US Immigration Process

Permanent Residence For Nurses

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 that she/he has passed the examination given by the Commission on Graduates of Foreign Nursing Schools (CGFNS), or evidence that she/he has passed the NCLEX-RN licensing examination but cannot obtain a license because she/he lacks a social security number.
The following states require that foreign nurses pass the CGFNS examination before taking the state RN licensing (NCLEX) examination: Alabama, Alaska, Arizona, Arkansas, Colorado, Connecticut, District of Columbia, Florida, Georgia, Hawaii, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nebraska, New Hampshire, New Jersey, North Carolina, North Dakota, Oklahoma, Pennsylvania, Rhode Island, South Carolina, South Dakota, Texas, Vermont, Virginia, Washington, West Virginia and Wyoming.

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 an application for alien labor certification to the Department of Labor or to a State Employment Security Agency.

The immigration process begins when an employer submits an immigrant visa petition (Form I-140) to the office of the Immigration Service (USCIS) having jurisdiction over the nurse’s place of intended employment. The petition must be accompanied by Labor Department forms ETA-750A and B and by various documents including those listed above. The petition should be accompanied by a check for filing fees. Typically, the USCIS will approve the visa petition in two to twelve months.

3. The USCIS first sends the approved visa petition to the National Visa Center (NVC) in Portsmouth, New Hampshire. If there is no backlog for immigrant visas from the RN’s native country (her “priority date” is “current”), the NVC forwards a packet to the nurse or his/her attorney containing biographical information forms and a fee invoice to be completed by her and her family members, and a list of documents which must be presented at her interview for permanent residence.

4. The RN, or her attorney, sends the signed and completed forms and fees to the NVC. The NVC then sends notice to the U.S. consulate where the nurse will have his/her interview for permanent residence. At this interview, the nurse must present various documents including the following:

a. Application for Immigrant Visa
b. Police Clearance
c. Birth Certificate
d. Marriage Certificate, if any
e. Divorce or Death Certificate of Spouse, if any
f. Valid Passport
g. Medical Examination
h. Photographs
i. Recent job offer letter (or employment contract)
j. Financial information regarding employer
k. VisaScreen Certificate

The VisaScreen Certificate requirement was imposed by §343, a last-minute amendment to the Illegal Immigration Reform and Immigrant Responsibility Act of 1996 (IIRIRA). It added “uncertified health-care workers” to the list of persons who are inadmissible to the U.S. See §212(a)(5)(C), INA.

A VisaScreen Certificate is issued only after the RN has demonstrated that (1) his/her education, license and training in his/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: support@cgfns.org

Caveat: It may be very difficult to contact the CGFNS. The CGFNS web site warns that
Due to an unusually large volume of phone calls (up to 4000 calls per week), CGFNS' phone lines are extremely busy. Your call is important to us. If you have been unsuccessful in contacting a CGFNS representative by phone, please call after 6:00 p.m. Eastern Time and leave a message, and we will respond as soon as we can.
You may also fax or email CGFNS, however please be advised that it may take some time before we can respond as we are receiving a marked increase in faxes and emails as well.
CGFNS is doing everything it can to try and alleviate the large number of calls, faxes and emails it is currently receiving. You can now download application packets for most CGFNS programs from the CGFNS web site. Also, please check the web site for the latest news on CGFNS exam dates and sites and other information.
CGFNS thanks everyone for their patience. We know your questions and inquiries are important and are making every effort to respond as soon as possible.
Obtaining such a certificate requires a significant expenditure of time, effort and money (currently $325) on the part of the nurse.
In addition, unless the nurse was educated in an English-speaking country (U.S., Australia, New Zealand, Ireland, United Kingdom or Canada - all provinces except Quebec), he/she must achieve a certain score on tests in written and spoken English administered by TOEFL (Test Of English As A Foreign Language), MELAB (Michigan English Language Assessment Battery), IELTS, TSE, TWE, or TOEIC in order to qualify for a VisaScreen certificate. (It is no longer possible to take the MELAB for VisaScreen purposes.
Passing scores for RNs are as follows:
IELTS: Academic Module 6.5 and Spoken Band 7.0
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 or
Information about taking the TOEFL, IELTS and TOEIC examinations may be obtained from their web sites. They are all offered worldwide.
Passing scores for the MELAB were as follows: Final Score 79+; Oral Interview 3+.
Generally, the process of obtaining permanent residence may take between 12 to 18 months assuming that the immigrant visa quota from the RN’s country of birth is not backlogged. Currently, none of the employment-based quotas are backlogged. However, it is probable that backlogs will develop in the near future for RNs born in India, mainland China, and possibly from the Philippines.

