For some hospitals, broadening their recruitment parameters means national advertising campaigns to interest professionals in relocating to their communities or encouraging older nurses to return to the workforce. Others have established community outreach programs or partnerships with nursing schools to develop a pipeline of new graduates. Still others rely on travelers and local per diem or agency nurses as short-term solutions. A growing number of institutions, however, have set their sights on foreign-trained professionals as a component to bridge the gap and fill out the staffing mix.

"During the last few years, foreign nurses have had an increased presence in U.S. healthcare facilities," says James R. Mayock, JD, managing partner of Elliot & Mayock, LLP, an immigration law firm with offices in Washington, DC, and San Francisco, California. "They are a major component behind putting more nurses into the marketplace."

"Facilities that are planning a new wing or another unit are looking at international candidates as a staffing solution," notes Lalit Pattanaik, JD, chief executive officer of RN India, an international staffing company specializing in recruiting Indian providers and headquartered in Costa Mesa, California. "These are long-term developments—executives who do not require nurses to be placed in the next few months can look forward to receiving staff with the necessary skill sets when they are most needed."

International recruitment is indeed a long-term process. "Foreign recruitment requires a cultivation of two years," asserts Gregory Siskind, JD, partner at Siskind Susser, an immigration law firm based in Memphis, Tennessee, with additional offices in the U.S., Canada, Mexico, Argentina, and the People's Republic of China. "To achieve success, hospitals must make the commitment for long-term employment and put the infrastructure in place to administer to the nurses' needs. By the same token, placement firms have to do their jobs, making sure that nurses are trained and orientated adequately."

Paying attention to details Years ago, the U.S. Citizen and Immigration Services (USCIS) categorized nursing as a specialized profession that qualified for short-track Visas. Foreign-trained nurses could gain special permission to work in the country and circumvent the lengthy Green Card process. Once on the job, they could pursue extended residency through the Green Card. The regulation, however, has since been rescinded.

"There no longer is any significant Non-Immigrant Visa that is easily available for healthcare providers who want to immigrate to the United States," states Mr. Mayock. "International nurses have been grouped in with other professionals who are perceived to be a threat to American workers," explains Mr. Siskind. "Ironically, foreign-trained nurses are typically received well by staff and management who realize they were hired to relieve overworked core personnel and provide much needed care. These nurses have a reputation for being hardworking, easy to work with, and very skilled, with excellent bedside manners."