Navigating the Visa Process for International Clinicians: A Hospital Leader’s Guide to Visa Types, Retrogression Delays, and Workforce Planning
International nurse staffing addresses healthcare workforce shortages in the United States. With the right visa, foreign-trained nurses can access life-changing career opportunities in the U.S., but there can be obstacles along the way. Visa retrogression poses one of the biggest challenges and can delay or disrupt the immigration process. Once health systems and healthcare professionals understand international visas and the effects of retrogression on applicants, strategies can be implemented to overcome these challenges.
Overview of the U.S. Visa Process for International Nurses
International nurses looking to work in the U.S. typically pursue one of three visa types, each with its own rules, benefits, and challenges.
Primary Visa Types
- EB-3 Visa (Employment-Based Category 3 Green Card for Skilled Workers):
- Advantages: Grants permanent residence (green card) to the nurse and their immediate family. Nurses on EB-3 visas can work indefinitely - this provides long-term job security.
- Requirements: A nursing diploma, NCLEX-RN exam pass, and a Healthcare Worker Certificate. The petitioning employer must secure a prevailing wage determination and petition approval.
- Disadvantages: EB-3 visas are subject to retrogression due to annual quotas, potentially resulting in long wait times for many applicants.
- TN Visa (Visa for Canadian and Mexican Nurses under USMCA):
- Advantages: Quick processing and renewable in three-year increments. Ideal for temporary staffing solutions.
- Disadvantages: Only available to Canadian and Mexican citizens and does not lead to permanent residency.
- H-1B Visa (Temporary Work Visa for Highly Skilled Professionals):
- Advantages: Suitable for specialty nurses, such as nurse practitioners or those in advanced practice roles.
- Disadvantages: Only for registered nurses with a Bachelor of Science in Nursing (BSN) being placed in a job where the work assignment requires a BSN. Subject to an annual lottery or special employer requirements.
The EB-3 Process Step-by-Step
The steps and responsibilities for the EB-3 process depend on the staffing model — whether it’s temp-to-perm or direct-hire. The chart below provides a clear breakdown of the main steps and highlights the key differences between these two approaches.
The Visa Process for Medical Technologists
Medical Technologists are another in-demand discipline that hospitals often recruit internationally. They can be a valuable addition to your workforce and help address staffing shortages. However, their visa process differs from that of nurses in several important ways:
- H-1B Work Visa Pathway: Medical Technologists (MTs) often qualify for H-1B visas because the role typically requires a bachelor’s degree. This makes it possible for MTs to begin working in the U.S. relatively quickly—often within 4–6 months of petition approval.
- Cap-Exempt Facilities (e.g., non-profit, university affiliation): Can sponsor H-1Bs at any time of year without going through the lottery.
- Cap-Subject Facilities (e.g., for-profit hospitals): Must enter the annual H-1B lottery in March. Due to high demand, the chance of selection is low (around 10%).
- No “Schedule A” Designation: Unlike Registered Nurses (RNs) and Physical Therapists (PTs), Medical Technologists are notdesignated as a "Schedule A" shortage occupation by the U.S. Department of Labor. This means MTs cannot skip the labor certification- a formal recruitment process (PERM)- when applying for a green card.
- EB-3 Green Card Process: To transition to permanent residency, the employer must complete the PERM labor certification process. This includes a formal recruitment effort to prove that there are no qualified U.S. workers for the role. Only after Department of Labor approval can the employer file the EB-3 immigrant petition (Form I-140). This process adds time and complexity compared to Schedule A occupations.
Our Recommendation: We recommend hospitals bring Medical Technologists in on H-1B visas (especially via cap-exempt routes) to address immediate needs and concurrently begin the PERM process for long-term retention through the EB-3 green card.
Understanding Visa Retrogression
Retrogression is a term that can cause concern for many visa applicants, but gaining a clear understanding of it is the first step toward managing the process. Visa retrogression occurs when the number of applicants in a specific visa category exceeds the number of available visas. This creates a backlog, forcing applicants to wait for visa numbers to become current, sometimes for years.
Retrogression occurs because the U.S. allocates a limited number of visas annually for each employment category and country, creating an annual quota system. Per-country limits are in place to ensure visa distribution is more balanced and not dominated by a few countries. Due to high demand, nurses from countries such as China and India, and less frequently, the Philippines—where healthcare professionals are frequently recruited—often face even longer wait times than those born elsewhere, due to the large volume of applications.
