According to the report "Health Worker Shortages & the Potential of Immigration Policy" of Immigration Policy in Focus (Volume 3, February 2004), 11.5 percent of registered nurses and 17 percent of nursing, psychiatric and home health workers in the United States were foreign-born. The situation is not very different in Canada. Seeking temporary and permanent immigration in these two countries, however, is a multiple-step, and in many cases, a bit of a time-consuming process. What is needed is basic knowledge about these issues so that nurses who want to immigrate will be aware of exactly where they stand in the process, and accordingly, take required steps in the right direction. This article gives a brief review of the immigration requirements and procedures for nurses desiring to immigrate to the US and Canada.
Immigration to US
The high demand for nursing professionals has resulted in foreign-born or foreign-trained professionals occupying many positions in hospitals and doctors' offices, health centers, clinics, community health agencies, nursing homes, extended-care facilities, rehabilitation centers, private homes, etc. In recent years, a number of new procedures have been introduced, which have made the immigration process for nurses look more complex and discouraging. But, that is not the case. The bottom line is foreign nursing professionals are very welcome and required.
Applying and Qualifying for a Visa
The first thing to keep in mind when applying for an immigrant or nonimmigrant work visa for working in the United States (or for that matter, any other country) is that getting a visa is a privilege and not a right. Since immigration is a process often involving many surprises it is helpful to keep a positive attitude and to understand clearly each and every step of the procedure. The USA has two classifications of visas for all foreign working professionals, and the same applies to nurses: immigrant or nonimmigrant work visas.
An immigrant visa or the "Green Card" allows the nursing professional to live and work in the United States permanently. The holder of this visa is a Lawful Permanent Resident of the US.
If a nurse is living in a foreign location, there is a five-step procedure to follow to obtain permanent residence:
Temporary "Nonimmigrant" Visas
- Getting the required professional/personal credentials
- Required nursing education and license to practice in the home country.
- US credentials such as license to practice in the state where the nurse intends to get employment, CGFNS (Commission on Graduates of Foreign Nursing Schools)/NCLEX-RN certificate, English language tests, completing the Visa screening certification process, and any other relevant certifications.
- Finding employment
A foreign professional nurse can get an employment based immigrant visa for permanent residence only through a prospective US employer/sponsor. US immigration laws mainly consider the benefits to the US employer/sponsor as a result of such employment rather than the benefits to the employee. The US employer/sponsor's job offer qualifies the foreign professional nurse for getting a green card.
- Petition for immigrant visa/permanent residence by the US employer/sponsor The US employer/sponsor begins the process by petitioning for permanent residence with the appropriate regional office of the USCIS (United States Citizen and Immigration Service). The processing of the petition may take four to eight months.
While normally employment based immigration cases require labor certification from the USCIS (Labor certifications are given on the basis that no US citizen or permanent residents are available to take the job) the US Department of Labor has pre-cleared registered nurses from such certification by putting them on a "Schedule A" being a list of occupations in high demand, where no labor certification is required. This is not likely to change in the foreseeable future.
- Application by the Nurse When the USCIS approves the petition filed by the US employer/sponsor, the foreign professional nurse will be required to attend an immigrant visa interview. The interview will be held in the Consulate office of his/her home country. Usually, it takes five to eight months between the approval by USCIS and the scheduling of the visa interview. The following documents will be required for the interview:
Since it may take a long time, the nurse should apply for VisaScreen clearance well in advance to present it at the time of the interview.
- Personal documents such as birth certificates, marriage certificates.
- Police clearance certificates from all countries where the applicant has lived for over six months since the applicant's 18th birthday.
- Letter of Employment (current or updated).
- Medical Certificates related to relevant examinations.
- VisaScreen clearance.
- Admittance to the US as a permanent residence This is the final clearance required to become a permanent resident of the United States. The foreign professional nurse should establish his/her intention of working in US with the sponsor/employer and also prove that there are no disqualifying reasons, such as a criminal record, for gaining admittance to the US as a permanent residence. This clearance process is conducted by the Immigration Officer at the port of entry.
