Retrogression - an update



The following article on retrogression was updated in January 2010.

Nursing shortages have been experienced by a number of countries and have been cyclical for decades, however the current US nursing shortage is only expected to steadily increase as the population gets older and their healthcare needs increase. This is coupled with the fact that US nursing schools struggle to meet enrolment levels, due to lack of teaching faculty.


The US nursing shortage means that there are many US nursing jobs across the country left unfilled. The American Association of Colleges of Nurses highlights the following statistics on their site


Despite the current easing of the nursing shortage due to the recession, the US nursing shortage is projected to grow to 260,000 registered nurses by 2025 according to Dr. Peter Buerhaus in his report in Health Affairs in July/August 2009.


On July 2, 2009, the U.S. Bureau of Labor Statistics (BLS) reported that the healthcare sector of the economy is continuing to grow, despite significant job losses in nearly all major industries. Hospitals, long-term care facilities, and other ambulatory care settings added 21,000 new jobs in June 2009, a month when 467,000 jobs were eliminated across the country. As the largest segment of the healthcare workforce, RNs likely will be recruited to fill many of these new positions. In September 2009, the BLS confirmed that 544,000 jobs have been added in the healthcare sector since the recession began.


As fewer new nurses enter the profession, the average age of the Registered Nurse (RN) is climbing. The 2004 National Survey of Registered Nurses showing that the average age of the US RN population in March 2004 was 46.8 years old, and a survey conducted by the Bernard Hodes Group reported that 55% of surveyed nurses intended to retire between 2011 & 2020. The analysed data also demonstrates that all 50 US states will experience a shortage of nurses to varying degrees by 2015.


In a web based report by Dr. Peter Buerhaus it seems that despite an increase in employment of 185,000 hospital RN’s in the US since 2001, there is no empirical evidence to show that the US nursing shortage was being addressed. This means that there will be a continuous need for nurses to fill US nursing positions and in 2007 there were more than 116,000 US nursing job vacancies, nationwide.


Every nurse wishing to work in the US must have passed the NCLEX-RN, have accepted a job offer and have an I-140 visa (green card). The US Congress imposes a limit on the number of visas issued over defined periods. The total number of visas is divided between all applicants according to the category of eligibility. As of October 31, 2006 the number of green cards issued had reached the maximum number and the issuance of green cards for nurses and PT’s effectively came to a halt, or rather put into a holding pattern. Retrogression is a term which refers to the holding pattern in regards to I-140 visas (green cards) for nurses and PT’s.


What does this mean for nurses wishing to work in the US? Many nurses who dream of working in the US have put their plans on hold as I-140 visas are now in retrogression as they believe that they will be in a better position by delaying their application until retrogression is lifted. However many US hospitals are continuing to recruit nurses from overseas because they are experiencing a chronic nurse shortage and they need to continue their international recruitment campaigns. None of these employers would continue to recruit from overseas if they didn’t believe that retrogression will end soon.


It can take 6 to 9 months to register with a US state nursing board, complete the NCLEX-RN, receive and accept a job offer and apply for a visa. It is therefore better to complete the formalities and be in the queue waiting for retrogression to be lifted, than to find yourself competing with other nurses for job offers and green cards when the quota is increased.


On the bright side there has been some forward movement in regards to the end of retrogression, by way of the Emergency Nursing Supply Relief Act which was approved by the House Immigration Subcommittee last year. This bill provides for a quota of 20,000 visas for nurses and PT’s per year, and for applications to be reviewed within 30 days. The nurse’s family members’ visas are not to be counted as part of the 20,000 visas.  President Obama’s immigration plan on his pre-election website specifically supports improvements to the immigration system to increase the number of people allowed into the US to a level that keeps families together and meets the demand for jobs that employers cannot fill.


Currently (January 2010) President Obama is introducing a new Healthcare Act that will have far-reaching effects on the US healthcare system. Separately there are plans to radically over-haul the immigration system and to give health care workers and nurses special status that could see the immigration process streamlined. watch this space for more details.


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