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.

April 2025 Visa Bulletin: Finally - Movement Forward for ALL EB-2 and EB-3 Categories

The Department of State has just issued the April 2025 Visa Bulletin. This blog post analyzes this month's Visa Bulletin.

Visa Bulletin

Table A: Final Action Dates -- Applications with these priority dates or earlier may be approved for their Green Card (Permanent Residency card) or Immigrant Visa appointment:

Table B: Dates for Filing

USCIS will continue to use the Table A Final Action Dates chart for I-485 employment-based filings in April 2025. See: USCIS Visa Bulletin Dates

MU Law Analysis

EB-2 China progressed 5 months, the most progress for any category since the start of the fiscal year in October 2024.

EB-3 Philippines and Rest of World moved forward 1 month, the most progress in that category since the start of the fiscal year in October 2024.

EB-2: EB-2 categories in all chargeability areas made progress forward in April 2025:

• EB-2 China: 5 months
• EB-2 India: 1 month
• EB-2 Rest of World, Mexico and the Philippines: 5 weeks

EB-3: EB-3 categories in all chargeability areas made progress forward in April 2025:

• EB-3 China: 3 months
• EB-3 India: 2 months
• EB-3 Rest of World, Mexico and the Philippines: 1 month

EB-1: EB-1 categories made no progress in any chargeability area. Rest of World, Mexico and the Philippines remain current in the EB-1 category.

FY 2026 H-1B CAP Lottery

 The fiscal year 2026 (March 2025) H-1B cap registration period will open this week, at noon eastern on March 7, 2025 and run through noon eastern on March 24, 2025.

H-1B CAP registrations are submitted electronically via USCIS’s website. H-1B CAP lottery winners are then eligible to submit an H-1B petition between April 1, 2025 – June 30, 2025.

The H-1B CAP lottery is open to employees filling positions requiring Bachelor’s degrees, which may include healthcare occupations such as Medical Technologists, Occupational Therapists, Physical Therapists, and even Registered Nurses.

This year, USCIS has increased its CAP registration fee from $10 to $215 per registration.

Further information on this year’s CAP lottery can be found on USCIS's H-1B Electronic Registration Process website. 

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.

MARCH 2025 VISA BULLETIN: Movement Forward for all EB-2 plus EB-3 China and India

The Department of State has just issued the March 2025 Visa Bulletin. This blog post analyzes this month's Visa Bulletin.

Visa Bulletin

Table A: Final Action Dates -- Applications with these priority dates or earlier may be approved for their Green Card (Permanent Residency card) or Immigrant Visa appointment:

Table B: Dates for Filing

In keeping with February 2025, USCIS will continue to use the Table A Final Action Dates chart for I-485 employment-based filings in March 2025. See: USCIS Visa Bulletin Dates

MU Law Analysis

EB-2 All Other, China, India, Mexico, and Philippines: EB-2 categories in all chargeability areas made moderate progress forward in March 2025:

• EB-2 Rest of World, India, Mexico and the Philippines: 6 weeks
• EB-2 China: 2 weeks

EB-3 China and India: EB-3 categories for China and India moved forward 4 weeks and 6 weeks, respectively. No other chargeability areas moved forward in the EB-3 category.

EB-1: EB-1 categories made no progress in any chargeability area.

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.

H-1B 2025 Cap Webinar

MU Law will be hosting a FREE webinar for our clients and friends on Tuesday, February 11, 2025 at 2PM Eastern (1PM Central).

Join us for this FREE webinar to learn more about:

• H-1B Cap Basics, Registration Process, and 2025 Changes
• What is a Specialty Occupation?
• Special Issues for Staffing Companies, Third Party Placements
• Cap-gap for F-1s as well as CPT/OPT maintenance
• Q&A

PLEASE JOIN US!

February 2025 Visa Bulletin: Little Movement and an Adjustment of Status Update

The Department of State has just issued the February 2025 Visa Bulletin. This blog post analyzes this month's Visa Bulletin.

