ers, which can make it hard for them to speak up about la­bor or pa­tient safe­ty con­cerns. She said hos­pi­tals that saw nurs­es quit dur­ing the pan­dem­ic are turn­ing to an over­seas work­force to re­place them.

“This kind of dy­nam­ic is par­tic­u­lar­ly at­trac­tive right now to em­ploy­ers who have not made any of the changes nec­es­sary to en­sure pa­tient and nurs­ing safe­ty dur­ing this COVID-19 pan­dem­ic,” Ma­hon said. “In­stead of them ad­dress­ing the ac­tu­al prob­lem, they want to go and piv­ot to this oth­er re­al­ly fake so­lu­tion.”

Hos­pi­tal ad­min­is­tra­tors, how­ev­er, con­tend there sim­ply aren’t enough U.S.-trained nurs­es to go around. Pat­ty Jef­frey, pres­i­dent of the Amer­i­can As­so­ci­a­tion of In­ter­na­tion­al Health­care Re­cruit­ment, said the Unit­ed States should ex­pand nurs­ing ed­u­ca­tion pro­grams to train more nurs­es do­mes­ti­cal­ly, as well as let more nurs­es come in from over­seas. But she ac­knowl­edged bring­ing in a much larg­er num­ber of nurs­es would re­quire leg­is­la­tion.

“The calls are every day ring­ing off the hook: We need 100, we need 200, we need all these nurs­es,” Jef­frey said.

Jorge Almei­da Neri, a 26-year-old nurse from Por­tu­gal, ar­rived in the Unit­ed States in De­cem­ber, though he be­gan the process be­fore the pan­dem­ic. He said a re­quired in­ter­na­tion­al nurs­ing ex­am was de­layed due to the virus and it took four months to get a con­sular in­ter­view, though oth­er in­ter­na­tion­al nurs­es he’s met wait­ed much longer. He in­ter­viewed for his cur­rent job at a Vir­ginia hos­pi­tal, which he got through a staffing agency, about a year ago.

“Af­ter get­ting every­thing cer­ti­fied, the im­mi­gra­tion process start­ed, and I was like, ‘Oh, this is go­ing to be quick.’ I was wrong,” he said.

Almei­da Neri said many Por­tuguese nurs­es seek work over­seas since wages are low, though many go else­where in Eu­rope, which doesn’t take as long as the Unit­ed States.

De­spite the de­mand, there’s no guar­an­tee hos­pi­tals will in fact snap up more visas. Greg Siskind, an im­mi­gra­tion at­tor­ney, said U.S. con­sular of­fices aren’t re­quired to is­sue visas sole­ly be­cause they’re avail­able, and are ham­pered by lim­its on re­mote work and video in­ter­views. He said most em­ploy­ment-based green cards tend to go to pro­fes­sion­als al­ready in the Unit­ed States, not over­seas, though more could be done to speed these up, too.

“Un­der their cur­rent poli­cies, if they don’t make any changes, it is go­ing to be hard,” he said of the like­li­hood the U.S. gov­ern­ment will is­sue all the avail­able visas, “but there’s a lot of things they could do.”