Lawful permanent resident (LPR), or "green card," status is the most frequently used immigration petition for registered nurses (RNs). LPR status allows a nurse and his or her family to permanently come into the U.S. through a sponsoring employer. The LPR process is explained below in detail.

CGFNS Certificate Program

The starting point for most registered nurses outside the U.S. is the CGFNS Certificate. The CGFNS Certification Program is designed specifically for first-level, general nurses educated and licensed outside the United States who wish to assess their chances of passing the U.S. registered nurse licensing exam, the NCLEX-RN® examination, and their chances of attaining licensure to practice as registered nurses within the United States. In many cases, passing an examination conducted by the CGFNS is required for state licensure.

The program is comprised of three parts: a credentials review of the nurse's education, registration and licensure; the CGFNS Qualifying Exam, a one-day qualifying exam testing nursing knowledge; and an English language proficiency exam. The applicant may choose from among three qualifying English language proficiency exams: the TOEFL or TOEFL iBT, the TOEIC, or the IELTS. These exams can be taken at centers outside of the U.S. Upon successful completion of all three elements of the program, the applicant is awarded a CGFNS Certificate.

VisaScreen Certificate

The U.S. consulate requires a nurse to have a VisaScreen Certificate or comparable certification from an authorized credentialing organization. Currently, the law requires all foreign-born nurses, irrespective of where they were educated or trained, to meet the certification requirement in order to enter the United States. The Visa Screen process is provided by the Commission on Graduates of Foreign Nursing Schools (CGFNS). The requirements of the VisaScreen Certificate, as well as procedures for obtaining the certification, are fully explained in our article entitled The VisaScreen Certificate: An Explanation of the Requirements for Nurses and Other Allied Health Care Professionals.

The VisaScreen program is comprised of an educational analysis, licensure validation, English language proficiency assessment, and an exam of nursing knowledge. Once the applicant has successfully completed all elements of the VisaScreen program, the applicant is awarded a VisaScreen Certificate, which can be presented to a consular officer.

State Licensure

Finally, a nurse must satisfy the requirements for obtaining a registered nursing license in the state in which s/he intends to practice. Each state has a state board of nursing that governs state licensure for health care professionals. At a minimum, a nurse will be required to take the state licensing exam to obtain a state license to work as an RN. Additional requirements for licensure are dictated by each individual state board of nursing. For further information on an individual state’s licensure requirements for foreign national nurses, see the National Council of State Boards of Nursing WebSite.

Schedule A - No Labor Certification Needed

Because the occupation of RN is listed by the DOL on "Schedule A;" a known shortage occupation. Schedule A is a blanket determination made by the DOL that foreign workers holding jobs listed on the schedule will not harm the U.S. workforce or the economy. This blanket determination means that people qualified to perform these jobs are able to petition the USCIS to process their green cards. On the other side of the coin, because Schedule A workers are part of the EB3 category, their visa numbers may not become available for a number of years, based on the current EB3 priority date. The law may change in the future, however, to allow for Schedule A workers to form their own subcategory with a more recent priority date.

In order to file the I-140 petition for an RN, it is necessary to submit the appropriate documents to show that the petitioner is eligible for the Schedule A designation and that the RN has a prospective employer who is willing to offer a position as the I-140 petitioner.

Registered Nurses within the U.S. Seeking LPR Status

Nurses already present in the U.S. can follow the same procedure to attain LPR status as nurses outside the U.S. by obtaining both the CGFNS Certificate and the VisaScreen Certificate. The nurse would also be required to obtain state licensure in the state of intended practice before starting employment as a registered nurse.

Alternatively, a nurse already present in the U.S. may elect to forgo the CGFNS Certificate and instead directly obtain state licensure. State licensure is an alternative to the CGFNS Certificate requirement for filing the Schedule A and obtaining the VisaScreen certificate. A nurse should be cautioned, however, that most states require the CGFNS Certificate for state licensure for foreign educated nurses. Therefore, this shortcut is only a viable route for a nurse who intends to practice in one of the approximately 12 states which does not require the CGFNS Certificate for licensure.

A nurse who is present in the U.S. may have more options for fulfilling the English language exam requirements. In the past, nurses have frequently chosen to take the TOEFL/TWE and TSE to satisfy the language requirement. Statistically, the TSE has proven to be the greatest obstacle for foreign nurses. Now, two additional English proficiency exams, the TOEIC and the IELTS, are offered to satisfy the English language proficiency requirement. While administration of each exam varies by country, each exam is offered in the U.S.

For foreign national nurses who wish to practice in the U.S., the option of obtaining permanent residence through a job offer remains one of the best options. Nurses benefit from being in a Schedule A occupation, which reduces some of the time and the overall expense of the process. While the process requires each nurse to complete a battery of exams as well as credential and licensure reviews, it provides assurance to nurse candidates that they are amply qualified in all respects to provide safe and effective nursing practices and meet their professional career goals while practicing in the United States.