RN Guide to U.S. Work or Immigrant Visa, 2017

How may you assure yourself of getting the specific work or immigrant visa to the U.S.? Read the official and comprehensive procedures.

RN Guide to U.S. Work or Immigrant Visa, 2017

Written by Crispin Aranda.

Posted on December 4, 2017 | United States of America

RN’s Guide to U.S. Working or Immigrant Visa

The U.S. would need 1.2 million Registered Nurses by 2024 - 649,100 of which are replacement nurses.

What’s more the Atlantic reports citing a 2009 research from a team of Vanderbilt University that by 2025, the shortfall is expected to be “more than twice as large as any nurse shortage experienced since the introduction of Medicare and Medicaid in the mid-1960s.”

In 1989 the U.S. Congress passed the Immigration Nursing Relief Act, created the nurse-specific H-1A visa in efforts to recruit foreign nurses faster while allowing those who are already in the U.S. to apply for permanent residency.

Over a 10-year period, the Bureau of Consular Affairs under the State Department reported a total of 36,743 H-1A visas. It was during this time that the enrolment of nursing students in the Philippines increased.  New nursing schools opened virtually as a school year ended.,.

Records of the Professional Regulations Commission in 2003 show there were 332,206 licensed RNs. However, only 193,223 were practicing their profession.  Of these, almost 85% were working abroad.  The lure of higher salaries and ability to send money home continued to fuel nursing enrolment and more school openings.

By 2006, the Commission for Higher Education (CHED) listed 460 nursing colleges that offer the Bachelor of Science in Nursing (BSN) program and graduate approximately 20,000 nurses annually, creating a net surplus of RNs.

So where did the nursing graduates and licensed RNs go?

POEA deployment records in 2007 show that of 9,178 nurses working overseas, 8,132 were in the Middle East, 6,633 in Saudi Arabia.  Across the ocean, the U.S. Citizenship and Immigration admission statistics list 5,196 from the Philippines who entered the U.S. on H-1B visas (no breakdown on occupations, though).

In 2010, deployment of nurses increased to 12,431 with KSA still the top Middle East destination (8,721).  There were a few new destinations: Libya, UK, Taiwan, Jordan and Bahrain.

As the immigrant and working visas in the U.S. became more difficult to come by, the oversupply of RNs and lack of jobs available in the Philippines resulted in the continued surge in nurse deployment to the Middle East and destinations other than the United States.

As terrorism ravaged Europe and refugees mixed with migrants in the exodus out of conflict EU zones, the nascent fear against newcomers, asylum seekers immigrants fueled a vote for Brexit. Then the U.S. elected Donald Trump President who rode to the White House on the orange horse of “America First.”

It was not long after that Australia and New Zealand adopted the “We First” policy blaming immigrants for their country’s troubles- from higher real estate prices to unemployment and crime.

Americans First

Before Donald Trump rallied White Nationalists, the Alt-Right Movement and Conservatives against the horde of “criminals and rapists” from Mexico (as well as the campaign to demonize and ban Muslims from the U.S.), the shift away from recruiting nurses from overseas had taken a foothold.

Healthcare advocacy groups rallied their members and kin, while lobbying legislators to fix a broken healthcare staffing system.  Statewide initiatives were launched to address both the shortage of RNs and nurse educators.

The American Association of Colleges of Nursing cited the example set by The University of Wisconsin (UW) in January 2014  which “announced the $3.2 million Nurses for Wisconsin initiative — funded through a UW System Economic Development Incentive Grant — to provide fellowships and loan forgiveness for future nurse faculty who agree to teach in the state after graduation. This program was launched in response to projections that Wisconsin could see a shortage of 20,000 nurses by 2035.

Instead of offering sign-on bonus, incentives and attractive wage packages, nursing schools with high levels of nursing enrollees and graduates worked for additional funding, grants and strategic partnerships with the private sector.  Nurse graduates who have ventured into other jobs are enticed with the promise of forgiveness of student loans if they pursue or resume nursing as a profession. Practicing nurses meanwhile were encouraged to pursue a progressive career pathway by completing baccalaureate and graduate nursing programs.

