January 31, 2023

Volume XIII, Number 31


January 30, 2023

Subscribe to Latest Legal News and Analysis

NAFTA Nurses: Filling Nurse Shortages through the TN Visa Category

As widely reported in the media[1], the United States needs more nurses. Despite this, foreign nurses often have a difficult time immigrating to the United States, particularly through common visa statuses, such as the H-1B. NAFTA provides a solution for Canadian and Mexican nurses through the TN visa category.

TN Application Overview:

To qualify for admission to the United States as a Registered Nurse in the TN (NAFTA Professionals) category, a Canadian or Mexican national must meet the following requirements:

  1. Hold a valid Canadian or Mexican passport.

  2. Hold a state or provincial nursing license, or hold a Licenciatura Degree.

  3. Obtain a VisaScreen: Visa Credentials Assessment from CGFNS International: http://www.cgfns.org/services/visascreen/.   CGFNS requires the following to issue the assessment:

    • Education that is comparable to a U.S. graduate in the same profession.

    • Verification that all of the applicant’s professional healthcare licenses are valid and without restrictions.

    • Completion of an English Language proficiency exam.

    • Verification that the applicant has passed one of the following:

      • NCLEX-RN: https://www.ncsbn.org/nclex.htm, or, in certain circumstances, its predecessor, the State Board Test Pool Examination (SBTPE).

      • The CGFNS Qualifying Exam:


  1. Obtain a letter, on the employer’s letterhead, from a U.S. employer with the following information:

    • Proposed job title.

    • Proposed job description.

    • Description of compensation.

    • Amount of time in the U.S. requested (up to three years for each adjudication).

A Canadian will take items 1-4 directly to the U.S.-Canadian border, including certain Canadian airports with U.S. Customs and Border Protection (CBP) preclearance; pay $56; and apply for admission.  If approved, the nurse will be admitted to the United States.

A Mexican will need to complete the DS-160 (https://ceac.state.gov/genniv/) make an appointment at a U.S. Consulate: https://www.usembassy.gov/, and pay the U.S. Visa (MRV) Fee of $160. If the applicant will apply in Mexico, further instructions can be found here: https://mx.usembassy.gov/visas/nafta-professionals/how-to-apply/. At the appointment, the nurse will bring items 1-4, along with additional documents (such as photos, previous visas, DS-160 confirmation page) that will be required by the individual consulate. If approved, the nurse will receive a TN visa stamp, which the nurse will use to enter the U.S.

General Considerations:

  • Family Members: If the nurse has a spouse or children (under the age of 21) who wish to accompany the nurse, they may apply for TD visa status. When the nurse applies for the TN, the spouse and children would bring their passport, along with proof of their relationship to the nurse: marriage certificate (for the spouse) or birth certificate (for the children). If applying at a different time than the nurse, the spouse or child will also need to bring proof of the nurse’s TN status, such as a copy of the nurse’s I-94. Note that non-Canadian spouses and children must apply for a TD visa at a U.S. consulate regardless of whether the nurse is Canadian.

  • Nurse Practitioners: Generally, nurse practitioners do fall under the Registered Nurse TN category. However, sometimes CBP officers are inconsistent. If the applicant is a Nurse Practitioner, he or she should be prepared for additional questions at the border.

  • Border Application Tips: CBP recommends that Canadians apply for TN status during regular business hours. In addition, CBP has issued a list of “Optimized Ports,” which can be found here: https://www.cbp.gov/travel/canadian-and-mexican-citizens/traveling-tn-or.... Furthermore, when applying at the border, CBP officers will expect to see original documents, not photocopies.

  • Consular Application Tips: The actual visa stamp issued to a Mexican will only be valid for 12 months; however, the visa stamp should have a notation or “PED date” listing the full amount of time (up to three years) requested by the employer. If the visa issued does not have this notation, the nurse should ask for this notation to be added. This will notify CBP to admit the nurse not just for the year validity of the visa, but rather the full time requested by the application (up to three years). Once in the U.S., the nurse’s I-94 will govern how long the nurse can stay in the U.S., and not the visa stamp.

  • Changing Employers: Changing employers will require the nurse to return to the point of application with items 1-4, including a new letter from the new employer. Note that the VisaScreen certification is valid for five years. If the VisaScreen certification has expired, the nurse will need to obtain a new certification from CGFNS prior to returning to the point of application.

Through the TN, healthcare providers have access to qualified nurses throughout North America, ensuring greater healthcare availability throughout the United States.

[1] See here.

© Copyright 2013 - 2023 Miller Mayer LLP. All Rights Reserved.National Law Review, Volume VII, Number 264

About this Author

David J. Wilks, Miller Mayer, Immigration Litigation Lawyer, employment-based visas attorney

David J. Wilks is an Associate in Miller Mayer’s Immigration practice group.

Mr. Wilks’ practice focuses primarily on employment-based immigration. He has represented a wide range of clients, including universities, multinational corporations, health care institutions, small businesses and entrepreneurs in seeking immigrant and nonimmigrant status for individuals in diverse fields and specialties. Mr. Wilks has also provided immigration expertise relating to large corporate acquisitions, as well as assisted clients with I-9 compliance and family...