Maryland, like much of the United States, has wrestled with a nursing shortage for decades — a seemingly incurable affliction — but a historic rate of burnout after treating patients through a grueling pandemic is about to make our nursing crisis much, much worse.
Even before the first coronavirus wave hit, health systems in Baltimore and virtually every corner of the state were already approaching collapse under the weight of too many patients and too few nurses. One pre-pandemic forecast estimated a local shortfall of 10,000 nurses and as many as 200,000 nationally. Now, worrying new data from a nationwide nurse survey shows that 36% of nurses are considering quitting.
If one-third of nurses vacate the bedside, our already-strained health care system will fail — it’s that simple. The question, then, becomes: How are hospitals going to offset what would be a historic, devastating exodus? As it turns out, we already have some of those nurses in the pipeline, but bureaucratic inefficiency prevents them from practicing.
According to one recent survey of the health care staffing industry, there are at least 5,000 qualified foreign nurses with approved green cards whose processing has been suspended without explanation by US embassies. The United States Citizenship and Immigration Services (USCIS) has already approved the immigrant worker petition for these nurses, verifying they have passed background checks and US licensure and English language proficiency tests, but embassies have failed to issue their visas. And no one can explain why.
As a practical matter, it means there are thousands of experienced nurses with sterling clinical records who could be treating patients this month if government employees did their jobs. When asked about the backlog by journalists, the U.S. State Department had no comment; they’ve similarly stonewalled inquiries from lawmakers. That’s unacceptable.
If you ask nurses — and we did — about the real-world impact on patients of the current shortage, nearly eight in 10 say hospital staffing has reached “unsafe levels.” More than half of nurses in the same survey reported workload increases of two or more patients over the last year. Fully 90% of nurses said their patients would benefit from additional nurses.
Model nurse staffing mix is one of the strongest predictors of positive patient outcomes. High nurse-to-patient ratios track with increased patient safety events, morbidity, and even mortality. One study by the National Institutes of Health found a 7% jump in patient mortality when a nurse’s workload is increased by just one patient.
Maryland is barreling toward catastrophe unless and until we listen to nurses when they say patients require more care. And we could provide those reinforcements almost immediately if U.S. embassies resumed a normal cadence of visa processing.
At the same time, there are legislative proposals that would offer more long-term relief to hospitals and patients by recapturing previously authorized but unused visas for qualified international nurses. The bipartisan Healthcare Workforce Resilience Act from Senators Dick Durbin and John Cornyn would recapture and reallocate 25,000 unused immigrant visas for nurses and another 15,000 for doctors.
The nursing shortage is not exclusive to just Maryland. Hospitals in places as varied as South Carolina and California have been scrambling for years to manage rising rates of chronic illnesses like heart disease and diabetes. Communities in every pocket of the country were starved for health care providers long before the pandemic, and that need will only grow as nurses leave the profession from burnout.
Policies that nurture the talent pipeline — by recapturing mothballed green cards or bureaucrats just doing their job — will have a measurable positive impact on patient outcomes in Baltimore. Listen to nurses.
Shari Costantini (ShariCostantini@avanthealthcare.com) is a registered nurse and president of the American Association of International Healthcare Recruitment. She also is the chief executive of Avant, a staffing and recruitment agency for international health care professionals.