Shortage no longer nationwide

In July 2017, the results were in; recommendations for nurse staffing shortages were out .

A report from the National Center for Health Workforce Analysis revealed that the shortage of nurses in the United States is not nationwide, but affect only certain States.

Using data from the Health Resources and Services Administration’s (HRSA) Health Workforce Simulation Model (HWSM), the report observed “substantial variation across states for RNs in 2030 through the large differences between their projected supply and demand. “

Methodology.  “The HWSM assumes that demand equals supply in the base year (2014). For supply modeling, the major components (beyond common labor-market factors like unemployment) include characteristics of the existing workforce in a given occupation; new entrants to the workforce (e.g., newly trained workers); and workforce participation decisions (e.g., retirement and hours worked patterns). For demand modeling, the major components include population demographics; health care use patterns (including the influence of increased insurance coverage); and demand for health care services (translated into requirements for full-time equivalents (FTEs). “

Key findings were:

  • There will be shortages and surpluses in RN workforce in 2030 across the United States by year 2030.
  • Assuming that “current level of health care is maintained, seven states are projected to have a shortage of RNs in 2030, with four of these states having a deficit of 10,000 or more FTEs, including California (44,500 FTEs), Texas (15,900 FTEs), New Jersey (11,400 FTEs) and South Carolina (10,400 FTEs).”
  • States projected to experience the largest excess supply compared to demand in 2030 include Florida (53,700 FTEs) followed by Ohio (49,100 FTEs), Virginia (22,700 FTEs) and New York (18,200 FTEs).

Getting Started

Whether you intend to work temporarily or stay in the U.S. permanently based on your occupation (as an RN) the law requires that you obtain the VisaScreen certificate. Applicants must pass the screening procedures which includes:

  • An assessment of an applicant’s education to ensure that it is comparable to that of a U.S. graduate in the same profession
  • A verification that all professional health care licenses that an applicant ever held are valid and without restrictions
  • An English language proficiency examination
  • For registered nurses only, a verification that the nurse has passed either the CGFNS Qualifying Exam®, NCLEX-RN® or for select years and provinces its predecessor, the State Board Test Pool Examination (SBTPE).

Section 343 of the Illegal Immigration Reform and Immigrant Responsibility Act (the IIRIRA) of 1996 requires specific health care professionals to complete a screening program before they can receive either a permanent or temporary occupational visa, including Trade NAFTA status. The CGFNS through the International Commission for Healthcare Professions (ICHP) has been tasked to implement the rules in complying with this requirement. 

Work visa, H-1A, H-1B, H-1C

There had been RN-specific visa categories.  The H-1A was created under the Immigration Nursing Relief Act of 1989 mainly to recruit qualified and eligible foreign nationals to work temporarily in the U.S. as registered nurse in areas with shortage of health professionals as determined by the Department of Labor.  The H-1A program expired on September 1, 1995.  However, those already in the U.S. were still allowed to apply for adjustemt of status or permanent residency. 

The H-1C visa program succeeded the H-1A program in 1999.  While the underlying rationale for the creation of both H-1A and H-1C was the continuing shortage of RNs, H-1C applicants may only be sponsored by designated hospitals that were officially designated as H-1C partners. The H-1C program expired in 2009. 

Below are H-1A visas issued each year as released by the U.S. Department of State - Bureau of Consular Affairs. Years here are "Fiscal years" so for instance the year 1993 refers to the time period from October 1, 1992 to September 30, 1993. A "N/A" indicates that data is not available; this is because country-level data became available only starting from Fiscal Year 1997.

