Foreign-trained nurses who want to work in the United States generally have three visa options: the EB-3 employment-based green card, the H-1B temporary work visa for advanced practice roles, and the TN visa for citizens of Canada and Mexico. The EB-3 is the main route because federal regulations classify registered nurses as a shortage occupation, which removes the biggest bottleneck in the green card process. Whichever path you take, you’ll need a VisaScreen certificate, a passing NCLEX-RN score, and a U.S. employer willing to sponsor the petition.
The EB-3 Green Card
Most internationally trained nurses pursue permanent residency through the EB-3 third-preference employment-based immigrant visa. This category covers professionals who hold at least a U.S. bachelor’s degree or its foreign equivalent, and USCIS specifically lists professional nurses under this classification.1U.S. Citizenship and Immigration Services. Employment-Based Immigration: Third Preference EB-3 The EB-3 leads directly to a green card, so the nurse becomes a lawful permanent resident on approval and admission rather than holding a temporary status that must be renewed.
The employer starts the process by filing Form I-140, the Immigrant Petition for Alien Workers, with USCIS.2U.S. Citizenship and Immigration Services. I-140, Immigrant Petition for Alien Workers The petition must show that the employer can pay the offered salary and that the nurse meets the professional qualifications for the role. Once USCIS approves the I-140, the case moves toward consular processing abroad or adjustment of status if the nurse is already inside the United States.3U.S. Citizenship and Immigration Services. Consular Processing
Why Nurses Skip Labor Certification (Schedule A)
Most EB-3 employers must run PERM labor certification, a Department of Labor process that requires domestic recruitment and proof no qualified U.S. worker is available. It can take a year or more. Nurses don’t do any of that.
Federal regulations classify registered nurses as “Schedule A, Group I” occupations, meaning the Department of Labor has already determined there aren’t enough U.S. workers to fill these roles.4eCFR. 20 CFR 656.5 – Schedule A Instead of filing a labor certification application with DOL, the employer submits an uncertified ETA Form 9089 directly to USCIS alongside the I-140.5U.S. Citizenship and Immigration Services. Chapter 7 – Schedule A Designation Petitions That collapses what would normally be a two-agency, multi-year process into a single filing.
Schedule A still comes with employer obligations. The employer must obtain a prevailing wage determination from the Department of Labor’s National Prevailing Wage Center before filing, offer full-time permanent employment at no less than 100% of that prevailing wage, and post a notice of the position at the worksite for at least ten consecutive business days.5U.S. Citizenship and Immigration Services. Chapter 7 – Schedule A Designation Petitions The posting has to happen between 30 and 180 days before the petition is filed and must be clearly visible where employees pass on their way to work.6U.S. Citizenship and Immigration Services. Adjudicators Field Manual: Schedule A Blanket Labor Certifications and Petitions
To qualify for Schedule A treatment, the nurse must meet at least one of three conditions: hold a certificate from the Commission on Graduates of Foreign Nursing Schools (CGFNS), possess a full and unrestricted nursing license in the state where they will work, or have passed the NCLEX-RN exam.4eCFR. 20 CFR 656.5 – Schedule A
H-1B: Advanced Practice Nurses Only
The H-1B covers specialty occupations that normally require at least a bachelor’s degree. Most bedside registered nurse positions don’t qualify, because hospitals don’t uniformly require a bachelor’s degree for those jobs.7U.S. Citizenship and Immigration Services. Adjudication of H-1B Petitions for Nursing Occupations Where the H-1B does work is for advanced practice roles such as nurse practitioners, nurse anesthetists, and clinical nurse specialists, where a master’s degree or higher is the standard entry requirement.
The H-1B carries an annual cap of 65,000 visas, plus another 20,000 reserved for beneficiaries with a U.S. master’s degree or higher.8U.S. Citizenship and Immigration Services. H-1B Cap Season Demand far exceeds supply, so USCIS uses a lottery to pick which petitions it will process. Nurses working at qualifying nonprofit hospitals or affiliated research institutions may be exempt from the cap, which matters when lottery odds are steep.
H-1B status is initially granted for up to three years and can be extended to a maximum of six, with further extensions possible if a green card petition is pending.
TN Visa for Canadian and Mexican Nurses
Citizens of Canada and Mexico can use the TN visa under the United States-Mexico-Canada Agreement. Registered nurse is a listed profession, so qualified applicants can work temporarily in the U.S. without labor certification or the H-1B lottery.9U.S. Citizenship and Immigration Services. TN USMCA Professionals The initial stay is up to three years and can be renewed indefinitely, as long as the nurse maintains the intent to eventually return home.
