Permanent Residence (Green Cards) for Nurses

What are the basic requirements for a worker to qualify for a green card?

Employment-based immigrant visas typically involve three main steps.

• First, the employer files a Labor Certification application with the U.S. Department of Labor. The purpose of the application is to test the employer's local labor market for available workers. If no qualified and available workers are located, the position is certified as open for a foreign worker.

• Second, the employer files an Alien Worker Petition with the USCIS. The purpose of this petition is to verify that the foreign worker has the minimum requirements to fill the open position, and serves to classify the foreign person as eligible for a particular visa category.

• Third, on the basis of the Labor Certification and Alien Worker Petition, the foreign worker makes an application for an immigrant visa at a U.S. Consulate. If the foreign worker is legally present in the U.S., s/he may instead apply for permanent resident status via a process called adjustment of status. A nurse in the U.S. can simultaneously file his/her application to adjust status to permanent resident when he employer files its petition.

The entire process can take several years. Labor certifications can take anywhere from a month to a year depending on where in the country the application is filed. The employer's petition can take anywhere from a month to a year. And another year to two years can be added for consular processing or adjustment of status. As explained below, however, nurses receive processing that is partially expedited.

Nurses receive special treatment in green card processing that makes the green card application process faster or easier.

Nurses seeking green cards do operate under an easier system and get their green cards faster than their counterparts in other professions. Nurses do fit into a green card category with a limited quota referred to as "Schedule A." In this context RNs are distinguished from CANs and LVNs (or LPNs) who are not Schedule A and thus will require labor certification.

Most employment immigration cases require the employer to first recruit and test the labor market for qualified citizens or permanent residents and receive a labor certification from the Department of Labor that no qualified American worker is immediately available to fill the position. Only then will the employer be able to sponsor a foreign worker. While these labor certifications are often successful, they can be time intensive and do not reflect the immediate needs of the business world.

Schedule A includes nurses on a very short list of pre-certified occupations for which a labor shortage was recognized. The list is included in Schedule A of the labor certification regulations and these types of green card cases are called "Schedule A labor certifications." The Department of Labor (DOL) has already determined that there are not enough American workers who are able, willing, qualified, and available to fill all of the openings for professional nurses. Therefore, no test of the labor market is required and the case can be directly filed with the USCIS. This does not necessarily mean that all cases are approvable or will be handled quickly. The importance of nursing being pre-certified is that it skips the first and most time consuming part of the employment based immigration process.

Note that this pre-certification is limited in scope. It only applies to "professional nurses" (RN's). Schedule A is not available to Licensed Practical Nurses, Nurse Assistants, or other nursing aides. Professional Nursing is defined as a course of study in professional nursing resulting in a diploma, certificate, baccalaureate degree, or associate degree. More specifically, an acceptable course of study for professional nurses generally includes theory and practice in clinical areas such as obstetrics, surgery, pediatrics, psychiatry, and medicine. Whatever training the nurse has received should result in licensure in the country in which the training occurred. This coursework may have been completed at a U.S. nursing school or an approved foreign nursing program. For an immigrant visa, it is not required that a nurse have a bachelor's degree in nursing, only that he or she completed a professional program in nursing and have subsequently been licensed.

How does a nurse in the U.S. adjust status?

A Foreign National nurse, like any other Foreign National ("FN"), applying for permanent residence through his/her employer must be in lawful nonimmigrant status when s/he applies for adjustment of status to permanent resident and have not accumulated 180 days or more of unlawful employment or failed to maintain status for this period of time. Generally, if a RN is in the United States, the nurse will be able to start working for the employer more expeditiously than if s/he resides abroad.

If a nurse is in the United States, then processing via adjustment of status will typically be easier and it will be possible to get authorization to work much more quickly than through consular processing. The nurse's employer files its Petition with USCIS just like if the nurse resides abroad. But a nurse in the U.S. has the ability to take the NCLEX examination. If the nurse can pass the NCLEX exam, then it is not necessary to take the CGFNS examination. Otherwise, the nurse would still need to present a CGFNS certificate or proof that the nurse has a full and unrestricted license as an RN. A nurse in the U.S. may simultaneously file his/her applications when the employer files its petition. [In order for the employer's 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. 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.]

Only RNs who:

• are in possession of a full and unrestricted license in the state of intended employment;
• have passed the predictor exam given by the Commission on Graduates of Foreign Nursing Schools (CGFNS); or
• have passed the NCLEX-RN licensure exam (but do not have a license because they lack a Social Security number) may be petitioned by a U.S. employer for permanent residence.

Once the nurse is licensed by a state and the nurse is in possession of an employment authorization document, the nurse can begin work. This work is authorized even though the processing of the application to adjust status to permanent resident will take some time to process through to final adjudication. License processing times vary between the states. USCIS regional service centers are required to process employment authorization documents in less than 90 days (applicants have the right to request an interim employment document at a local USCIS office if 90 days pass after applying). Adjustment applications typically take 18 to 24 months at USCIS regional service centers. A nurse still needs to present a VisaScreen Certificate prior to completing adjustment of status.

A nurse need not be in possession of a VisaScreen certificate in order to apply for permanent residence. However, s/he cannot obtain permanent residence without being in possession of a VisaScreen certificate. No RN is exempt form the VisaScreen requirement. RNs who received their nursing education in the U.S., the United Kingdom, Ireland, Australia, New Zealand and Canada (except Quebec) are exempt from the English language certification, either the Test of Spoken English (TSE) or the IELTS.

If the RN is married and has children (under 21 years of age and unmarried) born abroad, these family members, if they are residing in the U.S. and are eligible for adjustment of status, should submit their USCIS Forms at the same time as the RN.

Some registered nurses who have advanced practice certifications, management skills, or practice in a nursing specialty area may be able to enter the U.S. on the H-1B Visa.

The H-1C Visa allows a nurse to enter on a temporary work visa for employment by hospitals or employers that are pre-qualified by the U.S. as having a special need for nurses that is greater than the general need across the country. However, this category is limited to only 500 nurses each year for the pre-qualified hospitals or health care facilities and so is restrictive.