CGFNS International reports nurse migration rates to the U.S. remained high in 2024

CGFNS International released a report last month concluding that nurse migration to the US remains high as healthcare systems continue to look to foreign-educated nurses to address persistent staffing shortages.

In 2024, CGFNS received 24,733 VisaScreen applications, down 4.6% from 2023, but still nearly 200% above pre-pandemic fiscal year 2018.

Allocation by country and visa type

Candidates with credentials from the Philippines accounted for more than 51% of issued VisaScreen certificates in 2024, followed by Canada with 8%, and Kenya with 6.5%.

76% of visa screen certificates issued by CGFNS were issued to candidates seeking permanent green cards, followed by candidates seeking TN visas (12%) and H-1Bs (11%).

According to the President and CEO of CGFNS, the report’s findings confirm that U.S. healthcare systems, “continue to depend on nurse immigrants to address persistent staffing shortages.”

Looking ahead

The report states that between 6% and 16% of registered nurses (RNs) in the U.S. are foreign-born, representing between 258,000 and 688,000 migrant nurses as of 2023. 

High immigration rates in the face of barriers such as visa retrogression highlight the continued appeal of nurse migration as a pathway for career advancement and economic opportunity.

However, visa retrogression persists, alongside new, likely stricter, immigration policies from the Trump Administration.

The report notes that while an increase in visa wait times may strain direct-hire models, staffing agencies can more effectively absorb wait periods, making staffing and recruitment even more essential for nursing immigration to the US in the coming years.

CGFNS International to Change Its Name to TruMerit™

The Commission on Graduates of Foreign Nursing Schools (CGFNS) announced it will change its name to TruMerit™.

Immigration regulations require that when filing an immigration petition for certain healthcare occupations, including Registered Nurses, the Petitioner must include a healthcare worker’s certificate (sometimes called a Visa Screen) from an authorized credentialing organization, such as CGFNS.

CGFNS indicated the name change will be the centerpiece of a comprehensive rebranding of the organization, which will also involve changes to its website, customer portals, credentials and certificates, and social media channels. The rebranding effort will begin rolling out in mid-March and will be completed by the summer.

English Exam Score Set at 50 for International Nurses: Could Increase in Future, says HRSA

The Commission on Graduates of Foreign Nursing Schools (CGFNS) announced that it will reset its standard passing English exam score to 50, after raising the standard to 63 in the Fall of 2024.

Immigration regulations require that when filing an immigration petition for certain healthcare occupations, including Registered Nurses, the Petitioner must include a healthcare worker’s certificate (sometimes called a Visa Screen) from an authorized credentialing organization. A passing English exam score is required for Visa Screen issuance.

One such English exam, the PTE, will now have a standardized passing score of 50 across all Visa Screen providers.

However, the Health Resources and Services Administration (HRSA) could soon increase the standardized English exam score across all providers.

To determine the appropriate English exam score requirement to protect patient safety and to safeguard healthcare professionals coming into the U.S. to work, HRSA has asked for comments through the Federal Register and will be reviewing a comprehensive report on English proficiency standards within the coming month.

International Education Evaluations, LLC Now Authorized to Issue Visa Screens

As of October 25, 2024, USCIS has added International Education Evaluations, LLC to the list of organizations authorized to issue certificates and certified statements for Registered Nurses. Notice of the organization’s addition was provided in the Federal Register.

Immigration regulations require that when filing a nonimmigrant or immigrant petition for certain healthcare occupations, including Registered Nurses, the Petitioner must include a healthcare worker’s certificate (sometimes called a Visa Screen) from an authorized credentialing organization.

The immigration regulations expressly authorize the Commission on Graduates of Foreign Nursing Schools (CGFNS), the National Board for Certification in Occupational Therapy (NBCOT), and the Foreign Credentialing Commission on Physical Therapy (FCCPT), to issue valid healthcare workers’ certificates.

USCIS may also approve additional organizations for issuance of certificates by providing notice in the Federal Register. MU previously published an August 2021 blog post on the addition, via Federal Register notice, of Josef Silny Associates, Inc. to the list of authorized organizations.

APPROVAL OF A NEW CREDENTIALING ORGANIZATION FOR NURSES

Immigration regulations require that when filing a nonimmigrant or immigrant petition for certain health care occupations, including Registered Nurses, the Petitioner must include a healthcare worker’s certificate (sometimes called a VisaScreen) from an authorized credentialing organization for the Beneficiary listed in the petition.

