Pre-Certification

In 1996, Congress passed legislation that retained nurses on a very short list of pre-certified occupations for which a labor shortage was recognized. The list is included in Schedule A of the labor certification regulations and these types of green card cases are called ""Schedule A labor certifications"". The Department of Labor (DOL) has already determined that there are not enough American workers who are able, willing, qualified, and available to fill all of the openings for professional nurses. Therefore, no test of the labor market is required and the case can be directly filed with the Immigration and Naturalization Service. This does not necessarily mean that all cases are approvable or will be handled quickly. The importance of nursing being pre-certified is that it skips the first and most time consuming part of the employment based immigration process.

It is important to note that this pre-certification is limited in scope. It only applies to ""professional nurses"". It is not available to Licensed Practical Nurses, Nurse Assistants, or other nursing aides. Professional Nursing is defined as course of study in professional nursing resulting in a diploma, certificate, baccalaureate degree, or associate degree. More specifically, an acceptable course of study for professional nurses generally includes theory and practice in clinical areas such as obstetrics, surgery, pediatrics, psychiatry, and medicine. Whatever training the nurse has received should result in licensure in the country in which the training occurred. This coursework may have been completed at a U.S. nursing school or an approved foreign nursing program. For an immigrant visa, it is not required that a nurse have a bachelor''s degree in nursing, only that he or she completed a professional program in nursing and have subsequently been licensed.

Filing the I-140

The initial step in a Schedule A case is to file a Form I-140 application package to the appropriate supporting documentation to the appropriate I.N.S. service center. There are four regional I.N.S. service centers. They are located in Vermont, Texas, Nebraska, and California and each service center has jurisdiction over a section of the country. A case is properly filed in the service center having jurisdiction over the place of employment or in the service center covering the region where the employer''s office is located. This is an important distinction because service centers have varying processing times. Currently, the Texas service center is taking 9-10 months to complete an I-140, while Nebraska''s processing time is only 3 months. This may account for varying experiences in the HR industry as to how long it is taking to obtain the approval necessary before the nurse can apply for consular processing or adjustment of status.

Supporting documentation must be submitted with the I-140 as prescribed in 20 C.F.R. 656.22(c)(2). This supporting evidence includes the following:

• ETA Form 750 Parts A and B, in duplicate (these are the labor certification forms);
• A posted notice of the job opening. This notice must include a job description, work hours, and rate of pay. The notice must be posted in the worksite for a minimum of ten business days;
• Evidence that the petitioning employer has the financial ability to pay the salary offered to the nurse. Evidence of this ability shall be either in the form of copies of annual reports, federal tax returns, or audited financial statements. If the U.S. employer employs 100 or more workers, the INS may accept a statement from a financial officer of the organization; • CGFNS certificate and/or nurse license from state where the nurse will be working.
• Nursing diploma or degree;
• Nursing registration/licensure from the country where the degree was obtained.

As noted in number 4, an I-140 will not be approved unless the nurse can provide evidence that they have already passed the NCLEX exam or that they have obtained a CGFNS certificate.

A CGFNS certificate is evidence that the nurse has complied with a three step review of their nursing skills: 1. a credentials evaluation; 2. passage of an English language proficiency exam; and 3. passage of the CGFNS qualifying exam. Once these requisites have been met, the Commission on Graduates of Foreign Nursing Schools will issue the nurse a CGFNS certificate. The purpose of this certification program is to serve as a predictive evaluation process to accurately judge which nurses will be able to meet the requirements for U.S. licensure once admitted to the country. If the nurse has already passed the NCLEX-RN exam, they are exempted from the requirement of obtaining a CGFNS certificate.

The Visa Screen Certificate

The Immigration & Nationality Act controls the admission and presence of aliens in the United States. I.N.A. Section 212(a)(5)(C) sets out the guidelines by which foreign health care workers may gain admission. This law names the Commission on Graduates of Foreign Nursing Schools as an agency authorized to issue the document, referred to as VisaScreen. The CGFNS is the only agency designated to administrate the VisaScreen certification program. The fee per applicant is currently $325. One should contact the CGFNS directly for application instructions. The VisaScreen certificate is required in addition to the CGFNS certificate.

Issuance of the VisaScreen certificate is an indication that the nurse has met all of the requirements of the Commission. The requirements before the certificate can be issued are as follows:

• The alien''s education, training, license, and experience must:
• meet all applicable statutory and regulatory requirements for entry into the United States under the classification specified in the application;
• be comparable to that required for an American health-care worker of the same type;
• be authentic and, in the case of a license, unencumbered;
• The alien must have the level of competence in oral and written English considered by the Secretary of Health and Human Services... to be appropriate for health care work of the kind in which the alien will be engaged, as shown by an appropriate score on one or more nationally recognized, commercially available, standardized assessments of the applicant's ability to speak and write; and
• If a majority of States licensing the profession in which the alien intends to work recognizes a test predicting the success on the profession''s licensing or certification examination, the alien has passed such a test or has passed such an examination.

It is not necessary for the nurse to have completed the VisaScreen prior to filing the I-140 with the INS; they must only have a CGFNS certificate or passage of the NCLEX for this step. However, before an immigrant visa will be issued the nurse must have obtained the VisaScreen from the International Healthcare Authority, a division of CGFNS. In order to meet the educational requirements for the VisaScreen program, applicants must have:

• Successfully completed a senior secondary school education that is separate from their professional education;
• Graduated from a government-approved, professional healthcare program of at least two years in length;
• Successfully completed a minimum number of clock and/or credit hours in specific theoretical and clinical areas during their professional program;

If the nurse was educated outside the U.S. they must also provide evidence of licensure and registration in the country of education and evidence that they have a CGFNS certificate or have passed the NCLEX-RN exam.

The Certified Statement

There is one exception to the requirement of obtaining a VisaScreen certificate. This exception exists for nurses who:

• Completed their nursing education in English from certain designated countries;
• Have a valid, unencumbered license as a registered nurse in a state where the nurse intends to be employed • Have passed the NCLEX examination

The nurse must still complete the VisaScreen application and pay the $325 fee. However, the application will be completed within 35 days (which is a must shorter process than the VisaScreen process). Only nurses from the following designated countries may obtain a Certified Statement: Australia, Canada, Ireland, New Zealand, South Africa, the United Kingdom, and the United States.

This exception is most common with Canadian nurses who have entered the United States in TN status and become licensed in the state in which they are currently employed.

Final Steps

Upon approval of the I-140 and receipt of the VisaScreen certificate, a nurse is eligible to obtain their immigrant visa through consular processing. If they are in the United States in a lawful status they may adjust their status to that of permanent resident. Nurses are still required to adhere to licensing requirements of the state in which they intend to work.

Licensing requirements for registered nurses are maintained on a state-by-state basis, and each state has slightly different requirements for licensing. To demonstrate eligibility and preparedness for the NCLEX exam, most states require a combination of materials with the license application, which may include CGFNS certification, copies of foreign academic credentials with certified translations, an education/credentials evaluation and a demonstration of proficiency in English (i.e. TOEFL exam results).

All states permit an individual to obtain a license through examination, and some state permit licensing by endorsement, or acceptance of a registered nurse license from another state or country as evidence of the person's credentials. Again, requirements vary from state to state.