Our law firm has immigrated over 10,000 registered nurses to work in the hospitals across United States over the past 30 years. We represent hundreds of hospitals and other health care providers across the US.
With certain limited exceptions detailed below, petitioning for a foreign-born registered nurse (“RN”) to work in the United States involves sponsoring her for permanent residence.
It currently takes about 12 months for an RN to immigrate to the US, more if the RN was born in India or China.
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IMMIGRATION OF REGISTERED NURSES PRESENT IN THE US
- The RN is required to present to the USCIS many of the same documents as stated later in this article. However, since she is in the US, she may take the RN licensing examination (“NCLEX-RN”).
- The employer must submit a form I-140 immigrant visa petition to the appropriate USCIS Service Center on behalf of the nurse. In order for the visa petition to be approved, the RN must have passed either the CGFNS exam or the NCLEX exam, or be in possession of a “full and unrestricted license” as a registered nurse in the state of intended employment.
- The RN and her accompanying family members may apply for adjustment of status to permanent residence, for work permits and for travel permits but only if the RN is in lawful immigration status when her priority date is reached.
For more detailed information, see Nurses: How to Apply for an RN Residing in the U.S. .
IMMIGRATION OF REGISTERED NURSES RESIDING ABROAD
If the RN resides abroad, the following steps must be completed before the nurse may be employed in the U.S.:
1. The RN must be in possession of:
a. A diploma from a nursing school in her country;
b. An RN license in her country; and
c. A full and unrestricted license to practice professional nursing in the state of intended employment, or a certification issued by the Commission on Graduates of Foreign Nursing Schools (CGFNS), or evidence that she has passed the NCLEX-RN licensing examination but cannot obtain a license because she lacks a social security number.
Although some states require that foreign nurses pass the CGFNS examination before taking the state RN licensing (NCLEX) examination, the number of such states is on the decline. This is because, it now possible to take the NCLEX abroad. The examination is offered in Australia (Sydney), Canada (Montreal, Toronto and Vancouver), Great Britain (London), Hong Kong, India (Bangalore, Chennai, Hyderabad, Mumbai and New Delhi), Japan (Chiyoda-ku and Yokohama), Korea (Seoul), Germany (Frankfurt), Mexico (Mexico City), Philippines (Manila) and Taiwan (Taipei). In addition, RNs may take the NCLEX in Guam, Puerto Rico and Saipan.
2. RNs together with physical therapists are listed as shortage, or “Schedule A”, occupations in regulations (20 C.F.R. §656.22) issued by the Department of Labor. An employer who wishes to immigrate an RN is exempt from having to submit a PERM application to the Department of Labor.
The immigration process begins when an employer submits an immigrant visa petition (Form I-140) to the service center of the Citizenship and Immigration Services (USCIS) having jurisdiction over the nurse’s place of intended employment. The petition must be accompanied by Labor Department form ETA-9089, by a posting notice, a prevailing wage determination and by various other documents. The petition should also be accompanied by a check for filing fees.
3. The USCIS sends the approved visa petition to the National Visa Center (NVC) in Portsmouth, New Hampshire. The nurse (or her attorney) receives a “fee bill” asking for all government processing fees to be paid in advance of processing her application and those of her immediate family members. After the fees are paid, the NVC forwards a packet to the nurse or her attorney containing biographical information forms to be completed by her and her family members, and a list of documents which must be submitted.
4. A few months before her priority date is current, the RN, or her attorney, sends the signed and completed forms and documents to the NVC which then schedules an appointment for Immigrant Visas for the RN and her family at the US Consulate where they will have their interviews for permanent residence. At this interview, the government will examine various documents including:
a. Applications for Immigrant Visas
b. Police Clearances
c. Birth Certificates
d. Marriage Certificate, if any
e. Divorce or Death Certificate of Spouse, if any
f. Valid Passports
g. Medical Examinations
i. Recent job offer letter (or employment contract)
j. Financial information regarding employer
k. Government filing fees
l. VisaScreen Certificate
A VisaScreen Certificate is issued only after the RN has demonstrated that (1) her education, license and training in her country are equivalent to education, licensure and training in the U.S. and that (2) her level of competence in oral and written English are appropriate to practice professional nursing in the U.S.
