Related Practices

• Healthcare Business
• Immigration

Having trouble hiring nurses?  Join the crowd.  With more nurses retiring and fewer entering the profession, many hospitals and other healthcare institutions find it increasingly difficult to hire and retain qualified professional nurses.  As a result, many healthcare employers are looking abroad to fill their nursing ranks.

The Immigration and Naturalization Act provides several options for employers wishing to employ nurses on a temporary basis.  Depending upon the nationality of the nurses whom you are recruiting and how long you wish to employ them, healthcare employers have the following options when seeking to employ foreign nurses.

H-1C Visa
This new visa category was created by Congress in 1999 as part of the Nursing Relief for Disadvantaged Areas Act and is available only to employers located in federally-mandated Health Professional Shortage Areas (HPSA).  To be eligible, the nurse must have a full and unrestricted nursing license in his or her home country or the country in which he or she received nursing education, passed the Commission on Graduates of Foreign Nursing Schools exam and be fully qualified to practice as an RN immediately upon admission to the U.S.  This visa category is limited to a total of 500 nurses per year nationwide and nurses are limited to a single, three-year period of stay.

The law also imposes several attestation requirements on potential employers.  In addition to being located in a HPSA, the employer must certify that the employment of foreign nurses will not adversely affect the wages of RNs similarly employed and that the hospital is taking steps to recruit and retain U.S. citizens or permanent residents so it will not be dependent on foreign nurses.

Given the various restrictions on this program, the H-1C visa category is of limited use to most healthcare employers.

TN Visa
A far more useful category and one which several healthcare employees are taking advantage of, is the TN visa, created under the North American Free Trade Agreement (NAFTA).  While the TN visa category ostensibly is available to citizens of both Canada and Mexico, because of differences in filing requirements, it is particularly effective for Canadian nurses.  Under NAFTA, registered nurses are eligible to seek TN status so long as they possess a state or provincial license and have at least an interim nursing permit to practice in the state of intended employment.  Admission for TN status is valid for one year but may be renewed for additional one-year periods.

Canadian citizen nurses may apply for TN status directly at the U.S./Canada border or at an international airport with a pre-flight U.S. immigration inspection.  Thus, TN status can be obtained fairly quickly and inexpensively and without waiting for INS approval of a petition filed in the U.S.

For Mexican citizen nurses, however, employers must file a petition which must be approved prior to the employee being admitted under TN status.  Filing a formal petition with the INS makes the process far more time-consuming and expensive than for Canadian nurses, but still provides U.S. healthcare employers with an excellent option for employing Mexican nurses.

H-1B Visa
An H-1B visa is available to persons employed in a “specialty occupation,” which has been defined by INS as a position that requires a four-year degree.  The visa applicant must possess such a degree.  Many nursing programs can be completed in two years and graduates would likely not qualify for H-1B visa status.  Moreover, a majority of nursing positions do not require a four-year degree.  The INS has taken the general position that registered nurses are not a “specialty occupation” for H-1B visa purposes.

If, however, the employer can show that a particular position requires a college degree, an H-1B visa may be available.  H-1B petitions have been approved for nurses in positions such as Care Plan Coordinator, Rehab Professional/Charge Nurse and Nursing Unit Manager.  The common thread is that the nurse was performing duties beyond direct patient care and, thus, a college degree was required.

With the exception of Canadian and Mexican nurses who qualify for TN status, visa options for employers wishing to employ foreign nurses are somewhat limited.  Nonetheless, as the nursing shortage continues to increase, healthcare employers should look carefully at their needs in order to determine whether hiring foreign nurses may be beneficial.

For further information regarding immigration options for nurses or other healthcare professionals, please contact any member of the Cohen & Grigsby Immigration Group.