Visa Bulletin

Table A: Final Action Dates -- Applications with these priority dates or earlier may be approved for their Green Card (Permanent Residency card) or Immigrant Visa appointment:

Table B: Dates for Filing

In a change from the past several months, the USCIS will use the Table A Final Action Dates chart for I-485 employment-based filings in February 2025. As the Final Action Dates chart generally moves slower than the Dates for Filing chart, this means a longer wait time for those intending to file Adjustments of Status in February 2025. See: USCIS Visa Bulletin Dates

MU Law Analysis

EB-2, EB-3 China and India: EB-2 and EB-3 categories for China and India made the following progress forward in the February 2025 visa bulletin:

• EB-2 India: 2 weeks
• EB-3 India: 2 weeks
• EB-3 China: 1 month

EB-1 (all chargeability areas), EB-2 China, and EB-2 and EB-3 All Other, Mexico, and Philippines: These categories made no progress forward.

DHS Increases Flexibility for CAP-Exempt Work Placements

In its recent update to H-1B program requirements, DHS revised its regulation on H-1B CAP-exemptions for beneficiaries who are staffed at universities and certain nonprofits.

H-1B CAP exemption allows an employer to file an H-1B CAP case on behalf of an employee at any time in the fiscal year, outside of the usual annual limits on H-1Bs imposed by the H-1B CAP. H-1B CAP exemption is particularly useful for employers seeking to employ beneficiaries in the healthcare industry, where staffing needs are particularly urgent.

DHS is revising its CAP-exempt regulation to note that beneficiaries qualify for H-1B cap exemption when they spend at least half of their time providing essential work to a qualifying institution.

Previously, the regulation required a beneficiary to spend the majority of their time performing duties at a qualifying institution.

First, the revision reduces the time requirement by noting that the employee need only spend 50% of their time providing work to a qualifying institution.

Second, the revision allows for remote work, including telehealth, to count toward an employee’s time requirement for CAP-exemption, while the previous regulation required an employee’s physical presence at a qualifying institution.

In DHS’s final rule, the agency acknowledges that its CAP-exempt regulation revision may slightly expand who is eligible for the cap exemption. DHS’s intention is that the revision will increase flexibility for employers and beneficiaries, as well as better represent modern employment situations.

January 2025 Visa Bulletin: Movement Forward for Most Categories

The Department of State has just issued the January 2025 Visa Bulletin. This blog post analyzes this month's Visa Bulletin.

Visa Bulletin

Table A: Final Action Dates -- Applications with these priority dates or earlier may be approved for their Green Card (Permanent Residency card) or Immigrant Visa appointment:

Table B: Dates for Filing

The USCIS will use the Table B Dates for Filing chart for I-485 employment-based filings in January 2025. See: USCIS Visa Bulletin Dates

MU Law Analysis

EB-2, EB-3 China and India: EB-2 and EB-3 categories for China and India made the following progress forward in the January 2025 visa bulletin:

• EB-2 China: 1 month
• EB-3 China: 2 months
• EB-2 India: 2 months
• EB-3 India: 3 weeks

EB-2, EB-3 All Other, Mexico, and Philippines: The Visa Bulletin for categories EB-2 and EB-3 for Mexico, the Philippines and all other countries of chargeability moved forward 2 weeks.

EB-1: EB-1 categories made no progress in any chargeability area.

US Health Care Labor Shortage Could be Alleviated by Immigration Policy Reform

Rice University’s Baker Institute for Public Policy has recently published a report on current and future US health care labor shortages, as well as the role immigration policy reform could play in meeting the challenges of a labor shortage.

Health Care Industry Labor Shortages

Research from the Bureau of Labor Statistics (BLS) shows that fewer people are working in the health care sector, in part as a result of COVID-19 pandemic job losses. While the industry showed progress in 2023, the sector’s overall employment rates have not fully recovered to pre-pandemic rates.

Rice University’s report gathers data from the Association of American Medical Colleges (AAMC), Forbes, ADA Health Policy Institute, and the National Association for Home Care and Hospice that predict health care labor shortages in the coming 10-15 years across many positions in the industry, including physicians, nurses, clinical laboratory specialists, dental hygienists, pharmacists, and home care workers.