If the RN is in the United States, the nurse may be able to start working for the employer more expeditiously than if she resides abroad:
The RN is required to have the same documents as stated at the beginning of this article. However, since he/she is in the U.S., he/she may take the state licensing examination (officially known as the National Council Licensure Examination for Registered Nurses or “NCLEX-RN”). Generally, the NCLEX-RN may only be taken in the U.S., although it is also offered in Guam, Saipan, the Virgin Islands, Puerto Rico and American Samoa. NCLEX officials have indicated that starting in 2004, the NCLEX-RN will be offered abroad. The NCLEX-RN is administered by the National Council of State Boards of Nursing, Inc. For more information about taking the NCLEX-RN, see National Council’s web site at
http://www.ncsbn.org
This web site contains contact information for nurse licensing boards in each state.
The employer must submit an 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 nurses in the state of intended employment.
The USCIS does not forward the approved visa petition to the NVC when an RN submits an application to adjust her status to permanent resident in the U.S.
Historically, upon approval of her visa petition, assuming his/her priority date is current, the RN and his/her family members (spouse and unmarried children under 21 years of age) would apply for adjustment of status to permanent residence in the U.S. Simultaneously, they would apply for employment authorization cards, and possibly, travel authorization documents (“advance parole”). New procedures allow nurses to file the adjustment of status concurrently with the visa petition filed by the employer. Practically speaking this means the nurse will obtain work authorization in 3-6 months. However, a nurse can not qualify for permanent residence until she presents a VisaScreen Certificate.

Temporary Visas for 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:
Trade NAFTA Work Permits
Nurses who are citizens of Canada are exempt from visa requirements. They may work in the U.S. in Trade NAFTA (“TN”) status if:
1. They have an offer of employment from a U.S. employer for a period not to exceed one-year;
2. They are licensed in Canada and in the state of intended employment;
3. They have a proof of Canadian citizenship; and
4. They pay a small fee to enter the U.S.
TN status may be renewed on a yearly basis either by having the nurse reenter the U.S. with the documents listed above, or by requesting an extension of TN status from the USCIS Service Center in Lincoln, Nebraska.
A TN nurse is not supposed to have any intention of remaining permanently in the U.S.
Nurses who are citizens of Mexico may also qualify for TN status. However, for Mexican RNs, the procedure is considerably more complex than for Canadians. The employer must submit a Labor Condition Application (“LCA”) to the Department of Labor and a nonimmigrant visa petition (form I-129) to the INS Service Center in Lincoln, Nebraska. Once the LCA and the petition are approved, the RN must apply for a TN visa at a U.S. consulate in Mexico.

H-1B Specialty Occupation Status
Traditionally, RNs have been considered “professionals” under U.S. immigration laws. From 1952 to 1989, U.S. employers could employ foreign-born nurses 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.
Other occupations which formerly fell within the “H-1” category became part of the new “H-1B” category. The Immigration Act of 1990 provided that only those occupations for which a four-year university degree was a prerequisite for employment could qualify for “H-1B” status. However, in 1991, the “H-1B” category was amended to include certain foreign-born fashion models.
Although a commission appointed by the Secretary of Labor recommended that INRA be extended, Congress allowed the law to expire in 1995. Thereafter, health care facilities could no longer petition for additional foreign-born RNs to obtain H-1A visas. The last H-1A visas expired in 1997.
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) is the minimum entry requirement for a job, such an RN may be granted an H-1B visa. An INS memorandum, dated November 27, 2002, explains the requirements for a registered nurse to obtain H-1B status in detail.

Copied from: Nurses Law Office of Shayne Epstein( www.epsteinlaw.org/nurses)