THE OKLAHOMA BAR JOURNAL 18 | OCTOBER 2025 program wherein only 14 hospitals in nine states were eligible to apply for an H-1C, and by 2004, only about 12 nurses had received an H-1C visa.52 Apart from a few failed attempts at legislation, there have been no new efforts by U.S. lawmakers to provide pathways for foreign nurses to work in the United States since the early 2000s. The most common options that remain in place include: 1) a 12-month permit for work authorization known as optional practical training, which is granted at the end of a student’s academic program; 2) work authorization through an employment-based green card sponsored by the employer; 3) work authorization granted through an application for special status, such as asylum, temporary protected status, refugee status, etc.; or 4) work authorization granted as part of a family-based immigration petition (i.e., through a U.S. citizen spouse).53 The first two options are addressed below, including an explanation of their applications and eligibility processes. Optional Practical Training Foreign nationals who come to the U.S. to pursue full-time academic studies at an accredited college, university or other academic institution that is authorized to accept international students typically enter the country in F-1 status.54 F-1 students must be enrolled in a course of study that culminates in a degree, diploma or certificate.55 During the first academic year, F-1 students generally may not work off campus, but after one year, they become eligible to work in optional practical training (OPT) employment.56 OPT employment is arranged through the student’s academic institution and its international office/designated school officer (DSO), who, in turn, applies for work authorization from USCIS on the student’s behalf.57 OPT offers F-1 students 12 months of temporary employment directly related to their field of study.58 For F-1 students in certain science, technology, engineering and math (STEM) fields, a 24-month extension of their employment authorization is available, as long as they continue working in their field of study and with their employers and DSOs to create and maintain an employment training plan.59 The Department of Homeland Security (DHS) determines which fields of study are considered STEM fields and, therefore, eligible for extended work authorization.60 However, although the DHS list of STEM degrees includes many related disciplines – such as biology, nutritional science, anatomy and immunology – a nursing degree (such as a Bachelor of Science in nursing or BSN) is not considered a STEM field. Therefore, nursing students are ineligible for the 24-month STEM extension.61 Instead, they are limited to 12 months of OPT work authorization. When a student completes an academic program, applies for and receives an OPT work permit or employment authorization document (EAD) and gets a job offer from a hospital, there may only be nine or 10 months left of the worker’s 12-month OPT status. As will be demonstrated later, this is not enough time to secure any other kind of employment authorization for the worker, which means that this worker will either have to leave employment at the end of the 12-month period and return to full-time student status, change their immigration status to another temporary category that will allow them to stay in the U.S. but not work, or leave the U.S. and return to their home countries. Although this presents a hardship for many foreign nurses, it also creates an untenable situation for employers in the health care space who are forced to terminate some of their Statements or opinions expressed in the Oklahoma Bar Journal are those of the authors and do not necessarily reflect those of the Oklahoma Bar Association, its officers, Board of Governors, Board of Editors or staff.
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