How foreign nursing schools prepare for the U.S. market

Editor’s note: This is the second in a series of articles focused on workforce issues challenging US nursing, including immigration hurdles for foreign nurses who are poised to help fill workforce gaps and the many factors narrowing the nursing pipeline domestically. Visit the series homepage, Immigration and the US Healthcare workforce, to find all the series content. 

We offer this special article series in conjunction with our inaugural CompassionIT Virtual Summit, scheduled for May 20, 2025.  Our CompassionIT initiative explores the evolving relationship between technology and compassion in healthcare, including how AI, UX design, accessibility, and clinical innovation can ease burnout and build a more humane, inclusive, and sustainable healthcare system.  The summit program includes Insights from Nursing Informaticists for CIOs on how informatics and innovation can unite to develop technologies that care for the caregivers. Also, be sure to check out all of our CompassionIT-related content.

The U.S. healthcare system is amid a persistent nursing shortage. The aging boomer population combined with a mass exodus of nurses during the Covid-19 pandemic has led to a far greater need for demand than there is supply. To put it in perspective, the total supply of RNs in the US decreased by more than 100,000 from 2020 to 2021 (the height of the Covid-19 pandemic) – the largest drop that has ever been observed over the past 40 years. As American hospitals scramble to fill vacancies, the global pipeline of foreign-trained nurses — especially from the Philippines, India, and Nigeria — has become increasingly vital to filling staffing needs. Yet, even as international nursing schools invest in cutting-edge technology and digital health tools to prepare a “U.S.-ready” workforce, outdated immigration policies threaten to keep these much-needed professionals waiting on the sidelines. 

Where do most foreign-trained nurses come from? 

The United States has long relied on internationally educated nurses (IENs) to bolster its healthcare workforce. As of 2021, nearly 2.8 million healthcare workers in the U.S. were foreign-born, accounting for over 18% of the total healthcare workforce. Filipino nurses make up about 27% of all foreign-born nurses in the U.S., followed by nurses from India (7%), Jamaica and Mexico (5% each), and Nigeria (4%). The pipeline from the Philippines is particularly robust, owing to the country’s history as a former U.S. colony and its English-speaking, American-modeled nursing education system. 

Aligning education models with U.S. standards 

Foreign-trained nurses must meet rigorous requirements to practice in the U.S. Their education is scrutinized to ensure it aligns with American standards: a degree from an accredited nursing program, a valid RN license in their home country, and at least two years of full-time experience are baseline expectations. The Commission on Graduates of Foreign Nursing Schools (CGFNS) verifies that these nurses have received instruction in core areas such as adult medical and surgical care, pediatrics, neonatal, and psychiatric nursing. They must also demonstrate English proficiency and pass the NCLEX-RN, the same licensing exam required of U.S.-trained nurses. 

Tech, AI, and simulation: Building a “U.S.-ready” workforce 

Recognizing the demand for U.S.-ready nurses, major institutions abroad are investing heavily in technology-driven training. For instance, Apollo Hospitals in India offers a comprehensive suite of nursing programs that combine traditional instruction with hands-on experience and the latest in healthcare technology. Their vision is to produce nurses who are not only competent, but also adept at using digital tools and delivering care according to international standards.  

“We train a lot of our nurses,” said Dr. Sangita Reddy, Joint Managing Director at Apollo, in the 2024 CHIME Fall Forum featured keynote. “We have 16 schools of nursing. We also have a digital learning management system with content that we share with over 50 other partner nursing colleges and schools.” 

In the Philippines, simulation labs like those at HCT Academy are revolutionizing nurse training. These SimLabs, equipped with advanced hospital equipment and internationally created mannequins, immerse students in realistic clinical scenarios, including operating rooms, delivery rooms, ICUs, neonatal care units and more mirroring the gold standards set by the Joint Commission International (JCI).Scenario-based training hones critical thinking, decision-making, and patient care skills, ensuring that graduates can confidently transition into U.S. healthcare settings. 

Digital health tools and remote learning: Transforming training 

The digital transformation in nursing education is accelerating worldwide. AI-powered tutoring systems, immersive virtual simulations, and online mentorship programs are making learning more accessible and interactive. Virtual reality (VR) allows students to practice emergency procedures and diagnostic techniques in hyper-realistic environments, bridging the gap between theory and practice. Online educational and degree platforms also provide flexibility, enabling students to learn at their own pace and balance personal commitments, a crucial advantage for working professionals and those in resource-limited settings. 

These innovations are not just about convenience — they’re about quality. Digital tools enable continuous assessment, real-time feedback, and exposure to a broader range of clinical scenarios than traditional classrooms can offer. As a result, today’s internationally educated nurses are better prepared than ever to meet the complex demands of U.S. healthcare. 

The frustration: Immigration barriers stall progress 

Despite the readiness of this global workforce, thousands of foreign-trained nurses remain stuck in bureaucratic limbo. U.S. immigration policies have not kept pace with healthcare needs. H-1A and H-1C visas allowed many foreign-born nurses to come to the United States in the 1990s and early 2000s, but those programs have since expired. The most common work visa, the H-1B, is an option, but it requires a four-year bachelor’s degree, a nursing license in the state of employment, and an offer of employment in that state to be processed. As a “Registered Nurse” is a term of certification, not a degree, like a Bachelor’s of Science in Nursing (BSN), this leads to confusion around eligibility and narrows the pipeline of workers.  

Recent visa freezes have left many qualified nurses, who have already passed exams and secured job offers, unable to enter the country for years. Reddy noted that Apollo-trained nurses who have passed the US board tests wait around two years to get visas. They offer them to US healthcare providers as virtual nurses in the meantime.  

Unlike other professions, nurses do not qualify for temporary work visas, making the green card backlog a particularly acute bottleneck. This disconnect is deeply frustrating for both U.S. hospitals and nurses. While digital health innovation and international partnerships are producing a steady stream of U.S.-ready nurses, outdated policies prevent them from contributing to the American healthcare system.  

Various Congressmen have written legislation in an effort to modernize nursing visas to address staffing shortages. H.R. 6205, the Healthcare Workforce Resilience Act, was introduced in 2023 to the House Committee on the Judiciary and included a provision for 25,000 expedited visas for professional nurses but hasn’t moved forward through Congress since its introduction. Another piece of legislation, the NURSE Visa Act, was introduced in 2024 which would create 20,000 nonimmigrant visas per fiscal year to employ nurses in areas where the HRSA has determined there is a nursing workforce shortage. This has also stalled in Congress and could use additional support within the government as well as by nursing lobbying groups.  

Looking Forward 

The global pipeline of foreign-trained nurses is more sophisticated and better aligned with U.S. standards than ever before, thanks to advances in technology, simulation, and digital learning. Organizations like Apollo Hospitals and Philippine nursing academies are leading the way in preparing nurses for international practice. However, unless U.S. immigration policy evolves to reflect the realities of today’s healthcare landscape, the promise of these “U.S.-ready” nurses will remain largely unfulfilled. 

The solution is clear: modernize immigration pathways for nurses, so that the benefits of global training pipelines can be fully realized on the front lines of American healthcare. 

Other articles in this series

Amid healthcare workforce crisis, US immigration policies fall short

Should the US create a healthcare-specific visa program?

How the nursing shortage exposes cracks in the US’s healthcare and educational systems

Katie D. McMillan, MPH is the CEO of Well Made Health, LLC, a business strategy consulting firm for health technology companies. She is also a curious researcher and writer focusing on digital health evidence, healthcare innovation, and women’s health. Katie can be reached at [email protected] or LinkedIn.