For the U.S., in order to apply for permanent residence, the nurse must show one of the following:

1) receipt of the VisaScreen certificate from the Commission on Graduates of Foreign Nursing Schools (CGFNS) that proves that the individual has the requisite nursing skills and English proficiency; or

2) a permanent, full, and unrestricted license to practice professional nursing in the U.S. state of intended employment; or

3) passage of the National Council Licensure Examination for Registered Nurses (NCLEX-RN) examination administered by the National Council of State Boards of Nursing.

Before completing the adjustment of status process (inside the U.S.) or consular immigrant visa processing (outside of the U.S.), the nurse must provide the above-mentioned VisaScreen certificate. The VisaScreen certification verifies that the nurse's education is the equivalent of the education required of nurses in the U.S., and the certification is valid for 5 years.

Graduates of nursing programs in Australia, Canada (except Quebec), Ireland, New Zealand, United Kingdom or United States, are exempt from the English language proficiency examination portion of the VisaScreen process. Graduates of programs in other countries are required, as part of the VisaScreen process, to undergo examination of English language proficiency. There are multiple English examinations that are recognized. The Test of English as a Foreign Language (TOEFL) can be taken together with the Test of Written English (TWE) and Test of Spoken English (TSE). Alternatively, the nurse can take the Test of English for International Communications (TOEIC) or the International English Language Testing System (IELTS).

An additional exception exists for those nurses who intend to work in Florida, Georgia, Illinois, Michigan, or New York, and who graduated from a nursing program in Australia, Barbados, Canada (except for Quebec generally, but including five English-language nursing schools in Quebec), Ireland, Jamaica, New Zealand, South Africa, Trinidad and Tobago, United Kingdom, and United States, and who have a valid and unrestricted nursing license in the above-mentioned U.S. state, then those nurses may obtain a certificate from CGFNS in lieu of the VisaScreen (including exemption from the English proficiency examination).

The immigration process begins with the employer filing an I-140 immigrant petition with the U.S. Citizenship and Immigration Service (USCIS). With this petition, the employer must show that it is financially able to pay the nurse the prevailing wage, and that the nurse has the above-mentioned qualifications. If the nurse is in the U.S. in a non-immigrant status that allows the individual to apply to adjust status to permanent resident status in the U.S., and if the person is from a country from which the immigrant visa quota is not backlogged, that nurse can pursue permanent residence within the U.S. The benefit of this approach is that in connection with applying for permanent resident status, the person can apply for a work authorization, and upon its receipt, can begin working for the sponsoring employer. If the nurse is outside of the U.S., and does not have a non-immigrant visa to enable the person to apply for adjustment of status in the U.S., then the nurse must await the approval of the I-140 petition, and then go through the immigrant visa process through the U.S. consulate in the country of residence. Under the latter immigrant visa process, unless the nurse already has a non-immigrant work visa enabling her to work for the sponsoring employer, the nurse must wait until she receives the immigrant visa and enters the U.S. with the visa before she can begin to work for the sponsoring employer.

For some nurses, who have four-year degree in nursing, and will work in a specialized field of nursing which requires that level of education, it is possible to qualify for an H-1B visa. Examples of specialist nursing positions that typically require a four-year nursing degree are Nurse Practitioner, Nurse Anesthetist, Supervisor Nurse, Director of School of Nursing, and Instructor Nurse. Please note, however, that a nurse working under an H-1B visa is not eligible to apply for permanent residence under Schedule A, Group 1, which means that she is still subject to the labor certification requirement and subject to any backlog that exists in the EB-3 employment-based green card category.