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.