The USCIS regulations provide that the only organization authorized to issue VisaScreen certificates to RNs is the Commission on Graduates of Foreign Nursing Schools (CGFNS), the organization which is listed in §343. The CGFNS is located at 3600 Market Street, Philadelphia, PA, 19104-2651; telephone: (215) 349-8767; fax: (215) 349-0026; e-mail: firstname.lastname@example.org
USCIS VisaScreen regulations provide that even if a foreign-born RN is educated, licensed and trained in the US, she still must obtain a VisaScreen certificate. However, such RNs may be able to obtain a certificate on a streamlined basis. Obtaining such a certificate requires a significant expenditure of time, effort and money on the part of the nurse.
Immigration of Registered Nurses – English Exams
Unless the nurse was educated in an English-speaking country (US, Australia, New Zealand, Ireland, United Kingdom or Canada – all provinces except Quebec), she must achieve a certain minimum score on tests in written and spoken English administered by TOEFL (Test Of English As A Foreign Language), IELTS (International English Language Testing Service) or the TOEIC (Test of English in International Communications).
Passing scores for RNs on English exams are as follows:
IELTS: Academic Module or the General Training Module 6.5, Overall Band Score, 7.0 Speaking
TOEFL: Paper-Based 540; TOEFL Computer-Based 207; Test of Written English (TWE) 4.0; Test of Spoken English (TSE) 50.
TOEIC: 725; plus TWE: 4.0 and TSE: 50
Passing scores for the MELAB were as follows: Final Score 79+; Oral Interview 3+.
Generally, the process of obtaining permanent residence may takes 2-3 years assuming that the visa quota from the RN’s country of birth is not backlogged.
For additional information, see our article “Nurses: How to Apply for an RN Residing Abroad” .
Temporary Visas for Registered Nurses
Although most RNs do not qualify for temporary working visas, it is possible to obtain temporary visas or work permits for nurses in the following categories:
TN Status for Canadian and Mexican RNs
RNs who are citizens of Canada and Mexico may obtain Trade-NAFTA (“TN”) status if:
- They have an offer of employment from a US employer for a period not to exceed three years;
- They are licensed in Canada/Mexico and in the state of intended employment;
- They are in possession of a VisaScreen certificate;
- They have a proof of Canadian or Mexican citizenship; and
- They pay a small fee to enter the US.
For Canadian citizens, TN status may be renewed every 3 years either by having the nurse reenter the US with the documents listed above, or by requesting an extension of TN status from the USCIS.
While RNs who are Canadian citizens may obtain TN status without obtaining a visa or a petition, RNs who are citizens of Mexico must apply for TN visas at a U.S. consulate in Mexico only after their US employers have obtained the approval of a TN petition for them in the U.S.
A TN nurse is not supposed to have any intention of remaining permanently in the US. This becomes an issue if a TN nurse decides to apply for a green card.
H-1B Temporary Visa Status
Traditionally, RNs have been considered “professionals” under US immigration laws. Until 1989, employers could hire RNs using “H-1” temporary visas. In 1989, the Immigration Nursing Relief Act (INRA) was enacted as a five-year pilot program. INRA provided that only health care facilities with “attestations” approved by the Labor Department could obtain “H-1A” status to employ nurses on a temporary basis in the U.S. When INRA expired in the mid-1990s, Congress decided not to extend the law since there was no shortage of RNs in the U.S. according to the ANA.
At the invitation of Senator Sam Brownback (R-KS), Attorney Carl Shusterman testified before the Senate Committee on Immigration in 2001 regarding the need for Congress to reestablish a temporary visa program for foreign-born RNs. Attorney Shusterman also assisted Senator Brownback’s staff in drafting a bill which would have created a new temporary visa category for registered nurses. Unfortunately, this bill was not enacted into law.
The H-1B category is an ineffective vehicle for most health care facilities who wish to employ RNs since the minimum entry requirement for most staff RN jobs is a two-year associate degree rather than a four-year bachelors’ degree. However, where a facility can justify that a four-year degree (or equivalent) as the minimum entry requirement for a job, such an RN may be granted an H-1B visa. A USCIS memorandum, dated July 11, 2014, explains the requirements for a registered nurse to obtain H-1B status.
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Carl Shusterman served as an INS Trial Attorney (1976-82) before opening a firm specializing exclusively in US immigration law. He is a Certified Specialist in Immigration Law who has testified as an expert witness before the US Senate Immigration Subcommittee. Carl was featured in the February 2018 edition of SuperLawyers Magazine.
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