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.” 

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.

Social Science Research Network:  Understaffing of nurses in US hospitals is severely impacting the quality of healthcare and is predicted to worsen in future years.  By the year 2020, the nursing workforce is projected to be nearly a million nurses short.  The current nurse pool is retiring and the number of new nurses entering the profession is inadequate.  At the same time an aging baby boomer population will need to be cared for as they reach old age.

We link to the Abstract

BusinessWeek:  For more than a decade, the US has faced a shortage of nurses to staff hospitals and nursing homes.  While the current recession has encourages some who had left the profession to return, about 100,000 positions remain unfilled.  That alot!

Experts say that if more is not done to entice people to enter the field – and to expand the US’ nurse training capacity, that number could triple or quadruple by 2025.  President Obama’s goal of expanding health coverage to millions of the uninsured could also face additional hurdles if the supply of nurses can’t meet the demand.

For more on this article, we link here.