It doesn't matter how it's supposed to work. If it produces the wrong results then that's how it works in reality. After all if it's not working how it's supposed to work why not change it? If nobody is going to fix it that means the true intention was to produce that "wrong" result in the first place.
H1Bs are bound to the employer and a transfer costs $1k - $3k in legal fees. There's even an optional premium fee to ensure that it will be processed within two weeks instead of two to six months. Sure the new employer may cover this but it's obviously going to be priced in the salary.
Such a system pressures the employee to stick with their current employer even though it may be a suboptimal choice.
Have you been to a nursing home lately? I see a lot of nurses that are fresh in the country. Not sure if h1b or work visa or what. There is definitely some shady things going on around foreign nurses in nursing homes.
