The Three Doors

When people heard that the government might charge $100,000 for a work visa, many international nurses assumed their path to the US had just closed.

For most nurses, that’s not true. Most nurses were never using that visa to begin with. There are three main doors into the US, and only one of them is in the news.

The three doors

• The green card door (EB-3) leads to permanent residence, not a temporary visa. How long it takes depends on where you were born, not on how hard you work at it.
• The neighbors-only door (TN): fast, but only open to Canadian and Mexican citizens, and it’s temporary, not a path to a green card.
• The specialist door (H-1B): this is the one making headlines. It’s mostly unrelated to staff nursing, since it only applies to roles that legally require an advanced, specialized degree.

If you’re a staff nurse, you’re almost certainly using the green card door already, and nothing in the H-1B news changes that.

Some nurses have narrower options depending on citizenship, qualifications, and personal circumstances. Those are worth a one-on-one conversation, not a footnote here.

What this means if you’re hiring, not just applying

The short version is the same for hospitals: the H-1B fee fights don’t touch your Schedule A or TN pipeline, because cap-subject H-1B filings were never the usual way to hire staff RNs. The exact figures, dates and sources your team and legal counsel will want are collected in the appendix at the end of this guide.

What this looks like in real life

1. Confirm which US state you’d be working in, since licensing rules differ by state, and start that state’s credentialing steps: education evaluation, NCLEX, English testing, and licensure.
2. Get a permanent, full-time job offer from a hospital willing to sponsor you.
3. The hospital and its immigration lawyer file the required paperwork (prevailing wage, notice, the Schedule A package, and the I-140), which places you in line.
4. Keep your license, certification, documents, and English scores current while you wait.
5. When your turn comes, complete the remaining steps: National Visa Center processing, a medical exam, an interview, and admission to the US.

This is the general shape of the process, not a fixed timeline. It varies by state and by nurse.

How Global MedTeam helps

Global MedTeam helps US hospitals hire international nurses directly. We help determine which door fits best, keep credentialing on track, and work alongside licensed immigration counsel, who handle the legal advice and filings.

Because our nurses are hired directly by the hospital, not placed through an outside staffing agency, we stay involved from the first application through the first shift, not just until a placement date. We can’t control government processing times or when the Visa Bulletin moves. What we can do is catch avoidable delays early and help you make decisions based on the real process, not the headlines.

Next steps

• If you’re a nurse, are you not sure which door fits you? Check your eligibility based on your citizenship, where you were born, your qualifications, and goals.
• If you’re a hospital, are you building an international nursing pipeline? Speak with Global MedTeam about a plan built around the door your roles actually qualify for.
• Stay current: immigration rules changed more than once this quarter alone. Get updates like these as they’re confirmed in our quarterly immigration newsletter.

For Hospital HR & Legal Counsel

The guide above covers what a nurse needs. Everything below is the backup: the exact figures, dates, and sources a compliance review will want.

H-1B status: two unresolved developments

Neither of the developments below changes EB-3 Schedule A processing or TN eligibility.

1. A presidential proclamation attempted to add a $100,000 payment to H-1B petitions. That policy is currently vacated. On July 24, 2026, the US Court of Appeals for the First Circuit denied the government’s request to stay the district court’s vacatur while the appeal continues, finding the government had not shown it was likely to succeed on the merits. The proclamation is currently scheduled to expire on September 21, 2026, unless extended.
2. Separately, on August 25, 2026, DHS proposed a new $103,265 fee on cap-subject H-1B petitions through formal rulemaking. The comment period closes September 24, 2026. This fee is not yet in effect, and as drafted, it would apply only to cap-subject petitions, including advanced-degree cap petitions, not cap-exempt filings.

Case: State of California v. Noem, No. 1:25-cv-13829 (D. Mass.); First Circuit order denying stay, July 24, 2026 (docket via CourtListener)

Source: USCIS H-1B alerts

Source: Federal Register, proposed $103,265 fee

Source: Federal Register, September 2025 proclamation

Full pathway comparison

Why most staff nursing jobs don’t qualify for H-1B

H-1B classification is for a specialty occupation, meaning a position that normally requires at least a bachelor’s degree in a specific field as the minimum entry requirement. The test applies to the position, not the nurse: holding a BSN does not, by itself, make a job H-1B-eligible. Certain advanced-practice, clinical-specialist, and other highly specialized roles may qualify, and those cases turn on the documented requirements of the actual position.

Source: USCIS guidance on H-1B petitions for nursing occupations

EB-3 Schedule A: source & documentation

Professional nursing is listed under Schedule A, reflecting a Department of Labor determination that there are not sufficient US workers available for these occupations. That lets the employer bypass standard recruitment, though not the labor-certification requirements themselves: a prevailing wage determination, the required notice of filing, the ETA-9089, and the Schedule A package filed with USCIS alongside the I-140. For a professional nurse, the package also needs evidence of at least one of the following: a CGFNS certificate, a permanent, full, and unrestricted nursing license in the state of intended employment, or passage of the NCLEX-RN.

Source: Schedule A requirements, 20 CFR 656.15

TN: source & note

TN status is available to citizens of Canada and Mexico under the USMCA. Permanent residents of those countries do not qualify. Registered Nurse is specifically listed as a USMCA profession, and there is no annual lottery. TN carries non-immigrant intent considerations worth discussing with counsel before a nurse commits to it as a long-term plan.

Source: US Department of State guidance on USMCA professional workers

Visa Bulletin: September 2026 EB-3 Final Action Dates

Final Action Dates indicate when an immigrant visa can generally be issued, while Dates for Filing (in a separate chart) may allow documents to be submitted earlier. The country column follows visa chargeability, usually the country of birth rather than citizenship or current residence. Any employment-based category can retrogress when demand exceeds the numbers available.

Source: US Department of State Visa Bulletin, September 2026

Update history

First published September 15, 2026. Covers the vacated $100,000 H-1B payment policy and the separate proposed $103,265 cap-subject fee. This section will be updated as this article’s legal content changes.