We recently reported on our Immigration Blog that hospitals and medical centers, facing challenges in staffing during the pandemic, content with heightened struggles to find and hire sufficient numbers of registered professional nurses.  In the rural and medically underserved communities where it has always been a struggle to fill these positions, COVID has only exacerbated and highlighted this need – leading more and more hospitals to consider hiring international nurses.

The most common type of employment-based permanent residence category is based upon obtaining a PERM Labor Certification from the Department of Labor, certifying the unavailability of U.S. workers for the offered position.  However, for the “Schedule A” occupations of registered nurses and physical therapists, DOL has made a determination that there are not a sufficient number of U.S. workers and therefore hiring a foreign national nurse or physical therapist would not displace available U.S. workers.

The Schedule A occupations allow the employer to skip the first step in the employment-based green card process, the PERM Labor Certification application, which can take more than a year, and proceed straight to filing an I-140 immigrant visa petition to USCIS which is a streamlined process available to those categories of employees that are listed on DOL’s “Schedule A”.

Professional nurses that are licensed and meet certain educational qualifications fall under Schedule A which means an employer may file an I-140 petition (sponsoring the nurse for a green card) directly to USCIS once they have obtained a Prevailing Wage Determination from the Department of Labor. A nurse can be sponsored while on an F-1/OPT status and while working on his/her EAD under the Optional Practical Training period.  An Employer may also recruit internationally and sponsor a nurse outside of the U.S. by filing an I-140 petition to be processed via a U.S. Consulate abroad for purposes of the nurse entering on an Immigrant Visa (Permanent Resident Visa) to begin work with the sponsoring Employer.

The Process

Prevailing Wage Determination – (PWD) – although the Employer is able to skip the PERM process, they must first obtain a Prevailing Wage Determination from the Department of Labor in order to proceed with a Schedule A I-140 petition. The PWDs are filed online and currently taking 5-6 months for DOL to process.  The PWD must be included with the I-140 petition.

Union positions – where the position falls under a Collective Bargaining Agreement, the Employer must provide copies of the relevant portions of the CBA, as well as notice to the Union Representative in order to submit the PWD. In these cases, the Department of Labor will defer to the wage provisions in the CBA when assigning the prevailing wage for the offered position, instead of assigning the prevailing wage amount based on the DOL’s Occupational Employment Statistics wage database.

Prepare and file the I-140 petition – the Schedule A nurse petition (I-140) can be filed to USCIS once the PWD has been received. This is the Employer’s petition verifying certain terms of employment, showing ability to pay the prevailing wage, and requesting that the USCIS recognize the position as a Schedule A shortage position and allow the employee to file his/her I-485 Adjustment of Status (AOS) application seeking Lawful Permanent Resident or “green card” status. Premium Processing is available for the I-140 petition (USCIS will process in 15 days).

I-485 Adjustment of Status application – the individual employee and any eligible family members (spouse or children under age 21) may each send in the I-485 green card applications along with the I-140 petition or after the I-140 petition has been approved. For individuals from certain countries where visa numbers are unavailable/backlogged, such as China and India, they may have to wait to submit the I-485 until those visa numbers are available again under the per-country limits.

International Nurse Recruitment – Immigrant Visa via U.S. Consulate abroad – if the nurse is not currently in the U.S. in another valid nonimmigrant visa status (typically an F-1 student in their authorized work period (OPT) after graduation), the Employer may submit an I-140 petition to be Consular Processed through the National Visa Center. The nurse would then have to wait for an Immigrant Visa appointment in his/her home country or country of current residence in order to enter the U.S. in a Permanent Resident status and begin work for the sponsoring Employer.

The Strategy and the Timing

Prevailing Wage Determinations are taking five months or more for the DOL to issue, so we recommend filing a Prevailing Wage Request on a rotating basis (every 4-6 months) so that there is one continually pending and valid.   An Employer may have a valid PWD in place for a position without being obligated to file a green card petition.  Having an already valid and approved PWD determination in place for a registered nurse position eliminates a five-month wait from the process; so that if and when an Employer is ready to hire a nurse needing sponsorship, they may do so directly to USCIS without having to wait for prevailing wage delays.

The I-140 petition can be premium processed and approved in 15 days, but the nurse cannot start working until an EAD (Employment Authorization Document) is issued after filing the I-485 application.  In other words, the I-140 petition approval alone does not grant any work authorization or status to the sponsored employee.   The EAD applications are filed concurrently with the I-485 applications and take several months to get approved.

In the best-case scenario, where the nurse is not from a country experiencing a visa backlog and where he/she may be able to submit an I-485 concurrently with the I-140, the Employer could be able to employ the nurse under the terms of an EAD in less than a one-year time period from when they start the process.  However, if the PWD is not yet in place, this could take a year or more before an EAD is  issued and the nurse could begin his or her work.

Our health care team works collaboratively with our immigration practice to support our clients in understanding their options for hiring a registered nurse or physical therapist under a Schedule A petition. Please reach out with questions.