With the visa priority dates for employment-based third preference (EB-3) Registered Nurses (RNs) being chronically retrogressed, increasing attention is shifting to the feasibility of using the H-1B visa option for an occupation that is chronically in a shortage situation.
While financial issues have traditionally been the top priority for healthcare CEOs, for the past three years the most urgent priority for healthcare leaders has been workforce; particularly the growing shortages of RNs. CEOs have a very good reason for losing sleep over the workforce shortage issue: A recent McKinsey study in partnership with Oxford Economics found that clinical shortages, driven mostly by nursing, could create $170 billion in incremental costs in 2027. Further findings indicated that labor shortages could also stymie growth of individual health systems and lead to access risks from site-of-care closures and increased wait times.
Historically, H-1B visas for RNs were limited to those working as a Nurse Manager, Nurse Practitioner, Certified RN Anesthetist, Certified Nurse Midwife, or Clinical Nurse Specialist. This represented a very small fraction of the overall nursing workforce. Other RN positions generally did not meet the USCIS definition of a specialty occupation. However, in the summer of 2023, the U.S. Department of Labor changed its job classification for RNs from an occupation that usually requires an Associate’s degree to an occupation that usually requires a Bachelor’s degree. This change allowed U.S. hospitals and immigration attorneys to refocus on the H-1B visa option for RNs. Most attention has come from not-for-profit healthcare employers, as they are not subject to the annual H-1B visa cap.
But there is a catch: Finding international RNs who meet the U.S. Department of Labor definition of a Bachelor’s degree, which is either a Bachelor’s degree or an Associate’s degree with 6 years of nursing experience, is not that difficult. The much harder part is proving that they are being hired into a position that requires a Bachelor’s degree, when most health systems continue to employ large numbers of Associate’s degree prepared RNs.
On a positive note, proving that a Bachelor’s degree is usually required for a nursing role does not have to be done at the facility level. It is permissible to make this determination on a clinical department level meaning that some departments may be able to utilize H-1Bs while others in the same facility may not. Most employers quickly conclude that applicants don’t meet the H-1B Bachelor of Science in Nursing or equivalent requirement, only to find that when they take a closer look that they have several units that do qualify. Remember that an Associate’s degree with 6 years of experience qualifies as equivalent to a Bachelor of Science in Nursing in this case.
While healthcare immigration attorneys have taken different approaches to filing of H-1B petitions for RNs, ranging from very conservative to quite aggressive, the fact is that there has been a significant increase in the number of these types of petitions being approved by USCIS.
With the supply and demand gap in the RN workforce continuing to grow with no end in sight, all not-for-profit U.S. healthcare employers should carefully evaluate how using the H-1B visa program can support their staffing plans in a matter of months, from when a visa application is filed to when they are able to arrive in the U.S. and report for work.
Ron Hoppe is the CEO of WorldWide HealthStaff Solutions, a firm that has been connecting U.S. healthcare employers with international health care provides for the past 26 years.
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