3rd in a Series: Nurse Practitioners

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.

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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 (APRN) 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.

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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.”

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 continue to hope that the Obama administration take the abundant opportunities that already exist to make such statements more than just rhetoric.

The Library of Congress’ Thomas database has a hyperlinked version of the new CIR SAP 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.

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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

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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.

The Immigration Policy Center has assembled a top 10 list of resources for 2009.

For those of you not familiar with the IPC, their staff regularly serve as experts and leaders on Capitol Hill, opinion-makers and the media.  Their mission:  To provide policy makers, the media and the general public with accurate information about immigrants and immigration policy on US society.  Their studies and reports are widely disseminated and relied upon.

Here’s their list.  What are your thoughts?

Today, Rep. Luis V. Gutierrez (R-IL) announced that on Tuesday, December 15th he will introduce a Comprehensive Immigration Bill.  Congressman Gutierrez stated, “We have waited patiently for a workable solution to our immigration crisis by this Congress and the President.  The time for waiting is over.  This bill will be presented before Congress recesses for the holidays so that there is no excuse for inaction in the New Year.”  He further states, “This bill is ‘enough’ and presents a solution to our broken system that we as a nation of immigrants can be proud of”.

In light of the debate still raging on health care, coupled with high unemployment, we have concern about timing.  We’ll see how this is received and will, of course, continue to report on this.  The good news is that the stage is being set for a conversation – hopefully early next year.

Cite as “AILA InfoNet Doc. No. 09112060 (posted Nov. 20, 2009)”

As the clock is ticking on the H-1B quota, USCIS informed there are more than 9,000 H-1B numbers still available, but remember that 6,800 of these numbers are reserved for citizens of Chile and Singapore under the Free Trade Agreements that the USA has with these countries. The real amount of remaining H-1B numbers is only about 2,600. The H-1B cap could be reached early in December.

Our phone has been ringing off the hook with last minute questions and requests for expedited handling. Our healthcare clients who are eternally waiting for nurses in the retrogression pipeline want to file H-1B cases for desperately needed nurses. They ask, “Why does it seem so complicated – most of our foreign nurses who are onboard, and those we want to hire, already have BSN degrees?”

Registered Nurses are generally not eligible for H-1B visas because all states permit nurses to be licensed with less than a 4 year bachelor’s degree. However, in certain instances, it may be possible to obtain an H-1B visa for a nurse where the petitioning employer can prove the following:

1. A bachelor’s degree or higher degree or its equivalent is normally the minimum requirement for entry into the position;
2. The degree requirement is common to the industry for parallel nursing positions;
3. The employer normally requires a degree or its equivalent for the position; or the nature of the position’s duties is so specialized and complex that the knowledge required to perform the duties is usually associated with the attainment of a bachelor’s degree or its equivalent.

What Positions Qualify and will meet the Requisite Requirements?

Category 1: The first category of nurses who generally will be approved is the certified advanced practice registered nurse (APRN) category that includes:

· Clinical nurse specialists (CNSs)
· Certified registered nurse anesthetist (CRNAs)
· Certified nurse-midwives (CNMs)
· Certified nurse practitioners (NPs) fall within this category.

If an APRN position requires the employee to be certified in that practice, the nurse must possess an RN, at least a Bachelor of Science in Nursing, and some additional, graduate-level education. CNSs include Acute Care, Adult, Critical Care, Gerontological, Family, Hospice, Palliative Care, Neonatal, Pediatric, Psychiatric and Mental Health-Adult, Psychiatric and Mental Health-Child, and Women’s Health nurses. NPs include Acute Care, Adult, Family, Gerontological, Pediatric, Psychiatric & Mental Health, Neonatal, and Women’s Health nurses.

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, cardiology – but who are not APRNs.

In the above instances, the employer must show that the nature of the particular position is so specialized and complex that one would normally expect the person performing the duties to have attained a bachelor’s (or higher) degree, or its equivalent.

What is Required of the Employer?

