With the exception of advance practice and managerial registered nurses, the H-1B temporary visa category is not available to most foreign-registered nurses. Registered nurses who are citizens of Canada or Mexico can temporarily enter the U.S. in TN status. Owing to the very limited temporary nonimmigrant categories for nurses, the principal means of transferring foreign nurses to the U.S. has been via the immigrant visa, meaning that these health care professionals are faced with lengthy processing delays and backlogs. Foreign nurses overseas must apply for permanent residence and will have to wait abroad while the process is completed. Foreign registered nurses in the U.S. who have or had a temporary legal status may be able to apply to immigrate by adjusting status without the need to leave the country.

Fortunately, registered nurses who wish to immigrate to the U.S. are “pre-certified” by the U.S. Department of Labor (DOL) and do not have to go through a long and complicated process of filing for permanent labor certification by showing that there are no qualified nurses available for the position. A U.S. employer seeking a qualified foreign nurse can start the immigration process directly with the U.S. Citizenship and Immigration Service (USCIS).


A company sponsoring a registered nurse to immigrate to the U.S. must file an immigrant petition (Form I-140) with USCIS. Nurse’s not otherwise eligible to file an Application to Register Permanent Residence or Adjust Status, or those who are outside the United States, will apply for an immigrant visa at a United States embassy or consulate. This process requires that a visa number be immediately available, meaning that the priority date established for the approved immigrant petition is current. Once the I-140 has been approved, USCIS sends the approved petition to the U.S. Department of State’s (DOS) National Visa Center (NVC) in the United States. After submission to the NVC office of the necessary forms required to immigrate, the NVC will send the case to the U.S. embassy or consulate abroad to schedule an immigrant visa interview. Prior to the interview, the applicant, and any spouse or unmarried children (under 21 years of age), who are also immigrating, will obtain medical examinations overseas. After the interview, the applicant will receive an immigrant visa, valid for entry to the U.S. for six months. Upon arriving in the U.S. with the immigrant visa, the applicant (and family) becomes a lawful U.S. permanent resident.

Nurses lawfully in the U.S. pursuant to another nonimmigrant status may apply to adjust to permanent resident status (Form I-485) in the U.S., either simultaneously with the I-140 petition, or after approval of the I-140, if they have already obtained the VisaScreen certificate and the priority dates are current. The adjustment application is filed with USCIS.

To Begin the Process

In order to begin the process for filing the I-140, the applicant should also provide a copy of their nursing degree and license to practice. Either a certificate evidencing passage of the Commission on Graduate Foreign Nursing (CGNFS) examination, attainment of a U.S. State license in the state of intended employment, or evidence of successfully passing the National Council Licensure Examination for Registered Nurses (NCLEX) is required for approval of the I-140 immigrant petition. If the applicant has also received a CGFNS/ICHP VisaScreen immigration certificate, it should be provided. The VisaScreen Certificate is required to complete the immigration process. The VisaScreen Certificate application requires either passage of the CGFNS examination or NCLEX national nurse licensing examination, as well as the proof of English language capability through passage of the TOEFL (Test of English as a Foreign Language) examinations. English language scores must be less than two years old at the time of submission for the VisaScreen Certificate. The applicant must pass three parts with at least the following scores: 540 (paper-based) or 83 (internet-based) for the TOEFL portion; 4.0 for the TWE (Test of Written English) portion; and 50 for the Test for Spoken English (TSE) portion. Graduates of health care programs in Canada (except most of Quebec), the U.K., Ireland, Australia, New Zealand, or the U.S. are exempt from the English language tests.

Requirements for Immigrant Visa (Consular Processing) or Adjustment of Status

Following approval of the I-140 immigrant petition, in order to complete the immigration process at a U.S. consulate or embassy abroad, the applicant must have the VisaScreen Certificate. The applicant (and accompanying family members) must also have a valid passport, valid for six months past the date of the visa appointment. The applicant (and accompanying family members) must also provide copies of an original birth certificate, police clearances from all countries lived in past the age of sixteen, and marriage and birth certificates for all accompanying family members. The applicant and any accompanying family members are required to take a medical examination shortly before the interview. They should bring any vaccination records to the examination so that they will not need to be re-vaccinated for certain diseases.

The applicant must complete the necessary forms for submission to the NVC and embassy or consulate. Following the interview, the applicant will be given an immigrant visa and will have six months to use it to enter the U.S. Upon entry into the U.S., the applicant will be a lawful U.S. permanent resident.

Registered nurses in the United States may file the adjustment of status application (Form I-485) and supporting documentation, concurrently with the I-140 Immigrant petition, or at any time after the I-140 has been either filed or approved. The I-485 application will include documents such as birth certificates and medical examinations and, where applicable, marriage certificates and divorce decrees. Additional supporting documentation must also be provided. They may also apply for an employment authorization document (EAD) and an advance parole travel document, which will allow them to work and travel while their case is being processed.

Nurses who have not previously passed the national state license exam (NCLEX) may do so after immigrating. They are not required to pass the NCLEX or be state licensed prior to immigrating.