Angel Varghese, 25, has a clear plan. Nursing graduates from WellCare College of Nursing in Kochi, Kerala state in southern India have already passed the NCLEX, the US licensing exam for registered nurses.
She is now gaining the necessary work experience before taking the IELTS English-language exam and, she hopes, moving to New York, where her brother has already settled.
“I always wanted to work in America,” Varghese told DW. “It provides better opportunities to learn, grow professionally, and build a future. I know the process takes time, but I’m willing to wait.”
waiting for america
About 100 kilometers (62 miles) away in Kottayam, 26-year-old Susan Kurien is ahead on the same journey.
After completing the clinical experience required by US employers, she is working with a recruitment agency to complete credential verification and secure a job offer from a US hospital.
“The paperwork is long and complicated, but my goal has not changed,” Kurian told DW. “America is where I want to make my career. I hope everything works out.”
For thousands of young nurses across Kerala, America remains the final destination. The journey is rarely fast, it often involves years of exams, paperwork and waiting, but the promise of better pay, career growth and international experience continues to attract them.
That demand is being fueled by a U.S. health care system that is struggling to find enough staff.
Due to a growing population and a wave of retirements, the U.S. Bureau of Labor Statistics projects 189,100 registered nurse vacancies each year between 2024 and 2034.
Hospitals continue to recruit internationally, and India has become an important source of trained health care professionals.
Start the Immigration Process Early
Because Indian applicants face one of the longest employment-based immigration backlogs, nurses starting the process today may have to wait more than a decade before receiving a U.S. immigrant visa.
Despite this, recruiters across Kerala continue to sign up candidates.
“Yes, we continue to process applications,” Louis Terrence, operations manager of the Tiju Academy, which prepares health professionals for foreign licensing and language exams, told DW.
Terence said, “Nurses from Kerala are well trained, speak good English and are known for their dedication. Many still see the US as their dream destination because of the pay, working conditions and long-term career opportunities.”
Instead of waiting passively, many nurses start the immigration process early. Recruiting agencies help them pass the NCLEX exam, complete credential verification, and secure job offers from sponsored US hospitals.
Once an immigrant petition is filed, they receive a priority date, effectively securing their place in the visa queue.
“Despite the backlog, we are still filing US petitions and we hope it will be streamlined soon,” a senior official at Aphenix International, a leading agency that recruits foreign nurses, told DW.
gaining work experience elsewhere
Some nurses remain in India while they wait.
Instead, many pursue careers in countries such as the UAE, Saudi Arabia, the UK and Germany, earning higher salaries and gaining international experience by the time their US priority date becomes current.
US immigration lawyer Rajkrishna S Iyer says the US remains a long-term goal for many Indian nurses, despite long delays.
“Many nurses still aspire to work in the US,” Iyer told DW. “But because the backlog is so long, they often spend years working elsewhere before the opportunity comes along.”
Iyer said, “By then, family circumstances may have changed, forcing them to reconsider their plans. Others are left at the mercy of recruitment agents who do not always provide complete information.”
Ansy Philip understands that journey well.
The Kerala-born nurse moved to California in 2006, when hospitals were far more aggressively recruiting foreign nurses. Nearly two decades later, she is a US citizen and still works in an American hospital.
“The process was very easy when I arrived,” Philippe told DW.
“There is still a severe shortage today because of the aging population, but the immigration backlog has made the process more difficult. Nurses are still coming in, but it is much less than before,” she said.
Still, she says Kerala’s nurses enjoy an exceptional reputation.
Philip said, “They are committed, highly skilled, take ownership of their work and are extremely professional. Hospitals know what quality they are getting.”
building global reputation
Kerala’s reputation as a nursing powerhouse has been built over generations through missionary-run colleges, English-language education and a long tradition of foreign migration.
Today, its graduates work in hospitals from Dubai and London to New York.
“Demand remains strong, even though the immigration backlog has slowed the pace of migration,” Renu Susan Thomas, president of the Kerala chapter of the Trained Nurses Association of India, told DW.
“The Indian Nursing Council curriculum also closely matches U.S. nursing standards, making credential evaluation much easier.”
The numbers testify to this. India is the second-largest source of immigrant-registered nurses in the US after the Philippines, according to the Migration Policy Institute, which also estimates that about 80,000 Indian-origin doctors practice in the country.
According to health care workforce agency SPARAT, about 32,000 Indian-origin nurses work in the US today, making up about 6% of all immigrant nurses.
India also produced the second-highest number of NCLEX candidates in 2024, with 5,869 nursing graduates sitting for the exam.
This reputation has been strengthened since the Covid pandemic highlighted the shortage of healthcare workers around the world.
“Hospitals invest heavily in training their nursing staff, but retaining experienced nurses has become a major challenge as more people leave for opportunities abroad,” orthopedic surgeon Dhananjay Gupta told DW.
“An experienced scrub nurse is an integral part of the team and cannot be replaced overnight.”
Edited by: Srinivas Majumdaru