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I would like to comment on the U.S. Citizenship and Immigration Services (USCIS) Notice: H-1B Petitions Filed on Behalf of Nurses. I am currently a practicing RN who is completing my Baccalaureate education. Prior to my nursing career, I worked in health care in various capacities for the past eighteen years. One of the reasons I was compelled to join the ranks of nurses was the apparent vital role these professionals hold in our current health care system. If one truly has a heart to serve others and wants to make a difference in their community, its difficult to think of a more noble calling than that of nursing. However, too often nurses are asked to do more with less, and this can challenge ones resolve to continue working as a nurse. Accordingly, it seems that preventing H-1B qualified nurses from working in our country is antithetical to the realities of working nurses today. Further, this position seems to betray a lack of understanding of the true value of skilled nursing in the context of health care delivery.<br/><br/>Its no secret that our health care system is being challenged by a surging population of older adults with chronic illnesses and disabling conditions, many of which require long-term services and support (LTSS) (Health Resources &amp; Services Administration, 2018). According to the HRSA (2018), Registered Nurses (RNs) and Licensed Practical Nurses (LPNs) represent about one quarter of the LTSS workforce. This is just one example of how essential the nursing role is for providing care for our most vulnerable populations. The HRSA (2018) predicts between 2015 and 2030, demand for RNs will grow by 46%. Increased demand for nurses with current and future nursing shortages frames a crisis-in-the making. Snavely (2016) suggests high attrition rates in nursing (i.e. nurse burnout) and expansion of coverage secondary to the ACA (Affordable Care Act) appear to be widening these supply and demand gaps. However, this isnt an arbitrary conversation about market forces, its about patient safety. An earlier study by Harvard University identified that insufficient nurse staffing results in preventable complications, including patient deaths, and contributes to nurse burnout (Harvard University, 2003). The ANA (American Nurses Association) echo this point and states that adequate nurse (RN) staffing makes a critical difference for patients and the quality of care they receive (ANAs Case, 2018). Unsurprisingly, the watershed report issued by the Institute of Medicines (IOM) in 2010 called for expansion of nursing education and training in order to meet the needs of an increasingly diverse patient population (IOM, 2010).<br/><br/>All stakeholders of our health care system would benefit from adequate and flexible nurse staffing to fill these essential roles. Policy must be adapted to respond to these practical considerations. Skilled nurses control costs, improve outcomes, and improve quality of care (ANAs Case, 2018). Considering the evidence presented and practice realities experience by our nurses working today, any nurse that qualifies for H-1B status should be considered a resource we cant afford to ignore.<br/><br/>References<br/><br/>ANAs Case for Evidence-Based Nursing Staffing: Essential for cost-effective, high-quality hospital-based care and patient safety. (2018). Nebraska Nurse, 51(2), 1213. Retrieved from https://search.ebscohost.com/login.aspx?direct=true&amp;db=rzh&amp;AN=129676809&amp;site=ehost-live<br/><br/>Health Resources &amp; Services Administration (HRSA). (2018, December 01). Health Workforce Projections. Retrieved February 19, 2019, from https://bhw.hrsa.gov/health-workforce-analysis/research/projections<br/><br/>Harvard University study identifies inadequate nurse staffing as a major factor in medical errors. (2003). ISNA Bulletin, 29(2), 15. Retrieved from https://search.ebscohost.com/login.aspx?direct=true&amp;db=rzh&amp;AN=106886062&amp;site=ehost-live<br/><br/>Institute of Medicine (IOM). (2011). The Future of Nursing: Leading change, Advancing health. Washington, D.C.: The National Academies Press. DOI: 10.17226/12956<br/><br/>Snavely, T. M. (2016). Data Watch. A Brief Economic Analysis of the Looming Nursing Shortage In the United States. Nursing Economics, 34(2), 98100. Retrieved from https://search.ebscohost.com/login.aspx?direct=true&amp;db=rzh&amp;AN=114616391&amp;site=ehost-live<br/>

As a BSN, MSN, and soon to be DNP, I fully support the H-1B petition. In a time of great demand for healthcare workers, allowing a highly educated worker the ability to lend their expertise is very welcome. An individual is eligible for H-1B nonimmigrant classification if he or she is in a specialty occupation. This expanded VISA allows for assistance for many health professions. I feel strongly that specifically when looking at the role of an RN, the RN should be BSN prepared. In some areas, there is a push for all RN&#39;s to be BSN prepared or obtain within a timeframe post Associates Degree. <br/><br/>RNs with advanced education were more likely to be employed, tended to work in academic settings or ambulatory clinics, and were more likely to be faculty or in management/leadership positions. If the standard is to be set for international workers to only be allowed at a level of higher ed, then why do we not require this of our own RNs. <br/><br/>Roughly 40% of the nearly 3 million registered nurses (RNs) in the United States have an associate&#39;s degree (ADN) as their highest level of nursing education. Employers of RNs have increasingly preferred baccalaureate-prepared RNs (BSNs). Data from the American Community Survey (2003-2013) were analyzed with respect to employment setting, earnings, and employment outcomes of ADN and BSN-prepared RNs. The data reveal a divergence in employment setting: the percentage of ADN-prepared RNs employed in hospitals dropped from 65% to 60% while the percentage of BSN-prepared RNs employed in hospitals grew from 67% to 72% over this period. Many ADNs who would have otherwise been employed in hospitals seem to have shifted to long-term care settings. <br/><br/>I am full support of the H-1B petition and along with it would love to see a standard in place for the education of RN&#39;s to be also at the BNS level. <br/><br/> <br/><br/>Auerbach, D. I., Buerhaus, P. I., &amp; Staiger, D. O. (2015). Do Associate Degree Registered Nurses Fare Differently in the Nurse Labor Market Compared to Baccalaureate-Prepared RNs? Nursing Economic$, 33(1), 8. <br/><br/>Shen, Q., Peltzer, J., Teel, C., &amp; Pierce, J. (2015). The Initiative to Move Toward a More Highly Educated Nursing Workforce: Findings from the Kansas Registered Nurse Workforce Survey. Journal of Professional Nursing, 31(6), 452-463. https://doi-org.proxy-clarion.klnpa.org/10.1016/j.profnurs.2015.04.003