Proposed Immigration Policy Reform Targeting Health Care Industry Needs

Rice University cites the Migration Policy Institute’s research that immigrants made up 18% of employees in a health care occupation in the US in 2021, including 26% of physicians and surgeons and almost 40% of home health aides. Immigrants make up roughly 14% of the US population, meaning immigrants’ representation is outsized in the health care sector.

To alleviate the labor shortages in the health care workforce, Rice University’s report recommends immigration policy reforms, including:

• Raising the annual cap for H-1B visas for health care workers;
• Creating new sector-specific visa categories with expedited processing;
• Leveraging existing programs, such as the TN visa program, for RNs who are citizens of Mexico or Canada to work temporarily in the US;
• Reforming the public charge rule to exclude direct care health workers, such as frontline workers, to reduce the chance of entry denial based on potential use of public assistance;
• Increasing funding and resources for immigration processing to shorten lengthy processing periods, reduce delays, and ensure timely entry for health care workers. 

Musillo Unkenholt endorses the report’s contention that implementing comprehensive reforms such as these would help to meet the country’s growing health care needs, support economic growth by improving access to efficient health care, maintain high-quality patient services while promoting greater access to care, and create a more flexible and responsive health care workforce.

 

WEBINAR: Immigration under the Trump Administration

The forthcoming Trump Administration’s proposed immigration policies may have significant implications for employers.  Join our  FREE webinar on Wednesday, November 20th at 2pm EST to explore new regulations, compliance strategies, and best practices for adapting to these changes.

Discussion topics will include:

• Overview of the policies attempted and enacted in Trump’s first term

• Potential Administrative Changes to Employment-Based Visa Programs

• Possible legislative initiatives in 2025

• I-9, E-Verify and Compliance Requirements: What employers can do to ensure compliance?

PLEASE JOIN US!

December 2024 Visa Bulletin: Slight Movement Forward for India

The Department of State has just issued the December 2024 Visa Bulletin. This blog post analyzes this month's Visa Bulletin.

Visa Bulletin

Table A: Final Action Dates -- Applications with these priority dates or earlier may be approved for their Green Card (Permanent Residency card) or Immigrant Visa appointment:

Table B: Dates for Filing

The USCIS will use the Table B Dates for Filing chart for I-485 employment-based filings in December 2024. See: USCIS Visa Bulletin Dates

MU Law Analysis

EB-1, EB-2, EB-3: The Visa Bulletin for categories EB-2 India and EB-3 India moved forward 2 weeks and 1 week, respectively, in the Final Action Dates Chart. All other categories have not changed.

The January 2025 Visa Bulletin is expected to progress forward to begin the new fiscal quarter. In previous years, the January Visa Bulletin has progressed several months in employment-based categories. 

USCIS DATA ON SCHEDULE A NURSES 2018-2022

In April 2022, MU filed a Freedom of Information Act (FOIA) request, requesting a complete dataset of all I-140 registered nurse immigrant petitions approved between Fiscal Year (FY) 2018 – Fiscal Year 2022.  The USCIS finally responded, producing a 443 page list of I-140 immigrant petitions approved between FY 2018 – FY 2022 for registered nurses. MU has summarized the data provided by the USCIS below:

 

	FY 2018	FY 2019	FY 2020	FY2021	FY 2022
Total # of Approved RN I-140s	3905	5695	7484	7489	12095

 

As indicated by the data produced by the USCIS, there has been a steady increase in the number of approved I-140 immigrant petitions for registered nurses, with a notable jump in FY 2022, reflecting a critical need among U.S. employers for foreign national registered nurses. The demand among U.S. employers, coupled with a growing nursing workforce shortage should persuade Congress to embrace legislation, such as the Healthcare Workforce Resilience Act, which seeks to address the nation’s shortage of nurses in the aftermath of the COVID-19 pandemic.

In summary, the data produced by USCIS not only illustrates the urgent demand for foreign national registered nurses but also reinforces the need for legislative measures to address this critical shortage in healthcare.

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.

Department of State Launches AVITS Website for Appointment Scheduling

On September 30, 2024, the Department of State launched Applicant Visa Information Tracking System (AVITS), a new scheduling website for US visa applicants in certain countries.

