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A Personal Encounter with the Immigration Machine

In a luxurious hotel room in San Francisco 2010-2011, a foreign registered nurse (RN) with a small child and a single income—found herself face-to-face with a prominent Jewish gay lawyer who owned one of the East city’s most reputable immigration firms.

He sat with a friend, a glass of champagne in hand, smirking as they watched her.

For him, her desperate pursuit of a Green Card sponsorship was not a matter of life and death, but a frivolous game—a fancy, teasing play.

For her, it was everything: survival, stability, a future for her child.

What he said that day has haunted her for years.

With a sly smile, he leaned in and asked, “What are you willing to do and obey for this Green Card?”

His friend chuckled, their amusement cutting deeper than the question itself.

She felt mocked, reduced to a pawn in their entertainment.

But something wild in her roared back: “I will not obey EVER!”

His response was immediate and cold: “Then you will never have your Green Card!”

That moment was a bitter truth: for some, U.S. immigration is a playground of power and profit, while for others like her, it’s a life-or-death struggle.

Now, too old to fight the system herself, she can still tell her stories and point to where the dirt lies.

American Nurses love freedom, and she believes the United States remains the last bastion where it still is.

But who are the ones behind these dirty immigration practices?

Who profits from the schemes and wields control through these games?

The U.S. must uncover this—for its own sake.

A foreign American Nurse offers not just her story, but the data and insights to fuel that search.

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Immigrant Nurses in the U.S.: A 20-Year Overview (2005–2025) – Grok research

Providing a precise breakdown of immigrant nurses entering the U.S. over the past two decades—by country of origin, U.S. state, sponsoring organizations, and lawyers or agencies processing their documents—is no simple task.

No single, centralized, publicly available dataset tracks all these variables with exact numbers.

Yet, by synthesizing available data, trends, and industry insights, we can have an informed image, even as we acknowledge the gaps where details remain elusive.

The Scale of Immigrant Nurses

Over the last 20 years (2005–2025), the U.S. has leaned heavily on internationally educated nurses (IENs) to fill chronic nursing shortages.

Estimates suggest that 8–18% of the U.S. nursing workforce is foreign-educated.

By 2022, approximately 500,000 immigrant nurses were working as registered nurses (RNs)—about one in six nationwide.

With ongoing demand and immigration trends, this number may have edged closer to 600,000 by April 2025.

By Country of Origin

The countries sending the most nurses to the U.S. over this period include:

• Philippines: The top source, contributing over 30% of IENs (150,000–200,000 nurses). The Philippines has a nursing education system tailored for export, with many trained explicitly for U.S. licensure, such as passing the NCLEX-RN exam.
  
• India: Accounting for 7–10% (35,000–50,000 nurses), India’s numbers surged post-2008 recession, though visa backlogs slowed growth at times.
  
• Nigeria: Around 4–5% (20,000–25,000 nurses), with a notable uptick in recent years due to aggressive recruitment.
  
• Jamaica: Approximately 5% (25,000 nurses), a steady Caribbean contributor.
• Mexico: Roughly 5% (25,000 nurses), often entering via TN visas under NAFTA (now USMCA).
  
• Haiti: About 4% (20,000 nurses), concentrated in urban centers.
  
• Other Countries: The remaining 30–40% (150,000–200,000 nurses) hail from Canada, South Korea, the UK, and various African and Asian nations, with Canada and South Korea each likely sending 5,000–10,000.
  

These estimates stem from NCLEX-RN data (foreign-educated test-takers rose from 5,000 annually in 1994 to 15,000 by 2005, then stabilized) and workforce studies on country-of-origin trends.

By U.S. State

IENs gravitate toward states with robust healthcare systems and urban hubs:

• California: Likely hosts 20–25% (100,000–125,000 nurses), especially in Los Angeles and San Francisco, driven by its vast healthcare industry and diverse population.
  
• Texas: Around 15% (75,000 nurses), with Houston and Dallas drawing many from Mexico and the Philippines.
  
• Florida: Approximately 10–15% (50,000–75,000 nurses), fueled by an aging population in Miami and Orlando.
  
• New York: About 10% (50,000 nurses), a hub for Caribbean and African nurses in New York City.
  
• Illinois: Around 5–7% (25,000–35,000 nurses), centered in Chicago.
  