The Commission on Graduates of Foreign Nursing Schools (CGFNS), the National Board for Certification in Occupational Therapy (NBCOT), and the Foreign Credentialing Commission on Physical Therapy (FCCPT), were previously the only authorized credentialing organizations listed in the immigration regulations.

On July 22, 2021, USCIS approved the application for Josef Silny Associates, Inc., to be added to the list of organizations authorized to issue certificates and certified statements for Registered Nurses.

CGFNS MUST ISSUE CERTIFIED STATEMENTS TO US-EDUCATED BSNs

CGFNS has a fast-track “Certified Statement” Visa Screen for foreign nurses who are educated in the US, and a few other English speaking countries (see below). 

Franklin University, an Ohio college, offers graduate nursing degree, such as Bachelors of Science in Nursing (BSN) to foreign nurses who received a 2 year degree in other countries, such as the Philippines.  CGFNS was trying to force these BSNs to file for the more expensive and time consuming regular Visa Screen, instead of the Certified Statement.  

Franklin University tried to convince CGFNS that making these nurses apply for the costlier and time-consuming process was contrary to the relevant USCIS’ regulation.  When CGFNS refused to allow these nurses to apply for the Certified Statement, Franklin University sued.  This week, the court held that CGFNS must issue Certified Statements to these US-graduates of BSNs. 

The countries are:  Australia, Barbados, Canada (including only the following approved Quebec schools: McGill University and Dawson College in Montreal, Vanier College in St Laurent, John Abbot College in Sainte-Anne-de-Bellevue, and Heritage College in Gatineau), Ireland, Jamaica, New Zealand, South Africa, Trinidad/Tobago, the United Kingdom (England, Northern Ireland, Scotland and Wales) 

USCIS SHORTENS H-1B APPROVALS BASED ON PROFESSIONAL LICENSES

In recently issued H-1B approval notices the USCIS has approved the H-1B for less than the requested 3 years. The USCIS has explained the H-1B was issued for less than 3 years because the employee’s professional license expired before the end of the 3 year H-1B term.

The USCIS is mistakenly interpreting a clause of the code of federal regulations to state that an H-1B approval notice can be shortened to the validity period of an employee’s permanent professional license, when the law clearly states the H-1B can only be shortened to the term of a temporary license.

It is crucial that employees closely monitor the expiration date of their professional licenses, along with other documentation required for the H-1B filing, and timely renew all documents. This includes the professional license, passport, and Visa Screen (FCCPT certificate or CGFNS Visa Screen).

States vary in their procedures for renewing professional licenses and the validity term of the professional license. In addition, the length of time a passport is issued for varies by country. Visa Screens are valid for 5 years from the date of issuance and can take several months to renew. All foreign nationals should closely monitor the expiration dates of their documents.

CGFNS, AHA, PNAA ALL OPPOSE BILL RESTRICTING NURSES

CGFNS International, the US’ issuer on Visa Screens for nurses and other allied healthcare professions, has issued a letter to its Pennsylvania senators expressing concern over S.386 Fairness bill.  That bill would decimate healthcare immigration into the US, as explained in our March blog post.  The letter also notes that the American Hospital Association and the Philippine Nurses Association of America also do not support the bill.

The letter, which is signed by CGFNS President and CEO Franklin Shaffer, explains that while the bills’ aims are understandable, the consequence of the bill would be to create visa retrogressions for every country.  Shaffer asks that the bill is modified to ensure that healthcare professionals, including nurses, are not negatively impacted by this bill. 

There has been an intense effort to modify the bill to protect US patients by continuing to allow badly needed nurses and healthcare professionals into the US.  A competitive bill, sponsored by Sen. Rand Paul and titled the BELIEVE Act, would meet both aims: eliminate the unfair per country quotas, while still allowing nurses and healthcare professionals into the US. 

REGISTER FOR MU HEALTHCARE IMMIGRATION WEBINAR ON AUGUST 1

MU Law is pleased to announce a free healthcare immigration webinar on August 1, 2017 at 3PM ET for all clients and friend of the firm.  It is ideal for US employers, staffing companies, recruiters, and others interested in healthcare immigration.

