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Case Study - Hospital Creates a Nurse Pipeline

Business Problem

A Hospital was experiencing a major shortage of RNs in all units, leading to shutting down some units. The Hospital needed to fill RN positions so they could keep all units running to serve the need of their community. The Hospital was seeking long-term stability, so they were looking for long-term, permanent RN employees. Additionally, a limited supply of traveling agency nurses was costing the hospital 3-4 times more that their staff RN nurses, and was not a sustainable solution fiscally and strategically.  The Hospital identified international nurses graduating from U.S. nursing schools locally and experienced international nurses worldwide.  The Hospital needed help in building the pipeline of qualified international nurses.

Business Goals

To create a pipeline of international nurses by building a business onboarding process, to continue taking care of patients in a financially responsible manner.

Strategy + Solution

Our attorneys worked with legal, HR, and nursing management to identify the best path forward. We ascertained the position details, minimum education and licensure requirements, and suggested the Hospital proceed with Schedule A PERM + I-140 petitions for employment-based green card regarding international nurses The Schedule A PERM + I-140 petition is process by a U.S. employer for a profession which has a pre-certified shortage in the U.S, including RN nurses. The traditional employment-based green card requires employers to prove there are no minimally qualified and available American workers. However, Department of Labor has pre-certified occupations falling under schedule, such as Registered Nurses. Therefore, the employer could move forward with the green card process as a quicker pace.


We assisted the Hospital with filing a Prevailing Wage Application with Department of Labor, a required first step of any employment-based green card process. From there, the employer interviewed candidates and identified those which were qualified for the RN roles. Once the prevailing wage was issued, we prepared Schedule A PERM and I-140 petitions and filed with USCIS to lay the foundation for the RN green cards.  Once approved by USCIS, either the nurse could apply for a green card in the U.S. if the nurse was already in the U.S., or the nurse would apply for an immigrant visa at the U.S. Consulate abroad. Once nurses entered the U.S. with the immigrant visa or were approved for the green card, they were now permanency authorized to work in the United States, and the Hospital may employe the indefinitely.  For graduates already in the U.S., the Hospital was able to begin employing them on work permit/Employment Authorization Documents before the green card process was approved.  In cases where the Hospital was onboarding the international nurse for an advanced skills position, a faster H-1B visa process was also pursued.  

Planning Ahead, Short Term + Long Term

The short-term recommendation from us in this case was to further strengthen their pipeline to address the massive need for RNs at their hospital. The long-term recommendations included keeping the Prevailing Wage rolling and looking at each case for opportunities to begin employing the RN faster, such as pursuing H-1B and work permits. 

The information on this website is for general information purposes only, it is not legal advice applicable to a specific situation.  Viewing it does not create an attorney-client relationship.

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