We have received many emails and telephone calls regarding the new position taken by the CA Board of Nursing that now requires that an RN have a work authorized social security number in order to apply for licensure. 

There is a general misunderstanding concerning this issue; namely, there are social security cards that are issued for identification purposes that do not permit work – and there are SS cards that permit work and are annotated with work authorization.

There are 3 types of Social Security Cards:

 1)  Unrestricted Social Security Card:  If you are a US citizen or a permanent resident, you are permitted to work with any US employer without permission from a government agency.

2)  Restricted Card:  This social security card has an annotation: VALID FOR WORK WITH  USCIS AUTHORIZATION.  This type of card is issued to temporary visa holders such as H-1B, TN, E-3 or L-1 who are working for a US sponsoring employer.  Note that H-4 visa holders are not eligible to obtain a Social Security Number and cannot be employed, but can hold a driver’s license, open bank account(s) and obtain ITIN (see below) for IRS Tax purposes.

3)  A Non-Work Social Security Card: This card has the annotation NOT VALID FOR EMPLOYMENT. This card is issued on a limited basis in certain types of situations such as in order to receive federal, state or locally funded benefits or if a state requires it to receive public assistance.

What is an ITIN number?  ITIN numbers are for IRS identification and tax purposes and do not authorize work or provide social security benefits.  For more information:  http://www.irs.gov/individuals/article/0,,id=96287,00.html

What is an EIN Number?  EIN numbers, also known as FEIN (Federal Employer Identification Numbers) or TIN (Tax Identification Numbers), are issued by the IRS to employers operating in the USA for identification purposes.  In essence, it is the corporate equivalent to a social security number.  It is issued to individual business owners for identification purposes and for paying withholding taxes on their employees.  For more information:  http://www.irs.gov/businesses/small/article/0,,id=98350,00.html

Applying for Permanent Residency:  If you have a pending permanent residency case (I-485) and are in the USA and have filed and received approval of an I-765 Application for Employment Authorization, you can obtain a social security number for work purposes while you case is pending approval.

Consular Processing your Immigrant Visa:  If you have processed your immigrant visa (green-card) outside the USA at a US Consulate, you are entitled to apply for a work authorized SSN card upon entry to the USA. 

If you are a Student:  If you are an F-1 student who has completed a course of study, USCIS will grant temporary work authorization or training directly related to your course of study.  Optional Practical Training (OPT) can be authorized pre or post-completion of studies. The on-campus Designated Student Officer (DSO) will assist with the application process.  We link to more information concerning OPT. 

How to apply for OPT:  http://www.ice.gov/sevis/students/opt.htm    Fact Sheet:  http://www.ice.gov/sevis/factsheet/061404emp_fs.htm

Other Resources:

 ►  To locate a Social Security Office in your area  

 ►  Applying for a Driver’s License

►  Student Fact Sheet on Obtaining an SSN

We have recommended that RN licensure be obtained through states that do not require the above SSN Restricted Card requirements such as NV, TX or AZ.  If your job offer is in the state of California, following approval of your immigration case, you will be permitted to endorse your licensure over to CA.  It is important not to let your CA licensure lapse (expire), otherwise you will be required to re-take the NCLEX exam.  Give yourself plenty of time to endorse to another state if CA will not grant an extension of your current licensure.

Should you wish to consult with our office regarding this matter or any other immigration related issues, please contact our office.

The new healthcare reform law covers a lot of ground, measuring in at about 2,400 pages, and twice as long as “War and Peace.”

Much attention this week has focused on big-ticket provisions such as a national exchange for buying insurance, an end to excluding people with preexisting medical conditions.

But scattered throughout the law are also a number of provisions that focus on prevention of illnesses and keeping people fit. And, some healthcare experts say, this is where the real action will be in years ahead.  What jobs will be in demand to service this need?

If you’re considering switching careers, or are just starting to think about where to begin yours, this is the list for you:

#1  Registered Nurse: One of the most in-demand careers in the entire US, registered nurses are projected to generate over 580,000 new jobs by 2016. This does not count the hundreds of thousands of jobs that will become available when older nurses retire. Those following the path toward becoming a registered nurse will find abundant job prospects and ample opportunities.  Call your representatives and tell them to pass the W Visa for nurses that will provide a temporary nonimmigrant category for nurses.  Also tell them to tackle legal immigration first to get the nurses in waiting in the EB-3 category moving forward, given that this is a pre-certified shortage occupation.

#2  Home Health Aide: Home health aides function as caregivers to the many people who are unable to leave their homes or live on their own. Home health aides may check vital signs, administer medicines, and help with daily tasks. The job outlook for home health aides is excellent, especially as baby boomers age and home health aides retire or advance into other careers.

