Non-Immigrant Visa Options for Nurses – guerreroyee.com

In this post, other avenues for sponsorship are explored.

NIV Options for Nurses — Atty. Rio Guerrero

Since the H-1C nonimmigrant visa program sunset on December 20, 2009, visas for hundreds of nurses have expired or will soon expire, leaving H-1C-authorized healthcare employers struggling to provide much-needed professional nursing care with a dwindling nursing staff. Although H.R. 1933, which is currently pending before the U.S. Senate Judiciary Committee, would reauthorize the H-1C nonimmigrant visa program, the sunset of this program casts light upon the dearth of nonimmigrant visa options available for foreign nurses and its negative impact upon nurse staffing nationwide. What are the alternatives for healthcare facilities in the United States?

Currently Available Nonimmigrant Visa Options for Nurses

TN Status—NAFTA
Registered nurses are included in the list of professions eligible for TN status pursuant to Appendix 1603.D.1 to Annex 1603 of NAFTA.
It is difficult to accurately measure the precise number of Canadian and Mexican citizens currently employed as professional nurses in TN status, however, TN status is generally believed to be the most frequently utilized nonimmigrant option among foreign nurses employed in the United States. The primary advantage of TN status is the ease of entry. Registered nurses applying for admission in TN status may be employed in positions covering a wide scope of expertise – from entry-level RN placements to more senior administrative positions. However, the stark disadvantage of TN status is that the pool of potential foreign nurses is restricted to Canadian and Mexican citizens.

H-1B Specialty Occupation Workers
It is well-settled that certain specialty occupations in the nursing industry may qualify for H-1B  nonimmigrant status. Specifically, a narrow group of nurses holding a baccalaureate or higher degree (or equivalency) in nursing that includes advanced practice nurses (such as Clinical Nurse Specialists (CNS), Nurse Practitioners (NP), Certified Registered Nurse Anesthetists (CRNA), and Certified Nurse-Midwives (CNM)), nurse managers, and nursing administrators, may qualify for H-1B status. According to USCIS data, the issuance of H-1B visas for specialty occupation nurses varies greatly from year to year. In recent history, the greatest number of H-1B nurse visas issued in any given fiscal year was only 136. Unlike TN status, the H-1B visa for specialty occupation nurses is available to qualified nurses from all foreign countries. However, the limited scope of eligible specialty occupations greatly narrows the potential use of the H-1B to fill U.S. nursing job vacancies. For instance, many RNs may not qualify for an H-1B because employers and state licensing boards do not usually require a BSN to perform services as a registered nurse.

Return of the H-1C?
The H-1C nonimmigrant classification enables foreign nurses to perform services as a registered
nurse in a U.S. health professional shortage area as determined by the U.S. Department of Labor
(DOL). To qualify for an H-1C visa, both the employer and employee must meet certain
eligibility criteria. The U.S. employer must:
-Be a “subsection (d)” hospital under the Social Security Act;
-Be located in a “Health Professional Shortage Area;”
– Have at least 190 acute care beds;
-Have a Medicare population of no less than 35%;
– Have a Medicaid population of no less than 28%; and
-Be certified by DOL.

The employee must:
-Hold a full and unrestricted nursing license in the country where their nursing education was obtained, or have received a nursing education in the U.S.;
-Have passed the examination administered by the Commission on Graduates for Foreign Nursing Schools (CGFNS), or have a full and unrestricted license to practice as a registered nurse in the state where the employee will work, or have a full and unrestricted registered nurse’s license in any state and have received temporary authorization to practice as a registered nurse in the state where the employee will work; and
-Have been fully qualified and eligible under the laws of the state of intended employment to practice as a registered nurse immediately upon admission to the U.S.

According to recent information provided by the U.S. Senate Judiciary Committee, H.R. 1933 remains on the Committee’s agenda, but is not yet scheduled for a Senate vote. As drafted, this legislation reauthorizes the availability of 300 H-1C visas (a departure from the 500 originally authorized under NRDAA) for an initial validity period of three years, with the opportunity to renew H-1C status for an additional three years. New aspects of H.R. 1933 include the three-year extension and H-1C portability between any of the eligible hospitals under INA §214(n). Whether H.R. 1933 becomes law remains to be determined, but it would no doubt assist authorized healthcare facilities to meet their nursing staff needs given that most H-1C visas have already expired.

Click here to view complete text for “Non-Immigrant Visa Options for Nurses”.

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With Multiple Degrees and a Stable Job – Why Do They Still Leave?

I recently received an application from a Philippine-based RN ‘dreaming’ to work in US. The application packet, although complete and very professionally prepared, was sent through the applicant’s mother’s friend’s friend — infamously and laughably a common cultural practice in the Philippines that seeped its way into the modern workplace and overseas. Known as the ‘padrino system’ or patronage,  this is a system where one primarily gains favor through family affiliation  or friendship  before an applicant’s merit. 