Year

Total number of visas issued

Number of visas issued to each country

1990

2

N/A

1991

7443

N/A

1992

7377

N/A

1993

6388

N/A

1994

6441

N/A

1995

7261

N/A

1996

1745

N/A

1997

61

32 in Philippines, 2 in Australia, 3 in Nigeria, 4 in South Africa, 2 unknown, 2 in India, 2 in Mainland China, 1 in Norway, 1 in Great Britain and Northern Ireland, 1 in Panama, 1 in Saint Vincent and the Grenadines, 1 in Niger, 1 in Marshall Islands, 1 in Zimbabwe,

1998

18

3 in Spain, 3 in Mainland China, 2 in South Africa, 1 in India, 1 in Pakistan, 1 in Philippines, 1 in Greece, 1 in Great Britain and Northern Ireland, 1 in Slovakia, 1 in Australia, 1 in Chile, 1 in Venzuala

1999

5

1 in Senegal, 1 in Mainland China, 1 in Croatia, 1 in France, 1 in Mexico

2000

2

1 in Germany, 1 in Columbia

A year later, the Immigration Act of 1990 was enacted, creating five Employment-based categories allowing international RNs to apply for permanent residency from outside the U.S. provided there is a willing and able employer that would sponsor the RN under the EB3 category.

 October 2010, the Institute of Medicine released its landmark report on The Future of Nursing, initiated by the Robert Wood Johnson Foundation, which called for increasing the number of baccalaureate-prepared nurses in the workforce to 80% and doubling the population of nurses with doctoral degrees. The current nursing workforce falls far short of these recommendations with only 55% of registered nurses prepared at the baccalaureate or graduate degree level.

In July 2010, the Tri-Council for Nursing released a joint statement on Recent Registered Nurse Supply and Demand Projections, which cautioned stakeholders about declaring an end to the nursing shortage. The downturn in the economy has lead to an easing of the shortage in many parts of the country, a recent development most analysts believe to be temporary. In the joint statement, the Tri-Council raises serious concerns about slowing the production of RNs given the projected demand for nursing services, particularly in light of healthcare reform.

In 2012, the American Journal of Medical Quality projected a shortage of registered nurses across the U.S. between 2009 and 2030.

Higher Vacancy Rates

A larger percentage of hospitals have a higher vacancy rate for registered nurses in 2017 than in 2013, according to a survey conducted by NSI Nursing Solutions, a nurse recruitment and retention firm. In 2013, about 50 percent of the facilities surveyed had a vacancy rate of 5 percent or greater. That percentage rose to more than 80 percent in 2017. More than 130 healthcare facilities from 29 states responded to the survey.

According to the Bureau of Labor Statistics’ Employment Projections 2014-2024, Registered Nursing (RN) is listed among the top occupations in terms of job growth through 2024. The RN workforce is expected to grow from 2.7 million in 2014 to 3.2 million in 2024, an increase of 439,300 or 16%. The Bureau also projects the need for 649,100 replacement nurses in the workforce bringing the total number of job openings for nurses due to growth and replacements to 1.09 million by 2024.

According to the “United States Registered Nurse Workforce Report Card and Shortage Forecast” published in the January 2012 issue of the American Journal of Medical Quality, a shortage of registered nurses is projected to spread across the country between 2009 and 2030.  In this state-by-state analysis, the authors forecast the RN shortage to be most intense in the South and West

In October 2010, the Institute of Medicine released its landmark report on The Future of Nursing, initiated by the Robert Wood Johnson Foundation, which called for increasing the number of baccalaureate-prepared nurses in the workforce to 80% and doubling the population of nurses with doctoral degrees. The current nursing workforce falls far short of these recommendations with only 55% of registered nurses prepared at the baccalaureate or graduate degree level

Whether the shortage is cyclical, recurring, persistent, fake news or factual – a foreign Registered Nurse with education and training obtained overseas – must be qualified and eligible to apply for the thousands of jobs now mushrooming across classified ads and online jobsites, the POEA website

Until 1989, nurses and other professionals were able to work in the U.S. under the H-1B visa, and -where the same or another employer is willing and available to sponsor -  then apply for permanent residency through the old 3rd Preference visa category.

U.S. immigrant categories before 1990

Under the Immigration Act of 1965, family members of lawful permanent residents, members of the profession and skilled workers were admitted as immigrants under six preference categories. Immediate family members of U.S. citizens as were certain special immigrants, were not quota-bound.