AVITS will replace the previous scheduling system, US Travel Docs, for visa applicants applying for visas at US embassies located in the following countries:

• Belgium
• Burkina Faso
• Cameroon
• Côte d’Ivoire
• Democratic Republic of the Congo
• France
• The Gambia
• Ghana
• Liberia
• The Netherlands
• Nigeria
• Rwanda
• Senegal
• Sierra Leone

Appointments scheduled on the previous website will remain on the original date selected. Applicants whose appointment was scheduled on the previous website must create a new account on AVITS using their previously registered email address.

November 2024 Visa Bulletin: Visa Numbers at a Standstill

The Department of State has just issued the November 2024 Visa Bulletin. This blog post analyzes this month's Visa Bulletin.

Visa Bulletin

Table A: Final Action Dates -- Applications with these priority dates or earlier may be approved for their Green Card (Permanent Residency card) or Immigrant Visa appointment:

Table B: Dates for Filing

The USCIS will use the Table B Dates for Filing chart for I-485 employment-based filings in November 2024. See: USCIS Visa Bulletin Dates

MU Law Analysis

EB-1, EB-2, EB-3: The Visa Bulletin for categories EB-1, EB-2, and EB-3 made no movement from October 2024 in the Final Action Dates or Dates of Filing chart. 

NCHWA: NURSE SHORTAGE TO CONTINUE THROUGH AT LEAST 2036

The National Center for Health Workforce Analysis projects a 9 percent nursing workforce shortage through 2036.  The problem will be particularly acute in non-metro areas, where the shortage is expected to grow to 14%.  The ten states with the largest projected RN shortages in 2036 are: Georgia (29%), California (26%), Washington (26%), New Jersey (25%), North Carolina (23%), New Hampshire (23%), South Carolina (21%), Maryland (20%), Michigan (19%), and Oregon (16%).

The current shortage is about 250,000 and is expected to grow to a shortage of 350,00 full-time registered nurses in 2026.

The National Center for Health Workforce Analysis (NCHWA) collects data, conducts research, and generates information about the U.S. health care workforce to inform and support Public- and private-sector decision making. Learn about the National Center for Health Workforce Analysis.

Legislation proposed by Rep. Bayer (D-VA) calls for 20,000 nurse visas for rural shortage areas.  Unfortunately, that legislation has probably been introduced too late in this congressional term to pass both houses of Congress before the term ends on December 31, 2024.

PHILIPPINE NURSES CHOOSING TO WORK ABROAD

Philippines nurses seem to be choosing contract positions with an aim toward moving abroad.   ABS-CBN News reports that ACT-Teachers party-list Rep. France Castro questioned why there did not appear to be an increase in permanent (Plantilla) healthcare positions in the last year.

Rep. Angelica Natasha Co speculated that healthcare workers opt for temporary or contractual positions when they have plans to work abroad.  Last year saw one of the greatest numbers of Philippine nurses enter the US in many years, as the American nursing shortage continues to get worse.  As of 2021, about 300,000 Philippine nurses worked abroad.

USCIS EXTENDS GREEN CARD VALIDITY TO 36 MONTHS FOR RENEWALS

On September 18, 2024, USCIS issued a news alert that Lawful Permanent Residents (aka Green Card holders) who properly file Form-I-90 to replace an expired or soon-to-expire Green Card will receive an automatic 36-month extension, as opposed to the previous 24-month extension.

Receipt notices received on or after September 10, 2024 for Form I-90 should now include updated language granting Green Card holders the automatic 36-month extension. On September 10, 2024, USCIS began printing amended receipt notices for individuals with pending I-90s.

To evidence their lawful status, Green Card holders may present the updated I-90 receipt notice with their expired green card. This will allow Green Card holders to continue working and traveling, despite experiencing long processing delays to replace their expired Green Card.

Lawful Permanent Residents who no longer have their Green Card are not eligible for the automatic 36-month extension, but they may request an appointment at a USCIS Field Office by contacting the USCIS Contact Center in order to obtain an Alien Documentation, Identification, and Telecommunications (ADIT) stamp to prove their status while waiting to receive their replacement Green Card.