Nurses have left the profession at historic levels while demand for their services increases as the U.S. population ages. To fill these critical positions, many health care providers are looking abroad to recruit from an international pool of qualified nurses.

“Demand is extraordinary right now,” said Sinead Carbery, head of international recruitment at AMN Healthcare, who added that requests for international nurses have tripled since before the pandemic.

The United States recruits nurses from all over the world, but no country has contributed more when it comes to filling critical nursing positions than the Philippines. It accounts for 27% of foreign-born registered nurses or around 150,000 people, according to the Migration Policy Institute.

“Filipino nurses that graduated from the Philippines go through four to five years of nursing training, and it’s rigorous,” said Mila Sprouse, who studied in the Philippines and is now chief nursing officer at Seattle’s Virginia Mason Medical Center.

“It’s not for the faint of heart, and so we are very well-positioned to actually take on challenges,” she said.

“Filipino nurses are very caring,” said Cristina Dimafiles, a nursing director at Baylor St. Luke’s Medical Center, who comes from a family of nurses from the Philippines.

Many of these nurses prefer to stay at the bedside, she said. “That’s why we are the big global exporter of nurses.”

Dimafiles has been at the front lines of the worsening nursing shortage playing out in U.S. hospitals, especially at the bedside, where nurses directly interact with patients. As a leader in her field, she’s concerned about training and retaining the next generation — and she sees how valuable Filipino nurses are in the mix.

“We have a lot of young, new nurses,” Dimafiles said.

“Bedside-wise, [there’s] not a lot of competencies there,” said JohnRich Levine, who is also a nursing leader at Baylor St. Luke’s. That’s why U.S. health care providers are eager to hire experienced, well-trained nurses — like those from the Philippines.

But Canada, the United Kingdom, Saudi Arabia and other countries are competing for foreign nurses as well. So much so that the Philippines is dealing with a nursing shortage of its own.

But those working abroad play a critical role in the Philippine economy because many send money home. Total remittances to the country account for 9% of gross domestic product, according to the Philippine Central Bank.

The desire to work abroad, especially in the United States, is strong. Salaries are high in the U.S., according to Mila Sprouse, who emigrated for economic reasons.

“I grew up in a poor family, selling tomatoes to go to school,” she said.

She has a nephew who is working as a nurse in the Middle East with his wife. Both have secured visas to come to the United States and are planning to relocate soon. “Because ultimately, the promised land is the U.S.,” Sprouse said.

Even though the demand for foreign nurses is high and nurses want to work in the U.S., meeting that demand isn’t simple, considering the current visa restrictions. 

“We’re dealing with limitations on visas that reduce the supply,” said Carbery with AMN Healthcare. The process of procuring visas for health care workers is facing delays.

“Timelines are extending,” said Carbery. “Right now, we are seeing it take anywhere from 18 to 24 months from the point of recruitment to arrival in the United States.”

Most foreign nurses need to go through the green card process before they come to the U.S., and slots are limited. In a typical year, nurses around the world compete for a pool of 40,000 visas that are targeted to many different kinds of jobs — not just nurses or other health care workers — and are also for employee family members. Nationalities are capped in the allotments.

“From year to year, we run out of immigrant visas for individuals from the Philippines,” said immigration attorney Amy Erlbacher-Anderson, who helps rural hospitals in the Midwest with visas for their international nurses.

“If you think the big cities have a hard time finding nurses, try being a small town in the middle of nowhere in Nebraska, Iowa or Kansas,” she said.

In the best of times, Erlbacher-Anderson said, the visa process takes a year. When the allotment falls short of demand, like now, it takes longer.

According to the most recent State Department visa bulletin, a Filipino nurse would have had to file their paperwork in 2020 to be issued a visa today.

Erlbacher-Anderson said that timeline started after an employer was already desperate enough to seek out a foreign nurse in the first place. The vacancy had probably been open for months before the employer turned to international recruitment.

“No employer goes straight to foreign workers because it’s an expensive process,” she said. And at the point that they’re hiring an international worker, they probably have multiple openings.

“You’re not going to get somebody to fill that tomorrow. You’re going to get somebody to fill that a year from now,” she said.

While Congress could pass legislation to increase visas for foreign nurses, Erlbacher-Anderson said that, after 20 years in the business, she’s not holding her breath.

“Until the ink from the president’s pen is dry on that sheet of paper, it’s not happening,” she said.