CNN posted an interesting article on 12/23/09 that echoed what all of us have been saying in healthcare immigration and staffing, that the USA is facing an ever worsening nursing shortage as the population grows older.

Here are some of the comments:

America has had a nursing shortage for years, said Peter Buerhaus, workforce analyst at Vanderbilt University School of Nursing in Nashville, Tenn. But by 2025, the country will be facing a shortfall of 260,000 RNs, he said.  “In a few short years, just under four out of 10 nurses will be over the age of 50,” said Buerhaus. “They’ll be retiring out in a decade. And we’re not replacing these nurses even as the demand for them will be growing.”

Barry Pactor, international director of global health care for consulting company HCL International, agrees that more nurses should be trained within the U.S. system. But as a short term solution for this “huge shortage,” he said the U.S. government should loosen immigration restrictions on foreign health care workers.

“I don’t see this as foreign nurses taking American jobs, because these are vacancies that already exist and cannot be [filled] by nurses currently in training,” he said. “We’d be filling in the gaps until the training can catch up with the demand.” 

CGFNS announced a new pricing structure for its core services and several ancillary services effective January 1, 2010.   We link to the new CGFNS fees http://www.cgfns.org/sections/apply/fees.shtml

The new fees include increases for Visa Screen, Credential Evaluations, Certification Program fees and the Credential Verification Service for New York State and other ancillary services and will be effective as of January 1, 2010.

VisaScreen price increase to $540, from $498. The renewal Certificate price is increasing from $250 to $275.

NurseZone.com had an interesting article in their recent newsletter concerning the up and coming hottest specialities in nursing.

Judy Ozbolt, RN, Ph.D., FAAN, FACMI, FAIMBE, program director for the University of Maryland’s Nursing Informatics program, said that nurses specializing in informatics, which combines nursing science with computer and health sciences to integrate systems and help health care providers document care and record evidence of their practice, will be in greater demand as technology and health care become more integrated.

“Nursing informatics is a field that is certainly in growing demand,” Ozbolt said. “The Recovery and Rehabilitation Act covers $1 billion a year for projects that will help acquire and implement electronic health records. There will be an acute need for nurse informatics once this is implemented.”

Graduates of nurse informatics programs most often go on to work in health care organizations to help maintain and develop systems that support everything from patient information to care documentation. Nurse informatics graduates also work at companies that develop these systems as well as branches of the federal government.

“Health care reform is going to depend very heavily on electronic tools to improve the safety and quality of care,” Ozbolt said. “People trained in nursing informatics will be needed to help get good, useful systems in place. Because nurses are at the heart of the information flow in health care, they really have excellent insights into which kind of information systems will work well.”

Nursing specialties focusing on technology, geriatrics and the acute-care patient population are all expected to expand in the near future, according to Mary Jean Schumann, RN, MSN, MBA, CPNA and chief programs officer for the American Nurses Association.

Specialties centered upon more complex clinical cases are also expected to grow in demand as patients become sicker with chronic illness and disease. “Due to the economy, we are going to see more of these kinds of patients with complex needs because they are waiting to see the doctor and receive care.”   For more, we link to this article.

We also link to the best and most popular NurseZone articles of 2009.

This is the 2^nd in a series where we are addressing the specifics concerning what types of nurse positions qualify for H-1B visas and what criteria both the employer and nurse must meet.

If you missed our first Client Alert on this topic where we provided an overview and specifically discussed the category of Advanced Practice Nurses, let us know and we will send you a copy.

…A brief recap before we discuss the Clinical Nurse Specialist category:

What Positions Qualify for H-1Bs 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 (CNS’)
·        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.

What is a Clinical Nurse Specialist?

CNS’ plan, direct, or coordinate the daily patient care activities in a clinical practice. Ensure adherence to established clinical policies, protocols, regulations, and standards.A CNS is an advanced practice RN who functions as a health care provider, educator, consultant, researcher, leader/administrator and/or case manager.It is the CNS who often sets the standards for quality patient care; trouble shoots problems and crises; anticipates complications and helps to prevent their development; and views the individual, family or group within the context of a whole system.The CNS usually has a specialty practice area such as diabetes, cardiology, respiratory, pediatrics or psychiatric-mental health.

