dismissed H-1B Case: Health Care

(b)(6)
DATE: FEB 2 6 2015 
IN RE: Petitioner: 
Beneficiary: 
OFFICE: VERMONT SERVICE CENTER 
U.S. Department of Homeland Security 
U.S. Citizenship and Immigration Services 
Administrative Appeals Office (AAO) 
20 Massachusetts Ave., N.W., MS 2090 
Washington, DC 20529-2090 
U.S. Citizenship 
and Immigration 
Services 
FILE: 
PETITION: Petition for a Nonimmigrant Worker Pursuant to Section 10 1(a)( 15)(H)(i)(b) of the 
Immigration and Nationality Act, 8 U.S.C. § 11 0 1(a)( 15)(H)(i)(b) 
ON BEHALF OF PETITIONER: 
INSTRUCTIONS: 
Enclosed please find the decision of the Administrative Appeals Office (AAO) in your case. 
This is a non-precedent decision. The AAO does not announce new constructions of law nor establish agency 
policy through non-precedent decisions. If you believe the AAO incorrectly applied current law or policy to 
your case or if you seek to present new facts for consideration, you may file a motion to reconsider or a 
motion to reopen, respectively. Any motion must be filed on a Notice of Appeal or Motion (Form I-290B) 
within 33 days of the date of this decision. Please review the Form I-290B instructions at 
http://www.uscis.gov/forms for the latest information on fee, filing location, and other requirements. 
See also 8 C.P.R. § 103.5. Do not file a motion directly with the AAO. 
N� Ron Rosenberg 
Chief, Administrative Appeals Office 
www.uscis.gov 
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DISCUSSION: The service center director (hereinafter "director") denied the nonimmigrant visa 
petition, and the matter is now before the Administrative Appeals Office on appeal. The appeal will 
be dismissed. The petition will be denied. 
I. PROCEDURAL AND FACTUAL BACKGROUND 
On the Petition for a Nonimmigrant Worker (Form I-129), the petitioner describes itself as a 
71-employee "Home health care provider" established in In order to continue to employ the 
beneficiary in what it designates as a "Medical and Health Services Manager" position, the petitioner 
seeks to classify him as a nonimmigrant worker in a specialty occupation pursuant to section 
101(a)(15)(H)(i)(b) of the Immigration and Nationality Act (the Act), 8 U.S.C. 
§ 1101(a)(15)(H)(i)(b). 
The director denied the petition, finding that the petitioner failed to establish that it would employ 
the beneficiary in a specialty occupation position. On appeal, the petitioner asserts that the director's 
basis for denial was erroneous and contends that the petitioner satisfied all evidentiary requirements. 
As will be discussed below, we have determined that the director did not err in her decision to deny 
the petition on the specialty occupation issue. Accordingly, the director's decision will not be 
disturbed. The appeal will be dismissed, and the petition will be denied. 
We base our decision upon our review of the entire record of proceeding, which includes: (1) the 
petitioner's Form I-129 and the supporting documentation filed with it; (2) the service center's 
request for additional evidence (RFE); (3) the petitioner's response to the RFE; ( 4) the director's 
denial letter; and (5) the Form I-290B and the petitioner's submissions on appeal. 
II. THELAW 
The issue before us is whether the petitioner has demonstrated that the proffered position qualifies as 
a specialty occupation. Section 214(i)(l) of the Act, 8 U.S.C. § 1184(i)(l), defines the term 
"specialty occupation" as an occupation that requires: 
(A) theoretical and practical application of a body of highly specialized 
knowledge, and 
(B) attainment of a bachelor's or higher degree in the specific specialty (or its 
equivalent) as a minimum for entry into the occupation in the United States. 
The regulation at 8 C.P.R.§ 214.2(h)(4)(ii) states, in pertinent part, the following: 
Specialty occupation means an occupation which [(1)] requires theoretical and 
practical application of a body of highly specialized knowledge in fields of human 
endeavor including, but not limited to, architecture, engineering, mathematics, 
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physical sciences, social sciences, medicine and health, education, business 
specialties, accounting, law, theology, and the arts, and which [(2)] requires the 
attainment of a bachelor's degree or higher in a specific specialty, or its equivalent, as 
a minimum for entry into the occupation in the United States. 
Pursuant to 8 C.F.R. § 214.2(h)(4)(iii)(A), to qualify as a specialty occupation, a proposed position must 
also meet one of the following criteria: 
(1) A baccalaureate or higher degree or its equivalent is normally the m1mmum 
requirement for entry into the particular position; 
(2) The degree requirement is common to the industry in parallel positions among 
similar organizations or, in the alternative, an employer may show that its 
particular position is so complex or unique that it can be performed only by an 
individual with a degree; 
(3) The employer normally requires a degree or its equivalent for the position; or 
(4) The nature of the specific duties [is] so specialized and complex that knowledge 
required to perform the duties is usually associated with the attainment of a 
baccalaureate or higher degree. 
