When it comes to enabling mass migration, legal or not, the nursing profession has few peers. For the last several years, its representatives have been pressuring Congress to boost the number of work visas available for foreign-born nurses. The rationale is to alleviate labor shortages. Yet if enacted, either one of two active proposals would dig the hole even deeper. 

There are now over 4 million working nurses in America. About 15 percent arrived from elsewhere through a visa, mainly the EB-3, which provides permanent residency for workers in “skilled” occupations requiring at least an associate’s degree, or the H-1B, which allows domestic employers to sponsor foreign workers in “specialty occupations” for at least three years. The Philippines is by far the main sending nation, accounting for over 60 percent of all recipients.  

The use of visas to import nurses implicitly rests on the assumption that nursing is a job Americans can’t or won’t do. We do have a real nursing shortage. According to the Bureau of Labor Statistics, the national shortage rate in 2022 was 9.22 percent. But it’s not due to reasons routinely given by the oracles of respectable opinion.  

Thanks to the Biden-Harris administration’s obsession with opening our southern border, we are hosting an explosion of unassimilable Third World migrants, especially from Central America. Many of these newcomers check in at our hospitals, free of charge. The extra patient load has led to exhausting work schedules for existing nurses because hospitals can’t afford to hire enough new ones. Attrition often ensues. And the cycle continues. 

Two decades ago, California had a nursing job gap of roughly 14,000. By 2021, researchers at the University of California, San Francisco concluded that the shortage had risen to over 40,000. Surprising? Given that the state’s estimated immigrant population is now 10.6 million, 2.2 million of whom reside in the U.S. illegally, it shouldn’t be. 

Meanwhile, in Texas, vacancies for registered nurses nearly tripled from 6 percent to 17 percent from 2019 to 2022. The figure almost certainly has risen further. Indeed, during a five-day period last December, roughly 50,000 unauthorized migrants entered the state. Hospital nurses are feeling the stress. “Nurses are now finding their voice and saying, ‘we shouldn’t have to tolerate this anymore,’” observed Serena Bumpus, president of the Texas Nurses Association. “So some nurses are choosing to leave to go find alternative places to work outside of the hospital setting.”

If there is a villain here, it is the Emergency Medical Treatment and Active Labor Act (EMTALA). Enacted by Congress and signed by President Reagan in 1986, this legislation requires all medical facilities that accept Medicare payments to provide free emergency care to incoming patients, regardless of citizenship, legal status, or ability to pay. No patient can be turned away. Failure of a hospital to comply could mean steep fines and even the loss of Medicare reimbursements. 

The impact of EMTALA can be felt in delayed care, higher patient bills (for those who actually pay) and employee burnout. Yet given that the law was hatched in a fit of egalitarian hubris, repeal is unthinkable. As one chief original backer, then-Sen. David Durenberger, D-Minn., stated during debate, “Americans, rich or poor, deserve access to quality health care.” For the last nearly 40 years supporters of the law have echoed this sentiment. Never mind that migrants are not Americans.

Nursing organizations, for their part, are hooked on the prospect of more visas. Patty Jeffrey, president of the American Association of International Healthcare Recruitment (AAIHR), explained:   

We’re reaching a dangerous inflection point where acute nurse staffing shortages feed burnout in a force-multiplying cycle that grows worse every day. Until we can correct capacity issues that force nursing schools to reject thousands of qualified applicants annually, international nurses will remain essential to safe nurse staffing. The latest visa freeze halts the flow of qualified international nurses when American hospitals need them most, and the only way to correct it is through congressional action.

AAIHR is part of a coalition calling for a dramatic expansion of visas for foreign-born nurses and other medical personnel. Congress obliged them last year with two new proposals.   

The bipartisan Healthcare Workforce Resilience Act introduced last November would set aside 40,000 employer-sponsored visas for foreign-born doctors and nurses. Of this total, 15,000 would go to doctors and 25,000 would go to nurses. Recipients would have to undergo background checks. Employers would have to confirm that no American worker would be displaced (good luck with that!). And new visas would be drawn from a pool of unused, preexisting ones. 

