Vivian Barbosa lives in Sao Paulo, Brazil, and has worked as a registered nurse for more than 20 years.
She is applying for a visa to work in the United States as a nurse.
"There are many reasons why I want to leave, but the main one you'll hear from most Brazilians is the lack of professional recognition and the undervaluation of nursing professionals in Brazil," Barbosa told VOA.
The United States is facing a growing shortage of registered nurses as the baby boomer generation ages, increasing the demand for health care.
Many hospitals and nursing homes have recruited nurses from outside the U.S. to help fill vacancies estimated at nearly 200,000 a year, as burned-out nurses leave the field, according to the U.S. Bureau of Labor Statistics.
And because of high demand, the State Department stopped taking applications for employment-based visas, known as EB-3, which included nurses and other skilled workers for the remainder of the fiscal year that ended in September. Each year, about 40,000 of these visas are available, a cap unchanged since the category's creation in 1990.
In its latest update, the U.S. government said the annual visa limits on EB-3 would reset with the fiscal year that began October 1. That would allow embassies and consulates to resume taking applications for these visas.
The number of visas issued in October is not available. In September, no EB-3 visas were issued.
In a statement, Patty Jeffrey, president of the American Association of International Healthcare, said freezing visa applications is exacerbating staffing shortages across the U.S. health care system.
She said part of the problem is not enough U.S.-educated nurses.
"Until we can correct capacity issues that force [U.S.] nursing schools to reject thousands of qualified applicants annually, international nurses will remain essential to safe nurse staffing," she said in a statement to the media. "This 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."
For Barbosa, it means she does not know how long it will take to receive authorization to work in the U.S. as a nurse.
Foreign nurses
In Brazil, where Barbosa lives, there is a high number of nursing graduates.
According to Semesp, an organization representing higher education institutions in Brazil, nursing ranks fifth on the latest list of unemployed graduates, with nearly 1 in 4 graduates unable to find paid employment.
The International Council of Nurses, or ICN, has raised the alarm over countries losing their nursing workforce because of low pay and poor working conditions.
Howard Catton, CEO of ICN, also called for a global recruitment code to stop predatory recruitment.
"We are told that recruiters are [showing] up on graduation day to recruit nurses, but there isn't a return for the countries that are losing them. … If you're going to recruit nurses from a low-income country that's already challenged in terms of its health care, one of the real meaningful ways to give back is to say, 'We'll commit to build a nursing school so that the country can educate more nurses and meet its own needs,'" he said.
At the recent G20 summit in Rio de Janeiro, the ICN urged world leaders to commit to long-term investments in nursing education, improved working conditions and better pay. The outcome was a summit declaration that officially addressed recruitment practices that lure skilled professionals from vulnerable nations, aligning with the ICN's call for ethical workforce management.
"We support strengthening health workforce training, including through the WHO Academy," the declaration said, adding there is a need for better working conditions, education, and gender equity in health care professions.
At the G20 in Rio, the president of Brazil's national health council, Fernando Zasso Pigatto, recognized the need for improvement and said it is important that countries keep their workforce.
"Because ideally, countries should train professionals to address their local realities," he said. "These individuals live in those contexts and understand the specific needs of their communities."
Pigatto agrees that people should be allowed to move to other countries to work as nurses if they wish to do so, but he emphasized the need to address the root causes of nurse shortages and better pay.
"We know there are countries that do not invest [enough]," he said.
Catton of the ICN said that until nations address poor pay, working conditions, and lack of investment in education, the flow of health care professionals across borders will continue, with long-term consequences for both sending and receiving countries.
"Nobody stands in the way of the right of individual nurses to move and migrate. … That's a freedom we absolutely support. … But when they move, as well as the loss of the nurse to provide care, there's an investment that those counties have made, which they are also losing," he said.
Barbosa's situation highlights a broader challenge faced by health care systems worldwide.
But she won't wait any longer.
"It gets to a point, and it happens to every nurse practitioner here in Brazil, that we just get tired," Barbosa said.
Yan Boechat contributed to this report.
