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The Long story of nursing shortage in the US BY CRISPIN R. ARANDA - News - Nurses Arena Forum

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The Long story of nursing shortage in the US BY CRISPIN R. ARANDA by Idowu Olabode : December 04, 2017, 01:10:02 PM
A nurse should be familiar with a heart bypass: an open heart surgical procedure allowing blood to flow to the heart via alternative routes, if one or several vessels are blocked and thus, deprive the heart of the much-needed blood to keep it pumping and the patient alive.

Where four blood vessels are blocked, quadruple bypass is usually done to reroute the blood supply to keep a patient from suffering a fatal heart attack.

The US needs a bypass – apparently more than just a quadruple is needed – to keep the supply of registered nurses to the country to keep the healthcare of American citizens and residents at safe levels.

America’s need for nurses triggered the creation of the H-1A visa, through the Immigration and Nursing Relief Act of 1989. When the program ended in 1995, another visa was created, the H-1C. In 1990, the H-1B visa came into being for professionals.


It was during this period that nurses from the Philippines were able to work and later obtain permanent resident status in the US. Demand for nurses and the nurse-specific visas alleviated the shortage somehow. Meanwhile, advocacy groups in the US lobbied for action that would increase the number of nursing graduates from schools that are rewarded with funds.

Private partnerships were created to increase student statistics while government intervention from the federal to the state level rewarded schools with additional budgetary outlays.

The American Nursing Association (ANA), for example, issued policy statements and call to action for healthcare organizations to sound off their representatives in Washington, as well as employers to revise the way nurses are valued, while seeking adequate compensation and providing a clearer career pathway initially by funding nurses’ education, whether continuing education or academic progression.

Still, the shortage recurs and persists.

The Bureau of Labor Statistics’ Employment Projections 2014-2024 listed Registered Nursing (RN) “among the top occupations in terms of job growth through 2024. The RN workforce is expected to grow from 2.7 million in 2014 to 3.2 million in 2024, an increase of 439,300 or 16 percent. The Bureau also projects the need for 649,100 replacement nurses in the workforce, bringing the total number of job openings for nurses due to growth and replacements to 1.09 million by 2024.”

The Affordable Care Act allowed millions of Americans to get insurance coverage, which, in turn, directly benefits healthcare workers, including nurses. While US President Donald Trump has dedicated his first year toward abolishing and replacing Obamacare, the Republicans were unsuccessful despite rigging the Senate rules on voting.

ANA also confirms that “healthcare accounts for 18 percent of the US economy” and is expected to keep growing. While growing at a slower pace, US census shows healthcare accounts will still reach 20 percent of America’s gross domestic product because of changing demographics: “more than 70 million baby boomers will be crossing into the over-65 age group – the segment of the population that accounts for 34 percent of all surgical procedures, 26 percent of all physician office visits, and 90 percent of all nursing home residents.”

Nursing plays a major role in all these services, whether the care is preceded by “Obama” or “Trump.”

Working and immigrant visas for Nurses


Until 1989, nurses and other professionals were able to work in the US under the H-1B visa, before applying for permanent residency through the 3rd Preference visa category. Previously, skilled workers were admitted as immigrants under the 6th Preference. Before the 1990 Act, there were only 7 preference categories

First Preference (P1) was for the unmarried sons and daughters of US citizens now the F1, First Family-sponsored category.

Second Preference (P2) was created for the spouse and unmarried sons and daughters of lawful permanent residents (LPRs). This category has been further subdivided under the current immigration Act – the F2A – spouses and minor children of LPRs and the F2B – over 21 unmarried sons and daughters of lawful permanent residents.

Third Preference (P3) was previously granted to qualified members of the professions or who “because of their exceptional ability in the sciences or the arts will substantially benefit the US economy, cultural interests and welfare of the United States.” The P3 category had been incorporated into the new and current 5 Employment-based categories.

Fourth Preference (P4) was assigned to the married sons and daughters of US citizens, now the F3 category.

Fifth Preference (P5) applied to the brothers or sisters of US citizens, now the F4 category.

Sixth Preference (P6) visas were granted to applicants “capable of performing skilled or unskilled labor, not temporary or seasonal in nature and there is a shortage of employable and willing persons in the US.

Incidentally, nurses are classified as “skilled workers,” instead of “professionals” in the United States. In fact, US citizens or permanent residents who complete a two-year associate degree in nursing may take the national licensure exam for nurses (NCLEX), then subsequently complete the requirements of the state where they intend to practice.

Domestic US RNs who completed their education in the US are also not required to take the English language proficiency test (TOEFL/TSE, TOEIC or IELTS).

Filipino nurses have better chances of getting a green card than a working visa.

Whether applying for a work visa or immigrant visa, a Filipino RN must obtain the Visa Screen Certificate issued by the International Commission on Healthcare Professions (ICHP), a division of the Commission on Graduates of Foreign Nursing Schools (CGFNS).

Section 343 of the Illegal Immigration Reform and Immigrant Responsibility Act (the IIRIRA) of 1996 requires specific health care professionals born outside of the United States to first complete a screening program before they can be issued their working or immigrant visa.

While Filipinos – and other foreign-born and educated nurses – must obtain the VisaScreen certificate to work or migrate to the US, there is no work visa specific to nurses (unlike when the H-1A was created in 1989).

The working visa available for foreign RNs is the H-1B visa. However, new graduates and licensed RNs would not qualify unless the US employer could prove that the job must meet one of the following criteria to qualify as a specialty occupation:

Bachelor’s or higher degree or its equivalent is normally the minimum entry requirement for the position

The degree requirement for the job is common to the industry, or the job is so complex or unique that it can be performed only by an individual with a degree

The employer normally requires a degree or its equivalent for the position

The nature of the specific duties is so specialized and complex that the knowledge required to perform the duties is usually associated with the attainment of a bachelor’s or higher degree.

And that’s the easy part.

The hardest hurdle is not measured by skill, education, English proficiency or licensure: it is by luck. Getting an H-1B visa is by lottery.

Applicants seeking Lady Luck through qualified and willing US employers may submit their applications only on April 1 of each year. Because the lottery is available to candidates worldwide, the 65,000 quota gets filled in a matter of days (6,800 of the 65,000 are reserved for applicants from Singapore and Chile by free trade agreements).

Another 20,000 H-1B visas are exempt from the 65,000 quota but available only to applicants with advanced degrees (Masters), as well as those who will be working in the Commonwealth of the Northern Marianas Islands (CNMI) and Guam.

While the good news is that thousands of job openings for nurses have opened again in the US, sadly, there is no bypassing the visa application procedures.

Source: Manila Times

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