On January 16, 1998, a headline in the Los Angeles Times read ‘Shortage of Nurses Hurts Hospitals”. This headline and others around this time were what started my thinking about what the future of the healthcare workforce, in particular, nursing, may be. Working in the home health industry at this time, I was already aware that demographic projections all pointed towards population aging and the number of elderly doubling by 2025, alongside slowing youth growth. Looking back now, it seems so obvious that the healthcare workforce shortages would be what they actually are today. However, identifying the issue and developing a business model that would prove to be a transformational solution are two separate matters.

In 1998, international recruitment lacked clear rules and accountability, with unscrupulous recruiters routinely preying on clinicians in developing countries who sought a better future for themselves. From day one, we started with a commitment that endures to this time, that we would never charge any applicant any fees whatsoever for our services. Our commitments to charging no fees to applicants and adhering to high ethical standards took hold, and slowly WorldWide HealthStaff Solutions began to grow.

Much has changed over the past 27 years, and a few things have remained the same. 

The US NCLEX-RN licensure exam is now available in multiple locations around the globe. This has greatly streamlined the US licensure and employer onboarding processes. The global pool of international RN candidates has become far more diverse. While the Philippines still has the largest number of NCLEX passers, English-speaking countries in Africa and South America now represent a growing share of the candidate pool.

Another major development has been the advancements in hospital facilities, technology, and practices in many of the countries around the world where international RNs are primarily recruited from. With modern, sophisticated, western-style healthcare facilities being constructed across the Gulf region, and a growing number of hospitals attaining Joint Commission International accreditation in the Philippines and elsewhere, the clinical transition to U.S. practice is becoming less daunting than it was in the past.

One thing that really has not changed is the U.S. permanent residency visa program that is used by 98%+ of all international RNs recruited to the U.S. While having a well-established, stable immigration program in place is a good thing, the reality is that this program has not been meaningfully updated since its inception more than 30 years ago. An update to the EB-3 permanent residency visa program is urgently needed to reflect the realities of the U.S. population and workforce now.

Many companies claim to change people’s lives, and some really do. And while a certain brand of toothpaste or driving a certain vehicle or vacationing in a certain location may make your life more enjoyable for a short time, the work that I have the privilege of being a part of changes peoples’ lives in the most meaningful and enduring ways possible. This is what I think about the most when I reflect on the work that our team has done, is doing, and will do for many years to come. Obviously, the life of the international candidates is changed immensely by the professional, social, and economic opportunities they are able to pursue in the United States. But the benefits extend to their spouses, who have new personal and employment opportunities, and their young children, who will benefit from a U.S. education and all of the opportunities that this brings.

But the changed lives don’t end there. International RNs routinely enhance the standard of living for their family members in their home country. When I think about the care that our RNs have provided in hospitals, nursing homes, and dialysis centers over the years, the number of patients touched may well exceed one million. And each of those patients have family members who are impacted by the quality of care that their loved ones receive. The impact our work has had on changing lives for the better is immeasurable. Nothing is more humbling and gives me more pride in our team than this.

And now, as I step aside and new, visionary leadership is in place to continue the amazing legacy of WorldWide HealthStaff Solutions, I am filled with gratitude for the opportunity of playing a role in impacting so many lives for the better.

Ron Hoppe

December 28, 2025