International nurse recruitment to U.S. skilled nursing facilities increased 45% year-over-year in 2025, as operators facing persistent domestic workforce shortages turn to overseas labor markets. The Philippines, Jamaica, and other Caribbean nations have emerged as primary source countries, providing registered nurses willing to relocate for wages that far exceed local compensation.
Recruitment Landscape
Industry estimates suggest that approximately 8,000 internationally educated nurses joined the SNF workforce in 2025, up from 5,500 in 2024. The increase reflects both expanded recruitment efforts by facilities and improved visa processing times following pandemic-era backlogs. Large multi-facility operators have established dedicated international recruitment programs, with some maintaining permanent recruitment offices in Manila and Kingston.
The typical pathway involves facilities sponsoring nurses for EB-3 skilled worker visas, a process that takes 18-24 months from initial contact to arrival in the U.S. Nurses must pass the NCLEX-RN examination before visa issuance and complete additional training on U.S. clinical practices and documentation requirements upon arrival.
Cost-Benefit Analysis
International recruitment involves significant upfront investment. Facilities report total costs of $15,000-$25,000 per nurse, including recruitment fees, visa sponsorship, travel, and initial housing assistance. However, this compares favorably to agency nurse costs that can exceed $80 per hour in high-demand markets, or the revenue lost from unstaffed beds.
Retention rates for international nurses generally exceed domestic hires, with three-year retention rates of 85% compared to 60% for domestically recruited RNs. Visa sponsorship creates a mutual commitment: nurses are tied to the sponsoring employer during the green card process, while facilities benefit from workforce stability.
Ethical Considerations
The surge in international recruitment has raised ethical concerns from public health advocates and nursing organizations in source countries. The Philippine Nurses Association has called for limits on nurse emigration, citing domestic healthcare workforce shortages exacerbated by the outflow of trained professionals to wealthy nations.
The World Health Organization’s Global Code of Practice on International Recruitment of Health Personnel discourages active recruitment from countries with critical health worker shortages, though it lacks enforcement mechanisms. Some U.S. nursing organizations have called for ethical recruitment standards that include investments in healthcare education and infrastructure in source countries.
Operational Integration
Facilities report that successful integration of international nurses requires intentional cultural and clinical onboarding. Language differences, even among English-speaking nurses from the Philippines and Caribbean, can create communication challenges with residents and families. Clinical practice variations, particularly around medication administration and documentation, require training and adjustment.
Best practices include pairing international nurses with experienced mentors during their first 90 days, providing cultural orientation that addresses American healthcare practices and patient expectations, and creating support networks among international staff to reduce isolation and improve retention.
Policy Implications
Federal immigration policy significantly impacts international recruitment feasibility. The annual cap on EB-3 visas and country-specific quotas create bottlenecks that limit recruitment scale. Industry groups have lobbied for nursing-specific visa categories or exemptions that would accelerate the process, though immigration reform remains politically contentious.
The Healthcare Workforce Resilience Act, currently pending in Congress, would recapture unused immigrant visas from prior years for healthcare workers, potentially providing 25,000 additional visas for nurses and physicians. The bill has bipartisan support but faces an uncertain legislative path.