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Immigration of Registered Nurses

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 almost four years to immigrate a registered nurse to the U.S., more if the RN was born in India or China.

We hope the American Hospital Association can persuade Congress to pass the Emergency Nursing Relief Act which would allow 20,000 registered nurses and physical therapists to immigrate to the U.S. annually for the next three years. The bill has been introduced in both the House of Representatives and the Senate. It has been approved by the House Immigration Subcommittee.

Permanent Residence For Nurses Present In The U.S.

Generally, if an RN is in the United States, the nurse will be able to start working for the employer more expeditiously than if she resides abroad. The RN is required to present to the CIS many of the same documents as stated later in this article. However, since she is in the U.S., she may take the RN licensing examination (officially known as the National Council Licensor Examination for Registered Nurses or the  NCLEX-RN ) in any state. The NCLEX-RN is administered by the National Council of State Boards of Nursing.

The employer must submit an immigrant visa petition to the appropriate CIS 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.

Simultaneously with the submission of the visa petition, the RN and her accompanying family members may apply for adjustment of status to permanent residence, for work permits, and in most cases. For travel permits, a nurse need not be in possession of a VisaScreen certificate in order to apply for permanent residence. However, she cannot obtain permanent residence without being in possession of a VisaScreen certificate.

Permanent Residence For 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. The RN, or her attorney, sends the signed and completed forms and documents to the NVC which then schedules an appointment for an Immigrant Visa for the RN and her family at the U.S. Consulate or Embassy 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
h. Photographs
I. Recent job offer letter (or employment contract)
j. Financial information regarding employer
k. Government filing fees
l. VisaScreen Certificate

The VisaScreen Certificate requirement was imposed by 343 of 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), INA.

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, Licensor 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 CIS 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.

The CIS VisaScreen regulations provide that even if a foreign-born RN is educated, licensed and trained in the U.S., 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 (over $300) on the part of the nurse.

Unless the nurse was educated in an English-speaking country (U.S., 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). Also, if the RN registered for the MELAB (Michigan English Language Assessment Battery) before November 27, 2002, this result may be sent to the CGFNS for VisaScreen purposes.

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 take between 12 to 18 months assuming that the immigrant visa quota from the RN s country of birth is not backlogged. Currently, the quota for RNs is not backlogged.

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 (TN Status)   For Canadian and Mexican Citizens Only U.S. employers may apply for registered nurses who are citizens of Canada and Mexico to work in temporary  TN  status.
They may obtain Trade NAFTA ( TN ) status if:

▪ They have an offer of employment from a U.S. 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 U.S.

For Canadian citizens, 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.

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 U.S. 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 U.S. This becomes an issue if a TN nurse decides to apply for permanent residence in the U.S.

H-1B Specialty Occupation Status Traditionally

RNs have been considered professionals under U.S. immigration laws. From 1952 to 1989, U.S. employers could hire 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. 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.

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 after extensive lobbying by that industry.

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.

Registered nurses need to be in possession of a VisaScreen certificate in order to obtain H-1B status.

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