Green Card Application

Us Immigration Nurses

Need for Immigrant Nurses and Health Professions

The United States has placed a welcome mat to Registered Nurses (RNs) applying for a green card. The market is so good that RNs may find several recruiting companies and hospitals competing for their services. As an immigration attorney and Certified Specialist in Immigration Law in the State of California, I have analyzed the situation. This article is written to educate RNs about available options.

What Hospitals Want ?

What are US hospitals looking for, beyond the basic examination and immigration requirements? According to President of Alpha International Employment Services in Los Angeles, California, hospitals put in so much money, effort, and commitment that they must ensure that the RN will meet their needs. She states: “An RN must have the commitment and compassion to meet the demands of sick or dying people, the ability to communicate with other medical healthcare workers and families of their patients, and the ability to adapt to a challenging environment.”

What are the drawbacks that hospitals have about hiring RNs?

Some applicants may be English-proficient on paper and yet not have a speaking knowledge of the language.

That would not be acceptable. The RNs must be conversant in English reading, writing, and speaking, especially with respect to medical and clinical terminology. Poor language skills would be a drawback regarding nurses from any locale, as would unacceptable hygiene habits. The successful nurse must have personality and character traits that are adaptable to new environments.

The US has such a wide spectrum of cultures, from the Northeast, to the traditional South, to the static Midwest, to the free-wheeling West, and to the differences in Hawaii and Alaska. One must also be able to tolerate changes in the availability of food products and regional preferences. For example, the Midwest, South, and Southwest have a high consumption of meat products, so vegetarians must be able to plan meals to assimilate. The clinical practice of nursing in the US is more collaborative than in some other countries, especially in interacting with other clinicians, including physicians. One who is strictly subservient to physicians may be at a disadvantage.

Once an RN chooses a path to a US green card, recruiting agencies and hospitals often compete for an Registered Nurse‘s services. Which is the right door for the RN to open? The following is a guide.

Sometimes, US hospitals recruit directly in and then sponsor the RNs for green cards. This can have the advantage of a secure placement in a single hospital. However, there can be drawbacks. An RN who works at a hospital directly is limited to that hospital only and the contracts are usually from two to three years. Also, most hospitals are unfamiliar with the process of locating and placing qualified foreign nurses. Hospitals are also often too busy, disorganized, understaffed, and underfunded to manage the process efficiently.

There are two types of recruiting agencies. The first type is a contract agency, which arranges the placement but the hospital actually employs the RN. The second type is a permanent agency, where the agency itself employs the RN and then makes one or more placements to a hospital or hospitals.

Recruiting agencies can provide many advantages that hospitals usually cannot, such as guidance throughout the examination and immigration process. In addition, recruiting agencies often provide services for such practical challenges as classes in US culture, and obtaining US housing, driver’s licenses, and social security cards.

Beware of the reputation and track record of the agency. Some agencies put profit and hospital convenience ahead of the best interests of the RN. The agency then pays the RN below the prevailing wage, and rotates the RN in and out of geographical locations, hospitals, and night and day shifts, at will. Some agencies promise H-1B temporary visa processing which in reality is usually difficult or impossible for RNs to obtain. Some agencies even falsely promise faster immigration processing times if the RN chooses that agency.

A good recruiting agency, according , should offer the nurse a wide range of nursing placements, pre-placement screening of the hospital, the opportunity to learn about the hospital beforehand, and the chance for the RN to relocate if he or she wishes a change after placement.

So what should an RN look for, with so many agencies and hospitals to choose from?

Agency provides guidance: Look for experience and competency in recruiting internationally, a local presence, and an excellent reputation. Also, the agency or hospital should pay a competitive salary and benefits, and should not charge a fee or deduct from the RN’s salary. Finally, look for assistance in areas such as examination and immigration processing, airfare, and housing.

In other words, shop around. Check references to find the most efficient and benevolent employer. If you meet the qualifications, the RN has the advantage.
“Now is the best time to immigrate to the US with your family. It may entail a lot of work along the way, but it will be worth the work.”


The United States Department of Labor (DOL) has determined that there are not sufficient U.S. Registered Nurses in the U.S. who are able, willing, qualified, and available. Therefore, Registered Nurses (and Physical Therapists) receive special immigration treatment which allows them to immigrate to the U.S. faster and with fewer processing steps than most foreign nationals with a job offer in the U.S.

The DOL requires most U.S. employers to undergo a lengthy and laborious “Alien Employment Certification” process before the foreign national may achieve U.S. permanent residence (also called a “green card”). The employer must recruit for U.S. workers and then report the recruiting results to the DOL. If the recruitment is deemed inadequate or if a qualified and available U.S. worker applies, the application may fail. The application process may take three years or more at the DOL alone, due to the government workload. More and more of these applications are currently delayed or denied due to the recession in the U.S., which triggers a close review of the applications to determine whether a true U.S. labor shortage in that occupation truly exists. After the Alien Employment Certification is approved, the foreign national’s file must still pass through two more immigration processing steps before the foreign national becomes a U.S. permanent resident.

The good news is that, due to the proven nursing shortage, The DOL has determined that U.S. employers of RNs (and Physical Therapists) may bypass the Alien Certification Employment Process entirely.

To qualify, the Registered Nurse much meet certain certification requirements. The CGFNS (Commission on Graduates of Foreign Nursing Schools) in the U.S. issues the required certification for non-U.S. Registered Nurses. U.S. law requires that certain healthcare professionals (including Registered Nurses and Physical Therapists, among others) complete a screening program in order to qualify for an employment-based U.S. visa. The certification process includes a review of the nurse’s professional education and licenses, and successful passage of a nursing competency exam and of exams in English written and spoken proficiency. Test centers are located throughout the world, including in Bangalore. To begin the certification process, contact CGFNS at Some of the elements of a certification are required for the first time petition processing step, and some for the second step.

There remain two immigration processing steps for a Registered Nurse to obtain U.S. permanent residence. The first step is a petition filed by the U.S. employer in the nurse’s behalf, with the Bureau of Citizenship and Immigration Services (BCIS). The petition includes an offer of employment, proof of the employer’s ability to pay the required wage, and proof that the Registered Nurse meets certain certification requirements.

The second step is the visa application process, filed by the nurse and by his or her immediate family (spouse and children under age 21) through the United States Department of State. This second filing step requires documentation that all of the nursing certification requirements have been met, and that the Registered Nurse and family meet general U.S. immigration admission requirements (such as a lack of criminal record and lack of ties to illegal organizations).

The second step culminates in an interview at a U.S. consulate abroad. The second and third steps may take a total of about one year or less; still lengthy, but very fast by U.S. immigration standards. Many employers and Registered Nurses obtain the services of a U.S. immigration attorney to assist them in the paperwork-intensive process and ensure that all goes as smoothly and as quickly as possible.

If the nurse is already in the United States, then the paperwork for the second step can be filed at U.S. BCIS.

The Registered Nurse must pass one a U.S.-administered national licensing test called the NCLEX, (National Council Licensure Examination) in order to receive a license in the state of intended practice.

Overall, the immigration process for Registered Nurses is an attractive and fast immigration option, if he or she is willing to undertake the various certification and immigration requirements. U.S. employers are desperately looking for Registered Nurses, and the job outlook is very good.

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