1. The employer must offer a position as a Clinical Nurse Specialist (CNS), Certified Registered Nurse Anesthetist (CRNA), Certified Nurse-Midwife (CNM), or a Certified Nurse Practitioner (APRN-certified) Critical Care and the nurse holds the certification

2. The employer must offer a position working in an administrative position ordinarily associated with a Bachelors Degree, such as Charge Nurse or Nurse Manager or the more subjective group mentioned above in Category 3.

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Remember, for citizens of Canada and Mexico, the TN visa or classification is available under the North American Free Trade Agreement (NAFTA) as an alternative to the H-1B visa for registered nurses and other professions listed in NAFTA.

As reported by the American Immigration Council, Janet Napolitano delivered her first detailed speech today on immigration reform.  She indicated that the security and enforcement measures that have been undertaken have revealed that “the more work we do, the more it becomes clear that the laws themselves need to be reformed.”

She further commented, “DHS is ready to implement reform”, according to the Secretary who noted,  “We’ve ended a year-long backlog for background checks on applicants for green-cards and naturalization.  We’ve expanded the opportunity for a widow to gain legal status here, despite the untimely death of her US citizen spouse.  We’ve launched a new interactive website that allows people to receive information about the status of their immigration cases by email or text message, and we have reduced the time it takes to process those cases.”

Another positive message she conveyed was: “Businesses must be able to find the workers they need here in America, rather than having to move overseas.  Immigrants need to be able to plan their lives – they need to now that once we reform the laws, we’re going to have a system that works, and that the contours of our immigration laws will last.  And they need to know that they will have as many responsibilities as they do rights…This Administration does not shy away from taking on the big challenges of the 21 Century, challenges that have been ignored too long and hurt our families and businesses.”

An interesting comment by Ben Johnson, Executive Director of the American Immigration Council who attended the speech today noted, “Napolitano’s speech today evidenced a real understanding by the Administration of the comprehensive policy prescriptions necessary to reform a broken system…..Her clear statement on the value of immigrants to our society and economy, and the important role that immigration reform can play in building a foundation for growth and prosperity is a welcome response to the angry, misinformed rhetoric that has otherwise clouded the debate on immigration.”

We link to the video of Secretary Napolitano’s speech

Senators Bernard Sanders (I-VT) and Charles Grassley (R-IA) announced that they will introduce a bill to restrict the ability of employers to hire non-immigrant workers if the employer conducts “mass layoffs” under the Worker Adjustment and Retraining Notification (WARN) Act. The new bill, titled the Employ America Act (EAA), will be introduced in the U.S. Senate soon.

EAA would require employers filing temporary worker petitions to attest that they have not had a “mass layoff” in the 12 months immediately preceding the foreign worker’s proposed hire date and that they do not intend to have a mass layoff in the future. In addition, if an employer does conduct a mass layoff, all existing visas approved in the 12 months before the employer issued a “WARN Notice” would expire 60 days after the notice. Affected foreign nationals would be required to leave the United States within the 60-day period.  We link to the Senate Press Release

The Warn Act defines a massive lay off as:  A reduction in force that will result in employment loss at a single employment site during any 30-day period of (1) at least 500 employees, not including part-time employees; or (2) 50 to 499 employees, excluding part-time employees, if the laid-off employees constitute at least 33% of the employees at the site, also not including part-time employees. For purposes of WARN, an employment loss is (1) an employment termination, other than a discharge for cause, a voluntary departure or retirement; (2) a layoff that exceeds six months; or (3) a reduction in an employee’s work hours of more than 50% in each month of any six-month period. However, certain transfers to other employment sites are not considered to be employment losses.  An employer is not required to issue a WARN Notice if a mass layoff is the result of the completion of a particular project or undertaking, if the workers were hired with the understanding that their employment would be of a temporary duration.

The good news is – with comprehensive immigration reform (CIR) on hold until next year, it is doubtful that this will pass although it still could be introduced in another piece or legislation.

