Nursing in the U.S.A

TN Visas and VisaScreen: Effects on U.S. Nursing

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VisaScreenTM requirements:

  1. VisaScreen application and application fee.
  2. Complete nursing school(s) forms. Academic transcripts must come directly from the nursing school(s).
  3. Complete licensing authority(ies) forms. Validations of all licenses, past and present, must come directly from the licensing authority.
  4. Successful completion of an English language proficiency test. Scores must be directly forwarded to the International Commission on Healthcare Professions (ICHP) from the testing agency. Some countries are exempt from this requirement– specifically Canada (except for Quebec).
  5. Completion of either the Commission on Graduates of Foreign Nursing Schools (CGFNS) Qualifying Exam or the NCLEX-RN.
  6. Copy of high school diploma or equivalent.


For more information on VisaScreen, TN Visas or CGFNS, please visit or call (215) 349-8767.

By Jennifer Diamond, contributor

Hundreds of nurses who have come to the United States from Canada must satisfy new immigration requirements if they wish to continue working when their current TN Visa expires after July 26, 2004.

AMN Healthcare, a temporary health care staffing company based in San Diego, California, is gearing up to help Canadian nurses meet the challenge.

“We know the legislation is a reality and [we] are ready to fully comply with the new laws,” said quality management manager Leigh Little, one of the lead members of a new AMN Healthcare tactical team focused on Canadian nurse screening.

Under the new law, Canadian nurses are no longer able to work in the U.S. without additional screening as part of the TN Visa requirement. Section 343 of the Illegal Immigration Reform and Immigrant Responsibility Act (IIRIRA) of 1996 requires most health care professionals from foreign countries–physicians are exempt–to obtain additional requirements before taking a position at a health care facility in the U.S. The new screening process is an assessment of the health care professional’s educational background and licensure.

Nurses will also be required to successfully complete either the current NCLEX-RN exam or the Qualifying Exam administered by the Commission on Graduates of Foreign Nursing Schools (CGFNS), testing their English language and skill set compatibility.

The new assessment, called VisaScreen, can be administered only by the International Commission on Healthcare Professions (ICHP), a division of the CGFNS. Because CGFNS is the only agency currently approved to administer VisaScreen, it may take Canadian nurses as long as six months to qualify to work in this country.

As the deadline draws closer, health care staffers, both in health care facilities and agencies, worry how the new legislation will affect the nursing shortage in the U.S.

The National Council of State Boards of Nursing (NCSBN) estimates that 10,000 to 15,000 nurses, currently licensed by their state boards and working in the U.S., might not be able to continue work if they are unable to get their certification on time.

Losing these health care workers will put more strain on an already understaffed health care system. The U.S. faces a shortage of nearly 126,000 nurses.

The U.S. has long looked to Canada for a steady supply of nurses because of their similar training and educational background–meaning there’s virtually no ‘learning curve’ with Canadian nurses. Plus, TN Visas can usually be obtained in days, enabling these nurses to start working immediately at U.S. health care facilities.

The new law, however, is expected to delay the compliance process by two to six months, prolonging the time it takes to staff U.S. hospitals with Canadian nurses.

VisaScreen compliance is an extensive process that can sometimes be confusing. For example, individuals applying for a TN Visa before the deadline of July 26 will have one year upon entering this country to complete the VisaScreen requirement. Those already working in the country will have until their current visa expires to comply with the new requirement. Furthermore, when renewing their TN Visa after the proposed deadline, the foreign health care professional will also be responsible for the VisaScreen requirement.

AMN Healthcare employs many Canadian health care professionals. Since the new legislation directly affects all of them, AMN Healthcare formed a tactical team to focus on the issue by addressing the revised Canadian application process. AMN Healthcare is also taking steps to ease the financial burden on Canadian travelers obtaining VisaScreen certification through a generous expense reimbursement program.

“The creation of our team not only streamlines the screening process for our current Canadian travelers, but also helps take the hassle out of coming to work in the U.S. for future Canadian nurses,” Little said.

Although AMN Healthcare, other temporary staffing companies and various nursing organizations sent letters to Tom Ridge, Secretary of Homeland Security, urging that the Department delay its implementation of the rules for an additional 12-to-18-month period, the July 26 deadline still exists.

“We’re in a wait-and-see situation with the new requirements,” said Marcia Faller, RN, BSN and senior vice president of nursing at AMN Healthcare. “We know it will go into effect eventually, but we are expecting that there may be some relief on implementation on a temporary basis. However, given that this relief may not arrive until the 11th hour, we’ve already implemented a program within our organization to ensure efficient VisaScreen compliance for current and future Canadian travelers.”

© 2004. AMN Healthcare, Inc. All Rights Reserved.