If the foreign professional nurse is physically resident in the US at the time of petitioning for permanent residence, there is a slight difference in procedure. The first three steps remain the same. The difference, and a very good one, is that when the US employer petitions for permanent residence, the foreign nurse can simultaneously apply for permanent residence from within the country. The USCIS can issue an EAD (Employment Authorization Document) before the approval of the petition filed by the US employer for permanent residence, and this allows the foreign nurse to start work immediately. If the petition is rejected, the EAD will also be terminated.
Temporary nonimmigrant visa applicants also now need a VisaScreen clearance. Previously, only applicants for permanent residence were required to obtain this certification.
A NAFTA (North American Free Trade Agreement) Professional visa (TN visa) allows Canadian and Mexican citizens, who are on NAFTA's list of qualified professionals, which includes nurses, to work in the US.
Only Canadian and Mexican citizens can apply for TN entry.
This is a direct application process requiring no pre-clearance of a US sponsorship petition within the USCIS. A licensed Canadian nurse can apply for TN entry at the Canadian-United States border. The approval or disapproval of admission is done on the spot. A Request for admission under TN status to the US Immigration Officer, Employment Letter, Proof of Professional Qualifications, Proof of meeting applicable license requirements, and proof of Canadian citizenship are the main documents required. The applicant should demonstrate nonimmigrant intent by showing the applicant has "roots" in the country of origin, i.e. family, property, a job to return to, money in an account, etc. An appropriate license is also requirement. Similar requirements apply to Mexican nurses.
The TN visa lasts up to three years and needs to be renewed to work more than three years. Extensions may be approved for a maximum three years at a time. Spouses and unmarried children of a Canadian NAFTA professional nurse must submit relevant documents such as, proof of Canadian citizenship, birth/marriage certificates, etc. to obtain TD dependant family member status.
Qualifying for H-1B is limited for nurses. A baccalaureate R.N. degree is required for a nurse to get an H-1B visa. The position itself should also require such a degree or the state regulations should require such a degree for providing a license. Nursing positions where a 4-year R.N. degree is not required will not qualify for an H-1B visa.
A Labor Condition Application (LCA) is to be filed by the US employer with the US Department of Labor. The LCA is different from Labor Certification. The former does not involve placing an ad in the newspaper and is easier to get approved than the latter. An employer can file this application for more than one person at a time. The employer must have supporting documents for the statements he/she makes. Once the LCA is approved, the US employer files a petition for Nonimmigrant Worker, with H supplement and supporting documents which include the approved LCA. This petition is filed with the appropriate Regional Service Center of the USCIS. When the USCIS approves the H-1B petition, it is forwarded to the US Consulate.
The processing time for this visa can two weeks through premium processing which cots an extra $1,000.00. Thereafter consular approval, depends on scheduling an appointment.
This visa is generally approved for an initial period of up to three years and can be renewed for up to six years. A spouse or an unmarried son/daughter of an H-1B visa bearer can apply for an H-4 visa, but cannot work in US. However, they can attend school.
Converting into Permanent Stay
Converting from a temporary nonimmigrant status to permanent resident is not easy for the TN professional. A TN visa requires a showing of non-immigrant intent. A petition for immigrant visa may be considered negatively when nonimmigrant intent is assessed for TN professionals. In the case of an H-1B visa holder, whose non-immigrant intent is not an issue, the H1B visa holder can apply for a green card at any time once the H1B visa is secured.
There are two methods for going for an immigrant visa from a temporary nonimmigrant status.
- Adjustment of status while in the US, OR
- Consular processing.
The second option has generally been found to be more preferable. See the discussion about green cards above for more details on how the application is made.
Immigration to Canada
Every year thousands of nurses immigrate to Canada. Here is a summary of the immigration procedures.
Applying and Qualifying for a Visa
Nurses interested in immigrating to Canada can do so under two main options:
Permanent Resident Status
- Permanent Residence Status
- Work Permit
Living and working in Canada is much easier if you obtain "permanent resident status" in Canada, which is also called 'immigrating to Canada' or becoming a 'landed immigrant of Canada'. A permanent resident can apply for Canadian citizenship after three years of becoming a resident.