Lou Dobbs stepped down today from the controversial role as an advocacy anchor at CNN at the end of his show, announcing plans to seek a more activist role.

In an e-mail to CNN staff members, Jonathan Klein (CNN President) described the parting as “extremely amicable,” and said Dobbs’ replacement would be announced soon.

Dobbs cited the growth of the middle class, the creation of jobs, health care, immigration policy, the environment, climate change and the U.S. military involvement in Iraq and Afghanistan as “the major issues of our time.”  But, he said, “Each of those issues is, in my opinion, informed by our capacity to demonstrate strong resilience of our now weakened capitalist economy and demonstrate the political will to overcome the lack of true representation in Washington, D.C. I believe these to be profoundly, critically important issues and I will continue to strive to deal honestly and straightforwardly with those issues in the future.”

His no-holds-barred, sometimes acerbic style brought him a loyal following, but also attracted controversy both to him and to the network, especially over the subject of illegal immigrants.

Dobbs will continue as anchor of The Lou Dobbs Show, a daily radio show that began in March 2008 and is distributed to more than 160 stations nationwide by United Stations Radio Networks Inc.

We link to the CNN website post and a video of Dobbs goodbye segment.

The NCSBN has posted the 2010 NCLEX-RN Detailed Test Plan Candidate version and Item Writer/Item Reviewer/Nu Educator version on its Website The new test plan goes into effect April 1, 2010.

The NCLEX-RN Test Plan is evaluated every 3 years, and changes are made based on empirical data from a practice analysis, expert judgment and feedback from member boards.  The purpose of the Detailed Test Plan is to provide more in depth information about the content areas listed in the basic NCLEX-RN Test Plan.  Both tests include sample items at the end of each category, which are specific to the Client Needs category being reviewed in that section.  Also, the Item Writer/Item Reviewer/Nurse Educator version includes an item writing tutorial with sample case scenarios to provide nurse educators with hands-on experience in writing NCLEX style test questions.

As of October 25, 2009, approximately 52,800 H-1B cap-subject petitions and approximately 20,000 petitions qualifying for the advanced degree cap exemption had been filed. Seven months into this fiscal year and there are still H-1B visas available – but not for long!

Any H1-B petitions filed on behalf of a foreign national with an advanced degree will now count toward the general H1-B cap of 65,000. USCIS will continue to accept both cap-subject petitions and advanced degree petitions until a sufficient number of H-1B petitions have been received to reach the statutory limits, taking into account the fact that some of these petitions may be denied, revoked, or withdrawn.

The H-1B Petition is still a valid option for professionals with degrees in IT, Engineering, those in science and the arts, as well as many healthcare workers including PTs, OTs, Physicians, Pharmacists,  AHPs, and some nurses.

When considering Nurses for H-1B Visas, these are the threshold issues and key questions:

For Nurses:

1. The nurse must hold at least a Bachelor’s Degree in Nursing (a BSN), and

2. The position must normally require a Bachelors Degree.

For the Employer:

A. The hospital is offering the nurse a position as a Clinical Nurse Specialist (CNS), Certified Registered Nurse Anesthetist (CRNA), Certified Nurse-Midwife (CNM), a Certified Nurse Practitioner (APRN-certified) or positions in Critical care where the nurse holds certification;

B. If the nurse will be working in an Administrative position ordinarily associated with a Bachelors Degree, such as Charge Nurse or Nurse Manager;

C. If the nurse will be working in one of these specialties: peri-operative, school health, occupational health, rehabilitation nursing, emergency room nursing, critical care, operating room, oncology and pediatrics. And the hospital will attest that these roles are only offered to those with Bachelors Degrees. Some magnet hospitals have the BSN as its standards, and these make great destination hospitals for RN H-1Bs.

Contact Immigration Solutions if you are seeking representation to assist you with your H-1B case filings.  We have a professional team ready to handle your casework with reasonable and fair fees.  We specialize in IT, Engineering and Healthcare immigration, amongst other business sectors – both in the US and Canada.