Click here to REGISTER

 The Healthcare Immigration Seminar will feature these topics:

• Green card Immigration for Nurses and Physical Therapists (Schedule A occupations)
• Filing for Green card when you have an Unanticipated Worksite
• Visa Screens and Healthcare Worker Certificates
• FCCPT and the future of PT immigration
• H-1B visas for PTs, OTs, Med Techs, and other allied healthcare workers
• Managing Social Security Numbers and Licensure
• H-1B cap-exempt entities
• Immigration under the Trump administration
• Legislative and Regulatory changes that may be on the horizon

FAQ ON THE NEW FCCPT STANDARD

What is the new policy?

All applicants for the FCCPT Type I Certificate must now hold a diploma that says the word “Masters”.  If you have a diploma that says “Bachelors” you will not be eligible for the Type I Certificate.  Also, an applicant must have at least 202.1 credit hours.

When does the new policy go into effect?

It is effective immediately.  If you have a pending Application before the FCCPT, they will be returning your Application and issuing you a refund.

I have heard that the standard may be again raise to a Doctorate of Physical Therapy.  True?

Yes.  It is expected that if you apply for the Type I after January 1, that you will need to have a DPT in order to qualify for the Type I.

But when I graduated from University, the American standard was a lesser degree.  Am I “grandfathered in” under the old standard?

Unfortunately the USCIS is taking the position that the Application filing date is controlling, not the date of graduation.

I have a Type I that is expiring shortly.  Should I be concerned?

No.  Renewals do NOT examine education, only licensure verification and proof of English proficiency.

Why is the USCIS doing this?

The USCIS’ decision was predicated on a number of misunderstandings and inaccuracies. USCIS’ decision to terminate FCCPT accrediting these international programs is largely based on flawed assumptions around required coursework hours and degree titles. 

Is anyone doing anything to try and change this new policy?

Yes.  There is a concerted effort from stakeholders to educate the USCIS about the problems with its new interpretation and the massive impact on US patients and on internationally-trained Physical Therapists.

USCIS DEMANDS THAT FCCPT RAISES STANDARD FOR THE TYPE I

In an unprecedented development, USCIS is demanding that FCCPT only issue FCCPT Type I Certificates to graduates of university programs whose diploma titles read “Masters Degree,” and who have at least 202.1 credit hours.  Any graduate of a program that is equivalent to a US Masters Degree will no longer be eligible to enter the US and practice Physcial Therapy.  USCIS’ actions put US patients’ lives at risk, decimate an already dire Physcial Therapy shortage, and alienate fully qualified foreign-trained Physcial Therapists.

USCIS has issued a Notice of Intent to Deny the FCCPT’s ability to issue Type I Certificates.  FCCPT is understandably ceding to the USCIS’ wishes in spite of USCIS outrageous action.  The USCIS’ actions were done without the advice and consultation of interested stakeholders, such as FSBPT, APTA, CAPTE and the AAIHR.  It is unclear if the USCIS has consulted with the US HHS, which it is required to do by statute.

The AAIHR has issued a press release on this matter, which sums up the issue:

“USCIS’ decision was predicated on a number of potential misunderstandings and inaccuracies. USCIS’ decision to terminate FCCPT accrediting these international programs is largely based on assumptions around required coursework hours and degree titles.  However, the comparison of degree “titles” or credit hours is irrelevant. Titles and credit hours vary by institution."

MU Law is releasing an FAQ shortly. 

CGFNS NAMES FILIPINO AS NEW DIRECTOR OF EVALUATIONS

CGFNS has just announced that Jasper Tolarba, DNP, RN, NEA-BC will be their new Director of Credentials Evaluation Services.  Dr. Tolarba will manage the operations of the Credentialing Service programs.  From their press release:

Dr. Tolarba will be responsible for managing the operations of the Credentialing Service programs including VisaScreen®, Credentials Evaluation Service and International Consultants of Delaware. Along with CGFNS’ Executive Team, Dr. Tolarba will establish and coordinate the Foreign Educated Professionals Advisory Group, providing a more robust voice on a global scale.

Dr. Tolarba’s alma mater, Bicol Univerity in Legazpi City, Philippines, also highlighted the appointment.  Bicol notes that Dr. Tolarba earned his first bachelors and masters from Bicol and also taught nursing there from 2002-2004, whereupon he moved to Cincinnati and enrolled at Xavier University.  He later obtained his Ph.D from Yale University in Connecticut.  Bicol also notes that Dr. Tolarba is the first foreign-educated nurse to join CGFNS leadership team.