To obtain permanent resident status, a foreign nurse should apply for and be issued a Canadian Permanent Visa.(If a foreign nurse wishes to live and work in the Province of Quebec, he/she should apply for a Quebec Certificate of Selection and pay attention to Quebec requirements.) There are several options available to qualify for Canadian permanent resident status.
Federal Skilled Workers/Professionals Program
For a nurse to be accepted as a Skilled Worker, the following three main criteria need to be fulfilled:
Provincial Nominee Program
- Meet Minimum Years of Work Experience
A minimum of one year experience is a
must. Work experience must be gained within
the last 10 years. It should be actual work
experience for which the nurse has been paid
- Prove Possession of the Required Funds
for Settling in Canada
The amount of funds required depends on the
number of family members the foreign nurse
has. Applicants should have the ability to
economically support themselves and their
families in Canada. To prove economic
stability, they must have the specified
amount of funds as per family size. The
funds should not include money borrowed from
others. Roughly US $ 12,500 for a family of
four would quantify. This criterion does not
apply if the foreign nurse has approved
arranged employment in Canada.
- Earn the Minimum Points in Six Selection
Skilled Worker/Professional applicants are
evaluated on the basis of a series of
factors. Each factor is assigned a maximum
number of points by Visa Officers. An
applicant should have a minimum of 67 points
to qualify for a Canadian Immigrant Visa.
But, attaining more points does not
guarantee a visa. Visa Officers have the
right to accept or refuse an applicant for
Canadian Immigrant Visa in their discretion.
However, applicants who meet the required
points rarely are refused entry.
The factors, evaluated include:
Applicants are awarded up to 25
points under this factor. A PhD and
relevant experience earns maximum
points. The minimum is Secondary
School Educational Credential, which
is 5 points.
- Language Skills
Up to 22 points are awarded under
this factor, which evaluates
proficiency in the first or second
language of Canada-English or
French. A language test is required
of those for whom English or French
were not a first language.
This is the most important
criterion, because inadequate points
will lead to an automatic refusal.
Up to 21 points are awarded under
this factor. To get 21 points at
least four years of experience are
required. Also a minimum, one year
is required to qualify at all.
Up to 10 points are awarded under
this factor. The minimum age is 17
years. After the age of 49 points
- Arranged Employment
Up to 10 points are awarded under
this category. This is a government
approved job offer, which certifies
there are no Canadians ready,
willing and able to take the
position. It is often not necessary
and hard to get.
This criterion evaluates factors
such as spouse's or common-law
partner's education, authorized work
experience in Canada and other
factors, which demonstrate the
applicant's ability to economically
establish in Canada. Other
considerations include periods of
study or work in Canada as well as
close relatives living there.
The same factors do not apply for
applicants intending to reside in
the Province of Quebec. They are
assessed under Quebec selection
criteria. See below.
A majority of provinces in Canada have an agreement with the Canadian Government that permits them to play a direct role in choosing immigrants who intend to settle in that province. If a foreign nurse intends to immigrate to one of Canada's provinces as a Provincial Nominee, he/she should first apply to that province and complete the provincial nomination process. The provinces will approve applications based on their immigration needs and the applicant's genuine intention to settle in that province.
A foreign nurse will have to contact the province and obtain detailed information regarding the various criteria for immigration as a provincial nominee. The criteria differ from province to province. For example, in British Columbia's Provincial Nominee Program, a foreign nurse can apply under the Strategic Occupation Category's relevant sub categories, which are:
- Skilled Workers
- Registered Nurses
After the province approves the provincial nominee applications of the applicants, they have to submit a separate application to Citizenship and Immigration Canada (CIC) for permanent residence. A CIC officer will evaluate the application based on Canadian immigration regulations. The six selection factors of the Federal Skilled Workers Program do not apply to a Provincial Nominee. The main advantage of workers under a Provincial Nominee program is that an application may take less time to be processed.