The bill’s sponsors have made the expected noises. Rep. Yadira Caraveo, D-Colo., speaking of a “national physician and nurse shortage,” declared: “Bureaucratic delays keep thousands of qualified doctors and nurses stuck overseas instead of coming here to fill this critical gap.” Tom Cole, R-Okla., an archetypical useless Republican, lends an aura of bipartisanship. Back in 2018 he dismissed Trump’s plan to construct a border wall as “a fight not worth having now.” Of the proposed Healthcare Workforce Resilience Act, Cole asserted, “Considering that Oklahoma has the third largest shortage of primary care doctors in the nation and a shortage of nurses well above the national average, there is clearly a need for solutions to strengthen our health care workforce and increase the capacity for delivering critical care.”

The other bill, the Nurse Staffing Standards for Hospital Patient Safety and Quality Care Act, unveiled months earlier in 2023, is co-sponsored by Rep. Jan Schakowsky, D-Ill., and Sen. Sherrod Brown, D-Ohio. It would require hospitals participating in Medicare (i.e., virtually all of them) to establish minimum nurse staffing levels by service category or face the loss of Medicare funding. While not calling for more visas, it advocates such a goal all but in name.

National Nurses United, which ferociously opposed former President Trump’s border protection efforts, is all-in with this shakedown. The 225,000-member, Silver Spring, Md.-based union recently assembled a chart listing its ideal enforced minimum nurse-to-patient ratios, which calls for a significant expansion of the nursing work force. Self-interest is easy to detect here, as its ratios would lead to more members, dues collections, and collective bargaining power. 

The American Nurses Association also supports the Schakowsky-Brown measure. “This legislation is an example of intentional action that demonstrates the value of nursing care and the nursing workforce,” stated ANA Chief Nursing Officer Debbie Hatmaker.

State governments already have launched their own versions. California and Massachusetts for several years have mandated nurse-to-patient ratios by service category. Connecticut, Illinois, and New York each impose minimum staffing requirements, though without explicit ratios.

The interplay between mass migration and nurse staffing can be seen as a variation on Parkinson’s famous law: the number of workers within public administration, bureaucracy, or officialdom tends to grow, regardless of the amount of work to be done. As migration to the U.S. remains high, so do migrant health care “needs.” This translates into a need for more visa-holding nurses, especially those fluent in the patients’ native languages. With higher staffing levels, in turn, hospitals can expand their services and fully comply with federal law. 

Under the guise of “compassion,” then, unfunded EMTALA mandates have led to an entirely avoidable crisis in nursing employment and hospital solvency. Dozens of U.S. hospitals near the Mexican border in fact have closed their doors or are sliding toward bankruptcy. One facility on life support is Yuma Regional Medical Center. By early 2023 the hospital had racked up at least $20 million in unpaid debt thanks to the crush of nonpaying migrants, especially pregnant women, entering Arizona. 

Broadly speaking, the nursing profession, which is overwhelmingly female, is helping to facilitate the West’s nonwhite population transformation. As I discussed months ago in these pages (“Trans Lunacy: The Feminine Touch,” February 2024 Chronicles) women more than men are genetically wired for intergroup altruism. This makes nurses ideal functionaries in the emerging global rainbow regime dedicated to weaving together sentimentality, an expanding administration, and moral scolding.

An April 2020 article in the trade magazine Nursing World, “Nurses as Immigration Advocates,” typifies the world-saver sensibility. Its authors write:

Social justice, or the belief that economic and social inequality affects health and should be addressed, is a concept at the core of nursing. There is a long tradition of nurses acting as advocates for vulnerable populations within healthcare
settings. The American Nurses Association (ANA) and the International Council of Nurses’ (ICN) codes of ethics mandate that all nurses work to advocate for social justice. Thus, nurses are expected to use these ethical principles in practical applications in their professional roles. 

Immigrants are considered one of the most vulnerable populations in the United States. This article will discuss immigrant vulnerability in the healthcare system and offer a framework to increase understanding about why these vulnerabilities exist. We will address ways that nurses can advocate on immigrants’ behalf individually; within a hospital system of community; and at the federal level.

We get it, we get it. Immigrants are cuddly, helpless, and vulnerable.

Oddly, the authors seem uninterested in vulnerable Americans, including those murdered by illegal migrants. Perhaps they could talk to family members and friends of the late Laken Riley or Jocelyn Nungaray. Mainstream journalists, eager to regale the public with migrant health care sob stories, might do likewise.

Our national nursing shortage is a self-fulfilling prophecy. The mass migration that health care industry officials find so heartwarming is driving this shortage. These professional altruists should pay more attention to American patients suffering from longer wait times, lower quality care, and higher costs. 

But that might be expecting too much. After all, they would have to recognize that America is a nation, not an enormous global emergency room.