As a threshold issue, it is noted that 8 C.F.R. § 214.2(h)(4)(iii)( A) must logically be read together 
with section 214(i)( 1) of the Act and 8 C.P.R. § 214.2(h)(4)(ii). In other words, this regulatory 
language must be construed in harmony with the thrust of the related provisions and with the statute 
as a whole. SeeK Mart Corp. v. Cartier, Inc., 486 U.S. 281, 291 (1988) (holding that construction 
of language which takes into account the design of the statute as a whole is preferred); see also COlT 
Independence Joint Venture v. Federal Sav. and Loan Ins. Corp., 489 U.S. 561 (1989); Matter ofW­
F-, 21 I&N Dec. 503 (BIA 1996). As such, the criteria stated in 8 C.F.R. § 214.2(h)(4) (iii)(A) 
should logically be read as being necessary but not necessarily sufficient to meet the statutory and 
regulatory definition of specialty occupation. To otherwise interpret this section as stating the 
necessary and sufficient conditions for meeting the definition of specialty occupation would result in 
particular positions meeting a condition under 8 C.F.R. § 214.2(h)(4)( iii)(A) but not the statutory or 
regulatory definition. See Defensor v. Meissner, 201 F.3d 384, 387 (5th Cir. 2000). To avoid this 
result, 8 C.F.R. § 214.2(h)(4)(iii)(A) must therefore be read as providing supplemental criteria that 
must be met in accordance with, and not as alternatives to, the statutory and regulatory definitions of 
specialty occupation. 
As such and consonant with section 214(i)( 1) of the Act and the regulation at 8 C.F.R. 
§ 214.2(h)(4)(ii), U.S. Citizenship and Immigration Services (USCIS) consistently interprets the 
term "degree" in the criteria at 8 C.F.R. § 214.2(h)(4)(iii)( A) to mean not just any baccalaureate or 
higher degree, but one in a specific specialty that is directly related to the proffered position. See 
Royal Siam Corp. v. Chertoff, 484 F.3d 139, 147 (1st Cir. 2007) (desc ribing "a degree requirement in 
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a specific specialty" as "one that relates directly to the duties and responsibilities of a particular 
position"). Applying this standard, USCIS regularly approves H-1B petitions for qualified aliens 
who are to be employed as engineers, computer scientists, certified public accountants, college 
professors, and other such occupations. These professions, for which petitioners have regularly been 
able to establish a minimum entry requirement in the United States of a baccalaureate or higher 
degree in a specific specialty or its equivalent directly related to the duties and responsibilities of the 
particular position, fairly represent the types of specialty occupations that Congress contemplated 
when it created the H-1B visa category. 
To determine whether a particular job qualifies as a specialty occupation, USCIS does not simply 
rely on a position's title. The specific duties of the proffered position, combined with the nature of 
the petitioning entity's business operations, are factors to be considered. users must examine the 
ultimate employment of the alien, and determine whether the position qualifies as a specialty 
occupation. See generally Defensor v. Meissner, 201 F. 3d 384. The critical element is not the title 
of the position nor an employer's self-imposed standards, but whether the position actually requires 
the theoretical and practical application of a body of highly specialized knowledge, and the 
attainment of a baccalaureate or higher degree in the specific specialty as the minimum for entry into 
the occupation, as required by the Act. 
III. EVIDENCE 
The Labor Condition Application (LCA) submitted to support the visa petitiOn states that the 
proffered position is a Medical and Health Services Manager position, and that it corresponds to 
Standard Occupational Classification (SOC) code and title 11-9111, Medical and Health Services 
Managers, from the Occupational Information Network (O*NET). The LCA further states that the 
proffered position is a Level I, entry-level, position. 
With the visa petition, the petitioner submitted a letter, dated February 5, 2014, from 
signing as the petitioner's director of operations. That letter contains the following 
description of the duties of the proffered position: 
• Plan, direct and coordinate healthcare operations to improve quality of service of 
the organization. His salary will be $68,494.00 per year. He will be reporting to 
our establishment in VA. 
• Perform resident care, admissions and facility operations. 
• Be responsible for coordinating activities with other managers, such as evaluating 
work and personnel, developing reports, and implementing policies and 
procedures of the organization. 
• In addition, evaluate work activities of heath information personnel. 
also stated: ."The minimum requirement of the professional position described 
above is a bachelor's degree, with two (2) years experience in the field of Nursing, Medical records 
Management, or related study." With respect to the beneficiary, stated that the 
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beneficiary is "well qualified to continue in the position as he is a Registered Nurse in the United 
States and has maintained his practice license in good standing." 
On March 10, 2014, the service center issued an RFE in this matter. The service center requested, 
inter alia, evidence that the petitioner would employ the beneficiary in a specialty occupation. The 
service center provided a non-exhaustive list of items that might be used to satisfy the specialty 
occupation requirements. 
In response, the petitioner submitted, inter alia, (1) a description of the proffered position; (2) an 
organizational chart; (3) an evaluation, dated October 20, 2011, of the proffered position; (4) a letter, 
dated May 14, 2014, from signing as the petitioner's executive vice president; and 
(5) a letter from counsel, dated May 21, 2014. 
The description of the proffered position states: 
RESPONSIBILITIES: 
I. DIRECT-80% 
A. Plan, direct and coordinate healthcare operations to improve quality of 
service of the organization. 
a) Review, evaluate policies, standards and operations of our company. 
b) Develop, implement new regulations and train staff in coordinating with the 
development staff. 
c) Develop procedures to ensure that our concerned staff complies with the Federal 
and State regulations and implement changes. 
d) Responsible for our company's compliance with the requirements for 
accreditation and certification with all applicable federal, state and local laws and 
regulation. 
e) Prepare budgets annually. 
f) Response and answer inquiries from other, relating to the information of our 
services. Coordinate updates and changes in our information system, the 
community health consultant. 
g) Follow up patient complaints. 
h) Do performance evaluation. 
