Facilities wishing to hire H1C nurses must file an attestation with the Employment and Training Administration (ETA) of the U.S. Department of Labor (DOL) indicating :

1. the facility was a hospital located in a designated health professional shortage area as of March 31, 1997 and (for the cost-reporting period beginning during fiscal year 1994) had at least 190 licensed acute-care beds with at least 35 percent of its acute-care patients entitled to Medicare and at least 28 percent entitled to Medicaid, thereby meeting the definition of "subsection (d) hospital" found in the Social Security Act;

2. employment of the H1C nurse will not adversely affect the wages and working conditions of similarly employed nurses;

3. the H1C nurse will be paid the same wages as other, similarly employed nurses;

4. the facility has taken, and is taking, timely and "significant steps" to recruit and retain U.S. citizen or eligible immigrant nurses;

5. there is no strike or lockout in the course of a labor dispute, the facility did not, and will not, lay off a registered nurse employed by the employer within the 90-day period before or after the filing of the H1C petition and the employment of the H1C nurse is not intended or designed to influence an election for a bargaining representative for registered nurses at the facility;

6. notice of the H1C petition has been provided to the designated union bargaining representative or, if there is no bargaining representative, has been posted in conspicuous places within the facility;

7. H1C nurses at the facility will never number more than one-third of the total registered nursing staff; and

8. the H1C nurse will not work at a site other than a worksite controlled by the petitioning facility, nor transfer from one worksite to another.

Under the NRDAA, "significant steps," as used in item 4 above, may include, but are not limited to, the following :

• establishing a training program for nurses at the facility or participating in a program elsewhere;
   
• providing career development programs to encourage other health care workers to become registered nurses;
   
• paying registered nurses at a rate higher than the prevailing wage; and
   
• providing registered nurses with reasonable opportunities for meaningful salary advancement.

Generally, the employer's attestation is valid for a period of one year, but may be extended for one year from the date of admission of the last H1C nurse with respect to whose admission the attestation was filed, whichever is later.

The restrictions on both the facility and the nurse hamper the effectiveness of the H1C Program. Few facilities qualify to apply for H1C visas and the small annual cap and limited three-year stay requirements imposed on the nurse effectively make the H1C an option for only a small group of nurses.