The Emergency Nurse Supply Relief Act (H.R. 2536) that was introduced by Rep. Robert Wexler (D-FL) and Rep. Jim Sensenbrenner (R-WI) are urging support of the Bill.  “This is not just about nurse staffing, it is about quality healthcare.”  The ASA references stats from  federal health authorities:  56% of the US nurse work force is 45 years of age or older and there are 3 Mil new and replacement nurses needed by 2020 to meet the shortage.

The Bill would provide up to 20,000 visas per year over a 3-year period for nurses and Physical Therapists and includes a $1,500 filing fee per application which is to fund US nursing schools.

Contact your local and state representatives to support this Bill.  We link to more on this.

BusinessWeek‘s 4th article in its Immigration in the Recession series concerns the extreme shortage of nurses in the USA.  The article addresses that proponents of foreign nurse recruiting feel that the nurse shortage is negatively affecting patient health; that expanding into government-funded healthcare will escalate the situation. Other points of view assert that domestic nurses should be utilized and trained to put US workers back on the job; however, there is no such system in place for educating and training nurses on a mass scale in the USA to make a dent in the shortage that will only continue to increase with time.  This debate must culminate in nurse legislation being passed by Congress.

Hello:  Wanted to share a few excellent resources with you today:

1)  New website that produces podcasts about nurses called Nurse Station.  Check them out, you’ll like it: 

http://nursesstation.wordpress.com/

2) Wanted to share our own Immigration Solutions podcast on the topic of  “Living and Working in Canada” – a User Friendly Immigration System”.  If you’d like a free assessment, please contact us at info@immigrationsolution.net.

There’s been a rift going on for several months in re degree requirements when USCIS wandered off the reservation and decided that all PTs and OTs required master’s degrees for H-1B classification regardless of state licensing requirements.  The issue has finally been resolved:
http://www.docstoc.com/docs/6468237/Velarde-healthcare-memo-5-20-09-_USCIS_

The President held a meeting with 5 employers, a state health department and a union to discuss innovative ideas that are being implemented in the workplace to improve the health of workers and decrease the rising cost of health care

On 5/11/09, the President hosted a health reform meeting, both for the $2 trillion in national savings that was discussed, and for the stakeholders attending.  Few would have imagined them sitting across the table from one another not so long ago.

We link to the Brief Room Blog and video and to more about the landmark meeting and the letter from the President to health care stakeholders.

$500 Million for Nursing and Health Professional Training

$300 Million is to be allocated to the National Health Service Corps with the remaining for Titles VII and VIII for health professional and nurse development programs.

American Association of Colleges of Nursing President Fay Raines said in a press statement, “Nurse educators are grateful for this infusion of funding which will help nursing schools battle the financial challenges they are currently facing.”

Additional provisions in the bill:

• $2 Billion in renovations and health IT purchases for community health centers
• $9.5 Billion for biomedical research
• $1.1 billion for comparing the effectiveness of treatments funded by Medicare, Medicaid and the State Children’s Health Insurance Plans (SCHIP)
• $2 Billion for the Office of national Coordinator for Health Information Technology
• $50 Million to improve IT security at the Dept of Health and Human Services

For a copy of the bill: www.Recovery.gov

Schedule A Nurse Visas: Improving the Processing

In a very promising development, on December 5, 2008 the Office of the Citizenship and Immigration Services Ombudsman published it recommendations as to how to improve the processing of Schedule A nurse cases and delivered the 11-page Report to Congress on Monday, December 8, 2008. 

The recommendations are based on a recent nationwide teleconference conducted by the Ombudsman at which Immigration Solutions was present. Immigration Solutions has obtained an advance copy of the report which can be accessed here.

Those of you who have read the monthly newsletters and periodic newsflashes published by Immigration Solutions and who have participated in teleconferences presented by Immigration Solutions, will readily recognize that the report repeats and reinforces everything that Immigration Solutions has discussed and presented over the past few years.

The attached report, while specifically providing recommendations for improving the processing of Schedule A nurse cases, should also be required reading for all persons active in the field of recruiting foreign nurses to the United States. 

