An Overview on Hiring andEmploying Foreign Healthcare

WorkersTiffany L. Baldwin

Greensfelder, Hemker & Gale, P.C.

SLAHCR"2009 Collaborating for Success" Conference

June 9, 2009

VisaScreen

• Required for employment-based nonimmigrant and immigrant petitions and involves:– Educational review– Licensure validation– English language proficiency assessment– RNs: NCLEX-RN or CGFNS International

Qualifying Exam

VisaScreen Occupations

• Nurses• Physical Therapists• Occupational Therapists• Speech Language Pathologists & Audiologists• Clinical Laboratory/Medical Technologists• Clinical Laboratory/Medical Technicians• Physician Assistants

VisaScreen Not Required

• Technologists who do not handle blood or body fluids such as:– Nuclear Medicine Technologist– Ultrasound Technologist– Radiologic Technologist and Technician– Cardiovascular Technologist and Technician– Respiratory Therapy Technologist

NONIMMIGRANT VISAS

• Limited in duration• Geared toward a specific purpose• Employment authorized for some classifications• H-1B, TN, F-1

H-1B Professionalsand E-3 (Australians)

• Professional “specialty occupations” where Bachelor’s in field is a minimum requirement– Available: PT, OT, SLP/Audio, PA, Medical

Technologists• If state requires a license, FN must have one

– Unavailable: most RNs* & Medical Technicians

H-1B Professionals

• H-1B requires the paying of the “prevailing wage” – Must pay the same as similar U.S. workers– Must offer the same benefit package

H-1B Professionals

• H-1Bs are limited in number – 46,000 of 65,000 visas used for FY2010– Exceptions for non-profits that are affiliated with

colleges or universities– Someone previously counted can change employers

• When can H-1Bs begin work? – New H-1B employees: when case is approved – Transfer of employers: when USCIS receipts in filing

H-1B for Registered Nurses

• Advanced Practice Nurses

– Clinical Nurse Specialists and Nurse Practitioners: Acute Care, Adult, Critical Care, Gerontological, Family, Hospice and Palliative Care, Neonatal, Pediatric, Psychiatric & Mental Health, Women’s Health

– Certified RN Anesthetists– Certified Nurse Midwives

• Administrative Positions• Specialized Areas (Critical Care & Perioperative)

H-1B for Registered Nurses

• Positions requiring certification– Occupational Health– Rehabilitation Nursing– Emergency Room Nursing– Critical Care– Operating Room– Oncology– Pediatrics

Requirements for RN H-1Bs

• FN must have BSN• FN must have VisaScreen• BSN common for parallel nursing positions• Employer requires BSN for these positions

– Will need to show that nurses currently employed have BSNs– If APRN position, must require appropriate certification– Nurse Specialties with Certifications – must require appropriate

certification

• Independent Affidavits showing job duties are specialized and complex

H-1C

• USELESS!– No current Form ETA 9081 to file– Eligibility frozen as of HHS reporting statistics

for 1994• No area hospitals included

TN Visa

• Available only to Mexican and Canadian Citizens • Available: RN, PT, OT & Medical Technologist • Unavailable: LPN/LVN, PA, SLP/Audiologist• Issued in increments of up to 3 years

TN Visa

• TN application will include: – Employment offer letter

• Position and description• Salary• Term of employment

– Copies of degrees, certificates, licenses – Proof of Canadian/Mexican citizenship

IMMIGRANT VISAS

• Also known as Permanent Residence or “Greencard” visa

• Allows one to live and work permanently in the U.S.

• Based on Family, Employment, or Diversity

Immigrant Visa Options

• Schedule A for RN or PT positions• PERM Labor Certification required for all others

Problems

• No visa availability and expected large backlogs = file, then wait several years

• Filing of Schedule A or regular I-140, PERM secures NO employment authorization

Schedule A I-140 Petition

• Exemption from Labor Certification requirement• Registered Nurses and P.T.• 10 day in-house posting plus 30 day wait• All in-house media• Documents

– Nursing degree– NCLEX or State License

PERM Recruitment

• 2 Sunday Ads – Post-Dispatch• 30 day posting on state job bank (

www.missouricareersource.org)• 10 day paper posting in-house

PERM Recruitment Continued

• 3 additional recruitment for professional (H-1B) positions– Employer website– Internet job database– Employee referral program– Professional/trade organization– Job Fairs

General Immigrant Visa Strategies

• For those not eligible for H-1B or TN – start IV process as soon as possible

• Keep in-house posting and state job bank postings up continuously

Additional Options

• Military Accessions Vital to the National Interest (MAVNI) pilot program will fast track to U.S. citizenship those nonimmigrants who agree to serve in the Army or Army Reserves for a minimum period of time. These individuals would be eligible for U.S. citizenship without the requirement of first becoming lawful permanent residents

MAVNI

Health Care Professionals• Applicants applying as health-care professionals

must:– fill medical specialties where the service has a shortfall– meet all qualification criteria required for their medical

specialty, and the criteria for foreign-trained DoD medical personnel recruited under other authorities

– demonstrate proficiency in English– commit to at least 3 years of contractual active duty, or six

years in the Selected Reserve

H. R. 2536

• Main provisions of H.R. 2536 include:– Exempting from the normal numerical limitations of

immigrant visas Schedule A petitions– Making 20,000 or more visas available for Schedule A

petitions– Requiring USCIS to process Schedule A petitions within 30

days– $1,500 per Schedule A petition unless said employer is

exempt– Grants to Nursing Schools to increase number of students

and faculty

ANY QUESTIONS?