Estimated reading time: 6 minutes
USCIS has updated its guidance for Adjustment of Status applications, introducing heightened scrutiny that immigration attorneys say could make it more difficult for some internationally educated nurses and healthcare professionals to obtain permanent residency without leaving the United States. The change could also create new challenges for healthcare employers that rely on internationally educated nurses to help fill critical workforce gaps.
As healthcare organizations across the country struggle to recruit and retain nurses, a recent USCIS update could create new challenges for internationally educated nurses seeking permanent residency.
According to immigration attorney Ann-Rose Johnson-Lewis, director of legal services at WorldWide HealthStaff Solutions, the changes introduce heightened scrutiny for some Adjustment of Status applications and could create hurdles for both applicants and healthcare employers.
What Changed?
According to Johnson-Lewis, the updated guidance directs USCIS officers to apply a more rigorous review process when adjudicating Adjustment of Status applications.
“The policy instituted a more rigorous vetting standard, elevating the threshold from ordinary to extraordinary circumstances,” she explained. “Under this framework, applicants must demonstrate the existence of extraordinary circumstances for USCIS to approve their adjustment of status applications.”
However, she noted that the policy memorandum did not clearly define what qualifies as extraordinary circumstances.
“To date, USCIS has not provided a precise definition of this requirement, leaving attorneys to interpret its meaning based on professional experience and prior cases.”
Importantly, the policy does not eliminate the Adjustment of Status pathway.
“The policy does not eliminate the adjustment of status pathway; it remains a viable option,” Johnson-Lewis said. “Rather, the policy provides guidance to USCIS officers on how to evaluate and adjudicate adjustment of status applications.”
Why Nurses Should Pay Attention
The guidance could have the greatest impact on internationally educated nurses and healthcare professionals who entered the United States under visa categories that do not allow dual intent, such as J-1, TN, or F-1 visas.
According to Johnson-Lewis, individuals who entered under these visa categories and who have not maintained valid underlying nonimmigrant status may face a significantly greater risk of denial when applying for permanent residency through Adjustment of Status.
“This change is likely to negatively impact affected individuals based on several factors, including (1) the visa used to enter the United States and (2) their current immigration status,” she said.
She added that affected clinicians should seek legal guidance before pursuing an Adjustment of Status application.
“These individuals will need to engage in thorough consultation and case analysis with an immigration attorney to assess potential outcomes before filing an adjustment of status application.”
New Challenges for Hospitals Sponsoring Nurses
Healthcare employers sponsoring international nurses may face additional hurdles, as USCIS officers now have broader discretion in evaluating cases.
“The uncertainty created by this heightened level of scrutiny lies in how adjudicating officers will interpret and apply the new policy guidance,” Johnson-Lewis said. “Officers are now charged with evaluating each case on an individual basis, exercising broad discretion in their determinations.”
She noted that reports indicate additional questions have been incorporated into immigrant visa interviews, including inquiries about why applicants remained in the United States after their nonimmigrant status expired and why they did not pursue alternative immigration pathways.
For healthcare organizations investing significant resources into international recruitment, the possibility of delays or denials can complicate workforce planning and increase financial risk.
What This Could Mean for International Nurses
For some nurses already living and working in the United States, the consequences could be significant.
Johnson-Lewis explained that some applicants pursuing permanent residency through Adjustment of Status could ultimately be required to leave the United States and complete the immigrant visa process from their home countries.
“A non-dual intent non-immigrant visa holder who is currently in the United States and pursuing permanent residency through adjustment of status may be required to depart the U.S. and complete the immigrant visa process in their home country,” she said.
“This can result in not only the applicant but also eligible family members having to leave the United States. Such a requirement can significantly disrupt employment, interrupt children’s education, and create substantial financial strain.”
“The costs associated with international travel, coupled with the need to maintain a residence in the U.S. while abroad, can be extremely burdensome and, in some cases, untenable.”
Johnson-Lewis noted that applicants who must pursue consular processing abroad face another challenge.
“Additionally, the period of time these individuals may be required to remain outside the United States can extend for several months, during which they may have no income while continuing to incur daily living expenses abroad as well as ongoing financial obligations in the United States.”
She explained that consular processing decisions are generally not subject to judicial review.
“This is further compounded by the fact that consular processing decisions are subject to the doctrine of consular non-reviewability, meaning that adverse visa determinations made abroad are generally not subject to judicial review. As a result, U.S. courts will typically decline to review or overturn a consular officer’s decision to grant or deny a visa.”
Could Staffing Challenges Get Worse?
The timing is significant, as many hospitals continue to struggle to fill nursing positions. Johnson-Lewis believes the added risk may make some employers more cautious about sponsoring international candidates and could further limit hiring options.
“Yes, this uncertainty is likely to discourage healthcare organizations from extending employment offers to individuals subject to this policy,” she said.
“The costs associated with sponsoring an international employee are significant and can be difficult to absorb if the application is ultimately denied. As a result, this added risk will further exacerbate staffing challenges for healthcare organizations that are already struggling to fill critical positions.”
Potential Impact on Patient Care
Although most internationally educated nurses enter the workforce through the EB-3 visa process rather than the Adjustment of Status, Johnson-Lewis says multiple immigration barriers are affecting healthcare employers simultaneously.
She pointed to travel bans, visa pauses, slower adjudications, and recent policy changes affecting employment authorization as factors limiting the flow of healthcare professionals into the workforce.
“Most positions filled by international applicants are obtained through the EB-3 visa process, while the adjustment of status pathway represents a significantly smaller portion,” she said.
“We have also observed slower adjudication of adjustment of status applications, particularly for individuals from countries affected by these restrictions. Those already in the U.S. may be forced to stop working due to recent policy changes eliminating the automatic renewal of employment authorization cards.”
She added that a new fee structure for H-1B visas has further discouraged some employers from pursuing that sponsorship route.
“Additionally, the introduction of a $100,000 fee for H-1B visas has effectively deterred healthcare employers from using that pathway to sponsor candidates.”
Taken together, these factors could place additional strain on an already limited healthcare workforce.
“These compounded challenges place further strain on an already limited healthcare workforce, particularly among registered nurses and other critical professionals. As a result, patients are likely to experience longer wait times for appointments, delays in elective procedures, and reduced responsiveness in healthcare settings due to ongoing staffing shortages.”
What Healthcare Leaders Should Watch Next
Over the next year, healthcare organizations and internationally educated clinicians will be watching to see whether current immigration restrictions and processing delays are extended, modified, or allowed to expire.
According to Johnson-Lewis, that decision could significantly influence the availability of international healthcare professionals entering and remaining in the U.S. workforce.
“One key issue to monitor is how the administration will respond when the various immigration-related delay mechanisms currently in place begin to expire,” she said.
“It remains unclear whether these measures will be renewed or extended, continuing to restrict international healthcare professionals, or whether they will be allowed to lapse.”
For healthcare leaders facing persistent workforce shortages, the answer could have important implications for recruitment, retention, and patient access to care in the months ahead.