2006 employment: 767,000
2016 projection: 1,156,000
Percent growth: 50.6
Salary range: Less than $21,220
Education/training: On-the-job training

#3  Medical Assistant: Medical assistants perform administrative and clinical tasks in a variety of work settings. A staple of the healthcare industry, medical assistants are in demand all over the US. Employment for medical assistants is estimated to grow much faster than average, and job opportunities should be abundant for medical assistants with formal training or certification.

#4  Pharmacy Technician:  Pharmacy technicians help pharmacists in providing medication and health care products to patients. Because there is currently few state, and no Federal, requirements for formal training, many employers have on-the-job training, which is appealing to individuals who want to further their education without attending multiple years of school.

2006 Employment: 285,000

2016 projection:  376,000

Percent growth:  32

Salary range:  $21,260 – $30,560

Job outlook:  The demand for pharmacy technicians will increase along with the elderly population.  Pharmacies looking to cut costs will shift more responsibilities form pharmacists to technicians

#5  Medical Secretary: Employment is expected to grow faster than average, and job opportunities should be especially good for those who are certified. Employment in hospitals and physician’s offices will continue to grow significantly.

#6  Dental Assistant: Dental assistants are the most in-demand job in the field of dentistry.  Here are the stats:

2006 employment: 280,000
2016 projection: 362,000
Percent growth: 29.2
Salary range: $21,260 – $30,560
Education/training: Moderate on-the-job training
Job outlook: As dental health among older generations improves, routine preventive care is needed more than ever before. Also, younger dentists entering the field are more likely to work with assistants.

#7  Healthcare Administrators; As the backbone of healthcare systems, healthcare administrators take on the duties of overseeing vast expanses of medial personnel. As the structure and financing of the healthcare industry changes, healthcare administrators must be able to adapt to new environments. However, administrators are still in great demand despite the evolving industry.

#8  Medical Records and Health Information Technicians: Medical records and health information technicians maintain the millions of documents the healthcare industry produces. Paperwork includes x-rays, medical histories, lab tests, and treatment plans. Every patient has detailed medical records, and it is necessary that these records be kept organized and confidential. Even with the proliferation of online and electronic health records, the medical records field is expected to grow considerably.

#9  Physical Therapist:  Physical therapy is a growing occupation, especially for those who was interested in pursing an advanced medical degree but do not want to be physicians. Currently, the number of physical therapy jobs is greater than practicing physical therapists because many physical therapists hold more than one job – such as having a private practice and also working part time at another healthcare facility.  Call your representatives and ask them to tackle legal immigration reform first so that the backlog of PTs waiting for green-cards (a pre-certified shortage occupation along with RNs), get moving forward for foreign PTs.

2006 employment: 173,000
2016 projection: 200,000
Percent growth: 27.1
Salary range: $46,360 or more
Education/training: Master’s degree
Job outlook: The growing elderly and disabled population will push demand for physical therapy, an industry that’s constantly expanding its scope.

#10  Physician Assistants:

2006 employment: $66,000
2016 projection: 83,000
Percent growth: 27
Salary range: $46,360 or more
Education/training: Master’s degree
Job outlook: As health care facilities, particularly in rural and inner-city areas, increasingly use physician’s assistants to address physician shortages and save money, job demand will grow.

More on this in the News:

• We link to an article in the LAT:  http://www.latimes.com/sns-health-growing-health-occupations,0,6656383.photogallery

• Healthcare Finance News: http://www.healthcarefinancenews.com/news/healthcare-hiring-could-boom-2010

• Healthcare Reform:  How it Might Work for Real People:

http://www.cnn.com/2010/HEALTH/03/23/health.care.scenarios/index.html

Beginning March 1, 2010, VisaScreen renewal applicants who can demonstrate employment in the United States in the health care profession that is designated on their International Commission on Healthcare Professions VisaScreen certificate do not have to take another approved English exam for renewal of their VisaScreen certificate if the following criteria are met:

1)  The period of employment must be for at least 27–36 months, including nine months of the year before the date an applicant submits the renewal application.

2)  They will need to have their employer submit an employment summary on corporate letterhead with the appropriate signature for the English requirement to be waived.

CGFNS has made the U.S. Department of Health and Human Services aware of this policy change.

CGFNS is an immigration-neutral, nonprofit organization based in Philadelphia, Pennsylvania, USA, and is an internationally recognized authority on the education, registration and licensure of nurses worldwide. CGFNS’s mission is to provide responsible leadership in the delivery of relevant services to the global nursing and health care community. The organization was founded in 1977 through a collaborative effort by representatives from the U.S. Department of Labor; Department of Health, Education and Welfare (now the Department of Health and Human Services); the Immigration and Naturalization Service; and representatives from nursing organizations, including the American Nurses Association and the National League for Nursing.

