The nursing shortage in the United States is not a future projection; it’s here today. Between 2020 and 2021, the total supply of nurses decreased by 100,000, the largest drop seen in four decades. In 2022, more RN jobs were available than in any other profession in the U.S. Projections estimate a shortage of 1 million nurses by 2030.
Americans need creative solutions to help bring more nurses into the workforce and keep them at the bedside. Many dedicated people outside of the U.S. could help fill critical needs here. A career in nursing offers international candidates a chance to work in a stable, vital industry while taking steps toward citizenship. Yet slow, complex, and expensive immigration processes deter many from trying.
inSpring works to help qualified and passionate applicants come to the United States, complete nursing programs, and continue honing their skills and serving patients. This process takes profound immigration and emotional support from the inSpring team. But it’s worth the investment to pursue their nursing education and subsequently work in the U.S. while helping fill critical healthcare needs.
Jason Garbarino, DNP, RN, is an experienced previous nursing educator for the University of Vermont and currently serves as talent director for healthcare at inSpring. “I jumped at the opportunity to join this team, to play a more intentional role in both growing and diversifying the nursing workforce.”
Jason is passionate about promoting new nursing talent and ushering in an era of greater diversity.
“I have the privilege of getting to work with all prospective inSpring students, from the point they are considering a nursing education to beginning their nursing career,” he says.
Jason’s steady guidance and assistance from inSpring’s immigration specialists supports candidates, academic programs, and employers in this highly complex process.
Ana Gonzalez is one of inSpring’s first nurses to navigate immigration with the team’s support.
In March 2024, she made her fourth move within the U.S. to begin orienting as a registered nurse at Gifford Medical Center in Randolph, Vermont. Her journey hasn’t been easy, but it has been rewarding.
Like many others, Ana chose health care because it was a family business. Her mother is a nurse in Colombia, her home country, and her father and sister are physicians.
“It was my mom’s idea to come and work here in the States.”
In her work as a nurse in Medellín, Ana’s mother regularly came home exhausted. She’d often be in charge of caring for two floors of 30-plus patients in a single shift.
Ana says, “Between a nurse here and a nurse back home, the pay will never compare.” The average nurse in Medellín makes what equates to less than USD 14,000 annually. While her Mom planted the idea, Ana’s hard work and determination made her dream of coming to the United States a reality.
Ana’s Move to the U.S.
At 18, Ana moved to Norfolk, Neb., to earn an associate degree in nursing (ADN).
“I was like, OK, let’s go for it. Here I am.”
As an international candidate, she was ineligible to secure a student loan. Her parents and small scholarships helped ease the financial burden, but she still worked full-time in health care while attending nursing school. Nursing classes were challenging—she had to quickly adjust to lectures and exams in English. Plus, nursing clinicals and exams used an entirely new vocabulary.
Despite the challenges of her program, Ana graduated with her ADN degree and moved to Lake
Charles, La., to pursue a bachelor’s degree in nursing (BSN). To pay for school, she worked two nursing assistant jobs, one in a hospital and one in a senior living facility. Then, in early 2020, COVID-19 hit. Ana couldn’t visit her family in Colombia or form meaningful connections in her new community. The pandemic left her even more isolated.
A Pandemic, Natural Disasters, and Nursing School
In August 2020, during the midst of COVID and nursing school, Hurricane Laura tore through Louisiana, destroying Ana’s apartment. She went without power for weeks, getting dressed for work and school in the dark. A few months later, Hurricane Delta followed. “That was a hard time,” she says, which sounds like an understatement. Nursing school, the pandemic, and natural disasters made Ana uncertain, and she worried she wouldn’t be able to continue her education and career aspirations in the United States.
Ana completed her nursing education under an F-1 student visa. These temporary permits allow foreign students to live in the United States while enrolled in eligible academic programs. After finishing her program, Ana was granted a year of Optional Practical Training (OPT) time, which allowed her to get practical field experience. But, OPT is limited and is not a path to permanent citizenship.
“Once that year is up, unless you have a work sponsorship pathway, you have to return to your home country or apply to pursue an additional, higher level of education,” Jason says.
Toward the end of her BSN program, Ana began searching for an employer to sponsor an H1B visa once her OPT ended. These temporary visas allow domestic companies to hire foreign workers in specific professions, such as nursing. However, employee sponsorship requires navigation of visa and immigration pathways many facilities choose to avoid.
Work Sponsorship Troubles
In late 2022, Ana graduated from her BSN program. Shortly after that, her NCLEX-RN licensure exam date was approaching.
“I was really scared and nervous,” she says about the exam.
