Employment Options for U.S.-Educated Foreign Nurses
Posted Aug 15, 2003

Many foreign nationals are enrolled in U.S. nursing schools. We frequently receive inquiries from these nursing students as to how they might obtain employment in the U.S. after graduation. Fortunately for them, the demand for qualified, licensed RNs continues to be high and employment options for nurses are plentiful nationwide. Each nursing graduate must obtain a state license to practice as an RN (registered nurse). Foreign nationals have the additional requirement of obtaining the appropriate immigration status, as well. This article puts forth a roadmap for U.S.-trained, foreign national nursing graduates who want to work in the U.S.

Easier for U.S.-Educated Nurses

It is easier for foreign-national nurses who earn their degrees in the U.S. to obtain immigration-related permission to work in the U.S. than it is for nurses who are educated abroad. There are several points the RN graduates must keep in mind when seeking employment. These include acquiring: (1) timely and appropriate work-authorized status; (2) the necessary state licensure; and (3) a job offer from an employer willing to sponsor the nurse for an employment-based green card.

Short-Term Option for U.S.-Educated Nurses

As a practical matter, nurses must consider the Optional Practical Training (OPT) following graduation from a U.S. nursing school. Most foreign students, who enroll in nursing schools in the U.S., do so on the
F-1 student visa. Student visa holders are permitted to work while enrolled in school through programs called Curricular Practical Training (CPT) and Optional Practical Training (OPT). OPT may be exercised after the completion of the nurse’s course of study, and it provides a useful transition period between school and work. The individual maintains his/her F status, but is eligible to work, generally for a maximum of one year. During that time, an individual may file a green card petition. Under current regulations, a student's request for OPT must be filed prior to the completion of all course requirements for the degree or prior to the completion of the course of study. This makes OPT a valuable tool for nurses eligible for this employment authorization. Good planning is essential, however, because a nurse who obtains one year or more of CPT may not be eligible for OPT.

Long-Term Option for Nurses

As a long-term option, nursing graduates recently have found the employment-based green card to be the most attractive alternative. Nurses enjoy preferential treatment from the Department of Labor (DOL), which has placed the profession on the short list of “Schedule A” labor shortage occupations. This means that nurses have an enormous advantage over other professionals, in that they are not required to undertake the lengthy and difficult labor certification process through the DOL prior to filing for a green card with the BCIS. As a result, green cards for nurses can be approved often years faster than those filed for other occupations. Additionally, since the necessary I-140 (Petition for Alien Worker) and I-485 (Application for Adjustment of Status to Permanent Residence, AOS) can be filed concurrently, the nurse would be lawfully in the U.S. and entitled to request Employment Authorization while the I-485 application is pending.

Schedule A Available for Nurses

Nurses, as health care professionals, have certain distinct certification requirements that do not apply to other occupations. In particular, the VisaScreen Certification is still required for U.S.-educated, foreign national nurses. This requirement may seem excessive for nurses educated in the U.S., as the purpose is to evaluate the nurses' academic credentials to determine if they are equivalent to those of U.S. nursing schools. Nevertheless, the VisaScreen is still required. The credentialing organization will undertake to ensure that each nurse's credentials are genuine, and that her/his present and past license/s are valid and unencumbered. VisaScreen certification can take 3 to 4 months to complete, and it should ideally be obtained before filing the adjustment of status (AOS) application. Sometimes, the I-485 is filed while awaiting the VisaScreen Certification, though the BCIS may sometimes deny the I-485 based on the applicant's being unqualified when filing the adjustment application. The safest course of action is for the nurse to apply for the VisaScreen as soon as possible after graduation, in order to obtain it before filing the I-485. U.S.-trained nurses will only need to satisfy the academic and licensure aspects of the VisaScreen. Since they were educated in the U.S., they do not have to satisfy the English language portion of the VisaScreen certificate.

States Vary Widely on Licensure Requirements

Another consideration for foreign national nurses is state licensure and the CGFNS Certificate requirement. There is a great deal of variance in the licensing requirements from state to state. Licensing requirements for the practice of nursing are established individually by each state. As a result, some states, such as Maine, may still require the foreign national nurse to pass the CGFNS exam even though s/he was educated in the U.S. Other states, however, such as Florida, only require “foreign-educated” nurses to fulfill the CGFNS requirements. Still, other states, such as Maryland, do not require the CGFNS exam for either U.S.-educated or foreign-educated nurses.

Foreign national nurses, therefore, are well advised to carefully review the licensure requirements of the states where they wish to practice. If a state’s requirements are too stringent for a foreign national nurse, the nurse should consider initial employment in another state. The need for nurses is so dire nationwide that nurses generally have the freedom to pick and choose the jurisdictions most favorable to them. Moreover, many states allow nurses to obtain licensure through endorsement, a process whereby one state recognizes the valid license from another state, and issues a license to a nurse on that basis. This enables a nurse who has a valid license in one state to obtain a license in another state without having to retake all of the initial licensing examinations. 

Sponsorship of Nurses - Not so Burdensome

A final concern shared by many foreign national nurses is the fear that U.S. employers will not want to hire them because of the burdens associated with obtaining the visa. While it is true that an employer will have to do more to hire a foreign national nurse than to hire a U.S. counterpart, the extra effort generally is not prohibitively burdensome. Moreover, because employers across the U.S. are uniformly experiencing a critical shortage of nurses, many are willing and eager to undertake the necessary steps required to hire foreign national nurses, especially those who are fluent in spoken English.

The key to successfully transitioning from student nurse to registered nurse is advance planning. A well-prepared, foreign national nurse, who has allowed sufficient time and has developed a strategy for working on OPT after graduation, should be able to find a willing employment sponsor. Many good immigration lawyers can guide the health care facility and the employee through this process. We at The Law Office of Sheela Murthy, P.C. work with nurses and health care facilities to help alleviate the critical shortage of nurses and other health care professionals in the United States.