We spoke with Sylvia Mullarkey, Founder and CEO of Global Nurse Partners, a nurse placement agency in the United States. Sylvia launched Global Nurse Partners in 2021, as a full-service direct-hire program to empower nurses and support healthcare facilities throughout the process. She works directly with internationally experienced nurses who are seeking placements in US healthcare facilities. In the below Q&A, Sylvia shares her insights on immigration to the US. 

Q: For someone who’s now selected the US as their destination country, what are the next steps to research and prepare for moving/finding a job?  

A: First, the nurse needs to decide whether they want to work in a permanent staff position as an employee of a healthcare facility (aka direct hire) or as an agency nurse working on an assignment at a client’s worksite (aka contract hire/contract placement). These two employment pathways offer significantly different career opportunities, compensation and benefits packages, and placement location options, so it’s worth comparing them to determine which option best fits the nurse's preference.  

H-1B visa 

The next consideration is the immigration pathway and the processing timeline to get to the US. There are two types of employment-based visas for international nurses—non-immigrant (H-1B) and immigrant (green card). The H-1B is restricted to positions that require a BSN, while green cards are not.   

The H-1B visa category has two pathway options—capped or non-capped—with no country quotas. The H-1B capped route is restricted to an annual visa quota (65,000) and application date, and it usually ends up in a lottery. While the non-cap H-1B visas are exempt from these restrictions, only employers registered as non-profit organizations affiliated with academic teaching facilities can sponsor them. Still, they can sponsor them any day of the year, bypassing the lottery system and allowing nurses to enter the US quickly, usually within three to four months if the nurse has passed the NCLEX. 

Also, another thing to keep in mind about the H-1B visa is that it allows for dual intent, meaning that an H-1B holder can have a pending green card application simultaneously. This enables nurses to adjust their immigration status to a green card while working in the US. Dependents (spouse and children) are entitled to an H-4 visa, which permits them to study in the US but not work. However, if the spouse is a professional and holds a bachelor’s degree, they may be able to obtain an H-1B visa with an employment sponsor.  

Green card 

The green card category has one pathway to permanent residency. It’s a relatively easy visa for nurses to get, and once approved, immediate dependents traveling with them also receive green cards. However, the process timelines are unpredictable, as more people usually apply for green cards than visa numbers available, and specific country quotas are often reached. When this happens, it triggers visa retrogression and causes long delays. At present, there’s a 16-month wait for most countries and over 11 years for India, but this timeline could move backward or forward between now and the new fiscal year starting on October 1.  

Once the nurse decides whether to work as a staff nurse in a permanent position (direct hire) or as an agency nurse on assignment (contract hire/contract placement) and selects the visa pathway that fits their needs, the next choice is location. But that’s the fun part! The US is a large country with much to offer, and every state is different. Whatever lifestyle you seek in whatever climate, you have options in the US. So, research your preferences, compile a list, and go from there. 

Q: How do you recommend healthcare workers find out about documentation and compliance with regulators? 

A: Nurses are responsible for maintaining their RN license to work as a registered nurse in the US. Each state board of nursing outlines its licensure requirements on its website, which are usually easy to follow. Also, many state boards utilise CGFNS International's services, and guidance on the appropriate application process can be found on their website.  

The employer’s Human Resources team will provide guidance on employment credential requirements.  

Q: What are the considerations when researching where to live/settle? 

A: When researching where to live, it’s essential to consider the cost of living in relation to your earnings. Whether in a city or a town, big or small, housing, by far, is the most significant expense. And when researching neighbourhoods, it’s important to consider safety and compare crime rates. Also, consider the route to work, available transportation options, and whether traffic is challenging.  

If traveling with family, research the local schools to see if they meet your child’s needs and job prospects for your spouse if they intend to work.  

Also, consider the climate and weather patterns. Do you enjoy all four seasons, or would you prefer sun all year round? And when you’re not working, you need to have fun. So, check to see what leisure pursuits are available indoors and outdoors, as well as entertainment venues and other social outlets you may enjoy. 

Considering all these variables should allow you to assess what’s most important to you when considering a new location and hopefully make the decision-making process a little easier.  

Q: How do healthcare workers find out about housing, tax, banks or even schools for their children? What are some things to consider beyond finding a job? 

A: Reputable agencies will provide guidance on all the nurse’s start-up needs and assist with essential tasks such as housing provision, applying for a social security number, opening a bank account, enrolling children in school, as well as everything else the nurse and their family need to get set up and settled in their new location.  

How can health professionals learn more about the healthcare system in their chosen state?  

The American Hospital Association (AHA) is the national organisation representing US hospitals. There’s a wealth of information and resources on their website. https://www.aha.org/about   

Q: Why is confidence in your communication skills so important in a healthcare setting? 

A: To be successful, nurses must have excellent technical abilities and outstanding interpersonal communication skills. The first point of nursing care is communication, and it remains crucial throughout the care cycle. Therefore, strong communication skills, verbal and non-verbal, are imperative to ensure positive patient outcomes.   

Teamwork is at the core of nursing, and communication is at the core of teamwork. Nurses must coordinate care by effectively communicating vital information to the patient’s multidisciplinary team, making their communication skills essential to delivering the highest possible patient-centered care.   

Given that communication is an essential component of nursing care, nurses coming to the US must have confidence in their ability to read, write, listen, and speak English clearly and concisely to support their patients’ journey, deliver compassionate care, and achieve positive health outcomes.