For additional information about CGFNS and its services, contact: CGFNS International, 3600 Market Street, Suite 400, Philadelphia, PA 19104-2651 USA; telephone: +1 (215) 222 8454.

The petitions of applicants who will be processed at an overseas US Consular post are forwarded by USCIS to the Department of State (DOS).  Applicants in categories subject to numerical limit are registered on the visa waiting list.  Each case is assigned a priority date based on the filing date of the initial petition.  There are about 3.5 million on this list.  This is positively disastrous when you consider that our current laws permit 376,000 people to immigrant to the USA each year under the family-based and employment-based systems, with the average wait being over 10 years long!

There are probably another 1 million in the USA waiting to adjust their status and these numbers aren’t even reflected in the DOS report.

About 95% of the people on the list are in the family-based categories and more than 1/2 of these are  in the brother-sister 4th preference category.  At the 65,000 number level for this category, this is a wait time that averages 10-26 years!

The total employment numbers waiting a priority date:  130,509 including 119,759 in the EB-3 category.  This is a 3-4 year wait, ignoring per country limits.  The countries with the largest backlogs are the Philippines (45,331 – mostly nurses and their families.  Yes, there’s something wrong with this picture!) and India (20,467 – mostly IT professionals and their families – something is wrong with this picture, too!).  Then we hear politicians and uninformed folks saying “get in line and wait your turn”  – like the line is actually moving!

It’s a sad state of affairs that points squarely at the fact that we must first focus on legal immigration reform – getting these wait times down to something reasonable.  Do we have any representatives courageous enough to vote for legal immigration reform so that we have a system that doesn’t punish people who play by the rules?

VisaScreen® renewal:

VisaScreen® certificate holders who have not obtained a permanent U.S. visa are required to renew their certificates within five years of the issue date. VisaScreen® renewal certificate applicants should begin the process six months before their current certificate expires. The renewal fee is
$250 USD. The renewal application is available for download at www.cgfns.org/files/pdf/apps/VisaScreenReApp.pdf or applicants may apply online through CGFNS Connect.

Expedited Review Service:

Service for VisaScreen® to include applicants who have an offer for employment, in addition to those who have a Request for Evidence or a deportation deadline regarding their U.S. visa application.

VisaScreen® applicants are eligible for this Expedited Review Service only I they have met the criteria of Section 343 of the Illegal Immigration Reform Immigrant Responsibility Act; we have received all required documents and we have received a copy of their Request for Evidence, deportation deadline or offer for employment accompanied by a completed CGFNS Expedited Review Service form.

To apply for the Expedited Review Service, eligible VisaScreen® applicants will need to call CGFNS Customer Service between the hours of 8am and Noon, U.S. Eastern Time, to receive instructions. (see contact info below)

We will need the items requested above with an online credit card payment of $500. CGFNS will then perform the necessary review within five business days and, if all requirements have been successfully met, issue a VisaScreen® certificate via UPS next day air. Applicants who are ineligible for a VisaScreen® certificate based on the review will be notified. Fees for the Expedited Review Service are not refundable.

CGNS increases prices on its services:

CGFNS International announced on 21 December 2009 a new pricing structure for core services and several ancillary services.  Applications for the Certification Program, the Credentials Evaluation Service, the VisaScreen®: Visa Credentials Assessment program, the Credential Verification Service for New York State and ancillary services received on or after 1 January 2010 will be charged according to the new fee schedule.

The updated 2010 fees can be found here.

Contact Information:

CGFNS Customer Service* +1 (215) 349 8767
Automated Voice Response Telephone System +1 (215) 599 6200
Appointments* +1 (215) 222 8454
Mailing address Suite 400, 3600 Market Street, Philadelphia, PA 19104-2651
CGFNS Web site http://www.cgfns.org
CGFNS Connect https://www.cgfns.org/cerpassweb/intro.jsp
Apply/Check Status https://www.cgfns.org/cerpassweb/intro.jsp
Email https://www.cgfns.org/cerpassweb/processContactUs.do

Unlike many other industries, the healthcare sector is projected to continue growing.  The federal Bureau of Labor Statistics released a report in December 2009 that projected an additional four million jobs will be created in the healthcare and social assistance fields during the period from 2008 to 2018.

There’s an extreme shortage of primary care physicians; there’s an extreme shortage of registered nurses.  Healthcare organizations need to be proactive in planning for the future.

Expanding the capacity of nursing schools is another essential element in preparing the workforce for coming changes, especially if the healthcare system evolves to the point where it needs more advanced practice nurses. There will be a need to educate even more nurses, and capacity would continue to be a problem.

That means that many healthcare organizations may be scrambling to fill vacancies and to develop creative and efficient strategies to deliver patient care.

We link to this article in Healthcare Briefings for more.

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.” 

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.