Faced with a severe shortage of nurses, one option for the United States is immigration.
But even though the federal government has given registered nurses a special designation that streamlines the employment-based permanent residency (green card) process, a lot would have to change for immigration to fully address the acute nursing shortage.
Under a “Schedule A” designation, registered nurses, as well as physical therapists, are exempt from some of the steps that would normally be required in an employer-sponsored green card process. For example, normally a U.S. employer can only proceed to sponsor a foreign worker for a green card if the employer first goes through a “labour market test” (known as the certification process of the PERM job) and advertise the job to determine if there are any U.S. workers who meet the minimum education/experience requirements for the job advertised. If no qualified U.S. workers apply, the employer can receive “certification” and proceed to sponsor a foreign worker for a green card based on a job offer for that particular position.
In the case of registered nurses, the “Schedule A” designation means that the U.S. government will assume that there are not enough qualified U.S. workers and exempt U.S. employers from having to conduct this labor market test. . This can save you 6-12 months on the normal employer-sponsored green card process. (Our immigration blog published a more detailed article on this process last October)
Nursing and H-1B visas
But that might not be enough. Even for Schedule A cases, the green card process can take 12 to 18 months, and unless a nurse is Canadian or Mexican, there are limited options for obtaining a temporary work visa allowing them to come. in the United States and work in the interim. . The most common temporary work visa is what is called an H-1B visa. To qualify for an H-1B visa, the position offered must be in a “specialty occupation” – a position that requires a bachelor’s degree or higher in a particular field. The long-standing view of U.S. Citizenship and Immigration Services and the Department of Labor is that ordinary registered nurse positions do not qualify for H-1B classification because most do not normally require not a bachelor’s or higher degree in nursing (since some nurses with only an associate’s degree may qualify for entry-level RN positions. See here: https://www.uscis.gov /sites/default/files/document/memos/2015-0218_EIR_Nursing_PM_Effective.pdf.)
So too often employers are left with the green card process and a wait of up to 18 months as their only option.
In a glimmer of hope and perhaps a sign of things to come, there have been small changes to some documents/resources that may portend that RNs will one day fall under the “Specialty Profession” criteria – e.g. , the DOL’s Career Prospects Handbook Now says that “the typical entry level education” for a registered nurse is a bachelor’s degree. And the Department of Labor’s O*NET Online, which provides general information on various occupations in the United States, says registered nurses are an “employment area four,” designated for positions that primarily require a four-year bachelor’s degree. .
Both changes were made a year or two ago. While some attorneys report success with H-1B petitions for RNs if they are able to document a particular hospital/facility, or at least a particular department within it, consistently requires a bachelor’s degree for its RNs, the USCIS memo linked above is still often relied upon as the basis for denying H-1B petitions for standard RN positions.
Healthcare employers therefore face a dilemma: face a shortage, invest in the 12-18+ months to hire foreign nurses through the Annex A green card process, or bet on the restricting hiring to only nurses with bachelor’s degrees in hopes that USCIS will grant an H-1B visa. Most don’t play. They choose the former, leaving them at the mercy of ever-longer government processing times.