The report provides an excellent history of the issues and discusses the effect of the nurse shortage in the United States.  It explains the limited nonimmigrant visa options available to nurses (TN, H-1B and H-1C).  Specifically, the report provides statistics of how few H-1B nurse cases have been approved recently (38 cases in 2006, 66 cases in 2007 and only 136 in 2008).  In addition, the report discusses the immigrant visa process for nurses through Schedule A and the two main problems with that process, i.e., the delays at USCIS in processing the I-140 visa petition and the immigrant visa quota delays.  We note that the report references the fact that one of the Service Centers charged with adjudicating Schedule A casework is some 4 months behind what the Processing Report presently indicates.

The Ombudsman concludes the report with the following recommendations:

• That USCIS separate and prioritize Schedule A green card nurse applications so that they can be expedited upon immigrant visa availability.
• That USCIS centralize Schedule A nurse applications at one designated USCIS service center to facilitate more efficient and consistent processing of Schedule A applications.
• That USCIS regularly communicate with DOL and develop points of contact at DOL to discuss concerns and direct inquiries regarding the processing of nurse applications.

In conclusion, while the report makes recommendations to improve the processing of the I-140 Schedule A petitions at the USCIS, legislative action is still needed to increase the number of immigrant visas available each year for nurses. Indications so far from incoming President Obama and the incoming Congress are good that this issue will be dealt with early in 2009.  The Ombudsman’s Report and the reasonably good chances of increased immigrant visa quotas for nurses reinforce our opinion that hospitals, staffing agencies and other healthcare providers should be filing I-140 Schedule A visa petitions now to establish their position on the immigrant visa quota waiting list in order to be ahead of the competition when more immigrant visas become available and the processing procedures improve and become faster.      

Please feel free to contact us with any questions that you might have pertaining to this information.  As always, we are available to assist you with your immigration needs for all healthcare occupations.  This is our area of specialty.  Our highly trained staff stands ready to work with you on designing an immigration program that suits your specific needs and requirements for 2009.

For more information on the report:
Read the original congressional memo

The United States and Immigration Services (USCIS) has increased the maximum period of time a TN professional worker from Canda or Mexico may remain in the United States before seeking readmission or obtaining an extension of stay. The final rule changes the initial period of admission for TN workers from one to three years, making it equal to the initial period of admission given to H-1B professional workers.

Please remember — with the immigrant visa (“green card”) annual quota currently backlogged thereby resulting in a long waiting list, and H-1B visas generally being unavailable for nurses, the search continues for faster ways for nurses to enter the United States to commence employment in their professions. Fortunately, under the North American Free Trade Agreement (“NAFTA”), nurses and physical therapists who are citizens of Canada and Mexico have a possible solution. The TN classification or visa pursuant to NAFTA is quicker and easier than the green card process, is not subject to annual quotas and is not subject to prevailing wage and other labor condition application (“LCA”) requirements.

Please note that TN’s are also available for Physicians, PTs, OTs, Pharmacists, Med Techs, Nutritionists & Dentists.

A VisaScreen certificate is required for nurses, PTs, OTs and Med Techs. All TN non-immigrants are subject to the laws of the state of intended employment regarding professional licenses but will not need to acquire the relevant license prior to admission to the US. However, the TN applicant must obtain the appropriate professional license from the state of intended employment prior to commencing employment.

A Canadian citizen may present the application package described above directly to an immigration officer at a US port of entry at the time of entry. The immigration officer will make the determination as to whether the applicant is admissible as a TN. No prior petition approval is required. No visa is required from a US consulate. Upon admission to the US, the Canadian citizen will be issued a Form I-94 for a period not exceeding 1 year which will be marked “multiple entry” and can be used for future entries to the US during its validity.

A Mexican citizen submits the application package described above directly to a US consulate as part of an application for a TN visa. The consul makes the determination as to whether the applicant is eligible for a TN visa. Upon admission to the US, the applicant will be given a “multiple entry” Form I-94 for a period not exceeding 1 year.

