Comparing Immigration Options for Nurses U.S.A. vs. Canada

by Andy J. Semotiuk

Introduction
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

Overview
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.

Immigrant Visa
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:

• Getting the required professional/personal credentials
  
  This includes:
  
  
  • 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:
  
  
  • 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.
  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.
• 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" Visas
Temporary nonimmigrant visa applicants also now need a VisaScreen clearance. Previously, only applicants for permanent residence were required to obtain this certification.

TN Entry

Eligibility
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.

Related Documents
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.

Time Limitations
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.

H-1B visa

Eligibility
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.

Related Documents
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.

Time Limitations
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

Overview
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 Residence Status
• Work Permit

Permanent Resident Status
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:

• Meet Minimum Years of Work Experience Requirements
  
  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 Factors
  
  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:
  
  
  • Education
    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.
  • Experience
    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.
  • Age
    Up to 10 points are awarded under this factor. The minimum age is 17 years. After the age of 49 points decrease substantially.
  • 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.
  • Adaptability
    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.

Provincial Nominee Program
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.

Temporary Status
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:

• 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.

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
Employers

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 foreign nurse
• 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 Temporary Work.
  • 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 specific period

The following procedure applies to the foreign nurse applicant

• 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 relevant documents.
• 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.

Free Trade Agreements
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.

Eligibility
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.

Requirements
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.

Duration
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.

Main requirements

• Minimum Educational Qualification
  Successful completion of an education equivalent to a Canadian high school education
• Employment/Training
  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 necessary.
• 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.

Application Procedure
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.

Comparisons

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 decide admissibility.
• 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 such pre-requisite.

Conclusion
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.