
Onboarding International Nurses: Employers’ Summary Sheet
Hospitals and medical centers often turn to international recruitment to fill their needs for nurses in the US. Hospitals typically engage in the employment driven Green Card process to onboard and retain international nurses. For some nurse positions, hospitals and medical centers may be able to engage in the H-1B process to be able to onboard the nurses more quickly. Hospitals and medical centers may either recruit recent nursing graduates from US nursing schools or experienced nurses from abroad. We briefly discuss both options below.
General Process & Hospital/Medical Center Requirements for Green Card Process for International Nurses:
To engage in the employment driven Green Card process for an international nurse, the hospital/medical center will need to have the following:
An issued and valid Prevailing Wage Determination
Proof of posting the position at the intended worksite for at least 10 business days, and
Proof of ability to pay the nurse the proffered wage.
The international nurse also needs to meet eligibility requirements, discussed below.
Once the hospital has the above listed three minimum items, and they have identified a qualified international nurse, they can proceed to filing a Labor Certification (9089) together with an I-140 petition for the international nurse, with USCIS.
The hospital does not have to engage in the typical Labor Certification process that applies to other positions because nurses are considered “Schedule A” positions for which labor certification process can be skipped. This greatly speeds up the process for onboarding and retaining international nurses.
Once the hospital secures an I-140 approval for their international nurse, the next step is to determine if the Department of State’s Visa Bulletin is current for that nurse’s category, meaning there is an immigrant visa number available for that nurse.
If the Visa Bulletin is current, the next step depends on whether the nurse is in the US or abroad. If the nurse is in the US, then the next step is filing Adjustment of Status in in the US, including application for work permit. If the nurse is abroad, then Consular Processing to bring the nurse to the US on Immigrant Visa to work for the hospital/medical center.
US Nursing School Graduates:
If a nurse is educated in the US, most likely they will get a one-year Optional Practical Training (OPT) work permit that will allow them to begin working for a US hospital or medical center.
It is important for hospitals and medical centers to begin the Green Card process for nurses as soon as possible, so that the nurses will have a way to continue working legally after their work permits expire. More on the Green Card process below.
To qualify for Green Card process, the international nurse educated in the US will need to have the following:
Education (Associates or Bachelors) in nursing or closely related field; and
Either pass NCLEX exam, or
Have a CGFNS certification, or
Have an unrestricted state nursing license in the state where they will be employed.
Nurses Educated Abroad:
If a hospital or medical center wishes to onboard an international nurse who is currently living/working abroad, they will be able to onboard the international nurse either when that nurse has Immigrant Visa issued (final stage of the Green Card process); or when an H-1B visa is approved and issued for that nurse. H-1B visas may only be available for certain nursing positions which require at least a bachelor’s degree, such as for example, critical care, certain specialty nurse positions, or nurse manager positions.
To be eligible for Green Card process, the international nurse educated abroad will need:
Education with an Education Evaluation from a reputable US evaluator showing that their education is equivalent to a US nursing education (either Associates or Bachelors equivalent);
Pass NCLEX exam, and
Have a CGFNS certification/Visa Screen when attending consular immigrant visa interview; and
Have passed an English proficiency exam.
For more details, please see USCIS guidance on Green Card process for healthcare workers here.
Summary & Recommendations:
If a US hospital or medical center does not find qualified US Nurses to fill their open positions, they may want to consider recruiting internationally, either international nurses graduating from US nursing schools or experienced nurses from abroad. There are many qualified international nurses looking to fill these positions in the US.
Because hospitals and medical centers tend to experience nursing shortages, we recommend that they plan as early as possible and that they consider filing prevailing wages as soon as they determine they may have a future need. Thinking ahead will help speed up the process and thus speed up the timeframe when they can employ their international nurse.
As always, it is important to consult with an immigration attorney with experience handling H-1B and Green Card process for healthcare positions.
The information provided here does not constitute legal advice. It is general information regarding law and policy that may be applicable to your particular HR issue or legal problem. Information provided in this blog, or any of our other public posts, does not create an attorney-client relationship. For specific advice you can rely upon, please contact your attorney.
Leyla McMullen, Corporate Immigration Lawyer
Mdivani Corporate Immigration Law Firm