II. SUP ERVISION AND COORDINATION 
a) Staff nurses, LPNs and CNA, CHHA and PCA. 
b) Supervise CNNCHHNPCA. 
c) Coordinate with Development Specialist for orientation and training of sta ff in 
classroom and field. 
III. Others- 10% 
A. Attend courses to enhance personal knowledge. 
B. Participate in the PI Committee. 
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C. Assist/participate with Department Heads and managers in the employee 
performance evaluation. 
D. Collect surveys after training and use result to improve the training program. 
E. Prepare reports as required. 
F. Participate in the on call system during weekend, after office hours and holidays. 
G. Participate in the coverage of scheduled vacation or emergency coverage for 
patient visit. 
H. Pe rform other duties as required. 
[Verbatim.] 
That description further states, as to the education and experience required for the proffered position: 
"Must have a Bachelor's Degree preferably in Nursing because of the nature of the job; with two 
(2) years of work experience in their field." 
The October 20, 2011 evaluation of the proffered position of the proffered position was prepared by 
a full-time faculty member at Florida. It 
indicates that found and considered six vacancy announcements, which she described as 
follows: 
Health Services Manager- Company: Location: Alameda, 
California. Job Requirements: Bachelor's degree in Health Administration, Public 
Health, Nursing, Business or a related field of work. 
Regional Health Services Manager- Company: . Location: San 
Antonio, Texas. Job Requirements: Bachelor's degree in a related field of work. 
Health Services Manager - Company: Location: St. Louis, 
Missouri. Job Requirements: Bachelor's degree in a related field of work. 
Health Services Manager - Company: Location: Bedford, 
Texas. Job Requirements: Bachelor's degree in Nursing or a related field. 
Health Services Manager - Company: Location: Missoula, Montana. 
Job Requirements: Bachelor's degree in Nursing or a related field of work 
Medical Services Manager- Company: 
Coast, California. Job Requirements: Bachelor's degree 
Management/ Administration or a related field of work. 
That evaluation also states: 
Location: Newport 
m Nursing, Healthcare 
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The Medical and Health Services Manager will coordinate actlvtttes with other 
managers, such as evaluating work and personnel, developing reports, and 
implementing policies and procedures of the organization; evaluate work activities of 
health information personnel; plan, direct and coordinate healthcare operations to 
improve quality of service of the organization; perform resident care, admissions and 
facility operations. 
In addition, a Medical and Health Services Manager typically performs the following 
job duties: direct and conduct recruitment, hiring and training of personnel; direct, 
supervise and evaluate work activities of medical, nursing, technical, clerical, service, 
maintenance, and other personnel; direct, supervise and evaluate work activities of 
medical, nursing, technical, clerical, service, maintenance, and other personnel; 
[Repetition in the original.] maintain communication between governing boards, 
medical staff, and department heads by attending board meetings and coordinating 
interdepartmental functioning; plan, direct and coordinate healthcare policies to 
improve quality of service to patient; perform facility operations; coordinate activities 
with other managers such as evaluating work and personnel, developing budgets and 
reports, and implementing policies and procedures; conduct and administer fiscal 
operations, including accounting, planning budgets, authorizing expend itures, 
establishing rates for services, and coordinating financial reporting; review and 
analyze facility activities and data to aid planning and risk management and to 
improve service utilization; plan, implement and administer programs and services, 
including personnel administration, training, and coordination of medical nursing and 
physical plant staff; establish work schedules and assignments for staff according to 
workload, space and equipment availability. 
The evaluator further stated: 
[I]t is my professional opinion that in order to adequately perform the responsibilities 
required for the job of Medical and Health Services Manager at [the petitioner] an 
individual would need the knowledge obtained by acquiring a Bachelor's Degree in 
Physical Therapy, Nursing, Medical Records Management or a related subject. 
I base my assessment on the fact that the job requires specialized knowledge to 
perform the following: 
• Coordinate activities with other managers, such as evaluating work and personnel, 
developing reports, and implementing policies and procedures of the organization. 
• Evaluate work activities of health information personnel. 
• Plan, direct and coordinate healthcare operation to improve quality of services of 
the organization. 
• Perform resident care, admissions and facility operations. 
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May 14, 2014 letter refers to unspecified Bureau of Labor Statistics research as 
indicating that most medi cal and health services managers have a minimum or a bachelor's degree 
and that master's degrees are also common. She stated that the petitioner requires a bachelor's 
degree in nursing for the proffered position. 
In his May 21, 2014 letter, counsel asserted that the evidence submitted demonstrates that the 
proffered position qualifies as a specialty occupation position by virtue of requiring a minimum of a 
bachelor's degree in a specific specialty or its equivalent. 
The director denied the petition on June 10, 2014, finding, as was noted above, that the petitioner 
had not demonstrated that the proffered position qualifies as a position in a specialty occupation by 
virtue of requiring a minimum of a bachelor's degree in a specific specialty or its equivalent. More 
specifically, the director found that the petitioner had satisfied none of the supplemental criteria set 
forth at 8 C.F.R. § 214.2(h)(4)(iii) (A). 
On appeal, the petitioner asserts that the evidence demonstrates that the proffered position qualifies 
as a specialty occupation position. 
