OCTOBER 2025 | 15 THE OKLAHOMA BAR JOURNAL Statements or opinions expressed in the Oklahoma Bar Journal are those of the authors and do not necessarily reflect those of the Oklahoma Bar Association, its officers, Board of Governors, Board of Editors or staff. THE UNITED STATES IS EXPERIENCING A CRITICAL NURSING SHORTAGE. This is not news. In fact, experts have been warning about the shortage of qualified nurses for more than a decade, and they expect the shortage to continue through the foreseeable future.1 A nursing shortage left unchecked will create a domino effect of problems that will impact all sectors of society, including higher health care costs and diminished quality of life for patients.2 The reasons for the shortage are varied and include factors related to an aging population requiring more frequent medical care,3 burnout caused by the COVID-19 pandemic, a retiring nursing workforce, lower nursing school enrollment and a severely backlogged pipeline of foreign national nurses (i.e., nurses who are not naturalized citizens of the U.S.) seeking lawful employment in the U.S. who are stuck in the U.S. immigration system.4 These nurses should be considered an important part of the overall solution, as employing them in the U.S. will help meet an urgent need in a field that is critically important to the health and welfare of the United States. This article will discuss current shortages and projections and offer suggestions on reforming and improving the present system of providing work authorization in the U.S. for foreign national nurses. THE PROBLEM The need for a steady workforce of qualified nurses5 in the United States is constant, and it will continue to grow over the next few decades. Unfortunately, the U.S. has struggled to keep a sufficient nursing workforce to meet national demand. On average in the U.S., there are only nine registered nurses per 1,000 people; in Oklahoma, there are between seven and 7.9 registered nurses per 1,000 people.6 As of 2022, there were 3.07 million registered nurses for a national population of over 333 million; in Oklahoma, by comparison, there were 30,320 registered nurses in a state of just over 4 million people.7 Experts estimate the U.S. will need to add more than 1 million new nurses to the workforce by 2030 to meet the nation’s health care demands,8 which is an average of 166,666 nurses per year, while others say that number will have to be closer to 200,000 nurses per year.9 However, estimates show that only about 177,400 nurses are expected to enter the workforce in the decade between 2022 and 2032, meaning that not even one year of projected need is expected to be met.10, 11 The U.S. is experiencing the current nursing shortage for a
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