Health Care Worker Certification
Foreign nationals seeking admission to perform labor as health care workers, other than physicians, are only admissible to the United States if they present certification from USCIS-approved credentialing organization verifying that the worker has met the minimum requirements for training, license, and English language proficiency in his or her field.
Specifically, the certification verifies whether the foreign national has education, training, licensing, and experience that includes:
- The necessary level of competence in oral and written English as shown by passage of one or more nationally recognized, commercially available, standardized test of the applicant’s ability to speak and write; and
- Passed either: a) a predictor test (if the majority of States licensing the profession in which the foreign national intends to work recognize a test predicting a worker’s success on the profession’s licensing or certification examination), or b) the actual licensing or certification examination.
Health Care Occupations Requiring a Certification
The following health care occupations require a certification under 8 CFR 212.15(c):
- nurses (licensed practical nurses, licensed vocational nurses, and registered nurses ),
- physical therapists,
- occupational therapists,
- speech-language pathologists and audiologists,
- medical technologists (also known as clinical laboratory scientists),
- medical technicians (also known as clinical laboratory technicians), and
- physician assistants.
Certification Process for Nurses
Nurses have an alternative certification process. A foreign nurse may present a certified statement from the Commission on Graduates of Foreign Nursing Schools or an approved equivalent independent credentialing organization verifying that the foreign nurse:
- has a valid and unrestricted license in the state of intended employment;
- has a foreign license that is authentic and unencumbered;
- has passed the National Council Licensure Examination (NCLEX ); and
- has graduated from certain English language nursing programs.
Organizations Authorized to Issue Health Care Worker Certifications
The following organizations are authorized to issue certifications for the following health care occupations:
- The Commission on Graduates of Foreign Nursing Schools (CGFNS) is authorized to issue certifications to all 7 health care occupations.
- The National Board for Certification in Occupational Therapy (NBCOT) is authorized to issue certifications for occupational therapists.
- The Foreign Credentialing Commission on Physical Therapy (FCCPT) is authorized to issue certifications for physical therapists.
- These organizations are approved by the Secretary of Homeland Security in consultation with the Secretary of Health and Human Services.
Providing Valid Health Care Worker Certification
A foreign national worker in an affected health care occupation must present a valid health care worker certification each time he or she:
- seeks admission into the United States,
- changes status,
- extends status, or
- adjusts status.
Renewing the Health Care Certification
A foreign worker’s certification must be used for any admission into the United States, extension or change of status within the United States, or adjustment of status within 5 years of the date that it is issued. For this reason, the certification is only valid for 5 years. This ensures that the individual continues to meet the regulatory requirements for issuance of the certification. Therefore, if the foreign worker has not used the certification because he or she has not been admitted into the United States or adjusted his or her status within 5 years of when the certification was obtained, a new certification is required at the time he or she seeks adjustment of status, to change or extend status with USCIS, or when seeking visa issuance by DOS or admission at the port of entry.
Please note that certification does not remove requirements for licensure, if applicable.
However, the credentialing organization must have a formal policy for renewing the certification if an individual’s original certification expires before admission to the United States or application for adjustment of status. The credentialing organization is limited to updating information on licensure to determine the existence of any adverse actions and the need to re-establish English competency, and therefore does not re-evaluate the educational credentials when renewing the certification.
For nonimmigrant petitions seeking admission, an extension of stay, or a change of status, there are two considerations:Consideration 1: The petitioning employer files a Form I-129, Petition for a Nonimmigrant Worker, for approval of the foreign national worker’s classification as a nonimmigrant. In adjudicating the petition for the classification requested, USCIS reviews all eligibility requirements, including licensure, if applicable. The health care certification must be presented at the time of visa issuance or admission (if the foreign national worker is visa-exempt).
Consideration 2: If the foreign national is already in the United States, Form I-129 may also serve as an application to extend the period of the foreign national's authorized stay or to change his or her status. Although the Form I-129 petition classification may be approved, the application for an extension of stay or change of status will be denied if the petitioner fails to submit the health care worker certification required by law.
Please note: USCIS does not accept health care worker certification as the sole evidence that the foreign worker has met the minimum requirement for the given position and is, therefore, eligible for the requested visa classification. While the health care worker certification verifies the worker’s credentials for admissibility into the United States under INA 212(a)(5)(C), it is not binding on DHS. See 8 CFR 212.15(f)(1)(iii).
TN STATUS (TRADE NAFTA WORK PERMITS – FOR CANADIAN AND MEXICAN CITIZENS ONLY.
Health care workers who are citizens of Canada and Mexico may enter the United States under TN-1 status to work. TN Classification is generally available to RNs, Physical Therapists/Physiotherapists, Occupational Therapists, and Medical Technologists, but not to licensed practical nurses, licensed vocational nurses, or speech language pathologists.
