Challenges facing healthcare systems in 2019 have created shortages of critical healthcare providers throughout the United States – a shortage that could exceed 100,000 physicians and 500,000 nurses by 2030.
While programs exist specifically to hire foreign doctors in medically underserved areas, there are no such solutions to address profound shortages in nursing. Luckily, there are three strategies used by today’s human resource leaders to hire foreign nurses and stem staffing shortfalls.
“Schedule A” Direct Recruitment
Professional nurses and physical therapist positions are designated as “Schedule A” by the U.S. Department of Labor (DoL), which means the DoL has determined that hiring a foreign worker for these positions will not negatively impact the labor market for U.S. citizens. As such, employers do not need to secure a foreign labor certificate when hiring for a Schedule A occupation.
When hiring through Schedule A recruitment, employers are agreeing to sponsor their employee for permanent residence in the United States by filing an I-140 petition. For new graduates of U.S. nursing programs who are foreign nationals, it is possible to sponsor the candidate while she or he works for your organization on a post-graduation work permit. For candidates located overseas, the process can be completed in as little as 12 months, though timelines can vary widely for national of certain countries.
To qualify as a professional nurse, the candidate must:
- Have a full, unrestricted and permanent license to practice nursing in the state they will be employed;
- A certificate of completion from the Commission on Graduates of Foreign Nursing Schools (CGFNS);
- As an alternative to the prior two requirements, the candidate can show evidence of passing the National Council Licensure Examination for Registered Nurses (NCLEX-RN).
USCIS will determine the nurse’s eligibility during the I-140 petition process.
Schedule A nurse recruitment can be an effective strategy for meeting nurse shortages, but is not without its limitations. Depending on the country of origin, it can take more than a year to process the I-140 petition. Schedule A recruitment should be considered a proactive, long term strategy to help meet the healthcare needs of healthcare communities.
TN Visa – For Mexican and Canadian Citizens
The TN visa provides employers with an avenue for hiring registered nurses from Canada or Mexico. The TN visa is a nonimmigrant visa, meaning it does not provide a pathway to U.S. permanent residence or citizenship. However, TN visas can be extended indefinitely in three-year increments, as long as the visa holder leaves the country and returns every three years, or files an extension petition with USCIS.
To qualify for a TN visa, the candidate must:
- Hold a valid passport from Canada or Mexico;
- Obtain a Visa Screen credentials assessment from the Commission on Graduates of Foreign Nursing Schools (CGFNS) International. The certificate will show the candidate has passed language proficiency exams and holds the necessary education and licensure for the position.
- Hold full, unrestricted and permanent license to practice nursing in the state they will be employed; and
- Show proof of employment.
H-1B Visas – For Registered Nurses and Advanced Practice Nurses
The H-1B visa is known as the “professional visa” and we are often asked whether it can be used to sponsor nurses. Because the H-1B visa requires at least a bachelor’s degree or its international equivalent, nurses who have gone through a two-year nursing program do not qualify for this popular employment visa. As an additional hurdle, state licensure for registered nurses does not require a bachelor’s degree – a mandate of the H-1B visa.
Especially in light of increased scrutiny of H-1B visa applications during the Trump Administration, healthcare providers should be prepared to show the RN fulfills a specialty occupation within the organization, that always requires the minimum of a bachelor’s degree. These positions could include:
- Certified Nurse-Midwife
- Certified Nurse Practitioner
- Certified Registered Nurse Anesthetist
Additional requirements, specific to the H-1B visa, include:
- The employer must provide wage information that shows the RN will be paid prevailing wage or actual wage for the position, whichever is higher, of the collective bargaining wage, if applicable;
- Similar positions within the healthcare organization should require the same level of education and certifications;
- The candidate is working under similar conditions to all other employees in similar positions within the organization.
Cap-exempt hospitals and healthcare institutions can hire qualifying nurses outside of the competitive H-1B lottery. For more information on hiring an RN in the H-1B cap lottery, download our 19-page H-1B Guide for Employers.
With no end in sight for nursing shortages in the United States, it makes sense for hospitals and healthcare institutions to develop long-term strategies that augment their workforce with foreign workers. This can be especially helpful in diverse communities where multiple languages are spoken. If you are looking for ways to diversify your workforce and recruitment strategies, contact us for a complimentary consultation.
If you are a nurse or other healthcare professional and are exploring your employment options, read more about how to seek healthcare employment in the United States.