IV. ANALYSIS 
To determine whether the proffered position qualifies as a specialty occupation position, we turn 
first to the criteria at 8 C.F.R. § 214.2(h)( 4)(iii)(A)(1) and (2): a baccalaureate or higher degree in a 
specific specialty or its equivalent is normally the minimum requirement for entry into the particular 
position; and a degree requirement in a specific specialty is common to the industry in parallel 
positions among similar organizations or a particular position is so complex or unique that it can be 
performed only by an individual with a degree in a specific specialty. Factors we consider when 
determining these criteria include: whether the U.S. Department of Labor's Occupational Outlook 
Handbook (Handbook), on which we routinely rely for the educational requirements of particular 
occupations, reports the industry requires a degree in a specific specialty; whether the industry's 
professional association has made a degree in a specific specialty a minimum entry requirement; and 
whether letters or affidavits from firms or individuals in the industry attest that such firms "routinely 
employ and recruit only degreed individuals." See Shanti, Inc. v. Reno, 36 F. Supp. 2d 1151, 1165 
(D. Minn. 1999) (quoting Hird/Blaker Corp. v. Sava, 712 F. Supp. 1095, 1102 (S.D.N.Y. 1989)). 
We will first address the requirement under 8 C.F.R. § 214.2(h)(4)(iii)(A)(l): A baccalaureate or 
higher degree or its equivalent is normally the minimum requirement for entry into the particular 
position. We recognize the Handbook as an authoritative source on the duties and educational 
requirements of the wide variety of occupations that it addresses. 1 The petitioner claims in the LCA 
that the proffered position corresponds to SOC code and title 11-9111.00, Medical and Health 
The Handbook, which is available in printed form, may also be accessed on the Internet, at 
http://www.bls.gov/oco/. Our references to the Handbook are to the 2014 -2015 edition available online. 
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Services Managers from O*NET. The Handbook describes the occupation of "Medical and Health 
Services Managers" as follows: 
What Medical and Health Service Managers Do 
Medical and health services managers, also called healthcare executives or healthcare 
administrators, plan, direct, and coordinate medical and health services. They might 
manage an entire facility or specialize in managing a specific clinical area or 
department, or manage a medical practice for a group of physicians. Medical and 
. health services managers must be able to adapt to changes in healthcare laws, 
regulations, and technology. 
Duties 
Medical and health services managers typically do the following: 
• Work to improve efficiency and quality in delivering healthcare 
services 
• Keep up to date on new laws and regulations so that the facility in 
which they work complies with them 
• Supervise assistant administrators in facilities that are large enough 
to need them 
• Manage the finances of the facility, such as patient fees and billing 
• Create work schedules 
• Represent the facility at investor meetings or on governing boards 
• Keep and organize records of the facility's services, such as the 
number of inpatient beds used 
• Communicate with members of the medical staff and department 
heads 
In group medical practices, managers work closely physicians and surgeons, 
registered nurses, medical and clinical laboratory technologists and technicians and 
other healthcare workers. 
Medical and health services managers' titles depend on the facility or area of expertise 
in which they work. The following are some examples of types of medical and health 
services managers: 
Nursing home administrators manag� staff, admissions, finances, and care of the 
building, as well as care of the residents in nursing homes. All states require them to 
be licensed; licensing requirements vary by state. 
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Clinical managers oversee a specific department, such as nursing, surgery, or 
physical therapy, and have responsibilities based on that specialty. Clinical managers 
set and carry out policies, goals, and procedures for their departments; evaluate the 
quality of the staff's work; and develop reports and budgets. 
Health information managers are responsible for the maintenance and security of all 
patient records. They must stay up to date with evolving information technology and 
current or proposed laws about health information systems. Health information 
managers must ensure that databases are complete, accurate, and accessible only to 
authorized personnel. 
Assistant administrators work under the top administrator in larger facilities and 
often handle daily decisions. Assistants might direct activities in clinical areas, such 
as nursing, surgery, therapy, medical records, or health information. 
U.S. Dep't of Labor, Bureau of Labor Statistics, Occupational Outlook Handbook, 2014-15 ed., 
"Medical and Health Services Managers," http://www .bls.gov/ooh/management/medical-and-health­
services-managers.htm#tab-2 (last visited Feb. 18, 2015). 
There is an issue to be resolved before dete rmining whether the duties of the proffered position show 
that it is a Medical and Health Services Manager position as described in the Handbook. First, we 
must determ ine what duties the beneficiary would actually perform if the visa petition were 
approved. For instance, although the description of duties contained in February 
5, 2014 letter states that the beneficiary would "Plan, direct and coordinate healthcare operations to 
improve quality of service of the organization," we observe that the petitioner's organizational chart 
shows that the petitioner employs a Quality Assurance Staff (Studies) that includes three people and 
a Performance Improvement Committee with an unstated number of people, both of which are above 
the proffered position in the petitioner's chain of command. Further, the petitioner employs an 
Ancillary Health & Quality Assurance Manager who is not in the beneficiary's chain of command. 
As such, although the beneficiary, in the proffered position, may contribute to the petitioner's efforts 
to improve its quality of service, he does not appear to bear the sole, or even the primary 
responsibility for that duty. 
More telling, the organizational chart shows that the petitioner is directly under the petitioner's 
Certified Wound, Ost omy and Continence Nurse (CWOCN) Manager in the petitioner's chain of 
command. The petitioner's CWOCN Manager is under the petitioner's Director of Professional 
Services, who is under the petitioner's Medical Director, who is under the petitioner's Administrator. 