Quebec Immigration Programs, Permanent Workers Category
The Quebec Government has an agreement with the Government of Canada that allows it to establish its own immigration requirements and select immigrants who wish to settle in its territories. However, the Government of Canada will approve or reject their admissions. Therefore, a foreign professional nurse should first apply to the Quebec government for a Certificat de selection du Quebec. If the Quebec Government approves the application, the next step would be to make a separate application to the Government of Canada for permanent residence. A Federal visa officer will evaluate the application based on Canadian immigration requirements including security clearances and a medical clerk. An undergraduate university degree in nursing attesting to three years of full-time studies or a post secondary level education and three years of full-time studies in nursing care are the pre-requisites.
Quebec permanent workers are not assessed on the six selection factors of the Federal Skilled Workers/Professionals Program.
A valid work permit is necessary for working temporarily in Canada. Professionals of certain vocation/jobs are exempt from work permits. Unfortunately, nursing does not come under this category. However, there are a number of options available.
Temporary Status - Work Permits
A foreign nurse seeking to work temporarily in Canada should obtain a work permit called an "Employment Authorization" document issued by Canada Immigration Officers that allows a foreign professional to work at a specific job for a specific Canadian employer. A work permit is valid for a limited period of time.
The following steps have to be followed to obtain a work permit:
Port of Entry
- Obtain an Employment Offer From a Canadian Employer
The Canadian employer should provide details of the employment offer to the local Office of Human Resources and skills Development Canada (HRSDC).
- Confirmation of the Employment Offer by HRSDC
An HRSDC officer issues a confirmation of the
employment offer in his or her discretion to the
employer and enters the same into a database
accessible to all Citizenship and Immigration
Officers. Approval is based on adequate evidence
that there are no Canadian workers ready, willing
and able to take this position.
The employer on receiving the confirmation should
send the foreign nurse a copy of the HRSDC letter.
The employer should also send the foreign nurse a
detailed employment letter to provide to an
immigration officer when applying for a work permit
- Apply for Work Permit at a Canadian Embassy,
High Commission or Consulate at Any Time
After a foreign nurse receives the copy of the
confirmation letter sent by HRSDC to the employer
and the detailed letter of employment offer, the
next step is to submit an application for a work
permit with those documents to the local Canadian
Consulate to obtain a work permit letter which is
to be presented to the Canadian visa officer at the
port of entry.
Even if a foreign nurse obtains a work permit, he/she must still satisfy an Immigration Canada Officer at the port of entry that the purpose of his/her entry into Canada is of a temporary nature and in accordance with the job offer and Canadian immigration law. A person with a criminal record, for example, would not quality. If approved, the work visa is issued.
Quebec Immigration Programs, Temporary Workers
The following procedure applies to employers of foreign nurses.
- Fill the Foreign Worker Application form and
send it to HRSDC along with:
- A letter confirming intention to employ a
foreign nurse for a specific period of time
- A written confirmation from the local union
indicating consent with regard to hiring a
- Send the Application and documents to MRCI (Ministère
des Relations avec les citoyens)
- An employer located in Montreal should send
a copy of the application form and relevant
documents to the Direction des services aux
entreprises et aux régions.
- An employer located in other areas of Quebec
except Montreal should send the application form
and relevant documents to an integration center
or the regional office for the territory to
which the employer belongs.
The foreign nurse needs to sign An 'Optional
authorization to employer' part in the
application for a Certificate of Acceptance for
- Send a copy of HRSDC/MCRI validation letter
to the foreign nurse applicant
If HRSDC and MCRI approve the application, a validation letter is sent to the employer regarding the joint approval. The employer should then send the foreign nurse:
- A copy of the HRSDC/MRCI validation letter
- A copy of employment offer covering a
The following procedure applies to the foreign nurse applicant
Free Trade Agreements
- After receiving a copy of the HRDSC/MCRI
validation letter and the detailed employment
offer, the foreign nurse can apply for a work
permit at the Canadian Embassy or Canadian Visa
Office in his/her home country with a completed
Application for a Work Permit form and the
- Undergoing health and security checks is
necessary. A physician designated by Citizenship
and Immigration Canada will conduct the medical
examination. This requires a fee.
- The foreign nurse should obtain a letter of
authorization issued by the Canadian embassy.
