Is there really a U.S. nursing shortage? And how international talent can provide clinical stability

By Liz Nesladek, Chief Commercial Officer, Conexus MedStaff

For years, the phrase “nursing shortage” has dominated U.S. staffing conversations and headlines. However, more recently, questions have arisen: Is this still a problem, or are we witnessing temporary relief following the extreme staffing pressures of the pandemic?

It’s true some hospitals have reported fewer critical gaps in staffing and added to their core staff. But others still heavily rely on travel nurses, facing persistent turnover and struggling to compete for the same talent pool. In truth, the issue goes beyond short-term fluctuations; it’s systemic.

An ongoing long-term staffing shortage, not a temporary dip

When you scratch the surface, data trends and workforce realities still show a growing disconnect between supply and demand. Aging demographics, nurse retirements, limited nursing school educators and changing workforce expectations are all still contributing to a long-term imbalance that won’t simply heal by itself. There are not enough projected nurses to meet the current or future demand in the U.S.

Understanding this gap is the first step in establishing a more cost-effective and retained workforce, and that’s why international staff need to be a core part of the solution.

Key highlights from the 2024 AACN Nursing Workforce Fact Sheet indicate that the registered nurse workforce is projected to grow from 3.1  million in 2022 to 3.3  million by 2032, a 6% increase, with 193,100 annual openings expected. These aren’t new roles, many being the result of retirements, an aging population and rising chronic health conditions. Nearly a million nurses are expected to exit the workforce by 2030.

This all points to the fact that staffing challenges remain a critical issue for U.S. healthcare providers, particularly in the face of increasing clinical demands and an aging population. It’s also important to note that persistent staffing shortages span a variety of areas and factors, including rural locations, critical settings, and night, holiday or weekend shifts.

At the same time, education bottlenecks mean that we’re not replenishing the workforce quickly enough. In 2023 alone, U.S. nursing programs turned away over 91,000 qualified applicants due to limited faculty, clinical placements and resources.

It’s clear that this isn’t a momentary staffing issue. It’s a structural challenge that requires systemic change and innovative solutions, with international recruitment being one such solution to help alleviate the burden.

How international talent supports core staff today and secures core staff for tomorrow

Foreign-educated RNs and allied healthcare professionals have more to offer U.S. hospitals beyond their qualifications. They bring resilience, dedication and a long-term mindset to their U.S. careers. These professionals often spend years preparing for U.S. practice, earning credentials, passing English and clinical exams and navigating complex immigration pathways. That level of commitment signals intent to stay, grow and contribute.

Here’s how international talent can strengthen your workforce:

• Immediately available: Depending on the visa type, some international talent are ready to begin work in the short term, filling roles that have remained vacant for months.
• Future workforce planning: International healthcare professionals allow you to build your own pipeline of talent well in advance, aligning arrivals with forecasted needs.
• Cultural competence: These clinicians enhance diversity, which supports culturally responsive care and improved patient satisfaction
• Retention and stability: Unlike direct hire models, international nurses placed through Conexus on a contract-to-perm basis often demonstrate strong retention, especially when supported throughout their transition and integration.

When applied to broader workforce planning, international clinicians not only fill gaps, but also help build a more balanced, cost-effective and resilient core staff.

Addressing common hospital concerns around international hiring

While the benefits of hiring from an international talent pool are clear, many U.S. healthcare employers are still hesitant due to perceived or previous challenges in this area. Many of these concerns are either outdated or have been fully remedied with the assistance of an expert staffing partner.

Concern one: Immigration delays
Yes, immigration processes can be lengthy, but with the right partner and proactive planning, these timelines become strategic tools, not roadblocks. Larger hospitals now build talent pipelines 12 to 24 months in advance, aligning the number of international arrivals with forecasted staffing needs.

Concern Two: International Talent Onboarding
One of the most persistent concerns we hear from hospitals is around integration, particularly when comparing international nurses hired through agencies with those recruited directly. There’s a misconception that agency-based hires are less embedded in the team or community. However, when executed well, a contract-to-perm model offers far more than just a staffing solution; it becomes a strategic onboarding and assimilation pathway.

Concern three: Retention
Data shows that international nurses who are supported with immigration guidance, clinical guidance and acclimation support beyond their first 60 days often stay longer than domestic hires. Their commitment to relocation, licensure and building a life in the U.S. translates into solid engagement, particularly when employers provide the right wraparound support.

By contrast, the 2023 NSI National Health Care Retention & RN Staffing Survey reported a 23% annual turnover rate for med‑surg nurses. This translates to nearly a quarter of med‑surg nurses exiting their roles each year. At that rate, the average med‑surg nurse stays in a role for around two to three years, often under two years for many. Unlike the average two-years turnover trend in med-surg roles the Conexus model is designed for longevity. We offer the resources to support healthcare providers assimilate to the facility and community, with approximately 85% of our nurses transitioning to permanent roles after their initial assignment.

The high cost of nurse turnover

Nurse turnover isn’t just a staffing issue, it’s a significant financial burden. While many healthcare leaders recognize the importance of retention as a strategic priority, fewer than half of hospitals (just 42.9%) actively track the cost of turnover. Yet the numbers speak for themselves. In 2024, the average cost to replace a single staff RN reached $61,110, representing an 8.6% increase year over year. These costs show up across the labor budget, from overtime and higher base salaries to critical staffing pay and reliance on travel or agency nurses.

For acute care hospitals, the cumulative impact is staggering with an average $4.75 million lost annually due to RN turnover, with losses ranging from $3.85 million to $5.65 million. Even a 1% change in RN turnover can translate to a $289,000 swing in costs. In a tight margin industry tackling turnover isn’t optional, it’s essential to financial stability.

Where international talent fits into a balanced workforce strategy

Workforce planning isn’t just about meeting today’s needs. It’s about creating a roadmap that blends immediate hiring with long-term vision. That’s why we’ve developed a visual staffing mix framework to help you map out your talent pipeline.

With this model, you can clearly see where international hiring fits in alongside new graduates, internal mobility, travel staffing and on the day support. It’s a layered strategy that allows you to plan with confidence, rather than react in times of crisis.

Rethink ‘foreign’ as ‘forward focused’

The real question isn’t whether a nursing shortage exists – it’s how we choose to address it. International healthcare professionals aren’t a last resort. They’re a forward-looking investment in your clinical excellence and operational stability.

With the right support model in place, international healthcare professionals are often some of the most valuable members of clinical teams. When integrated into a broader staffing strategy, international hiring builds resilience, reduces costs and supports better patient care over the long term.

At Conexus MedStaff, we help organizations forecast their needs and strategically integrate international nurses and medical technologists into their workforce on a contract-to-permanent basis. Our approach isn’t about filling gaps; it’s about retaining teams.

Ready to future-proof your workforce?

Whether you’re exploring staffing options or curious about how international talent can help you address retention, cost and succession planning, our experienced team is here to guide you. Let’s talk about how international talent solutions can complement your staff recruitment strategy and bring sustainable value to your organization.