The three domains of CNS practice, known as the three “spheres of influence”, are the patient/family, nursing personnel and system/network organization. The three spheres are overlapping and interrelated, but each sphere possesses a distinctive focus.n each of the spheres of influence, the primary goal of the CNS is continuous improvement of patient outcomes and nursing care.

Sample job titles that would qualify: Critical Care Clinical Nurse Specialist, Clinical Nurse Specialist, Intensive Care Unit Clinical Nurse Specialist, Cardiology Clinical Nurse Specialist, Cardiothoracic Surgery Clinical Nurse Specialist, Emergency Department Clinical Nurse Specialist, Nurse Clinician, Pediatric Clinical Nurse Specialist

The Department of Labor, Division of Employment & Training Administration Occupation Information Network (known as the O*NET) lists the following specific tasks associated with the position:

1. Collaborate with other health care professionals and service providers to ensure optimal patient care.
2. Provide specialized direct and indirect care to inpatients and outpatients within a designated specialty such as obstetrics, neurology, oncology, or neonatal care.
3. Observe, interview, and assess patients to identify care needs.
4. Monitor or evaluate medical conditions of patients in collaboration with other health care professionals.
5. Read current literature, talk with colleagues, or participate in professional organizations or conferences to keep abreast of developments in nursing.
6. Develop or assist others in development of care and treatment plans.
7. Develop, implement, or evaluate standards of nursing practice in specialty area such as pediatrics, acute care, and geriatrics.
8. Plan, evaluate, or modify treatment programs based on information gathered by observing and interviewing patients, or by analyzing patient records.
9. Make clinical recommendations to physicians, other health care providers, insurance companies, patients, or health care organizations.
10. Identify training needs or conduct training

Education:Many of these positions might require graduate level preparation, such as a master’s degree, or master’s level coursework, or a bachelor’s degree with extensive on-the-job experience. Related Experience:Extensive skill, knowledge, and experience are needed for these occupations.

For your future reference, here is the O*NET page that lists several possible positions that qualify as Advanced Practice Nurses and here is the O*NET page that also lists many positions that qualify as Clinical Nurse Specialists

Again, remember – for citizens of Canada and Mexico, the TN 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

Stay with us -next in our series will be the Nurse Practitioner.

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If you have any questions pertaining to this information or are an employer and wish to discuss bringing H-1B nurses and other healthcare professionals onboard, please contact us for a free consultation at info@immigrationsolution.net  |  562 612.3996.

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.

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.

The NCSBN has an excellent Resource Manual available for International Nurses and was developed as a user-friendly resource.

The manual focuses on 3 main topics related to foreign nurses:  Education, English Exam and Immigration.  Very intelligently, each chapter has 4 sections:  Definitions, Issues, FAQs and Resources.

It is important to understand that each state is responsible for the licensure of nurses within the state. Variations exist among the states.  It is very important to be working with a knowledgeable certification and licensure specialist or be in direct contact yourself with the State Board.

Immigration Solutions are specialists in health care immigration – for all occupations.  We have placed hundreds of foreign health care personnel with US hospitals and top medical facilities in the USA.  We have worked with some of the most reputable international staffing professionals in the industry; have attended countless recruitment events abroad and in the USA, and interface one-on-one with the health care professional and their families throughout the entire process.  We continue to advise and consult with some of the top recruiters and medical facilities in the USA.

Contact Immigration Solutions for all of your US and Canadian health care immigration matters.  Here is the link to the NCSBN Manual and here is a link to our healthcare brochure.

Our Immigration Newsletter and Podcast are now available.  This month’s issue addresses Immigration Reform, Employer Compliance Issues, Healthcare and IT news.  We link here

Social Science Research Network:  Understaffing of nurses in US hospitals is severely impacting the quality of healthcare and is predicted to worsen in future years.  By the year 2020, the nursing workforce is projected to be nearly a million nurses short.  The current nurse pool is retiring and the number of new nurses entering the profession is inadequate.  At the same time an aging baby boomer population will need to be cared for as they reach old age.

We link to the Abstract

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.