The six preferences were:

First Preference (P1) was for the unmarried sons and daughters of U.S. citizens now the F1, First Family-sponsored category.

Second Preference (P2) was created for the spouse and unmarries sons and daughters of lawful permanent residents (LPRs). This category has bee further subdivided under the current immigration Act – the F2A – spouses and minor children of LPRs and the F2B – over 21 unmarried sons and daughters of lawful permanent residents.

Third Preference (P3) was previously granted to qualified members of the professions or who “ because of their exceptional ability in the sciences or the arts will substantially benefit the U.S. economy, cultural interests and welfare of the United States.” The P3 category had been incorporated into the new and current 5 Employment-based categories.

Fourth Preference (P4) was assigned to the married sons and daughters of U.S.  Citizens, now the F3 category.

Fifth Preference (P5) applied to the brothers or sisters of U.S. citizens, now the F4 category.

Sixth Preference (P6) visas were granted to applicants “capable of performing skilled or unskilled labor, not temporary or seasonal in nature and there is a shortage of employable and willing persons in the U.S. 

Incidentally, nurses are classified as “skilled workers” instead of “professionals” in the United States. In fact, U.S. citizens or permanent residents who complete a two-year associate degree in nursing may take the national licensure exam for nurses (NCLEX) then subsequently complete the requirements of the state where they intend to practice. 

Domestic US RNs who completed their education in the U.S. are also not required to take the English language proficiency test - TOEFL/TSE, TOEIC or IELTS.

Filipino nurses need luck not skills, to work in the U.S.

Whether applying for a work visa or immigrant visa, a Filipino RN must obtain the VisaScreen Certificate issued by the International Commission for Healthcare Professionals (ICHP) a division of the Commission for Graduates of Foreign Nursing Schools (CGFNS).

This requirement was set by Section 343 of the Illegal Immigration Reform and Immigrant Responsibility Act (the IIRIRA) of 1996.

Certain health care professionals, born outside of the United States, must “successfully complete a screening program before they can receive either a permanent or temporary occupational visa, including Trade NAFTA status.

As illustrated above, the screening includes:

  • Assessment of an applicant’s education to ensure that it is comparable to that of a U.S. graduate in the same profession;
  • Verification that all professional health care licenses that an applicant ever held are valid and without restrictions n an English language proficiency examination
  • For registered nurses, a verification of passing either the CGFNS Qualifying Exam®, the National Council Licensure Examination for Registered Nurses (NCLEX-RN®) or its predecessor, the State Board Test Pool Examination (SBTPE)

For the latest news and requirements to obtain a VisaScreen Certificate, click here - http://www.cgfns.org/services/visascreen/

USCIS official rule on Healthcare Worker Certification

Foreign nationals seeking admission to perform labor as health care workers, other than physicians, are only admissible to the United States if they present certification from a USCIS-approved credentialing organization verifying that the worker has met the minimum requirements for training, licensure, and English proficiency in his or her field.

For foreign nurses the Commission on Graduates of Foreign Nursing Schools issues the certified statement that the foreign nurse, applying for wither a work visa or immigrant visa:

  1. has a valid and unrestricted license in the State of intended employment;
  2.  has a foreign license that is authentic and unencumbered;
  3. passed the National Council Licensure Examination (NCLEX ); and
  4. graduated  from certain English language nursing programs.

When must the Health Care Worker Certification be submitted?

For immigrant petitions, a two-step process applies to RNs whether applying inside or outside the U.S.

Step 1: The employer files Form I-140, Immigrant Petition for Alien Worker on behalf of the prospective foreign national worker. After determining the applicant’s eligibility

Step 2:

  1. If the RN is in lawful status in the U.S. he/she applies for adjustment of status  and submits the health care worker certification;
  2. If the RN is outside the U.S., the RN presents the health care certification before a consular officer at the time of visa issuance.

For Nonimmigrant petitions:

Step 1. The employer/sponsor files Form I-129 and supporting documents, usually for an H-1B classification whether the applicant is already in the U.S. or in a foreign country (Philippines or any other foreign country e.g., Saudi Arabia, Singapore, the U.K. or Canada.

