SEPTEMBER 15, 2021—The frontline in the fight against the coronavirus is crumbling, and Washington is unfazed.

Traumatized and overburdened nurses in every corner of the country are eying the exits. Many have already vacated the bedside for early retirement or careers outside of healthcare. And who can blame them?

But America’s nursing shortage has become so acute that hospitals—large and small, rural and urban—are being forced to ration medical care. We’ll say it louder for those in the back: the United States is rationing healthcare because it has too few nurses to provision it.

• “Alaska E.R. patients are waiting hours in vehicles as a major hospital rations care,” read a headline in Wednesday’s New York Times. The paper reports that Alaska’s largest hospital is now operating under “crisis standards of care,” a protocol that leaves some patients with substandard care to manage crushing demand. One physician wrote that the hospital was “unable to provide lifesaving care to everyone who needs it.”
• In Idaho, the Department of Health and Welfare implemented “crisis standards of care” protocols. The designation impacts ten health systems across the state and means that ICU nurses might be treating as many as six patients at a time. The optimal nurse-to-ICU patient ratio is two-to-one in most jurisdictions. 
• The Detroit, Michigan Henry Ford Health System announced that it was closing 120 beds this week because it could not staff them. The bed closures come after 50 workers filed a federal lawsuit against the health system in an attempt to block its vaccination mandate.
• In Upstate New York, one hospital has suspended the delivery of babies after a wave of staff resignations left its labor room a ghost town.
• In Northwest Georgia, Calhoun County is negotiating an agreement to re-deploy non-medical government employees as emergency hospital personnel. 
• In North Carolina, 77 percent of nurses told pollsters their facilities have severe or moderate staffing shortages.
• In Alabama, a man died after being turned away from 43 separate hospitals that could not treat him.

When hospitals are understaffed, patients die avoidable deaths. 

Despite the bleak staffing outlook for hospitals across the United States, there remain thousands of qualified international nurses who are stuck in bureaucratic limbo.

• These nurses have sterling clinical records and have passed background checks, English language, and U.S. licensure tests. They even have job offers from U.S. health systems. What they lack—a quick green card exit interview—is something that U.S. embassies and consulates are either unwilling or unable to provide. This interview is the final procedural hurdle before a nurse may legally emigrate and treat patients.

Last month, the Department of State updated its visa processing protocols to provide a possible pathway for emergency visa processing of foreign healthcare workers. As it turns out, though, that pathway isn’t much of one at all. 

• State told embassies and consulates that they could classify healthcare professionals’ immigrant visa applications as emergencies to ease this massive administrative backlog. But embassies and consulates have long possessed this authority, and they’re still not making good use of it. 
• In the weeks since the Department issued its latest bulletin, members of the American Association of International Healthcare Recruitment have reported no significant movement of nurse visa processing.

The Department of State must prescribe a clear, actionable path for U.S. embassies and consulates to finalize the processing of nurse visas.

The Department of State isn’t to blame for America’s nursing shortage—the shortage has existed for decades. But at some point, it begins to own an increasing share of the blame for un-American medical rationing when it fails to expedite green card processing for qualified healthcare workers.