• Other States: The remaining 40–50% (200,000–250,000 nurses) are scattered across New Jersey, Pennsylvania, Ohio, and rural shortage areas, with annual shifts based on hospital needs and visa processing.
  

These figures are inferred from hospital hiring patterns (e.g., 32% of U.S. hospitals employed IENs in 2022) and state healthcare data, though comprehensive 20-year state-by-state tallies aren’t publicly available.

By Sponsoring Organizations

Sponsorship typically involves healthcare employers or staffing agencies filing EB-3 visas (the main RN pathway) or temporary visas like H-1B or TN:

• Hospitals and Health Systems: Giants like HCA Healthcare, Kaiser Permanente, AdventHealth, and Henry Ford Health have sponsored thousands. AdventHealth, for instance, hired over 400 IENs in 2023 (up from 280 in 2022), suggesting a 20-year total in the thousands per system. Hospitals likely account for 50–60% (250,000–300,000 nurses).
  
• Staffing Agencies: Firms like Health Carousel International, AMN Healthcare, and WorldWide HealthStaff Solutions have facilitated tens of thousands of visas. Health Carousel claims hundreds annually via EB-3, potentially totaling 5,000–10,000 over 20 years per agency. Agencies likely handle 30–40% (150,000–200,000 nurses).
  
• Nursing Homes and Smaller Facilities: These sponsored 5–10% (25,000–50,000 nurses), often in rural or underserved regions.
  

Exact sponsor data is proprietary, but the jump in hospital reliance on IENs (from 16% in 2010 to 32% in 2022) highlights their dominance.

By Lawyers and Agencies Processing Documents

Immigration lawyers and credentialing agencies are linchpins in this process:

• Credentialing Agencies: The Commission on Graduates of Foreign Nursing Schools (CGFNS) processes VisaScreen certificates for over 90% of IENs (450,000+ cases). Alternatives like the International Education Research Foundation (IERF) handle a minor share.
  
• Law Firms: Prominent names like Scott D. Pollock & Associates, Shusterman Immigration Lawyers, and Malescu Law have managed thousands of nurse petitions. Shusterman claims over 10,000 RN cases in 30+ years, with a hefty chunk in the last 20, suggesting 5,000–15,000 per major firm. Smaller firms process hundreds annually.
  
• Staffing Agencies with Legal Teams: Health Carousel and similar outfits often bundle legal services, covering 30–50% of cases (150,000–250,000 nurses).
  

No public registry tracks individual contributions, so these are educated guesses based on industry prominence and self-reported figures.

Data Gaps and Challenges

• Exact Numbers: No unified source tracks IENs by country, state, sponsor, and lawyer/agency over 20 years. USCIS visa data lacks public granularity, and NCLEX stats only reflect test-takers, not entrants.
  
• Sponsorship Variability: Sponsors shift, and nurses often change employers post-arrival, muddying the trail.
  
• Time Frame: The 2005–2025 span saw policy changes (e.g., H-1C’s 2009 expiration, EB-3 backlogs), skewing annual flows.
  

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Who Plays the Dirty Games?

The lawyer’s question—“What are you willing to do and obey?”— shows a system underground.
Who’s behind it?
Look to the profiteers: staffing agencies raking in fees, hospitals exploiting shortages to keep wages low, and lawyers charging exorbitant rates to navigate the process.

Who controls through immigration?

Those who benefit from a compliant workforce—corporations, policymakers, even the lawyers who saw the desperation as a fun game to play.

The U.S. must dig deeper.

We can’t name every player, but the data hints at where to start: follow the money from visa fees to hospital boards, trace the lawyers’ networks, and question why backlogs persist while shortages worsen.

Freedom is there, and it’s up to those who still cherish it to expose the games and reclaim the promise of this nation.

Conclusion

Over 20 years, an estimated 500,000–600,000 immigrant nurses entered the U.S., mostly from the Philippines, India, and Nigeria, landing in states like California, Texas, and Florida.

Hospitals and staffing agencies drove sponsorship, with CGFNS and key law firms handling the paperwork.

For precise answers, the U.S. needs USCIS records or a dedicated study—tasks beyond our reach here.

But the stories, like that nurse story and the data together ask for scrutiny.

Who profits, who controls, and why?

That’s the fight worth having.

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