It's not access to face masks that should worry us about coronavirus — it's America's nursing shortage

It's not access to face masks that should worry us about coronavirus — it's America's nursing shortage
© Getty Images

As the United States continues to address an outbreak of the novel coronavirus that has confounded governments across the world, our already-frayed health care system is quietly incubating a deadly disease of its own: An acute nursing shortage that will undermine patient safety and confidence at a critical time for public health.

Before it's all over, this pandemic will expose what those in the industry have known for decades. America doesn't have enough nurses, and it's the country's caregivers and most vulnerable populations that will pay the price.

Indeed, the real question isn't whether we'll have enough protective gear like face masks for our health care professionals, but whether we'll have enough caregivers when this crisis reaches a crescendo.

ADVERTISEMENT
Even before the coronavirus, our system was on the verge of collapse.

An estimated 200,000 nursing positions are projected to go unfilled at hospitals across the country this year. All told, one-in-eight nursing positions will go unstaffed. Analysts believe about one-third of the country's nurses – more than one million altogether – will retire within the next decade as the post-World War II Baby Boom generation ages into their sunset years.

At the same time, demand for care by an aging population is skyrocketing. Seventy-five percent of Americans over 65 are living with multiple chronic conditions.

In an attempt to bridge this widening deficit, U.S. health care providers have begun increasingly relying on foreign-educated nurses and clinicians. By some estimates, as much as 16 percent of US nurses were foreign-educated.

Foreign-educated health care professionals are vital to preserving the United States' delicate health care staffing balance. Still, one of the country's most significant sources of foreign health care talent has been recently stung by a complicated, bureaucratic visa apportionment system that has effectively blocked all employment-based health care immigration.

ADVERTISEMENT
About one-third of foreign-educated U.S. nurses emigrated from the Philippines. But the country recently saw all employment-based (EB3) visas frozen amid a visa retrogression by the Department of State, driven by the surging demand for visas from individuals already in the U.S. adjusting status to an immigrant visa.

Congress determines the number of immigrant visas that can be issued each year while the Department of State administers them, regulating the number and type of visas offered to individual countries relative to global demand. The agency has broad authority to freeze all or certain types of visas from countries if it believes the cadency of immigration is surging too high.

Because the Philippines is such a vital source of health care talent, the Department of State's decision to retrogress immigrant visas means America will be denied more nurses at precisely the moment we need them most.

But why should ordinary Americans care about the legal ability of a hospital to recruit and hire a foreign-educated nurse from the Philippines or anywhere else? Simple: That nurse has a material impact on the care and welfare of their family. Even without the strain of the outbreak, we know that increasing a nurse's workload by just one patient increases patient mortality by 7 percent.

And in the context of coronavirus, which has disproportionately and acutely affected elderly and immunosuppressed populations in Asia and Europe, nurses will play an outsized and crucial role in delivering health care.

Worse, we know based on the experience of other countries that coronavirus is a caregivers' illness. In Italy's Lombardo region, one of the country's hardest-hit, as much as 10 percent of all nurses and doctors have been infected and placed in quarantine.

If the United States already has too few nurses to meet pre-coronavirus demand for care, what would happen in the event of sustained transmission of a deadly pathogen that also claims 10 percent of health care workers?

Now, more than ever, America needs its nurses, and every corner of government should be working in concert to make it happen.

Shari Costantini is a registered nurse who has spent two decades working to address chronic clinician shortages in the United States. She serves as president of the American Association of International Healthcare Recruitment (AAIHR).