1. What do I need to apply for an immigrant visa/green card?
There are two correct answers to this question:

• You can apply to take the Commission on Graduates of Foreign Nursing Schools (CGFNS) exam, which is now a two-part process. Once you pass the CGFNS exam, you must also pass the Test of English as a Foreign Language (TOEFL/IELTS) exam (Countries whose primary language is not English) with a score of 220 or more. Once CGFNS receives both passing scores, they will issue a certificate, OR
• The exam that is given in the U.S. or a U.S. territory called the National Council Licensure Examination (NCLEX) exam.

2. Which exam should I take?
For most International nurses, it is usually easy to obtain a tourist visa (B-I) that allows you to travel to the U.S. or a territory like Guam or American Samoa and take the NCLEX exam. You may also take the CGFNS exam in your home country. This exam is offered 3 times a year.

3. If I do not have either the CGFNS or NCLEX certificates am I still eligible for your program?
Yes, we can still assist you. However, you must have either the GCFNS or the NCLEX in order to file for a “green card”. If you do not have the CGFNS certificate we will arrange for you to take the NCLEX and use your state license to file for your green card. Keep in mind that even though CGFNS is not a requirement for our program, having the CGFNS certificate will expedite your entry into the U.S.

4. While I am waiting for my green card can I go to the US to take my NCLEX exam?
No, you may not enter the U.S., Hawaii or Guam for any reason once we have filled a “green card” for you until you receive your actual green card. If you do enter the U.S. during this time, we will have to restart the process.

5. I have taken and passed the CGFNS but now they say I must take the TOEFL/IELTS exam (Countries whose primary language is not English) before I can receive my certificate. Is this true?
Yes, it is now a two-step process before the CGFNS group will release the certificate.

6. How long does the entire process take?
Depending on the country the process can take anywhere from 12 to 18 months.

7. How may a foreign national nurse obtain an H1B visa?
Not all nurses will qualify for an H1B visa. The reason is that many registered nursing positions do not require a Bachelor's degree. BCIS will generally approve an H1B petition if: the nurse works in a supervisory capacity; the state where the nurse will work requires a Bachelor's degree in nursing to obtain a license; the nurse is an Advanced Practice Registered Nurse or otherwise has additional, specialized training or experience required for the position; or the Petitioner can successfully show why a four-year degree is necessary for the particular nursing position.

8. May a nurse obtain an H1B visa even when s/he does not have a license in the state where a job has been offered?
Nurses who qualify for an H1B petition approval in all respects except for possessing the nursing license to practice in a particular state may obtain an H1B petition approval valid for up to one year, provided the only barrier to the license is the need for a social security number. There was a 'Catch 22' situation created where the Social Security Administration could not issue the Social Security Number (SSN) to a person who did not have an H1B petition approval and the INS could not approve the H1B petition without the SSN. So INS agreed to issue an H1B petition approval for a period of one year to enable the nurse to qualify for the state licensure requirements and obtain the SSN. Accordingly, a nurse will be able to enter on the H1B visa, obtain the required social security number and finalize the licensure requirements in order to practice as a RN. S/He would have to show the valid nursing license in order to extend the H1B status beyond the first year approval period.

9. Are nurses who are nationals of either Canada or Mexico eligible for the TN visa?
Yes, nursing is a qualifying "Profession” under the North American Free Trade Agreement (NAFTA). A registered nurse holding a state/provincial license and having an appropriate sponsoring employer meets the criteria for admission on the nonimmigrant TN visa status. There are significant benefits attendant to the TN visa. First, eligibility for the TN visa is not predicated on meeting the high bar set by the “specialty occupation” requirement for obtaining an H1B visa. Second, time to issuance in many cases is shorter for the TN visa than for a nurse greencard case. Finally, because there is no statutory limitation on stay, nurses are not restrained by the maximum stay limitations that exist for other nonimmigrant visas. TN visas are valid for 1 year, and are renewable each year. Under current law, there is no limit to the number of annual renewals permitted for a TN visa holder. Filing procedures vary depending on whether the nurse is a Canadian national or a Mexican national.

10. What is the difference between a "CGFNS Certificate" and a "VisaScreen Certificate"?
A “CGFNS Certificate” is awarded after the successful completion of the CGFNS Certification Program. The Program is designed specifically for first-level, general nurses educated and licensed outside the United States who wish to assess their chances of passing the U.S. registered nurse licensing exam, the NCLEX-RN® examination, and attaining licensure to practice as registered nurses within the United States. The program is comprised of three parts: a credentials review of the nurse's education, registration and licensure; the CGFNS Qualifying Exam, a one-day qualifying exam testing nursing knowledge; and an English language proficiency exam. Nurses who do not hold a state licensure in their state of intended practice must have a CGFNS certificate in order to file an immigrant visa petition. Also, many state boards of nursing require the CGFNS Certificate for state licensure.

