By Brian Figeroux, Esq. | Editorial Credit: Yuri A. / shutterstock.com

Becoming a registered nurse (RN) in the United States as a foreign national involves navigating the complexities of federal immigration law, fulfilling professional licensing requirements, and meeting various state-specific criteria. This analysis provides a comprehensive overview of the immigration pathways available to foreign-educated nurses seeking employment in the United States, outlines the visa options, details the application processes, and provides a checklist of the necessary documents required for a successful transition.

1. Overview of Immigration Pathways for Foreign-Educated Registered Nurses

Registered nurses are in high demand in the United States due to ongoing nursing shortages across the country. The U.S. Bureau of Labor Statistics projects a significant increase in the need for RNs over the next decade, which opens up opportunities for qualified foreign nurses. To work as a registered nurse in the U.S., foreign nationals need to obtain a visa that permits employment. Several visa categories cater to healthcare professionals, each with specific eligibility requirements, processes, and documentation.

2. Types of Visas Available for Registered Nurses

There are primarily two types of visas that a registered nurse can use to work in the United States: employment-based immigrant visas (green cards) and non-immigrant temporary work visas. Below is an analysis of each visa type relevant to registered nurses:

2.1. Employment-Based Immigrant Visas (Green Cards)

The employment-based immigrant visa is a pathway to permanent residency in the United States. Nurses can qualify under several employment-based categories:

1. EB-3 Visa: Employment-Based Third Preference Immigrant Visa
   • The EB-3 visa is the most common immigrant visa category for registered nurses. It is specifically designated for “skilled workers, professionals, and other workers.” Registered nurses are categorized under the “skilled worker” designation.
   • Requirements:
     • A full-time job offer from a U.S. employer.
     • A valid and unrestricted nursing license from the country where the nurse is currently practicing.
     • Successful completion of a nursing program that is equivalent to a U.S. nursing degree.
     • Passage of the National Council Licensure Examination for Registered Nurses (NCLEX-RN).
     • A VisaScreen Certificate issued by the Commission on Graduates of Foreign Nursing Schools (CGFNS) or another approved credentialing organization.
2. Schedule A, Group I Designation
   • Registered nurses are listed on the U.S. Department of Labor’s Schedule A, Group I, which allows them to bypass the lengthy labor certification process (PERM). This is an expedited process compared to other employment-based immigrant visa categories.
3. EB-2 Visa: Employment-Based Second Preference Immigrant Visa
   • This category is less common for registered nurses, as it requires an advanced degree or its equivalent. However, certain nursing specialties that require a master’s degree or higher (e.g., nurse practitioners, nurse anesthetists) may qualify under the EB-2 visa category with a National Interest Waiver (NIW).

2.2. Non-Immigrant Temporary Work Visas

Non-immigrant temporary work visas are designed for individuals who wish to work in the U.S. on a temporary basis. The primary non-immigrant visas available to registered nurses are:

1. H-1B Visa: Specialty Occupation Visa
   • The H-1B visa is a temporary visa for specialty occupations that require at least a bachelor’s degree or its equivalent. However, it is generally not applicable for registered nurses because a standard RN position typically does not meet the “specialty occupation” criteria requiring a bachelor’s degree.
   • Exception: Certain advanced nursing roles, such as clinical nurse specialists, nurse practitioners, and nurse anesthetists, may qualify for an H-1B visa because these positions require advanced education and specialization.
2. TN Visa: Trade NAFTA Visa for Canadian and Mexican Citizens
   • The TN visa allows Canadian and Mexican citizens to work in the U.S. under the United States-Mexico-Canada Agreement (USMCA). Registered nurses from Canada and Mexico can qualify for the TN visa as it recognizes the nursing profession as a TN-eligible occupation.
   • Requirements:
     • Proof of Canadian or Mexican citizenship.
     • A job offer from a U.S. employer for a registered nursing position.
     • Credentials evaluation to show equivalency to U.S. educational and licensure standards.
3. H-1C Visa: Nurse Visa (Expired)
   • The H-1C visa was a non-immigrant visa category specifically created for registered nurses to work in underserved areas in the U.S. However, this visa category expired in 2009 and is no longer available.