Registered nurses (RNs) may obtain TN status subject to the following conditions:
Valid U.S. state or Canadian provincial license for the occupation, or proof of eligibility for prospective licensure, if applicable.
- Proof of citizenship.
- Offer of employment from the U.S. employer
- Possession of Visa screen certificate
- Education and experience credentials
- Payment of required fee
A nurse on TN should not have an intention of remaining permanently in the U.S.
H-1B visa category for temporary workers in a “professional specialty occupation” is not available to RNs per se because most states allow nurses to take the licensing examination after completion of a two-year associate’s degree. General staff RNs are not classifiable as H-1B. However, the following specialties would qualify for H-1B:
- Advanced Practice Registered Nurses (APRNs) or Licensed Nurse Practitioners (LNPs) in the fields of acute care, adult care, critical care, family care, hospice and palliative care, neonatology, pediatric care, psychiatric and mental health care, women’s health care;
- Certified Registered Nurse – Anesthetists (CRNAs); and Certified Nurse-Midwives (CNMs);
- Also senior nurse managers at the policy-setting level who are not providing direct patient care nor acting as direct supervisors typically qualify for H-1B classification.
Thus, H-1B visa status can be used for nursing jobs that require at least a four-year bachelor’s degree.
Finally, physical and occupational therapists are both recognized as qualifying for H-1B classification. Physical therapists were previously required to have at least a bachelor’s degree. Subsequently, master’s degree became the industry standard. Now, efforts are seen to raise the standard to a new type of doctoral degree, the Doctor of Physical Therapy.
For immigrant petitions, there is a two-step process:
Step 1: Generally, Form I-140, Immigrant Petition for Alien Worker, is first filed by an employer on behalf of the prospective foreign national worker. In adjudicating the I-140 petition, USCIS reviews all eligibility requirements. This review includes examination of the beneficiary’s educational qualifications.
Step 2: If the foreign national worker is in the United States, he or she may file a Form I-485, Application to Register Permanent Residence or Adjust Status. It is only upon the filing of an I-485 that the health care worker certification is required and will be used to determine admissibility for adjustment of status.
If the foreign national worker is living outside the United States or living in the United States, but chooses to apply for an immigrant visa abroad, USCIS will send the approved petition to the Department of State’s (DOS) National Visa Center (NVC), where it will remain until an immigrant visa number is available. The foreign national worker must present the health care certification to the consular officer at the time of visa issuance.
Registered nurses and physical therapists are the only two occupations explicitly exempted from the labor market test of permanent alien labor certification. These two positions have been designated as “Schedule A, Group I,” these are the occupations for which the Department of Labor has acknowledged a chronic shortage of qualified U.S. workers.
For nurses present in the United States
Due to his/her presence in the U.S., he/she may take the RN licensing examination (known as National Council Licensure Examination for Registered Nurses or the “NCLEX-RN”) in any state. You can review www. Ncsbn.org for more information on the examination..
The employer must submit an immigrant visa petition to applicable USCIS office. It is important that RN has passed either CGFNS exam or the NCLEX exam, or be in possession of a “full and unrestricted license” as a registered nurse in the state of intended employment.
RN and his/her family members may apply for adjustment of status to permanent residence and for EADs. A nurse need not be in possession of a Visa Screen certificate in order to apply for permanent residence. However, he/she cannot obtain permanent residence without being in possession of a Visa Screen certificate.
For nurses residing abroad
The registered nurse should have the following:
A Registered Nurse license in her country;
- A diploma from a nursing school in his/her own country;
- A full and unrestricted license to practice professional nursing in the state of intended employment, or a certification issued by the Commission of Foreign Nursing Schools (CGFNS), or evidence that he/she has passed the NCLEX-RN licensing examination but cannot obtain a license because he/she lacks a social security number.
Some states require the foreign nurses pass the CGFNS examination before taking the state RN licensing (NCLEX) examination. However, the number of such states is on the decline. This is due to the fact that it is now possible to take the NCLEX abroad.
The employer to begin with submits an immigrant visa petition (I-140) to USCIS. The petition is accompanied by Labor Department Form ETA-9089, a posting notice, a prevailing wage determination and by other required documents along with the filing fee. If the petition is found approvable, USCIS mails the approved visa petition to the National Visa Center (NVC) in Portsmouth, New Hampshire. The nurse receives the fee bill. After fees are paid, the NVC forwards a packet to the nurse or her attorney, and a list of documents which must be submitted. The U.S. Consulate schedules an appointment for the nurse and her family for permanent residence.
IMPORTANT WEBSITE LINKS
- English Language Testing Scores: www.toefl.org
- Application Materials for Educational Credentialing: www.cgfns.org or www.fccpt.org
- International Commission of Healthcare Professionals: www.ichp.org
- IELTS International: www.ielts.org
- TOEIC Service International: www.ielts.org
- National Council Licensing Examination: www.ncsbn.or