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.

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.

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.

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?

There’s been alot of chatter today about the introduction of Rep. Gutierrez’ (D-IL) immigration bill that is called Comprehensive Immigration Reform for America’s Safety and Protection (CIR ASAP).

Yesterday, Rep. Gutierrez stated, “We have waited patiently for a workable solution to our immigration crisis to be taken up by this Congress and our President.  The time for waiting is over.”

To address some of the key points:

Backlog Reduction: This would be  a recapture of unused employment-based visas from  previous years (1992 – 2008) with an allowance for future unused visas to roll over the next year; exempting spouses and children from the annual cap; increasing the country quotas; the ability to file for AOS (adjustment of status; i.e. green-cards) before a visa number is available by paying a fee of $500, even thought a visa cannot be issued until a visa number is available.  This does, however, allow for work authorization, travel authorization and maintenance of status.

Employment Verification: Would make E-Verify work verification mandatory for all employers by phasing in current employees and new hires; would impose additional pealties on employers’ failure to follow the E-Verify program.

H-1B and L-1 Nonimmigrant Visas: Would impose requirements on employers to recruit US workers before applying for an H-1B and would increa3se penalties for H-1B violations.  Would create penalties for L-1 violations.

The Undocumented: Would create a 6-year ‘conditional’ non-immigrant status for undocumented (illegal) foreign nationals in the USA.  This would include work authorization and travel authorization; would waive unlawful presence bars and provide a path to permanent residence (green-card) and citizenship.

The Immigration Policy Center has an excellent 6-page more detailed review of the bill which we link to.

AILA applauded the introduction of Rep. Gutierrez’ Bill and stated, “We know how dedicated Rep. gutierrez is to immigration reform,” commented Bernie Wolfsdorf, president of AILA.  “Gutierrez has long been a strong and vocal leader in the CIR movement.  We look forward to analyzing this new CIR bill and hope to work with him and other members of Congress to fix our nation’s dysfunctional immigration system and help spur the country back to economic recovery.”

AILA further stated:  Already, the Congressional Progressive Caucus, the Congressional Asian Pacific American Caucus and members of the Congressional Black Caucus have endorsed the bill as a solution to both stem illegal immigration and promote legal migration that will protect and strengthen our nation’s economic and national security.

Gutierrez explained at his press conference yesterday that the Senate will still take the lead on debating immigration reform with a bill to be introduced by Sen Charles Schumer (D-NY), Chair of the House Judiciary Subcommittee on Immigration.  Janet Napolitano (DHS Secretary) has indicated that they have provided extensive technical assistance to Schumer and his staff as they draft the bill that is predicted to be introduced early 2010.

We will continue to report on any and all news and progress on the immigration reform front.

If you’re interested in more reading….Homeland Security Today NY Times ABC News The Hill

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.

The January Visa Bulletin has extensive notes and interpretation for those of you who find it difficult to comprehend in re numerical control and cutoff dates and how they’re determined, how per country quotas are calculated, future projections and more.  We have made these Notes available to our readership.  For more

For questions concerning the visa bulletin and any immigration case issues that you require assistance with, please contact us.

The DOL has designated a centralized Washington, DC location to handle Prevailing Wage Requests (PWRs) for all case types as of January 1, 2010.

PWRs for PERM, H-1Bs, H-1B1s (Chile and Singapore), H-2Bs and E-3s (for Australians) will be prepared on the PWR form that DOL rolled out for the H-2B program, form ETA-9141.  DOL has not yet offered an electronic version of this form so there isn’t any way to submit it online, neither are they accepting faxes.  If you subscribe to an immigration forms program, such as INSZoom, you can access a fillable version there.

All PWRs are to be mailed to the OFLC’s NPWHC in Washington, DC. at:  US Department of Labor-ETA, National Prevailing Wage and Helpdesk Center, Attn:  PWD Requests, 1341 G Street, NW, Suite 201, Washington, DC  20005-3142.

Here is AILA’s advance copy of the Federal Register Posting.

We’ll see how this centralized process goes.  To roll out a new system without electronic submission doesn’t make much sense.  Let’s keep our fingers crossed.

First they were arrested and faced deportation under what has proven to be the Obama administration’s only workplace raid.  Then they were given work permits and told they could stay in the USA while their employer was prosecuted…

Now, the more than 2 dozen undocumented workers arrested during the February raid are again facing deportation.

The deportations and likely removals are a conclusion to a case that displeased both advocates for illegal immigrants and those who lobby for stricter immigration enforcement.

In this case – the company, the workers and even the Seattle US Immigration and Customs Enforcement (ICE) office that conducted the raid came in for some sort of punishment or special scrutiny

Shortly following the raid, ICE officials traded urgent emails going over Q&A sent by an apparently miffed White House, according to emails obtained by the AP through a federal records request.

In all, 27 workers have been deported; 7 have been allowed to leave the country voluntarily and 15 await court dates with an immigration judge, said ICE spokeswoman Lorie Dankers.

Read more

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.