Step 2:

(a)  If RN is in the U.S., he or she may also have to apply for an extension of authorized stay or apply for change of nonimmigrant status.  Please note that the I-129 Petition for Nonimmigrant Worker may be approved; however, the extension of stay or change of nonimmigrant status may be refused if the RN applicant fails to present the health care certification.

(b) If the RN is outside the U.S. the foreign nurse presents the health care certification at the time of visa issuance.

Important:  the USCIS emphasizes that the health care worker certification in itself, is “not the only evidence that the foreign worker has met the minimum requirement for the given position and is, therefore, eligible for the requested visa classification.”

H-1B Working Visa Lottery

At the first working or business day of April, the USCIS begins accepting H-1B petitions for the next fiscal year.  There is a general cap of 65,000 worldwide.  Another 20,000 visas are issued to beneficiaries who have earned a U.S. master’s degree or higher.  In addition, “H-1B workers who are petitioned for or employed at an institution of higher education or its affiliated or related nonprofit entities or a nonprofit research organization, or a government research organization are not subject to this numerical cap.”

An employer or sponsor may not file an H-1B petition more than six (6) months before the employment start date requested for the beneficiary.  This usually means the start day that the employer must indicate in the RN’s (H-1B applicant’s) petition is October of the same fiscal year.

The US’ fiscal year starts October of the current year and ends September of the following year.  For example, the USCIS started accepting H-1B petitions for the Fiscal Year 2018 on April 3, 2017.

For the complete, official details on H-1B filing for Fiscal Year 2018, click here -  https://www.uscis.gov/working-united-states/temporary-workers/h-1b-specialty-occupations-and-fashion-models/h-1b-fiscal-year-fy-2018-cap-season#how

Costs of Filing and Eligibility for the Visa

An employer must be assured that the potential applicants are qualified for the visa classification -nonimmigrant/working or immigrant visa category.

The basic requirements of academic credentials, ability to practice, evidence of work experience, documents establishing identity and ability to travel (passport), moral character (NBI and police clearance if the applicant has worked or lived in another country for six (6) months or more; are usually paid for by the applicant. 

A decade or more ago and during the “nursing shortage years”, employers were paying for all the costs of recruitment and placement – even offering a sign-on bonus.  That practice is long gone.

The costs of filing the petition and costs directly related to the recruitment and placement are paid by the employer or its POEA-licensed recruitment agency in the Philippines. The POEA’s policy is that applicants should not pay for any recruitment and/or placement fees.

It is understandable, however, that employers (and/or their agencies) will accept or recruit candidates who can present initial evidence of eligibility for sponsorship (basic requirements).

Since an applicant’s education/academic credentials, license to practice and English proficiency are part of the CGFNS/ICHP certification, applicants usually pay for the VisaScreen Certificate.

Generally, the costs of establishing an applicant’s eligibility for sponsorship are borne by the candidate.  This includes taking and obtaining the required English proficiency exam.  In most cases, review for the IELTS or TOEFL/TSE exam is needed to obtain the required minimum scores. (Check the VisaScreen application process for details).

Read and understand your contract:  the Employer must include a contract of employment when filing the petition with the USCIS.  Also, before the employer may recruit applicants in the Philippines, the POEA-licensed agency appointed by the employer must have the employer’s credentials authenticated by the specific Labor Attache who has jurisdiction over the Employer’s place of business or where the RN would be employed.

Part of the documents to be authenticated is a POEA-approved contract defining the terms and costs of recruitment and/or employment.

Note that the contract of employment is separate and different from a Recruitment Agreement – which the Employer may ask the RN applicant to sign through the recruitment agency.

For a list of approved POEA-licensed agencies and approved job orders for RNs in the United States, you may log on to  http://www.poea.gov.ph/

Got a question? Let us know - we're here to help.

About the Author

Crispin Aranda

Crispin Aranda

Crispin R. Aranda is an established International Visa Conselor and Immigrant Advocate. He is the president of IVC and is in several migration radio programs.


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