MU LAW COMMENT TO USCIS: ALLOW H-1Bs WHEN APPLICANT HAS HEALTHCARE WORKER CERTIFICATE

The USCIS and Department of Homeland Security recently issued a lengthy proposed rule. As per US law, USCIS and DHS had to ask the public for our comments about their proposed rule.  Many lawyers and the public commented on the proposed rule.

The proposed rule covers many areas.  Musillo Unkenholt's comments focused on one area: asking DHS to allow one-year H-1B approvals in instances where the alien does not hold a license, but does hold a Healthcare Worker Certificate.

The most common Healthcare Worker Certificates are Visa Screen, FCCPT Type 1 Certificates and NBCOT Certificates.

Click here to read our complete comment

The Musillo Unkenholt comment is also on Regulations.gov.

CGFNS LAUNCHES E-COACH

One of internationally-trained Physical Therapists biggest headaches is equating their foreign college degrees to US college degrees.  With the aim of curing this headache, CGFNS has recently launched e-Coach Learning Service.   

The new program helps internationally educated health professionals by providing the resources necessary to help meet the requirements as specified in the assessment tool by outlining the courses needed to remediate the educational deficiencies identified on their Coursework Tool Evaluation and Summary Statement.

Coursework Tools include the Federation of State Boards of Physical Therapy (FSBPT) Coursework Tool for Foreign-Educated Physical Therapists and Physical Therapist Assistants (CWT) and the CGFNS Education Comparability Tool (ECT).

The service is available through CGFNS’ webpage.

CGFNS TO OPERATE THE ALLIANCE FOR ETHICAL RECRUITMENT

The Alliance for Ethical Recruitment was formed in 2009 as a result of a funding grant from the MacArthur Foundation.  There always are perceived recruitment abuses in the international arena.  Some of these perceptions are borne out of very real abusive behavior.  Some of these perceptions are borne out of hysteria and junk statistics. 

The Alliance has tried for several years to root out the former.  It has struggled to gain traction.  Despite the Alliance’s efforts, only four employers have endorsed the Alliance Code of Ethical Recruitment, only one of which has joined since the pilot phase ended in 2010.  The AAIHR (of which MU Law is a member) also has a Code of Ethics, which has been more accepted by the industry. 

The Alliance is now about to shift gears.  CGFNS, who have long been involved in international nurse matters, will be operating the Alliance.  The Alliance will now be managed by Mukul Bakhshi, JD. 

The official launch of this new phase of the Alliance will take place at a reception in January at a location in Washington, D.C.

AILA AUDIO CLE ON NURSES AND ALLIED HEALTH

The AILA Education Department has scheduled an audio seminar for Thursday, October 9, 2014 @ 2:00 pm (Eastern Time) entitled “Petitions for Nurses and Allied Healthcare Workers.”  MU Law’s Chris Musillo is the Moderator of this audio seminar.  Chris’ co-speakers are with Tiffany Baldwin and Carl Shusterman.

The audio seminar will include these topics:

• H-1B for Nurses: 2002 and 2014 USCIS Memorandum
• Using Schedule A for Nurses and Physical Therapists
• EB-2 Consideration for Healthcare Worker
• USCIS Reliance on the EDGE Database in Evaluation of Foreign Education
• The Role of State Licensing and Credentialing in H-1B and PERM Cases
• Drafting Immigrant Visa Applications for Roving Healthcare Workers
• Visa Screen: Who Needs It and Why?

The panel has reserved 30 minutes for Questions and Answers at the conclusion of the presentation.

FCCPT VERIFICATION OF INDIAN EDUCATION

All foreign-educated Physical Therapists must be issued a Healthcare Worker Certificate prior to receiving a temporary (e.g. H-1B or TN) or permanent visa, as per 8 CFR 212.15(c):.  Two originations are permitted to issue these HWC’s.  CGFNS issues the Visa Screen, which is also issued to qualified Registered Nurses, Occupational Therapists, and several other healthcare occupations.  FCCPT issues the FCCPT Type I Certificate.  The FCCPT Type I is only issued to Physical Therapists. 

