Hospitals ramp up international recruitment

Faced with hundreds of vacant nurse positions and dozens of unstaffed hospital beds, executives at Henry Ford Health system dusted off an old strategy to offset the staffing shortage: international recruitment.

The system, which operates five hospitals across Michigan, planned to bring in 500 nurses from the Philippines—something it did in the 1990s and 2000s—under a multiyear plan, President and CEO Bob Riney announced in September 2021.

Almost 18 months later, however, those nurses have yet to land in Michigan. And Eric Wallis, the SVP and chief nursing officer at Henry Ford Health, told Healthcare Brew that the system expects them to start arriving this summer.

“The immigration process is slow,” he said.

It’s a scene that’s playing out at hospitals across the country. More health systems have taken their recruitment efforts abroad and started relying on US travel nurses to fill staffing shortages exacerbated by the pandemic.

And with pandemic-related stalls to the already lengthy US immigration and visa approval processes, many hospital administrators don’t see international recruitment as a quick fix to healthcare staffing challenges. The delays even prompted the American Hospital Association to urge Congress to expedite “visas for foreign-trained nurses.”

Searching overseas

CGFNS International reported that VisaScreen, the nonprofit’s visa credentials assessment service for health professionals looking to work in the US, saw a record 17,354 applications from 116 countries in 2022—up 44% increase from 2021 and 109% from 2018.

The bulk of VisaScreen applicants attended school in the Philippines (58%), followed by those who were trained in Canada (15%) and the US (7%).

Depending on labor needs, there are a few immigration pathways for those foreign-born workers.

Applicants from the Philippines usually go through the direct green card sponsorship process, also known as the Schedule A permanent residence process, which can take at least a year.

The Department of Labor designates nurses as Schedule A because there are “not sufficient US workers who are able, willing, qualified, and available” for the roles. If a hospital sets up a rolling green card application process, “eventually they’ll start getting a lot of these nurses on a regular basis,” said Yova Borovska, an immigration attorney at Buchanan Ingersoll & Rooney.

Wallis said execs at Henry Ford Health see international recruitment as a “midterm solution to a long-term problem.”

About 10% of the system’s nursing positions are vacant as of January, according to Henry Ford Health.

In addition to relying on foreign-born labor, Henry Ford Health has operated an internal staffing agency since 2013 and partnered with Michigan State University in 2021 to grow the system’s pipeline of new nurses.

About 420 international nurses have accepted employment offers that require at least a three-year work commitment, Wallis said. The first 50 to 75 of them are expected to come to Michigan as early as July.

Meanwhile, AdventHealth, a Florida-based health system, expects to hire over 400 foreign-born nurses in 2023, up from 280 in 2022, Cathy Henesey, the company’s VP of talent acquisition, told Healthcare Brew.

Building community

In addition to sponsoring visas, Henry Ford Health will provide the nurses with short-term housing (about 30–60 days) upon arrival, Wallis said. More than 50 nurses who came to Henry Ford Health from the Philippines in the ’90s have also volunteered to help the new nurses settle into life in the US.

“We’re trying to be thoughtful about creating a community […] so that people aren’t just coming and being dropped off in a country they’ve never been in and trying to figure it out,” he said.

The strategy isn’t cheap. The administrative costs associated with sponsoring just one H-1B visa—a popular, employment-bound nonimmigrant visa for specialty occupations—can range from $7,000–$8,000, according to Borovska. But she added that it is difficult to estimate visa costs since attorney fees and recruiting agency fees vary.

Wallis, however, said that the investment is worth it.

“When you have someone turn over, it costs [the system] something like one-and-a-half times their salary to replace them. So this process is significantly cheaper than that,” he said. “We’re certainly paying and partnering with a firm to help us recruit these folks and help us choose the best of the best. But as we did the math, it financially made sense for us to [recruit foreign-born nurses].”

Another benefit is that health systems will be able to reopen beds that closed in recent years or expand their healthcare offerings. Wallis pointed to the planned expansion of Henry Ford Health’s main campus as one reason why the system’s workforce needs to grow.

“We want to make sure that we’re running at full capacity,” he said. “We’re going to need new folks from areas that aren’t traditional Michigan nursing schools to help us stabilize the workforce a little bit until we can work on that part of the equation, too.”