Canadian citizens can apply directly at a port of entry with their supporting documents. Mexican citizens must obtain a TN visa stamp at a U.S. consulate before traveling. Either way, the VisaScreen certificate is still required.10U.S. Department of State Foreign Affairs Manual. 9 FAM 402.17 USMCA Professionals – TN and TD Visas
VisaScreen and NCLEX-RN
Federal law makes the VisaScreen certificate a hard requirement. Under the Immigration and Nationality Act, any foreign-born healthcare worker other than a physician is inadmissible to the United States unless they present a certificate verifying that their education, training, and license are comparable to U.S. standards, that the credentials are authentic, and that the applicant has sufficient English proficiency for clinical work.11Office of the Law Revision Counsel. 8 USC 1182 – Inadmissible Aliens This applies to both permanent and temporary visa classifications.
CGFNS International is the organization approved by the Department of Homeland Security to issue the certificate. Its VisaScreen program evaluates foreign education against U.S. nursing curricula, verifies licenses, and confirms English ability. Applicants who pass receive the ICHP Certificate, which satisfies the federal screening requirement.12CGFNS International. VisaScreen: Visa Credentials Assessment
The English component requires specific minimum scores on recognized exams. The Health Resources and Services Administration publishes the approved tests and passing thresholds, which include the TOEFL (internet-based score of 83 or higher for registered nurses, with minimum subsection scores) and the IELTS (academic score of 6.5 or higher with a minimum of 7 on the speaking section).13Health Resources & Services Administration. Updated List of Tests and Scores for Foreign Health Care Workers These score thresholds are set by the Secretary of Health and Human Services and are not subject to appeal.
You also need to pass the NCLEX-RN to obtain a U.S. nursing license. Every state board of nursing requires this exam, and no one can perform clinical duties without it.14National Council of State Boards of Nursing. U.S. Nursing Licensure for Internationally Educated Nurses Many nurses take the NCLEX-RN before the visa petition is filed, since a passing score also satisfies one of the Schedule A qualification criteria.
How Long the Green Card Wait Actually Is
An approved I-140 doesn’t put a green card in your hand. Each EB-3 petition receives a priority date, and the nurse has to wait until that date becomes current on the monthly Visa Bulletin published by the Department of State. The wait depends heavily on the nurse’s country of birth, not citizenship or country of training.
As of mid-2026, the EB-3 backlog varies dramatically by country:15U.S. Department of State. Visa Bulletin for June 2026
- Most countries: priority dates from roughly two years ago are being processed, so figure on about a two-year wait after petition approval.
- Philippines: priority dates from approximately three years ago are current, and the State Department has warned that further retrogression may occur during fiscal year 2026 due to high demand.
- India: the most severe backlog, with priority dates reaching back over twelve years.
- China (mainland-born): priority dates lag roughly five years behind.
These dates shift monthly and can move backward (retrogression) when demand exceeds the annual per-country visa limits. For Filipino and Indian nurses in particular, this means years spent in temporary status or waiting abroad before the green card comes through. Many nurses hold TN or H-1B status during the wait when they can.
Family Members
Spouses and unmarried children under 21 can accompany the nurse, but the rules differ by visa type and work authorization is not automatic.
Spouses and children of TN visa holders receive TD status. TD dependents cannot work in the United States unless they qualify for their own independent work visa.10U.S. Department of State Foreign Affairs Manual. 9 FAM 402.17 USMCA Professionals – TN and TD Visas
Spouses of H-1B holders receive H-4 status. H-4 spouses can apply for an Employment Authorization Document, but only if the H-1B nurse already has an approved I-140 petition or qualifies under certain provisions of the American Competitiveness in the Twenty-first Century Act.16U.S. Citizenship and Immigration Services. Employment Authorization for Certain H-4 Dependent Spouses Without an approved I-140, the H-4 spouse cannot work.
For EB-3, the derivative green card for spouses and children processes alongside the principal applicant’s case, and permanent residents face no work restrictions once admitted.
Wage Protections and Contract Red Flags
International nurses have more legal protection than many recruiters mention.
For nurses on H-1B visas, federal regulations prohibit “benching” — not paying wages during slow periods or while waiting for a state license. If the nurse isn’t working because of anything within the employer’s control, the employer must pay the full required wage. That includes gaps caused by lack of assigned patients, waiting for licensure, or facility shutdowns.17eCFR. 20 CFR 655.731 – What Is the First LCA Requirement The employer can only stop paying by genuinely terminating employment and notifying DHS to cancel the petition. An unpaid “waiting period” after arrival is a sign the employer is breaking federal law.
Recruitment contracts with large repayment clauses are another trap. Federal courts have found that unreasonably high repayment penalties in nurse recruitment contracts can violate the Trafficking Victims Protection Act when they effectively coerce a worker into staying, and one federal case treated a $25,000 breach penalty as a “threat of serious harm” sufficient to compel labor in violation of the TVPA.
Separately, federal regulations prohibit employers from passing on the costs of obtaining permanent labor certification to the employee. For Schedule A nurses, that means the employer cannot charge back immigration filing fees, attorney costs, or recruitment expenses tied to that process. Any contract clause requiring repayment of those specific costs is unenforceable on its face. If you see one, talk to an immigration attorney before you sign.