Further still, the petitioner's sole educational requirement is a bachelor's degree in nursing and the only 
employees below the beneficiary in the petitioner's chain of command, whom the beneficiary would 
supervise, are one of the petitioner's two Registered Nurse Case Managers, one of the petitioner's 
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two Licensed Practical Nurse/Certified Nursing Assistants, a Registered Nurse WCN/ some of the 
petitioner's Registered Nurses, and one of the petitioner's Home Health Aides. The organizational 
chart makes plain that the beneficiary's duties would be largely limited to the supervision of some of 
the petitioner's nurses, certified nursing assistants, and other home healthcare personnel. Although 
he may contribute to various other efforts such as promulgating policies and procedures and the 
improvement of the petitioner's quality assurance program, the record does not show that he would 
have personal charge of any such company-wide endeavors. 
In contrast, according to the Handbook, medical and health services managers, also called healthcare 
executives or health care administrators, "plan, direct, and coordinate medical and health services," 
and might do so in the context of managing an entire fac ility, such as the petitioner's Administrator, 
Director of Operations, or Director of Professional Services may do. 
Further, the duty description contained in February 5, 2014 letter indicates that, in 
the proffered position, the beneficiary would perform resident care. The duty de scription contained 
in the position description submitted in response to the RFE indicates that, in the proffered position, 
the beneficiary would participate in the petitioner's on call system and cover the scheduled visits of 
health care providers in emergencies or when those other health care providers are on leave. Those 
duties are inconsistent with a medical and health services manager position. 
The Handbook describes registered nurse positions as follows: 
What Registered Nurses Do 
Registered nurses (RNs) provide and coordinate patient care, educate patients and the 
public about various health conditions, and provide advice and emotional support to 
patients and their family members. 
Duties 
Registered nurses typically do the following: 
• Record patients' medical histories and symptoms 
• Administer patients' medi cines and treatments 
• Set up plans for patients' care or contribute to existing plans 
• Observe patients and record observations 
• Consult with doctors and other healthcare professionals 
• Operate and monitor medical equipment 
• Help perform diagnostic tests and analyze results 
• Teach patients and their families how to manage illnesses or injuries 
• Explain what to do at home after treatment 
2 The meaning of the acronym WCN in this context is unknown to us. 
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Most registered nurses work as part of a team with physicians and other healthcare 
specialists. Some registered nurses oversee licensed practical nurses, nursing 
assistants, and home health aides. 
Registered nurses' duties and titles often depend on where they work and the patients 
they work with. They can focus in the following areas: 
• A specific health condition, such as a diabetes management nurse who 
helps patients with diabetes or an oncology nurse who helps cancer 
patients 
• A specific part of the body, such as a dermatology nurse working with 
patients who have skin problems 
• A specific group of people, such as a geriatric nurse who works with 
the elderly or a pedi atric nurse who works with children and teens 
• A specific workplace, such as an emergency or trauma nurse who 
works in a hospital or stand-alone emergency department or a school 
nurse working in an elementary, middle, or high school 
Some registered nurses combine one or more of these specific areas. For example, a 
pedi atric oncology nurse works with children and teens who have cancer. 
Many possibilities for working with specific patient groups exist. The following list 
includes just a few other examples: 
Addiction nurses care for patients who need help to overcome addictions to alcohol, 
drugs, tobacco, and other substances. 
Cardiovascular nurses care for patients with heart disease and people who have had 
heart surgery. 
Critical care nurses work in intensive care units in hospitals, providing care to 
patients with serious, complex, and acute illnesses and injuries that need very close 
monitoring and treatment. 
Genetics nurses provide screening, counseling, and treatment of patients with genetic 
disorders, such as cystic fibrosis. 
Neonatology nurses take care of newborn babies. 
Nephrology nurses care for patients who have kidney-related health issues stemming 
from diabetes, high blood pressure, substance abuse, or other causes. 
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Rehabilitation nurses care for patients with temporary or permanent disabilities. 
Some nurses have jobs in which they do not work directly with patients, but they 
must still have an active registered nurse license. For example, they may work as 
nurse educators, healthcare consultants, public policy advisors, researchers, hospital 
administrators, salespeople for pharmaceutical and medical supply companies, or as 
medical writers and editors. 
Registered nurses may work to promote general health, by educating the public on 
warning signs and symptoms of disease. They may also run general health screenings 
or immunization clinics, blood drives, or other outreach programs. 
Clinical nurse specialists (CNSs) are a type of advanced practice registered nurse 
(APRN). They provide direct patient care in one of many nursing specialties, such as 
psychiatric-mental health or pediatrics. CNSs also provide indirect care, by working 
with other nurses and various other staff to improve the quality of care that patients 
receive. They often serve in leadership roles and may advise other nursing staff. 
CNSs also may conduct research and may advocate for certain policies. 
U.S. Dep't of Labor, Bureau of Labor Statistics, Occupational Outlook Handbook, 2014-15 ed., 
"Registered Nurses," http://www .bls.gov/ooh/Healthcare/Registered-nurses.htm#tab-2 (last visited 
Feb. 18, 2015). 
The Handbook states, "Some registered nurses oversee licensed practical nurses, nursing aides, and 
home health aides." It further states, "Some nurses have jobs in which they do not work directly 
with patients," and "they may work as nurse educators [or] ... hospital administrators .. .. " 
The Handbook indicates that some registered nurses work in positions that are chiefly, or even 
exclusively, supervisory and/or administrative. The duties attributed to the proffered position are 
consistent with the duties of a registered nurse position as described in the Handbook, and we, 
therefore, find that the proffered position is a registered nurse position as described in the 
Handbook. 
