U.S. Immigration for Nurses: Work Visas & Green Card Options

U.S. immigration law gives preference to certain types of immigrants by providing multiple (and sometimes quicker) options for them to obtain temporary work visas as well as permanent residence (a green card) in the United States. And because the U.S. is perpetually short of medical workers, one of the classes of immigrants who get focused attention is foreign nurses.

In order to encourage more foreign nurses to come to the country, the U.S. government has, over time, established various procedures that can facilitate their ability to work and reside in this country, including both:

• the H-1B visa (which is a temporary, or "nonimmigrant" visa), and
• a U.S. green card.

These options are explained below. Unfortunately, a visa option for nurses you might have heard of in the past, called the "H-1C visa," no longer exists.

As a Foreign Nurse, How Can I Work in the U.S. Temporarily?

If you are a foreign nurse and want to work in the United States on a temporary basis (without receiving a U.S. green card), there is a small chance you will be able to obtain an H-1B visa. An H-1B is a popular temporary work visa for foreign nationals who have a job offer from a U.S. employer to work in a "specialty occupation," which a few categories of nurses fit into.

To obtain an H-1B visa for a foreign nurse, the U.S. employer, such as a hospital or medical clinic, would first need to register on your behalf in the annual H-1B lottery (only a limited number of visas are given out each year); then if you are chosen in that process, 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 a particular worker.

Your prospective employer would need to demonstrate that your nursing position is in a specialty occupation. USCIS uses a four-pronged test for this; the position must meet one of the four prongs:

• A bachelor's or higher degree or its equivalent is normally the minimum entry requirement for the position.
• The degree requirement for the job is common to the industry among comparable employers.
• The employer normally requires a degree or its equivalent for the position.
• The nature of the specific duties is so specialized and complex that the knowledge required to perform the duties is usually associated with the attainment of a bachelor's or higher degree.

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 hope to work.

Although it might be difficult to obtain an H-1B as a registered nurse, if your position is that of a clinical nurse, nurse manager, or nurse practitioner, almost every state requires at least a bachelor's degree for these positions. Therefore, you would have a better chance of securing an H-1B visa.

Again, make sure you find out the state's requirements for whatever nursing position a U.S. employer offers 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, it is highly unlikely that USCIS will find that this position qualifies as a specialty occupation for H-1B purposes.

Can I Obtain a U.S. Green Card as a Foreign Nurse?

Your U.S. employer might also be willing to 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 might have heard a lot about the PERM/labor certification process, with all its advertising requirements, but this process is completely different (and easier) 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 United States 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 submits the form, along with an I-140 petition, to 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 I-140 and the foreign nurse's Priority Date is current (meaning that a visa number 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 explanation, see How to Determine Your Priority Date for Immigration Purposes).

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.

As a Foreign Nurse, What Certification Must I Show to Apply for a U.S. Visa or Green Card?

All foreign nurses, regardless of whether they are coming to the United States 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 this, the foreign nurse must be certified by either TruMerit (formerly the Commission on Graduates of Foreign Nursing Schools or CGFNS) or TheEvaluationCompany. The nurse must send all of their qualifications and educational credentials to the chosen company. After reviewing these, the company will issue a certified statement confirming:

1. The nurse has a valid and unrestricted license in the U.S. state in which the nurse 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 credentialing 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.

Do I Need an Attorney's Help?

As you can see, there are many nuanced issues that must be navigated through these procedures. That's why most applicants or their employers retain an immigration lawyer to facilitate the process.