The work permit will be provided to the foreign
nurse at the port of entry upon presentation of
the letter of authorization.
To date Canada has signed only two free trade agreements: NAFTA, covering the United States and Mexico and CCFTA covering Chile. The following applies only to applicants from those countries.
Generally, an application for a work permit should be by applicants from outside Canada at the Canadian Consulate in their home country. However, foreign registered nurses (possessing state/provincial license or Licenciatura Degree) who are citizens of the participating North American Free Trade Agreement countries and have pre-arranged employment with a Canadian employer can apply for a work permit directly at a Canadian Port of Entry. A job validation from HRSDC is not required for these professionals.
A foreign nurse entering Canada must provide professional services, in the field of qualification and not in any other area,. The work profile of the employment in Canada should conform to the job duties of the profession listed under the respective Free Trade Agreement lists, namely, nursing.
If the foreign registered nurse possesses a baccalaureate degree, it need not be in a NAFTA/CCFTA-signatory nation. But the credentials and licenses should be obtained from the NAFTA/CCFTA-signatory country to be qualified for a work permit.
The work permit will be given to the foreign registered nurse, at the discretion of the Immigration Officer at the Port of Entry. Relevant documents like, passport, proof of citizenship, etc. are required to be presented.
The duration of NAFTA/CCFTA Professional status is for an initial period of one year. Any number of one-year extensions can be obtained. However, the employment undertaken should be temporary in nature, and not permanent
The Live-in Caretaker Program
A number of foreign nurses immigrate to Canada through the Live-In-Caregivers Program. Though it is considered the easy way, it is not the preferred. Under this program, foreign nurses are required to sign a two-year contract and live with their employers. Only after successfully completing their contracts, can a foreign nurse apply for permanent resident status.
- Minimum Educational Qualification
Successful completion of an education
equivalent to a Canadian high school
A foreign nurse should have a minimum of six
months training (full-time) in a classroom
setting or one year full-time employment on
a paid basis, including six months of
experience with one employer in a field or
occupation related to the employment the
foreign nurse is seeking as a
live-in-caregiver. This experience must be
gained within the three years immediately
prior to the day on which the foreign nurse
applicant submits an application.
- Language Skills
Ability to speak, read and understand
English or French at a working level is
- Agreement to live in Employer's House
A written employment contract letter between
the foreign nurse and the future employer is
a must. The agreement must include residence
in the employer's home. The minimum
provincial wage requirement must be met.
The future employer should submit a request to hire the foreign nurse applicant. This request is submitted to a Human Resources and Skills Development Center. A form provided by HRSDC must be filled out. The prospective employer is required to show he or she made an effort to find a local caregiver before approval will be given. Once HRSDC approves the employment offer, a confirmation letter is sent to the employer. The letter requires the prospective employer to send a copy of the same to the foreign nurse applicant.
Once the foreign nurse receives the above-mentioned letter, the next step is to contact the visa office and submit a visa application for a work permit.
An option to apply for Permanent Resident Status
After completing two years of employment as a live-in-caregiver, a foreign nurse can apply for permanent resident status, within Canada. This procedure takes about six months.
The Unites States and Canada have different immigration procedures for foreign nurses, but there are also some similarities.
- The Free Trade Agreements between both
countries facilitate entry for certain types of
foreign nurse applicants without requiring
validation of their employment authorization.
- The Immigration Officers at the Port of
Entry of both countries are given the power to
- In both countries, a foreign nurse is
allowed to apply for conversion of his or her
status from temporary to permanent. and
- Both countries allow a foreign nurse to
apply for extension of his or her stay.
The point system selection criteria for
immigration to Canada under Federal Skilled
Workers Program, the provincial nominee programs
of certain provinces in the country, and the
work permit requirements are some of the factors
which make immigration procedure to Canada
different from the United States . In the United
States a sponsoring employer is a pre-requisite
to permanent immigration. In Canada there is no
Canada and the United States both offer numerous immigration options to foreign nurses. A proper understanding of the different immigration procedures will help a foreign nurse in dealing with the process in a better manner. An important point to keep in mind is to choose a program that best suits his or her professional, educational and financial capacities.