The Handbook states the following pertinent to the requirements of registered nurse positions. 
How to Become a Registered Nurse 
Registered nurses usually take one of three education paths: a bachelor's of science 
degree in nursing (BSN), an associate's degree in nursing (ADN), or a diploma from 
an approved nursing program. Registered nurses also must be licensed. 
Education 
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In all nursing education programs, students take courses in anatomy, physiology, 
microbiology, chemistry, nutrition, psychology and other social and behavioral 
sciences, as well as in liberal arts. BSN programs typically take 4 years to complete; 
ADN and diploma programs usually take 2 to 3 years to complete. All programs also 
include supervised clinical experience. 
Bachelor's degree programs usually include additional education in the physical and 
social sciences, communication, leadership, and critical thinking. These programs 
also offer more clinical experience in nonhospital settings. A bachelor's degree or 
higher is often necessary for administrative positions, research, consulting, and 
teaching. 
Generally, licensed graduates of any of the three types of education programs 
(bachelor's, associate's, or diploma) qualify for entry-level positions as a staff nurse. 
However, some employers may require a bachelor's degree. 
Many registered nurses with an ADN or diploma choose to go back to school to earn 
a bachelor's degree through an RN-to-BSN program. There are also master's degree 
programs in nursing, combined bachelor's and master's programs, and programs for 
those who wish to enter the nursing profession but hold a bachelor's degree in another 
field. Some employers offer tuition reimbursement. 
Certified nurse specialists (CNSs) must earn a master's degree in nursing. CNSs who 
conduct research typically need a doctoral degree. 
Licenses, Certifications, and Registrations 
In all states, the District of Columbia, and U.S. territories, registered nurses must 
have a nursing license. 
To become licensed, nurses must graduate from an approved nursing program and 
pass the National Council Licensure Examination, or NCLEX-RN. 
Other requirements for licensing vary by state. Each state's board of nursing can give 
details. For more on the NCLEX-RN examination and a list of state boards of nursing 
visit the National Council of State Boards of Nursing. 
Nurses may become certified through professional associations in specific areas, such 
as ambulatory care, gerontology, and pediatrics, among others. Although certification 
is usually voluntary, it demonstrates adherence to a higher standard, and some 
employers may require it. 
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CNSs must satisfy additional state licensing requirements. They may choose to earn 
certification in a specialty. 
Important Qualities 
Critical-thinking skills. Registered nurses must be able to assess changes in the 
health state of patients, including when to take corrective action and when to make 
referrals. 
Compassion. Registered nurses should be caring and sympathetic, characteristics that 
are valuable when caring for patients. 
Detail oriented. Registered nurses must be responsible and detail oriented because 
they must make sure that patients get the correct treatments and medicines at the right 
time. 
Emotional stability. Registered nurses need emotional stability to cope with human 
suffering, emergencies, and other stresses. 
Organizational skills. Nurses often work with multiple patients with various health 
needs. Organizational skills are critical to ensure that each patient is given proper 
care. 
Physical stamina. Nurses should be comfortable performing physical tasks, such as 
helping to lift and to move patients. They may be on their feet for most of their shift. 
Speaking skills. Registered nurses must be able to talk effectively with patients to 
assess their health conditions. Nurses need to explain how to take medi cation or to 
give other instructions. They must be able to work in teams with other health 
professionals and communicate the patients' needs. 
Advancement 
Most registered nurses begin as staff nurses in hospitals or community health 
settings. With experience, good performance, and continuous education, they can 
move to other settings or be promoted to positions with more responsibility. 
In management, nurses can advance from assistant unit manager or head nurse to 
more senior-level administrative roles, such as assistant director, director, vice 
president, and chief of nursing. Increasingly, management-level nursing positions 
require a graduate degree in nursing or health services administration. Administrative 
positions require leadership, communication skills, negotiation skills, and good 
judgment. 
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NON-PRECEDENT DECISION 
Some nurses move into the business side of healthcare. Their nursing expertise and 
experience on a healthcare team equip them to manage ambulatory, acute, home­
based, and chronic care businesses. 
Employers-including hospitals, insurance compames, pharmaceutical 
manufacturers, and managed care organizations, among others-need registered 
nurses for jobs in health planning and development, marketing, consulting, policy 
development, and quality assurance. 
Some RNs choose to become nurse anesthetists, nurse midwives, or nurse 
practitioners, which, along with certified nurse specialists, are types of advanced 
practice registered nurses (APRNs). APRNs may provide primary and specialty care, 
and, in most states, they may prescribe medicines. For example, clinical nurse 
specialists provide direct patient care and expert consultations in one of many nursing 
specialties, such as psychiatric-mental health. 
Other nurses work as postsecondary teachers in colleges and universities. 
!d. at http://www .bls.gov/ooh/Healthcare/Registered-nurses.htm#tab-4 (last visited Feb. 18, 2015). 
The Handbook does not indicate that registered nursing positions, as a category, require a bachelor's 
degree. To the contrary, it indicates that an associate's degree, or a "diploma program" that takes 
two to three years to complete, would be sufficient for entry into positions falling within this 
occupational category. 