Nursing test questions are famously tricky, even for native English speakers, with confusing wording, idioms, and double negatives.
“You have to think in a whole different way to answer those questions,” she says.
After years of education and months dedicated solely to exam preparation, Ana passed on her first attempt. With her nursing license in hand, her attention quickly shifted to securing her first nursing job.
Ana was offered a nursing position before graduating, but ultimately the offer fell through since they weren’t familiar with the H1B filing process. After much back-and-forth between the immigration lawyers she had hired and hospital administration, Ana got unfortunate news: They could offer a sign-on bonus but wouldn’t support her work sponsorship.
Now, she had no job offer and no sponsorship. Despite graduating from nursing school, passing the NCLEX-RN exam, and having a valid RN license to practice, Ana’s future was uncertain.
Eventually, she found employment for her OPT timeline in Corpus Christi, Texas, at an inpatient hospice facility. She made another move to a new city. At work, she helped patients in their final days of life, supporting families as they grieved and made funeral arrangements.
“After an incredibly short new-grad orientation, she was running the hospice patient care as the solo, on-site RN with one healthcare assistant,” Jason says.
Unfortunately, while the facility loved Ana and she enjoyed hospice, the facility did not meet the federal requirements for H1B nursing sponsorship as a for-profit facility. Ana worked for nearly a year there, and to continue working as an RN in the U.S., she would need to find another eligible employer.
Partnering with inSpring
Fortunately, Ana found inSpring.
“They told me, ‘We’re going to help you out, we’re going to get through the visa process.’”
Her OPT was nearly at its end, so they quickly began the process of finding an eligible sponsoring facility.
With the help of the inSpring team and Jason’s connections in Vermont, Ana was offered a position in the Operating Room residency at Gifford. inSpring’s immigration team facilitated collecting all the required immigration paperwork from the hiring hospital and Ana to prepare submission to the government for H1B sponsorship approval.
Meanwhile, Ana couldn’t work for several months. Her OPT had expired, and she would need to leave the country within 60 days.
“It was out of my hands,” she says.
Between January and March, all she could do was hope for the best.
In March, Ana, inSpring, and Gifford received the news that her H1B was approved. She’d be able to remain in the U.S. and continue working as a nurse. Ana will spend the next few years working under an H1B Visa. Additionally, Gifford can help file an application for Ana to obtain an EB3 Visa. This non-work sponsorship pathway ultimately will allow Ana to obtain a Green Card and permanent resident status.
The inSpring Team and Gifford established a solid partnership to ensure everything was in place once Ana had her H1B Visa in hand. Housing in Vermont can be difficult to find, but the team located nearby housing with a local family. After the 30-hour drive from Texas, Ana hit the ground running in her new role.
“I got here on a Sunday, and I got to work on Tuesday,” she says.
She’s relieved to have found what feels like a more permanent solution.
“Ana is the type of nurse you want to work with. She’s driven, she’s smart, she’s a team player,” Jason says.
Vermont already has seen rising wait times and an increasing reliance on travel nurses. Ana represents a new solution to nurse staffing that doesn’t rely on costly travelers.
“I’m excited about this opportunity with inSpring because it’s a different pool of nurses, people who are looking for that connection to community and a place where they can learn and grow,” says Jill Markowski, vice president of nursing at Gifford.
Jill looks forward to working with Ana and other nurses like her to care for patients in the OR and other specialties. They are in the process of hiring two additional inSpring nurses from the United Kingdom and Nigeria, to join in July.
Ana says having inSpring behind her made all the difference. The team made her feel taken care of, and their resources were far greater than what she could access on her own. Even though the process has been rocky, Ana believes that pursuing long-term work and eventual citizenship opportunities is worth it for people willing to go through the process.
This process “has been so rewarding for me—and I’m just really grateful for every single person I’ve met throughout my journey,” she says.
She looks forward to continuing her career by mentoring other nurses and returning to school.
Ana’s journey to citizenship isn’t over, but she’s closer than ever. When asked about advice she’d give to people going through a similar journey, she says community is everything.
“The people you surround yourself with really help you get through the bumpy roads.”
inSpring’s Dedication to Helping Talented Nurses
While Ana is the first inSpring candidate to make it this far in the immigration process, she’s only the beginning.
“We have hundreds of people coming in through our pipeline now,” says Jason.
The team looks forward to working with many other candidates, helping to ease the nursing shortage while giving talented nurses a path to permanent residency.
For more information about inSpring, visit inspringcareers.com. For more information about careers at Gifford, visit giffordhealthcare.org/careers or call 802-728-7000.
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