The rapid spread of the omicron variant threatens to challenge an already stressed health care system in the U.S. Nearly 1 in 5 health care workers have quit their job during the pandemic and the Labor Department projects a shortfall of more than a million nurses in the coming year. A recent survey by a large health care staffing firm suggests there’s one group that may be less likely to quit – foreign-born nurses.

Leo-Felix Jurado left the Philippines to come work as a nurse in the U.S. in the late 1980s.

“My mother always wanted me to come,” he said. “So I took the exam and passed it, and I was here when I was 22 years old.”

Because of its colonial history with the U.S., the nursing curriculum in the Philippines is very similar and the country has been a major source of immigrant nurses since World War II.

“Every time there’s a U.S. shortage, the U.S has turned to the Philippines for help,” said Jurado.

Now a professor of nursing at William Paterson University in New Jersey, Jurado said Filipino nurses often end up taking jobs in high stress environments that others might refuse.

“Obviously, they don’t have choices when they’re being recruited because they just want to come to America,” he said.

That may have contributed to disproportionate risks during the pandemic. Filipinos made up more than a quarter of COVID-19 deaths among nurses, despite being only 4% of the workforce.

The survey of nurses from the Philippines and other countries by AMN Health Care, a nurse staffing firm, showed international nurses were more likely to work in emergency and intensive care, and the majority had treated many COVID-19 patients.

More than 80% were burnt out, and yet a nearly identical share said they were satisfied with their job, said Sinead Carbery, president of O’Grady Peyton International, an international recruiting division of AMN.

“We conclude from the survey that they have a high level of resilience,” said Carbery.

Of course, these nurses may have a different calculus for staying in their jobs – their immigration status sometimes depends on it. Based on their level of licensing, nurses can come to the U.S. on either short-term H1B visas, or by being approved for a green card. 

Both options are in very limited supply, and inadequate to quickly fill the shortage said Amy Erlbacher-Anderson, an immigration lawyer with Baird Holm in Omaha, Nebraska.

“Even if you’re lucky enough to be able to get an immigrant visa, you can’t get an appointment at a consulate to get a stamp to come here and to start working,” she said.

The pandemic has created a massive backlog for interviews on applications that have already been approved.

“I just recently finally got two nurses out of the Middle East who’ve been approved since the middle of 2019,” said Erblacher-Anderson.

In September, the U.S. State Department announced embassies could prioritize visa applications for health care workers on a case by case basis.