Other Details for NAFTA-TN Classification for Citizens of Canada and Mexico:

• Spouses and unmarried children under the age of 21 will receive TD dependent status.
• Children can attend school, spouses are not accorded work authorization
• Green-Card Process (Permanent Residency) is available to TNs, and the 3-year periods of stay will offer greater flexibility for those who wish to pursue their green-cards while continuing to work in the USA

For more information on the TN Solution and how it will alleviate the high costs associated with the employment of temporary and travel nurses and other healthcare workers, please contact us today.

 Frequently Asked Questions on TN Admission Period

In this climate of immigration retrogression, it was recommended that California NCLEX nurses endorse to Vermont prior to the expiration of the 3-year window of opportunity to provide SSA numbers to The CA State Board of Nursing. The VT State Board reports that it has experienced an increase in endorsement requests as a result of this issue, leading them to review their policy and make some procedural changes, as follows:

1. VT requires the official NCLEX exam results. For example if you took the exam through CA; you will need to contact the California Board of Nursing and request a “Certified Copy of Test Results with Photo” to be sent to the State of Vermont Board of Nursing. California’s fee for this is $10.00. (If you’ve already completed this step please proceed to step 2)
2. VT will need to have the Verification of Education Form completed by your school and your official transcripts sent to them. You can print the verification of education form from their website www.vtprofessionals.org on pages 5 and 6 of the International Nurse Application.
3. VT requires the License Verification Form completed for your original nursing license and your most current nursing license. You can print this form from their website www.vtprofessionals.org on page 7 of the International Nurse Application.

Note: For nurses in the United Kingdom: VT can verify the license online. You need to fill out the Verification Form by putting in the caller code and pin number so that they can access your information from the NMC website.

Once VT receives this information, they will then be able to process your application for licensure through the state of Vermont.

As mentioned previously, please be aware when you start the re-endorsement process, that the CA Board of Nursing will have considered your application abandoned and your file will no longer be active.  Thus, it will be necessary for you to submit all educational credentials a second time to CA.  While it will be inconvenient to do so, it will protect you from having to re-take the NCLEX-RN exam.

By Thomas J. Joy, Esq.

October 2008 Newsletter

October 1, 2008 marks the start of the new government Fiscal Year 2009 (“FY 2009”). At this time the new annual quota of immigrant visa numbers becomes available. Unfortunately, retrogression is still with us.

The anxiously awaited State Department October Visa Bulletin indicates EB-3 cutoff dates as follows: China (October 1, 2001), India (July 1, 2001), Mexico (July 1, 2002), Philippines (January 1, 2005), all other countries (January 1, 2005). Earlier visa bulletins had predicted that FY 2009 would start with the more favorable cutoff dates that had existed in June 2008 just before the EB-3 category became totally unavailable from July through September 2008. 

However, heavier demand from USCIS than anticipated has caused the State Department to establish cutoff dates further back than those that existed for June 2008. Finally, a note in the October Visa Bulletin states that little if any forward movement is likely until the extent of the USCIS backlog of old priority dates can be determined. As a result, at this time, it is impossible to predict or even guess how soon immigrant visa numbers will become available for later filed cases. We will keep you advised of any new information as it is released by the State Department. 

In the area of proposed new laws to increase the immigrant visa quotas for nurses and to recapture unused immigrant visa numbers from previous annual quotas, significant progress has been made as previously reported here. The nurse legislation and the recapture legislation introduced in the House of Representatives has been repeatedly postponed for further hearings and the recapture legislation introduced in the Senate has not yet been scheduled for hearings. 

This proposed legislation is the result of bipartisan efforts. With Congress leaving for the upcoming national elections and the ongoing problems with the US economy, it is unlikely that this pending legislation will be enacted this year. 

However, due to the bipartisan support for and the significant progress of this pending legislation this past year, we are optimistic that same or similar legislation will be reintroduced in the new Congress which will start in early 2009.

As stated here previously, we advise and encourage you to continue to file your Schedule A immigrant visa petitions for nurses. This initial step in the immigrant process is not prevented by the presence of retrogression. 

By filing now, you will be ahead of the competition when retrogression is lifted by the enactment of the proposed nurse and recapture legislation.