Immigrant and Non Immigrant Visas for Registered Nurses (RN)

There are numerous options for foreign nationals who wish to work in the US as registered nurses, most of which allow only temporary residence in the US, but one of which is a way of obtaining permanent residence.

H-1C Visas

In 1999, Congress passed the Nursing Relief for Disadvantaged Areas Act, which calls for the creation of a new H-1C visa for nurses going to work for up to three years in health professional shortage areas. There are only 500 H-1C visas available each year, and no more than 25 H-1C nurses can be sent to one state in a year. Under the law, facilities interested in sponsoring nurses for H-1C visas must submit a document containing a number of attestations regarding the employment of H-1C nurses. As of early 2001, no H-1C visas had been approved. The H-1C visa is very similar to the H-1A visa for nurses. That visa category expired several years ago after efforts to extend its life were unsuccessful. The key differences are that a much smaller number of H-1C visas have been allocated and that the facility must be in a health professional shortage area. There are also new requirements limit a facility’s dependence on H-1C nurses.

TN Visas

TN visas were created by the North American Free Trade Agreement, and are available to Canadian and Mexican citizens who are coming to the US to work in activities at a professional level. These are defined to require at least a bachelor’s degree or specified credentials, and experience demonstrating that the beneficiary is a professional. Among the professions covered is that of registered nurse. To obtain a TN visa, the nurse must collect a letter from the prospective employer containing the job offer, their diploma (if the degree is from Canada or Mexico, it must be evaluated), and all licenses and professional memberships. They will also need to obtain a letter outlining the professional nature of the job, the proposed length of stay, the beneficiary’s educational credentials, evidence that the beneficiary has the required state license, and how the beneficiary will be paid. Canadian nurses can present this evidence at a port of entry without prior approval by the USCIS. They will be given leave to enter the US for one year. Applications for extensions may be filed, and there is no limit on the amount of time a person can remain in the US on a TN visa. Mexican nurses go through a different process. They must submit a labor condition application to the Department of Labor and they must submit an application for a TN visa with the USCIS. Also, while there is no limit on the number of TN visas that can be issued to Canadians, there is an annual limit of 5,500 for Mexican citizens.

H-1B Visas

Since the expiration of the H-1A category, registered nurses have been allowed to seek H-1B visas. However, the USCIS takes a narrow view of the ability of a nurse to qualify in the H-1B category and most registered nurses will not be able to obtain an H-1B visa. This is because H-1B visas require a bachelor’s degree to be the minimum qualification for entering the field and the USCIS takes the position that a bachelor’s degree is not required to be a registered nurse. However, in some cases, nurses can obtain H-1B visas. For example, nurses who will be working in a supervisory or highly specialized capacity might be able to obtain one, and if the facility demonstrates that it requires all the nurses it employs to possess a bachelor’s degree, obtaining an H-1B visa will be easier.

IMMIGRANT VISAS (GREEN CARDS)

The Department of Labor has determined that there are some job occupations in which there is a chronic shortage of workers, one of which is registered nursing. Nurses who have passed the Commission on Graduates of Foreign Nursing Schools Examination or possess an unrestricted license to practice nursing in the state in which they intend to work are eligible to seek a Schedule A labor certification. The effect of the Schedule A classification is that the position is “pre-certified” and no application needs to be filed with the Department of Labor. Instead, the Labor Certification application, Immigrant Petition can be filed together directly with the USCIS.

Section 343 of IIRAIRA specifically requires a certificate either from the Commission on Graduates of Foreign Nursing Schools ("CGFNS") or "a certificate from an equivalent independent credentialing organization approved by the Attorney General in consultation with the Secretary of Health and Human Services. The certification must verify that 1) the alien's education, training, license, and experience meet all applicable statutory and regulatory requirements for entry into the United States under the classification specified in the application; are comparable with that required for an American health-care worker of the same type; and are authentic and, in the case of a license, unencumbered; 2) the alien has the level of competence in oral and written English considered by the Secretary of Health and Human Services, in consultation with the Secretary of Education, to be appropriate for health care work of the kind in which the alien will be engaged, as shown by an appropriate score on one or more nationally recognized, commercially available, standardized assessments of the applicant's ability to speak and write; and 3) if a majority of States licensing the profession in which the alien intends to work recognize a test predicting the success on the profession's licensing or certification examination, the alien has passed such a test or has passed such an examination.
The USCIS has found that the CGFNS for nurses meets the statutory requirements for credentialing. CGFNS has established Visa Screen program, administered by its International Commission on Healthcare Professions division. For nurses, the Department of Health and Human Services has approved two testing services to test oral and written competency in English appropriate for the kind of health care work in which the alien will be engaged. The two approved services are the Educational Testing Service (ETS) and the Michigan English Language Assessment Battery (MELAB). Based on HHS standards, a Registered Nurse must obtain at least the following scores on the TOEFL 540 (paper based) or 207 (computer based): Test of Written English 4.0; Test of Spoken English 50; or MELAB final score 79 oral score 3+. There are no exceptions to the credentialing requirement, even for nurses educated in the US.