3. Process of Obtaining a Visa for Registered Nurses

The process of obtaining a visa to work as a registered nurse in the U.S. involves several steps. Each step requires careful attention to detail to meet the criteria set by U.S. immigration authorities and professional licensing boards. Below is an overview of the process:

3.1. Obtain a Job Offer from a U.S. Employer

The first step for any registered nurse looking to work in the U.S. is to secure a job offer from a U.S.-based employer, such as a hospital, clinic, or healthcare facility. This employer must be willing to sponsor the nurse for a visa.

• The employer will provide a formal offer letter that specifies the job title, job duties, salary, and terms of employment.

3.2. Credential Evaluation and English Language Proficiency

Foreign-educated nurses must have their credentials evaluated by a recognized organization to ensure they meet U.S. nursing education standards. The most widely recognized credential evaluation organization for nurses is the Commission on Graduates of Foreign Nursing Schools (CGFNS).

1. Credential Evaluation:
   • The CGFNS or a similar credentialing body will review the nurse’s educational and professional background to determine if it is equivalent to a U.S. nursing program.
   • The nurse must also pass the CGFNS Qualifying Exam, which assesses nursing knowledge and proficiency.
2. English Language Proficiency:
   • Nurses must demonstrate English language proficiency by passing an approved English language test (TOEFL, IELTS, or PTE Academic) unless they were educated in an English-speaking country.

3.3. Obtain a VisaScreen Certificate

The VisaScreen Certificate is a crucial requirement for all foreign-educated healthcare professionals seeking to work in the U.S. This certificate, issued by CGFNS, confirms that the nurse’s education, licensure, and English language proficiency meet U.S. standards.

• The VisaScreen Certificate is valid for five years and is necessary for obtaining both an immigrant visa (EB-3) and certain non-immigrant visas (H-1B and TN).

3.4. Pass the NCLEX-RN Exam

To practice as a registered nurse in the United States, foreign-educated nurses must pass the National Council Licensure Examination for Registered Nurses (NCLEX-RN). The NCLEX-RN is the standardized exam for RN licensure in the U.S. and is administered by the National Council of State Boards of Nursing (NCSBN).

• Once the nurse passes the NCLEX-RN, they are eligible to apply for a state-specific nursing license.

3.5. Submit the Immigrant or Non-Immigrant Visa Petition

Depending on the chosen visa type, either the employer or the nurse must submit a petition to U.S. Citizenship and Immigration Services (USCIS):

1. Immigrant Visa (EB-3) Petition:
   • The employer files Form I-140, Immigrant Petition for Alien Worker, with USCIS. Since nurses fall under Schedule A, Group I, they do not require labor certification (PERM).
   • If the priority date is current (according to the Visa Bulletin), USCIS will approve the petition, and the nurse can apply for a visa at a U.S. consulate or adjust status if already in the U.S.
2. Non-Immigrant Visa (H-1B or TN) Petition:
   • For the H-1B visa, the employer must file Form I-129, Petition for a Non-immigrant Worker, along with supporting documents, including proof of a bachelor’s degree or equivalent.
   • For the TN visa, Canadian citizens can apply directly at a U.S. port of entry with proof of employment and licensure, while Mexican citizens need to obtain a visa at a U.S. consulate.

3.6. Consular Processing or Adjustment of Status

If the nurse is outside the U.S., they must go through consular processing at a U.S. embassy or consulate. If they are already in the U.S. on a different visa, they may be eligible to adjust their status to an employment-based visa.