Where, as here, the Handbook does not support the proposition that the proffered position satisfies 
this first criterion of 8 C.P.R. § 214.2(h)( 4 )(iii)(A), it is incumbent upon the petitioner to provide 
persuasive evidence that the proffered position otherwise satisfies this criterion by a preponderance 
of the evidence standard, notwithstanding the absence of the Handbook's support on the issue. In 
such a case, it is the petitioner's responsibility to provide probative evidence (e.g., documentation 
from other authoritative sources) that supports a favorable finding with regard to this criterion. The 
regulation at 8 C.P.R. § 214.2(h)(4) (iv) provides that "[a]n H-1B petition involving a specialty 
occupation shall be accompanied by [ d]ocumentation .. . or any other required evidence sufficient 
to establish ... that the services the beneficiary is to perform are in a specialty occupation." Again, 
going on record without supporting documentary evidence is not sufficient for purposes of meeting 
the burden of proof in these proceedings. Matter of Soffici, 22 I&N Dec. at 165. In this case, the 
Handbook does not support the proposition that the proffered position satisfies 8 C.P.R. 
§ 214.2(h)(4) (iii)(A)(l), and the record of proceeding does not contain sufficient persuasive 
documentary evidence from any other relevant authoritative source establishing that the proffered 
position's inclusion in this occupational category establishes that a bachelor's or higher degree in a 
specific specialty or its equivalent "is normally the minimum requirement for entry into [this] 
particular position." 
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Page 17 
Further, we find that, to the extent that they are de scribed in the record of proceedi ng, the numerous 
duties that the petitioner ascribes to the proffered position indicate a need for a range of knowledge 
in the health care field, but do not establish any particular level of formal, postsecondary education 
leading to a bachelor's or higher degree in a specific specialty as minimally necessary to attain such 
knowledge. 
As the evidenc e of record does not establish that the particular position here proffered is one for 
which the normal minimum entry requirement is a baccalaureate or higher degree, or the equivalent, 
in a specific specialty, the petitioner has not satisfied the criterion at 8 C.F.R. 
§ 214.2(h)(4)(iii )(A)(l). 
Next, we find that the petitioner has not satisfied the first of the two alternative prongs of 8 C.F.R. 
§ 214.2(h)( 4)(iii)( A)(2). This prong alternatively calls for a petitioner to establish that a requirement 
of a bachelor's or higher degree in a specific specialty, or its equivalent, is common for positions that 
are identifiable as being (1) in the petitioner's industry, (2) parallel to the proffered position, and also 
(3) located in organizations that are similar to the petitioner. 
As stated earlier, in determining whether there is a common degree requirement, factors often .. 
considered by USCIS include: whether the Handbook reports that the industry requires a degree; 
whether the industry's professional association has made a degree a minimum entry requirement; 
and whether letters or affidavits from firms or individuals in the industry attest that such firms 
"routinely employ and recruit only degreed individuals." See Shanti, Inc. v. Reno, 36 F. Supp. 2d at 
1165 (quotingHird!Blaker Corp. v. Sava, 712 F. Supp. at 1102). 
Here and as already discussed, the petitioner has not established that its proffered position is one for 
which the Handbook reports an industry-wide requirement for at least a bachelor's degree in a specific 
specialty or its equivalent. Also, there are no submissions from professional associations, individuals, 
or similar firms in the petitioner's industry attesting that individuals employed in positions parallel to 
the proffered position are routinely required to have a minimum of a bachelor's degree in a specific 
specialty or its equivalent for entry into those positions. 
The position evaluation provided does refer to six vacancy announcements the evaluator 
encountered and considered. However, none of those vacancy announcements appear to have been 
placed by home healthcare firms, and the names of the firms suggest that none of them were. The 
positions they announce do not, therefore, appear to be in the petitioner's industry. Further, none of 
the positions offered have been shown to be parallel to the proffered position. Further still, none of 
those vacancy announcements, as quoted or paraphrased by the evaluator, make clear that the 
positions they announce require a bachelor's degree in any spe cific specialty, as all state that they 
must be in a related field, but do not specify what array of fields would be considered closely related 
to the positions announced to be a sufficient educational qualification for those positions. 
(b)(6)
NON-PRECEDENT DECISION 
Page 18 
Thus, the evidence of record does not establish that a requirement of a bachelor's or higher degree in 
a specific specialty, or its equivalent, is common to positions that are (1) in the petitioner's industry, 
(2) parallel to the proffered position, and also (3) located in organizations that are similar to the 
petitioner. 
The evidence of record also does not satisfy the second alternative prong of 8 C.F.R. 
§ 214.2(h)(4)(iii)( A)(2), which provides that "an employer may show that its particular position is so 
complex or unique that it can be performed only by an individual with a degree." A review of the 
record indicates that the petitioner has failed to credibly demonstrate that the duties that comprise the 
proffered position entail such complexity or uniqueness as to constitute a position so complex or 
unique that it can be performed only by a person with at least a bachelor's degree in a specific 
specialty. 
Specifically, the petitioner failed to demonstrate how the duties that collectively constitute the 
proffered position require the theoretical and practical application of a body of highly specialized 
knowledge such that a bachelor's or higher degree in a specific specialty, or its equivalent, is 
required to perform them. For instance; the petitioner did not submit information relevant to a 
detailed course of study leading to a specialty degree and did not establish how such a curriculum is 
necessary to perform the duties of the proffered position. While a few related courses may be 
beneficial, or even required, in performing certain duties of the proffered position, the petitioner has 
failed to demonstrate how an established curriculum of such courses leading to a baccalaureate or 
higher degree in a specific specialty, or its equivalent, is required to perform the duties of the 
particular position here. 
