Nursing Shortage Is Hurting Those Least Among Us: America’s Disabled Children

The scope and severity of America’s nursing shortage can be understood easily enough: Hundreds of thousands of unfilled job openings in every corner of the country have led to ballooning staffing ratios and declining patient outcomes.

Policymakers think they understand the crisis, but theirs is a detached, clinical view. For them, it’s a simple math equation of supply and demand. But for too many American families, it’s a question of life and death and a story of sleepless nights caring for their medically vulnerable children.

New mother Charissa Ostrom understands this shortage firsthand. Last year, she gave birth to a daughter with a rare genetic condition that requires a permanent tracheostomy tube and the assistance of a ventilator to breathe. Eight months later, baby Evelyn remains at the hospital because her parents still cannot find and hire at-home nursing care.

Said another way: An innocent baby and the mother that loves her desperately have become de facto prisoners of America’s nursing shortage.

Sadly, baby Evelyn’s story is one among too many. Today, there are children on ventilators and anxious parents watching over them in every pocket of the country. These children and their parents would have the in-home medical care that health insurance and federal policy provides in an ideal world, but ours is far from an ideal world.

The United States has endured a shortage of registered nurses for decades, but two unrelated trends — a grey tsunami of more than 500,000 baby boomer nurses who will retire by 2022 and concerns that as many as one-third of nurses will stop practicing because of burnout from the coronavirus pandemic — are exacerbating the crisis in ways we’re only now grasping.

Economists count about 4 million working registered nurses across the United States and most practice in hospital settings. At the same time, there are an estimated 4.5 million Americans, including hundreds of thousands of children, with life-threatening disabilities who require in-home medical care by nurses, aides and therapists.

But the urgency over the previous year to treat a historic influx of critical care patients drew many nurses away from home-care settings. Other nurses retired or left the profession prematurely because the emotional trauma of practicing during the coronavirus was so significant. That’s left countless families unable to find the care their children and loved ones require to survive.

Nursing schools have struggled for many years to train enough new clinicians to offset retirements and the rising demand for health care. Instead, hospitals have bridged the gap by recruiting foreign medical talent, and they’ve been wildly successful at it. As of 2020, as many as 1 in 6 nurses in the United States were highly qualified immigrant clinicians, and we could have many more treating patients if the US State Department prioritized the visa processing of international nurses.

The United States Citizenship and Immigration Services has approved green cards for at least 5,000 skilled international nurses. But their relocation has stalled indefinitely amid a massive processing backlog at U.S. embassies and consulates, who have effectively de-prioritized their applications under State Department protocol. These rules place nurses in the very lowest priority tier, at the back of a very long line to get into the country.

Lawmakers and reporters alike have requested information from the State Department as to why these nurses cannot break through the bureaucratic logjam. No answers — certainly no satisfactory ones — have been provided.

The pointed refusal by the State Department to schedule and prioritize the visa processing of qualified health care workers is hurting American families who desperately need in-home nursing care. If the U.S. Embassy in the Philippines would start prioritizing exit interviews with health care professionals, baby Evelyn could go home for the first time by her first birthday.

America’s nursing shortage isn’t just a math equation. It’s real people, consequences and pain. If more policymakers lived the shortage like so many families, this shortage would be a thing of the past.

Patty Jeffrey, a Florida-based expert on the U.S. nursing shortage, is chair of the American Association of International Healthcare Recruitment and serves as vice president of international operations for MedPro International, which recruits foreign-educated health care professionals.

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