U.S. immigration law gives preferences to certain types of immigrants by providing multiple (and sometimes quicker) options for them to obtain temporary work visas as well as permanent residence in the United States (a green card). One of these classes of special immigrants is foreign nurses.
The U.S. government recognizes that the U.S. has a shortage of nurses. In order to encourage more foreign nurses to come to the country, the U.S. government has, over time, established various procedures that may facilitate nurses’ ability to work and reside in this country.
However, some of these advantageous measures for foreign nurses have unfortunately come and gone. For example, there used to be a special visa just for foreign nurses called the H-1C visa. The H-1C no longer exists, and nurses are no longer able to come to the U.S. with an H-1C visa. But, other options are still available for foreign nurses who want to come to the United States, as explained below.
If you are a foreign nurse and you want to work in the U.S. temporarily, you may be able to obtain an H-1B visa. An H-1B is a very popular temporary work visa for foreign nationals who have a job offer from a U.S. employer to work in a "specialty occupation."
To obtain an H-1B visa for a foreign nurse, the U.S. employers would file an I-129 petition with United States Citizenship and Immigration Services (USCIS). This agency decides whether or not to approve the employer’s request for H-1B status for the worker.
Your prospective employer would need to demonstrate that your nursing position is a specialty occupation. USCIS uses a four-pronged test to determine whether a position qualifies as a specialty occupation. The position must meet one of the four prongs:
Usually, USCIS concentrates on the first prong and looks to whether a bachelor’s degree is required for the nursing job. This can make obtaining an H-1B visa as a nurse difficult, because many states do NOT require a bachelor’s degree for a typical registered nurse position. Instead, most states require a shorter, certification process for this position. Make sure to check with your employer about the requirements for the registered nurse position in the state in which you will work.
Although it may be difficult to obtain an H-1B as a registered nurse, if your position is that of a clinical nurse or nurse practitioner, almost every state requires at least a bachelor’s degree for these positions. Therefore, you will have a better chance of securing an H-1B visa if your job is a clinical nurse or nurse practitioner, than if your position is that of a registered nurse.
Again, make sure you find out the state’s requirements for whatever nursing position a U.S. employer offers to you. The qualifications you possess do not matter as much as the qualifications necessary for the job, in the context of whether the job is a specialty occupation. For example, let’s say you have a master’s degree in nursing, and a U.S. employer offers you a registered nurse position in California. California does not require a bachelor’s degree in order to be a registered nurse. Therefore, even though you possess a master’s degree, your position does not require even a bachelor’s degree, so it is highly unlikely that USCIS will find that this position qualifies as a specialty occupation.
Your U.S. employer can also sponsor you for a green card. The employer must first offer you a full-time, permanent nurse position. Second, your employer must complete a process known as "labor certification" on your behalf (more commonly referred to as PERM). Now, you may have heard a lot about the PERM/labor certification process, but this process is completely different for nurse positions.
A nurse position is classified as a "Schedule A" position. Schedule A positions are ones that the U.S. government has recognized the U.S. needs more workers to fill -- therefore, employers are not required to post advertisements for Schedule A positions (a usual PERM requirement), because the U.S. government already knows there is a shortage of workers in these positions.
To file the PERM for a foreign nurse, the U.S. employer completes the usual ETA Form 9089, but files the form with USCIS -- not with the Department of Labor, which is the agency that reviews ETA Form 9089s for all non-Schedule A positions. Once USCIS approves the ETA Form 9089, the employer can file the I-140 petition on behalf of the foreign nurse. Finally, once USCIS approves the I-140 and the foreign nurse’s priority date is current (meaning that a visa has become available, if a wait had been imposed due to the annual allotment of such visas having run out), the nurse can apply for the U.S. green card by filing the I-485, adjustment of status application, with USCIS (for an extensive explanation please see "Keep Track of Your Priority Date for a Green Card or Visa").
Importantly, although the typical PERM advertisement requirements do not apply to Schedule A positions, the Posting-Notice requirement does apply. Your U.S. employer must post a notice in the place of business that gives notice of the labor certification filing to the other employees.
All foreign nurses, regardless of whether they are coming to the U.S. with an H-1B visa or with a green card, must prove to USCIS that they are "certified" to work in the medical field in the United States. (This information is specific to nurses -- physicians and other medical personnel must meet different requirements.)
To do so, the foreign nurse must be certified by the Commission on Graduates of Foreign Nursing Schools (CGFNS). The nurse must send all of his or her qualifications and educational credentials to CGFNS. After reviewing the nurse’s credentials, the CGFNS will issue a certified statement confirming:
1. The nurse has a valid and unrestricted license in the U.S. state in which he or she will work and the state has certified that the nurse’s foreign license is authentic.
2. The nurse has passed the NCLEX, which is the U.S. licensing examination for nurses.
3. The nurse is a graduate of an English-language nursing program.
4. The nurse’s program was located in a country designated by the U.S. as acceptable for medical training, and
5. The nursing program was in operation on or before November 12, 1999.
The CGFNS certificate must be included in every visa or green card petition filed on the nurse’s behalf by the U.S. employer. If the employer forgets to include it, USCIS will almost certainly ask for it before approving the petition.
As you can see, there are many nuanced issues that must be navigated through these procedures, so most applicants or their employers will retain an immigration lawyer to facilitate the process.