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.

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.” 

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.

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.

The NCSBN has posted the 2010 NCLEX-RN Detailed Test Plan Candidate version and Item Writer/Item Reviewer/Nu Educator version on its Website The new test plan goes into effect April 1, 2010.

The NCLEX-RN Test Plan is evaluated every 3 years, and changes are made based on empirical data from a practice analysis, expert judgment and feedback from member boards.  The purpose of the Detailed Test Plan is to provide more in depth information about the content areas listed in the basic NCLEX-RN Test Plan.  Both tests include sample items at the end of each category, which are specific to the Client Needs category being reviewed in that section.  Also, the Item Writer/Item Reviewer/Nurse Educator version includes an item writing tutorial with sample case scenarios to provide nurse educators with hands-on experience in writing NCLEX style test questions.

As of October 25, 2009, approximately 52,800 H-1B cap-subject petitions and approximately 20,000 petitions qualifying for the advanced degree cap exemption had been filed. Seven months into this fiscal year and there are still H-1B visas available – but not for long!

Any H1-B petitions filed on behalf of a foreign national with an advanced degree will now count toward the general H1-B cap of 65,000. USCIS will continue to accept both cap-subject petitions and advanced degree petitions until a sufficient number of H-1B petitions have been received to reach the statutory limits, taking into account the fact that some of these petitions may be denied, revoked, or withdrawn.

The H-1B Petition is still a valid option for professionals with degrees in IT, Engineering, those in science and the arts, as well as many healthcare workers including PTs, OTs, Physicians, Pharmacists,  AHPs, and some nurses.

When considering Nurses for H-1B Visas, these are the threshold issues and key questions:

For Nurses:

1. The nurse must hold at least a Bachelor’s Degree in Nursing (a BSN), and

2. The position must normally require a Bachelors Degree.

For the Employer:

A. The hospital is offering the nurse a position as a Clinical Nurse Specialist (CNS), Certified Registered Nurse Anesthetist (CRNA), Certified Nurse-Midwife (CNM), a Certified Nurse Practitioner (APRN-certified) or positions in Critical care where the nurse holds certification;

B. If the nurse will be working in an Administrative position ordinarily associated with a Bachelors Degree, such as Charge Nurse or Nurse Manager;

C. If the nurse will be working in one of these specialties: peri-operative, school health, occupational health, rehabilitation nursing, emergency room nursing, critical care, operating room, oncology and pediatrics. And the hospital will attest that these roles are only offered to those with Bachelors Degrees. Some magnet hospitals have the BSN as its standards, and these make great destination hospitals for RN H-1Bs.

Contact Immigration Solutions if you are seeking representation to assist you with your H-1B case filings.  We have a professional team ready to handle your casework with reasonable and fair fees.  We specialize in IT, Engineering and Healthcare immigration, amongst other business sectors – both in the US and Canada.