The “VisaScreen Certificate” by contrast is needed for consular processing or adjustment of status. The document must be presented to a consular office or, in the case of adjustment of status, the BCIS, as part of a visa application. The VisaScreen Certificate evidences that the holder has completed a required screening program for health care professionals (other than physicians) in order to qualify for certain occupational visas. Screening includes an assessment of the applicant's education to ensure it is comparable to a U.S. graduate in that same profession; verification that licenses are valid and unencumbered; English language proficiency; and, in the case of nurses, verification that the nurse has either earned a CGFNS Certificate or passed the NCLEX-RN® Examination.

11. If a foreign national nurse obtains her/his R.N. degree from an accredited U.S. school and has a nursing license from the state in which s/he is working, will s/he still need to have a VisaScreen Certificate?
Unfortunately, yes, according to INS' current interpretations of the law and regulations. In a strange anomaly of the law, a nurse who has studied in a U.S.-accredited school will still need to obtain a VisaScreen Certificate in order to demonstrate that the U.S. Nursing degree and state licensure equate to a U.S. Degree in Nursing. This is an area where hospitals and health care facilities may do well to lobby for a change in the law.

12. Must the VisaScreen Certificate be filed when the I-140 is filed? If not, what happens in concurrent filing cases?
The VisaScreen Certificate need not be filed when the I-140 petition is filed. BCIS has not specifically indicated what it will do in situations where the I-140 and I-485 are filed at the same time. We have seen and heard of BCIS denials of the I-485 in such cases, if the VisaScreen Certificate is not included at the time of filing the I-485, but typically the BCIS will send a Request for Evidence to ask for the VisaScreen Certificate. This RFE generally requires a response within 12 weeks of its issuance.

13. There are companies that contract nurses to various medical facilities throughout the United States but may not know exactly where the nurse will be placed at any given time. May these companies still file I-140s for nurses?
Generally, yes. The contracting company may wish to file the I-140 designating the state where the nurse is licensed or will be licensed as the location where the nurse will work, rather than designating a particular hospital or other health care facility that may be unknown at the time of filing the I-140 petition.

14. If a nurse is licensed in State A, which does not require the CGFNS qualifying exam, but a hospital wishes to file an I-140 for that nurse to work in State B, and State B requires the NCLEX but also grants a license based on reciprocity with State A, does that nurse need to take the CGFNS qualifying exam?
Likely not. The reason it is difficult to provide definitive answers is that the BCIS has recently issued regulations on nurses and many of their policies are not consistent among the various Service Centers and from one BCIS examiner to the next. Accordingly, it may be possible to file the I-140 petition showing the nurse has the license in State A but will work in State B. At least one Service Center has approved such a petition. When the I-485 is filed, the nurse should obtain an EAD and get the license from State B as soon as possible, to be prepared for the likelihood of an RFE.

15. Is there any way to avoid taking the CGFNS exam and obtain an approval of the I-140?
According to the regulations, a nurse need not take the CGFNS exam if s/he has either a valid, full and unrestricted nursing license from a state in the U.S. to obtain the I-140 approval or a certified copy of a letter from the state board of nursing from his/her intended state of employment which confirms that s/he has passed the NCLEX/RN exam and is eligible to be issued a license to practice nursing in that state. However, in most instances, s/he will still need the VisaScreen Certificate in order to obtain permanent residence status and for the BCIS to approve the I-485 application for the Nurse.

16. If a nurse obtains a CGFNS certificate abroad but does not have a state nursing license, may s/he complete consular processing and enter the U.S. as a lawful permanent resident?
In most cases, yes, as long as the nurse also has the VisaScreen Certificate. A number of employers indicate in their contracts with nurses that they will first be employed as a nursing assistant when they enter the U.S. until they are able to pass the NCLEX and obtain their RN license. To date, most consulates have accepted this position as valid.

17. If a nurse chooses to file the I-485 before obtaining the VisaScreen Certificate, will BCIS wait to issue the advance parole and employment authorization document until they receive the VisaScreen Certificate?
In most cases, there is no delay in issuing the EAD and AP. INS would typically approve the employment authorization document and advance parole document applications.

18. May a nurse download the CGFNS paperwork from the Internet?
Yes, the necessary forms may be downloaded from the CGFNS Website.

19. Will CGFNS contact me if they are waiting for documents from a certain school or state?
Not usually. It is best to check with CGFNS periodically to determine whether they need any additional information to process your application.

20. Must a foreign national nurse have a current license in his/her home country in order to qualify for either the CGFNS Certificate or VisaScreen Certificate?
In order to be eligible for the CGFNS Certificate Program, a nurse must be educated and hold both initial and current registration/licensure as a first-level, general nurse as defined historically by the International Council of Nurses (ICN). A nurse need not have a current license to register for the VisaScreen Certificate, but as a practical matter most nurses will have become licensed by this stage of the process.