Therefore, the eviden ce of record does not establish that this position is significantly different from 
other registered nurse positions such that it refutes the Handbook's information to the effect that 
there is a spectrum of educational paths acceptable for such positions. In other words, the record 
lacks sufficiently detailed information to distinguish the proffered position as unique from or more 
complex than positions that can be performed by persons without at least a bachelor's degree in a 
specific specialty, or its equivalent. As the petitioner fails to demonstrate how the proffered position 
is so complex or unique relative to other positions within the same occupational category that do not 
require at least a baccalaureate degree in a specific specialty or its equivalent for entry into the 
occupation in the United States, it cannot be concluded that the petitioner has satisfied the second 
alternative prong of 8 C.F.R. § 214.2(h)(4)(iii)( A)(2). 
The third criterion of 8 C.F.R. § 214.2(h)(4)(iii)(A) entails an employer demonstrating that it 
normally requires a bachelor's degree in a specific specialty, or its equivalent, for the position. To 
this end, we usually review the petitioner's past recruiting and hiring practices, as well as 
information regarding employees who previously held the position. 
To satisfy this criterion, the record must establish documentary evidence demonstrating that the 
petitioner has a history of requiring the degree or degree equivalency, in a specific specialty, in its prior 
recruiting and hiring for the position. Additionally, the record must establish that the petitioner's 
(b)(6)
NON-PRECEDENT DECISION 
Page 19 
imposition of a degree requirement is not merely a matter of preference for high-caliber candidates but 
is necessitated by performance requirements of the position. 
While a petitioner may believe or otherwise assert that a proffered position requires a specific 
degree, that opinion alone without corroborating evidence cannot establish the position as a 
specialty occupation. Were USCIS limited solely to reviewing a petitioner's claimed self-imposed 
requirements, then any individual with a bachelor's degree could be brought to the United States to 
perform any occupation as long as the petitioner artificially created a token degree requirement , 
whereby all individuals employed in a particular position possessed a baccalaureate or higher degree 
in the specific specialty or its equivalent. See Defensor v. Meissner, 201 F.3d at 388. In other 
words, if a petitioner's stated degree requirement is only designed to artificially meet the standards 
for an H-lB visa and/or to underemploy an individual in a position for which he or she is 
overqualified and if the proffered position does not in fact require such a specialty degree or its 
equivalent to perform its duties, the occupation would not meet the statutory or regulatory definition 
of a specialty occupation. See § 214(i)(l) of the Act; 8 C.F.R. § 214.2(h)(4)(ii) (defining the term 
"specialty occupation"). 
Upon review of the record of proceeding, the petitioner has not established a prior history of 
recruiting and hiring for the proffered position only persons with at least a bachelor's degree in a 
specific specialty, or its equivalent. The petitioner has not provided sufficient evidence to establish 
that it normally requires at least a bachelor's degree in a specific specialty, or its equivalent, for the 
proffered position. Thus, the petitioner has not satisfied the third criterion of 8 C.F.R. 
§ 214.2(h)(4)(iii)( A). 
Finally, we will address the alternative criterion at 8 C.F.R. § 214.2(h)(4)(iii)( A)(4), which is 
satisfied if the petitioner establishes that the nature of the specific duties is so specialized and 
complex that knowledge required to perform them is usually associated with the attainment of a 
baccalaureate or higher degree in a specific specialty or its equivalent. 
Again, relative specialization and complexity have not been sufficiently developed by the petitioner 
as an aspect of the proffered position. 
The duties attributed to the proffered position, such as planning, directing, and coordinating the 
healthcare operations of a home health care provider; performing resident care; coordinating 
activities with other managers; supervising and evaluating personnel; developing reports; and 
implementing organizational policy, even if they were demonstrated to be an accurate account of the 
duties the beneficiary would perform, contain insufficient indication of a nature so specialized and 
complex that they require knowledge usually associated attainment of a minimum of a bachelor's 
degree in a specific specialty or its equivalent. 
In other words, the proposed duties have not been described with sufficient specificity to show that 
they are more specialized and complex than the duties of registered nurse positions that are not 
usually associated with at least a bachelor's degree in a specific specialty or its equivalent. The 
(b)(6)
NON-PRECEDENT DECISION 
Page 20 
petitioner has failed to submit sufficient evidence to support its claim that the proffered position's 
duties are so specialized and complex that knowledge required to perform them is usually associated 
with the attainment of a bachelor's degree in a specific specialty or its equivalent. The evidence of 
record does not, therefore, satisfy the criterion at 8 C.P.R. § 214.2(h)(4)(iii)(A)( 4). 
The petitioner has failed to establish that it has satisfied any of the criteria at 8 C.P .R. 
§ 214.2(h)(4)(iii)( A) and, therefore, it cannot be found that the proffered position qualifies as a 
specialty occupation. The appeal will be dismissed and the petition denied for this reason. 
V. CONCLUSION 
In visa petition proceedings, it is the petitioner's burden to establish eligibility for the immigration 
benefit sought. Section 291 of the Act, 8 U.S.C. § 1361; Matter of Otiende, 26 I&N Dec. 127, 128 
(BIA 2013). Here, that burden has not been met. 
ORDER: The appeal is dismissed. The petition is denied.