The HWC verifies that the foreign educated Physical Therapist has (i) qualifying education, training, licensing, and experience; (ii) passed a qualifying English fluency exam; and (iii) passed the actual licensing exam (NPTE exam). 

The FCCPT recently published an update about their verification of Indian distance education.  At issue is whether the educational experience is post-Secondary education and is not continuing education.  Several criteria are now considered by FCCPT.

-                      Verification that the study center does not violate the jurisdiction territory as outlined by the University Grants Commission (UGC).

-                      Evidence that the study center is not franchised. This means that it cannot be affiliated to more than one university.

-                      Verification that the University is in charge of admissions to the distance education program.  Admissions cannot be done by study centers as per UGC regulation.

-                      That the program is authorized to be offered through distance education by the Distance Education Council (DEC). Even though the DEC has been disbanded by the UGC, the regulations stay in effect until the UGC publishes new standards.

CGFNS: 40% OF FENs PERCEIVE DISCRIMINATION

CGFNS has co-authored a significant study, Perceptions of Employment-Based Discrimination among Newly Arrived Foreign Educated Nurses.”  The study was conducted by CGFNS and George Washington University and funded by a grant from the MacArthur Foundation. 

The CGFNS press release implies that the study’s findings are based on FENs perceptions of America.  It does not appear that the study actually found that 40% of FENs are discriminated by US employers, which is a significant difference and one that may be addressed in the full article that is to be published in the January 2014 American Journal of Nursing, Vol. 114, No. 1.

___

On a somewhat related note, Donna Richardson, longtime CGFNS Director of Governmental Affairs and Professional Standards, has announced her retirement.  Chris Musillo and Cindy Unkenholt have both sat on panels with Donna and have worked with her throughout her entire run at CGFNS.  She was also quick to help with problematic matters and quicker with a smile.  MU Law wishes her the best in her next phase of life.  She will be missed.  

AILA ASKS FOR AOS DENIED FOR LACK OF A VISA SCREEN

AILA TSC Liaison Committee is seeking examples of healthcare worker adjustment of status cases denied on the grounds that no visa screen was included at the time the adjustment was filed. Please send a brief description of the case along with a copy of the denial to reports@aila.org, with "Visa Screen Denial" in the subject line.

CHANGE IN POLICY FOR ONTARIO NURSES IN THE US

The below post was brought to my attention by Michigan attorney Marc Topoleski.  Much of this post is taken directly from a recent email exchange between us.

Canadian nurse licensure in Ontario is governed by the College of Nurses of Ontario.  The CNO has changed their policy for Non- Practising Ontario nurses, such as those who have moved to the US. 

Under the new policy non-practicing Ontario nurses must convert their CNO membership to a registration in the Non- Practising Class.  This requires an annual fee.  A nurse registered in the Non- Practising class cannot practice nursing in Ontario, not even in a volunteer capacity.  These nurses also have a second option.  They can resign their CNO membership. 

One question that Marc and I have is whether this new policy will have any impact on Canadian nurses from Ontario at the time of their VisaScreen renewal.  Neither of us has yet had a nurse in the Non-Practising class apply for a Visa Screen renewal.

Our opinion is that if an Ontario nurse allows his/her license to go inactive (by converting to the Non-Practising class) or lapse (by failing to renew license because they are not actively practicing in Ontario that this should have no impact as part of CGFNS’ license validation. 

Marc also passes along additional notes about nurses returning to Ontario.

Ontario nurses who choose to maintain registration in the Non-Practising class need to apply for reinstatement of their CNO membership if they want to return to Ontario to practice nursing.  The reinstatement process includes passing the Ontario RN Jurisprudence Examination.  The RN Jurisprudence Examination is an online examination that assesses an applicant's knowledge and understanding of the laws, regulations, by-laws, practice standards and guidelines that govern the nursing profession in Ontario.  There is a $40 fee (CDN) to take the exam.  This exam is different than the Canadian Registered Nurse Examination (CRNE), which is the Canadian national examination that measures the competencies required of nurses at the beginning of their practice.

For Ontario nurses who choose to resign their CNO membership, they can apply for reinstatement within 3 years of the date their CNO membership ended without having to take any examinations, but would have to pay reinstatement fees.  However, if a nurse wanted to return to practice as a nurse in Ontario after 3 years from the date their CNO membership ended, it appears they would have to apply for licensure under the same process as first-time applicants.