The applicant is initially a BS Biology graduate of one of the best universities in the country, of which entries to both the system and the course program are cut-throat battles in the Philippine academe. Yet despite the laurels, the applicant immediately  went back to school after graduation and took up BS Nursing. Armed with this new degree, he simultaneously applied to reputable hospitals in Metro Manila while diligently preparing for the exam administered by the Texas Board of Nursing. Bright and determined, the applicant succeeded in both: got a much desired job in a famous modern hospital and passed the Texas Board exam for nurses in one take. Unfortunately for the applicant, the visa classification for RNs and professionals is on retrogression so US is definitely not in the applicant’s horizon. Unfortunately for the Philippines, if not the United States, there will be other Western countries that will employ him. Unfortunately for all the developing countries in the world such as former African colonies, Carribean Islands, East Germany, Soviet Union, India,  the case is not isolated in the Philippines. These countries’ brain drain is a brain gain to most highly developed North American, European and Asian countries.

For more info on retrogression, click here for our previous post.

This biologist turned RN wanting to work in US is a classic case of brain drain. Brain drain aka human capital flight is the not only the departure of educated or professional people from one country, it can also be from one economic sector, or field for another, usually for better pay or living conditions. Brain drain is often associated with de-skilling of emigrants in their country of destination, while their country of emigration experiences the draining of skilled individuals. Worse, a lot of these professionals emigrate to another country taking with them a fraction of value of their training sponsored by the government or other local organizations. They can’t be blamed though. They move to countries where their highly marketable skills are  financially rewarded.

Just to better illustrate the disparity in compensation, below is an official rate sheet of an RN working in an Upscale hospital in Metropolitan Manila.

The current market rate of an RN working in an Upscale hospital in Metropolitan Manila. 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Cut this by half or third, and that’s the approximate salary of RNs working in less prestigious hospitals. Some RNs don’t even get paid and many others pay the hospital in order to get work experience.

This is the salary equivalent in US dollars based on $43.00-Php 1.00 exchange rate. 

Salaries in converted to US dollars.

 

 

 

 

 

 

……

Illustrated below is the estimated annual compensation  of Med-Surg and CCU RNs in Metro New York as published by http://www.salary.com. A Med Surg nurse’s median annual salary is $76, 937 ($6,412/month) while a CCU nurse gets $ 77, 303 ($6,442/month) based on a 35-40 hour work week. 

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Visa Retrogression – What does it mean to professional immigrant workers?

Before June of this year, there were two major visa categories that are popular among professional immigrant workers: the H1b Visa aka work visa and EB2 or the greencard route.

H1B visa is a non-immigrant visa that allows US employers to temporarily employ professional foreign workers in specialty occupations. On the other hand, EB2 Visa is a permanent residency route for professionals holding advanced degrees (Ph.D., master’s degree, or at least five years of progressive post-baccalaureate experience) or persons of exceptional ability in sciences, arts, or business.

Unfortunately, the USCIS has announced that the 2013 H-1B visa cap has been reached as of June 11th. Any cases received after June 11th will be rejected and returned with filing fees uncashed. However, the rejected and would-be applicants may file again next fiscal year. The next blow is that the July 2012 visa bulletin shows that the ‘worldwide EB2′ visa category has retrogressed almost 3 years. This is the one category that remained consistently ‘current’ in recent years (together with EB1).

What happens now?

Photo from http://redbus2us.com. Edited by author.

For more information about RETROGRESSION, click this link.

For USCIS Visa Bulletin, click here.

What does RETROGRESSION mean to professional immigrant workers and their employers? This could mean long waiting times for green cards.  This means job employment offers need to be rewritten or  projects be off-shored.  In uncertain cases such as this, not much can be done than to persevere and tuck growing disappointment. There are surely other legal routes to continue working in America while hoping that these two visas will be available again soon.

US immigration system is not ideal and reform is essential to ensure Uncle Sam does not lose talented people to help boost the economy and create jobs.Right now, all that is left to do is wait. Let us see what the future has in store.

SOURCE: http://www.uscis.gov

Disclaimer: This is a post written from a layman’s perspective and should not be regarded as an immigration advice.  For valid legal advice, consult an immigration lawyer.

Factors Affecting Tenure of Nurses

In this post some recurring patterns that may affect the duration of stay of nurses working in a facility are enumerated. These observations are derived from our interactions and involvement with different healthcare facilities mostly in the Tri-State area.

1. PsychologicalNurses, at the time of hire, may not be psychologically equipped to deal with pressures coming from work. Upon hire, recruits usually show the best of themselves and recruiters are given very little clue as to how one would fare at work.

♦What we do to counter this concern is to perform a multilayered assessment process that doesn’t just focus on credentialing, but also pays attention to attitude and personality clues of our candidates.

♦We work closely with the HR of a facility in pre-qualifying candidates. We usually send the facility representative several pre-qualified candidates to select whom she thinks will work out best for the facility.

♦Another tool we use is an Evaluation Form that functions as ‘check and balance‘ for the healthcare facility and agency. For the nurse, a regular evaluation reaffirms his work, leading to greater confidence in himself and his work that ultimately benefits everyone in the equation.