1. Consular Processing:
   • Attend a visa interview at a U.S. embassy or consulate.
   • Provide all required documentation, including the VisaScreen Certificate, employment offer, and Form I-140 approval notice.
2. Adjustment of Status:
   • If already in the U.S., the nurse may file Form I-485, Application to Register Permanent Residence or Adjust Status, to change their immigration status to a lawful permanent resident (green card holder).

3.7. Obtain a State Nursing License

After obtaining a visa, the nurse must secure a nursing license from the state where they intend to work. This involves submitting the required documentation, including NCLEX-RN results, foreign credentials evaluation, and proof of visa or work authorization.

4. Checklist of Documents Needed for Visa Application

The visa application process for a registered nurse seeking employment in the U.S. involves gathering various documents to prove eligibility and qualifications. Below is a comprehensive checklist of documents required for each step of the process:

4.1. Documents Required for Credential Evaluation and VisaScreen Certificate

• Copy of passport.
• Academic transcripts and degree certificates from nursing school.
• Nursing licensure from the country of origin.
• CGFNS Qualifying Exam results (if applicable).
• Proof of English language proficiency (TOEFL, IELTS, or PTE Academic).
• CGFNS application form and fee payment receipt.
• VisaScreen Certificate application form and fee payment receipt.

4.2. Documents Required for NCLEX-RN Exam Registration

• Authorization to Test (ATT) from the state board of nursing.
• Proof of eligibility to take the NCLEX-RN (credential evaluation).
• Payment receipt for NCLEX-RN exam fee.
• Valid photo identification (passport or other government-issued ID).

4.3. Documents Required for Immigrant Visa (EB-3) Petition

• Form I-140, Immigrant Petition for Alien Worker, filed by the employer.
• Copy of the VisaScreen Certificate.
• Employment offer letter from a U.S. employer specifying job title, duties, and salary.
• Form ETA 9089, Application for Permanent Employment Certification (pre-approved for Schedule A, Group I).
• Proof of experience and qualifications (resume/CV, nursing license).
• Form G-1145, E-Notification of Application/Petition Acceptance (optional).

4.4. Documents Required for Non-Immigrant Visa (H-1B or TN) Petition

• Form I-129, Petition for a Non-immigrant Worker (H-1B visa only).
• Form ETA-9035, Labor Condition Application (LCA) certified by the U.S. Department of Labor (H-1B visa only).
• Proof of Canadian or Mexican citizenship (TN visa).
• Proof of employment offer from a U.S. employer.
• Credentials evaluation report showing equivalence to U.S. education standards.
• Copy of professional nursing license.

4.5. Documents Required for Consular Processing or Adjustment of Status

• Form DS-260, Immigrant Visa and Alien Registration Application (for consular processing).
• Form I-485, Application to Register Permanent Residence or Adjust Status (for adjustment of status).
• Passport-sized photos.
• Medical examination results (Form I-693).
• Police clearance certificate(s) from any country of residence.
• Proof of financial support (Form I-864, Affidavit of Support, from the employer).

4.6. Documents Required for State Nursing License Application

• NCLEX-RN exam results.
• Credentials evaluation report from CGFNS or another approved organization.
• Proof of U.S. visa or work authorization.
• Completed state board of nursing application form.
• Application fee payment receipt.

Conclusion

The process for a foreign-educated registered nurse to work in the United States involves multiple steps, including obtaining a job offer, credential evaluation, obtaining the necessary visas, and securing a state nursing license. By following the outlined steps and ensuring that all required documentation is prepared and submitted accurately, foreign-educated nurses can successfully navigate the U.S. immigration system and pursue their careers as registered nurses in the United States. The availability of various visa options provides multiple pathways for qualified nurses to fulfill their professional aspirations while addressing the nursing shortage in the U.S. healthcare system.

  #CredentialEvaluation, #EB3Visa, #ForeignNurses, #H1BVisa, #HealthcareProfessionals, #ImmigrationLaw, #NCLEXRN, #RegisteredNurse, #TNVisa, #VisaScreen, USCIS