H-1Bs for Nurses:  What's the Magic Combination?

Danger Sign         NURSE PRACTITIONERS:  Part 3



While working on this series, USCIS notified that the H-1B cap was met on December 21, 2009 for fiscal year 2010.  USCIS will reject cap-subject petitions for new H-1B specialty occupation workers seeking an employment start date in FY 2010 that arrive after Dec. 21, 2009. 

USCIS will apply a computer-generated random selection process to all petitions that are subject to the cap and were received on Dec. 21, 2009 and will use this process to select petitions needed to meet the cap.  USCIS will reject, and return the fee, for all cap-subject petitions not randomly selected. 

Petitions filed on behalf of current H-1B workers who have been counted previously against the cap will not be counted towards the congressionally mandated FY 2010 H-1B cap. Therefore, USCIS will continue to process petitions filed for:

1)       Extensions of H-1B's for the same employer

2)       Changes of employer from one H-1B employer to another

3)       Petitions amending a material change in employment (such as a change in jobsite location)

4)       H-1B employer petitions seeking concurrent H-1B employment; and

5)       Petitions filed by exempt employers. Exempt employers are non-profit organizations that are affiliated with institutions of higher education, nonprofit  research organizations or governmental research organizations.



What Nurse Positions Qualify and meet the Requisite Requirements for H-1Bs?
Category 1:  The first category of nurses who generally will be approved is the certified advanced practice registered nurse (A
PRN) category that includes:
        Clinical nurse specialists (CNS')
        Certified registered nurse anesthetist (CRNAs)
        Certified nurse-midwives (CNMs)
        Certified nurse practitioners (Nurse Practitioners fall within this category)


Category 2:  The second category of nurses who may qualify for the H-1B are those in administrative positions requiring graduate degrees in fields such as nursing or health administration.
Category 3:  A final, more subjective group that may receive H-1B approval includes those who have a nursing specialty such as critical care and peri-operative nurses, or who have passed examinations based on clinical experience in school health, occupational health, rehabilitation nursing, emergency room nursing, critical care, operating room, oncology, and pediatrics, ICU, dialysis and cardiology.


At an American Academy of Nursing news briefing earlier this year on nurse-managed care and health solutions for our ailing healthcare system, former Health and Human Services Secretary Donna Shalala and others sent a coherent message: 

Nurse practitioners (NPs) have developed an infrastructure of health centers and convenient care clinics (such as Minute Clinics) that can help our nation reform a health care delivery system that is currently unable to meet the primary health care needs of its people.  Shalala noted,"NPs are going to be key to health care reform and must be at the health care reform tables. Nurses are part of the solution.  It's a solution in plain sight."

The Library of Congress' Thomas database has a hyperlinked version of the new CIR ASAP Bill that is better to use if you're just trying to focus on any one section. The important sections for Healthcare immigration are Chapter I, Title III.

Sec. 301 - Recaptures past unused visa numbers
Sec. 302 - Exempts LPR dependents from the IV quotas.
Sec. 303 - Slightly increases the per country quotas.
Sec. 320 - Provides IV cap exemptions for certain STEM and shortage occupations
Sec. 321 - Allows those with pending IVs to file Adjustment of Status even if their priority date is not current.

Nurse Practitioners (NPs) have provided health-care services to patients for more than 40 years. The nurse practitioner role had its inception in the mid-1960s at the same time that Medicare was introduced, which dramatically increased the need for primary-care providers. In addition to providing many of the same services less expensively such as primary and some acute care, they are qualified to meet the majority of patients' health-care needs. They promote a comprehensive approach to health care and emphasize the overall health and wellness of their patients.

NPs offer something else that makes them darlings to health reformers: a focus on patient-centered care and preventive medicine. "We seem to be health care's best-kept secret," says Jan Towers, health-policy director for the Academy of Nurse Practitioners. Nurse practitioners may have less medical education than full-fledged doctors, but they have far more training in less measurable skills like bedside manner and counseling.

NPs are registered nurses (RNs) who are prepared, through advanced education and clinical training and are granted either a certificate or a master's degree that is most common today -  this is why they qualify for H-1Bs. 

NPs work independently and collaboratively on the health-care team.  Some healthcare analysts and experts see nurse practitioners and Physician Assistants (PAs) as the answer to the growing physician shortage, particularly in primary care. 

A TIME Magazine article  published  this year concerning nurse practitioners indicated that they would perform a key role in healthcare reform:  "Even without reform, experts on the health-care labor force estimate there is currently a 30% shortage in the ranks of primary-care physicians". Fewer than 10% of the 2008 graduating class of medical students opted for a career in primary care, with the rest choosing more lucrative specialties. That could pose problems if a national health-care bill is enacted.

After Massachusetts enacted mandates for universal health insurance in 2006, those with new coverage quickly overwhelmed the state's supply of primary-care doctors, driving up the time patients must wait to get routine appointments. It stands to reason that primary-care doctors could be similarly overwhelmed on a national scale.

Depending on the state in which they practice, nurse practitioners, with advanced training can often treat patients and diagnose ailments as well as prescribe medication. And they can do these things at a lower cost than doctors.  Medicare, for example, reimburses nurse practitioners 85% of what is paid to doctors for the same services.

The new HHS Secretary Kathleen Sebelius recently said that "to make health reform a reality, we need nurses at the forefront of the effort."  Let us hope that the Obama administration takes the abundant opportunities that already exist to make such statements more than just rhetoric.


For your future reference here is a link to the O*NET for nurse positions that would quality for H-1Bs.  The O*NET is the Occupation Information Network sponsored by the Department of Labor and was released to replace the Dictionary of Occupational Titles.

If you missed our first 2 articles in this series, you can view them here:

Advanced Practice Nurses

Clinical Nurse Specialists

Again, remember -- for citizens of Canada and Mexico, the TN classification is available under NAFTA as an alternative to the H-1B visa for RNs and other professions listed on the NAFTA List of Occupations.

Read more - Time Magazine:  "If Healthcare Reform Passes, Nurse Practitioners Could be Key"

NurseZone:  Spotlight on Nurse Practitioners


What can Immigration Solutions do for you?

We can consult with you to determine that the nature of the position and the beneficiary's background are appropriate for an H-1B or any other nonimmigrant visa classification, and suggest alternatives if the initial proposal is not a viable option. We can advise both the employer and prospective employee regarding documentation requirements and legal issues - and successfully file your case with USCIS.  You can contact our office by email - or phone 562 612.3996.


Disclaimer/Reminder: This newsletter does not constitute direct legal advice and is for informational purposes only. The information provided should never replace informed counsel when specific immigration-related guidance is needed.  Copyright 2009 Immigration Solutions