2. Personality and Culture. A big question is matchingIs the nurse, personality-wise, matched to the culture of the new workplace? In culturally diverse workplaces such as New York City where customs and traditions are fanned alive by immigrants, the ‘standard’ becomes confusing. Add to that the variety of patients’ cases, situations and other factors that come into play further blurring the lines between the acceptable and what is not.

♦We have a culturally sensitive recruitment procedure that looks deeper into a candidate profile. Insights drawn from our deliberations are then used to match our retinue of nurses to facility needs and requirements.

3. Education. A lot of local schools did not prepare the nurses for real-life work situations. Nurses, especially the new ones, have these preconceived ideas of what the ideal work setup should be as shown in media (i. e ER, Grey’s Anatomy, Nurse Jackie), which they unwittingly bring to the workplace. Comparison of their ideal versus the reality results to confusion, disappointment and in some case, extreme disgruntlement.

♦What we do to counter this issue is to let the nurses undergo our uniquely designed orientation that is most often customized according to facility requirements. This orientation covers the basics such as scheduling, policies, facility idiosyncrasies, documentation and many more. The objective is to let the nurses be given an overview of the setup of the facility of assignment. As early as possible, we proactively address all predictable issues and manage the expectation of nurses in these sessions.

4. Work EnvironmentSeveral environmental dynamics come into play as well. Factors such as union policies, lackluster attitude of ‘regular workers’ towards ‘agency workers’, minor politics, cultural insensitivity of some parties, difficulty adapting to technology required in modern patient care tasks, gaping difference in rates and benefits between regulars and agency workers, and many other factors are likely to affect the employment duration of a nurse.

One glaring example is in one huge geriatric care facility where we placed nurses that were given 2-day orientation as opposed to the 2-week to a month-long orientation of directly hired nurses. The agency nurses had some apprehensions about continuing work at the at the facility because of lack of orientation. They further reasoned that they were frequently on ‘float status’, thus requiring more orientation days in order to avoid any unwanted incident that may cost them their license.

♦The best answer here is preparation.  As mentioned earlier, a nurse that has been prepared right beforehand has a higher likelihood of staying committed to a place of assignment.

5. Options. Once issues are not resolved timely, any worker would seek other opportunities. Fortunately for nurses, they have numerous options at bay that may look like the cure-all to their employment ails. So once dissatisfied, they would rather leave than take the excruciating process of correction. The handling agency should have foresight and proactive ability in managing the issues in a timely manner.

Our office is always open to suggestions on how we can further improve our services. We customize our services according to a healthcare facility’s current setup, preferences, and situation. We are available for consultation. Email me at mprimero@meridiannurse.com for an appointment.

Culture at Work

“Culture is about societal norms, communication preferences, and global outlook. At the organizational level, this includes which leadership styles are most effective, and how workers interact with each other. In dealing with customers, it’s about understanding customer segmentation, digital readiness, and inclination to participate.”                                                         

From How to Engage Your Customers and Employees

Wang, Ray. “How to Engage Your Customers and Employees.” Harvard Business Review. 9 May 2012. Web. 10 May 2012.

Can A Nurse Be In Two Places At Once?

THIS NURSE WAS EXPECTED TO PROTECT A PATIENT AND RESPOND TO A CODE.

A 92-year-old woman with heart failure, pulmonary fibrosis, anemia, and other problems came to the emergency department with viral pneumonia. Once her condition stabilized, she was transferred to the cardiac care unit (CCU).

Still in the CCU 2 days later, the patient got out of bed, even though both side rails were up, the footboard was on the bed, and the nurses had warned her to stay in bed. The nurses’ notes indicated that she was confused.

The next day, reports on the patient’s mental status varied. At 8:30 a.m., her physician assessed her and didn’t find her condition serious enough to order restraints. At 12:30 and 2:00 p.m., the nurse documented that the patient thought she was at home. When the nurse checked her at 3:20 p.m., however, she was alert and oriented. Thirty minutes later, she was on the floor. Her right hip was fractured.

The patient underwent an open hip reduction and internal fixation and was discharged 10 days later. Using a walker, she was able to walk with assistance. After three follow-up examinations, the fracture had healed and the patient didn’t have pain.

Seven months after her admission to the hospital, the patient was readmitted for numerous disorders, including sepsis, renal failure, and acute pulmonary edema. She died 9 days later. Her children sued the hospital, the physician, and the nurse for negligence regarding their mother’s fall.

In court, the testimony revealed that the nurse had been assigned exclusively to this patient. However, after she had checked the patient at 3:20 p.m., a code was called on another patient. Hospital policy also required her to respond to the code, so she left her patient for 30 minutes.

A jury found in favor of the plaintiffs and awarded them $555,000 in damages. Although the defendants appealed, the appeals court upheld the decision but reduced the amount to $500,000.

The lesson? Nurses are vulnerable even when they follow the rules. By adhering to the facility’s policy, this nurse was drawn into a no-win situation.

 

Credits: This article was referenced from http://www.nso.com/nursing-resources/article/25.jsp