Nebraska is at risk of becoming a health care desert. Thirty counties currently lack hospitals, staff and infrastructure serving the rural population. At the same time, many of the hospitals we do have lack nurses and rely on hiring traveling labor from other states, which is costly. It’s estimated Nebraska needs to hire 5,435 nurses to fill this gap.
This is affecting Nebraskans’ health outcomes, especially in the areas of maternal health, primary care and end-of-life care. But there is an obvious solution: welcoming more skilled migrant health care workers.
Migrants play an essential role at all levels of the health care ecosystem — and they are vital when foreign patients face linguistic and sociocultural challenges. Nebraska is home to a growing and diversified migrant population. In 2021, nearly 143,000 of the state’s residents were foreign born. A portion of these workers were heath care workers in their home countries, yet cannot work in their field in the United States.
As it stands, foreign-educated nurses, nurse aides and physicians must undertake lengthy exams and training in order to work here. For nurses, Nebraska requires the Commission on Graduates of Foreign Nursing Schools exam, followed by the National Council Licensure Examination. Foreign-trained physicians, meanwhile, are often required to pass up to three U.S. Medical Licensing Exams and re-complete a residency program.
Most international medical physicians must also apply for an H-1B or J-1 visa in order to come to the United States and enroll in residency programs. Unfortunately, fewer and fewer programs are sponsoring these visas due to cost and time requirements. Even when successful, these processes can take years for workers and their spouses, delaying the start of training.
While most immigration policy is made at the federal level, Nebraska does have tools to address this situation.
The Nebraska State Boards and hospitals could remove some of the requirements for foreign-trained doctors and nurses. Many of these policies are set at the state board level, giving our health care leaders flexibility to address the shortage. New Mexico, Oregon, Arizona, Utah and New York, for example, have already eliminated the CGFNS exam for nurses.
Boards could also issue more temporary restricted licenses for foreign-trained physicians and allow them to work in rural areas without them having to re-complete a residency program. Many states have begun relaxing requirements and issuing temporary licenses to allow physicians to work in rural areas — and Illinois and Tennessee have passed legislation to allow foreign physicians a pathway to permanent licensure.
Nebraska’s congressional representatives should put pressure on federal agencies to accelerate the visa granting process for foreign trained workers and their spouses. This would reduce the financial and emotional burden placed on families and more quickly staff positions in which health care labor is needed.
Finally, to assess key challenges and progress over the long term, a consortium is needed, with relevant public and private sector collaboration to address the issue of foreign-trained skilled health care workers going forward.
To be sure, foreign-trained health care workers do not have the same educational background as U.S.-trained staff. While this is a valid concern, frequent training once on the job could assure that staff stay up-to-date with advances and clinical guidelines. This is already a regular practice for traveling nurses and physicians, who receive training when they switch hospitals to stay up to speed. The same could be done with migrant health care workers, which would be more economical than hiring costly traveling health care workers.
Critics might also point to the linguistic barrier that foreign staff may face. On the contrary, these workers would be a tremendous linguistic and cultural asset to the care of our growing migrant patient population.
While the majority of the immigration narrative focuses on undocumented migrants, it is important to remember that skilled legal migrants also face difficulties and sometimes prejudice during their process toward being legally allowed to work in the United States. As Nebraska’s health care system suffers due to a lack of skilled workers, it is imperative that we incorporate more skilled health care migrants into the workforce so we don’t become a health care desert.
These changes will require collaboration between government and the private sector, as well as a reduction in the stigma typically associated with foreign-trained workers and migrants. But the opportunity exists – we only have to be brave enough to pursue it.