To stay updated about the visa quotas and distribution, the U.S. publishes the Visa Bulletin, which is released monthly by the Department of State. The Visa Bulletin shows the “cutoff date” for each visa category and country. Applicants can only proceed when their priority date (i.e., the date their I-140 petition was filed) is earlier than the cutoff date. For example, if the cutoff date is December 1, 2021, only petitions filed on or before November 30, 2021, are eligible for visas.
Impact of Retrogression on Nurse Staffing
Visa retrogression creates delays for international nurses, often extending their start dates by months or even years. This uncertainty creates challenges for healthcare organizations relying on foreign-trained professionals to meet staffing needs. These delays lead to short-term workforce gaps, resulting in facilities turning to temporary labor, such as travel nurses, to fill vacancies.
Additionally, without reinforcements, existing domestic staff face heavier workloads, contributing to burnout and negatively impacting both employee well-being and patient care. The financial burden for healthcare facilities also increases, as retrogression delays result in higher labor costs due to frequent turnover and contingent staffing solutions.
These staffing shortages directly affect patient care, leading to longer wait times and potentially compromising the delivery of critical services. International nurses help close these gaps, making these delays even more significant for healthcare organizations and the patients they serve.
Strategic Workforce Planning to Overcome Retrogression Challenges
Healthcare facilities can mitigate the impacts of retrogression with proactive strategies to build resilience into their workforce plans.
Develop a Long-Term Talent Pipeline
- Plan Several Years Ahead: Employers should start filing petitions early. If the need is projected to occur in two years, consider the temp-to-perm international model as those nurses are already in the visa queue. If the needs are two to five years from now, then the temp-to-perm or direct-hire model will work in staffing plans.
- Diversify Recruitment Models: Consider a mix of domestic recruitment, direct hires, and temp-to-perm international models, depending on financial strategy and risk tolerance.
Choose the Right International Partner
Partner with staffing agencies experienced in navigating visa retrogression and know how to handle delays. These organizations will:
- Predict visa availability and start dates using expertise and technology
- Provide pre-established candidate pipelines to accelerate deployment when visas become available
- Welcome transparency to set realistic start date expectations
- Fully understand the Visa Bulletin and the annual limitations on visas to plan effectively for future events
Understanding the Impact on Your International Candidate Pipeline
When retrogression slows down the visa process for international nurses, it can lead to increased dependence on short-term contingent labor, which usually has higher costs and can interrupt continuity of care. Delays in bringing international clinicians onboard may disrupt your workforce strategy, making it harder to maintain consistent, high-quality patient care.
Early action is the key to successful international recruitment. Visas are issued based on when candidates enter the queue, so filing petitions early secures their place in line. An international recruitment strategy should be an ongoing component of your workforce planning—not something that starts and stops—because inconsistent efforts can create gaps in the pipeline and delay candidate arrivals. With domestic labor shortages continuing, successful organizations integrate international recruitment into a long-term staffing strategy. The best time to build or strengthen your international staffing strategy is now.
How AMN Healthcare International Supports Your Workforce Amid Visa Retrogression
- Expert Guidance and Planning: With decades of experience navigating retrogression and delays, AMN International has skilled leadership to help model your international pipeline based on application dates, and provides insight into when candidates become eligible for visas and can start in the U.S. If you need help anticipating visa timelines or planning your pipeline, we are here to assist.
- Supplementing Your International Pipeline: If your current pipeline has been delayed, we offer access to a pre-established pool of international candidates ready for placement. This is an ideal option for healthcare organizations looking to adopt a temp-to-perm model. Our pipeline includes international nurses already in line for visas who are waiting to be matched with employers.
The process of managing international visas and retrogression may seem cumbersome, but with AMN International, success is achievable. Looking ahead to 2026 and 2027, we have a full pipeline of international clinicians who will soon become visa-eligible and be ready to join U.S. facilities. By filing early, working with experienced partners, and staying informed, you can turn immigration challenges into opportunities for growth and success.
Reach out today to consult with one of our international staffing experts and develop a sustainable workforce strategy.
