The Rise of Internationally Trained Nurses (ITNs) in the U.S. and Canada: Immigration Pathways and Key Developments

With healthcare workforce shortages intensifying in both the United States and Canada, internationally trained nurses (ITNs) have become an essential part of the solution. Both countries have developed pathways and policies to attract these skilled professionals and address critical gaps.

Here’s a detailed exploration of the immigration pathways, credentialing processes, and key support initiatives shaping the landscape for ITNs.

United States: Comprehensive Pathways for ITNs

Employment-Based Green Card (EB-3 Visa)

• Eligibility: Registered nurses (RNs) fall under the Schedule A designation, which exempts them from the labor certification process typically required for employment-based green cards.

  
  

• Steps:

  
  

  1. Job Offer: ITNs must secure a job offer from a U.S. healthcare employer, such as a hospital or long-term care facility.

     
     

  2. Visa Petition: Employers file Form I-140 with U.S. Citizenship and Immigration Services (USCIS) on behalf of the nurse.

     
     

  3. VisaScreen® Certification:

     • Administered by the Commission on Graduates of Foreign Nursing Schools (CGFNS), this certification verifies:

       • Nursing education equivalency with U.S. standards.

       • Active nursing licensure.

       • English proficiency (via IELTS or TOEFL, unless educated in an English-speaking country).

         
         

  4. Consular Processing or Adjustment of Status: Nurses outside the U.S. undergo consular interviews, while those already in the U.S. can adjust their status.

     
     

• Processing Time: Green card issuance depends on country-specific visa backlogs, particularly for nurses from the Philippines and India

Temporary Work Visas

• TN Visa (USMCA):

  
  

  • Available to Canadian and Mexican nurses under the United States-Mexico-Canada Agreement (USMCA).

    
    

  • Requires proof of licensure, a job offer, and nursing credentials.

    
    

  • Processing is fast, with Canadian nurses often obtaining visas directly at border crossings.

    
    

  • Valid for three years, renewable indefinitely.

    
    

• H-1B Visa:

  
  

  • Reserved for specialized nursing roles requiring advanced degrees, such as nurse practitioners.

    
    

  • Subject to an annual cap of 85,000 visas unless the employer is cap-exempt.

Licensing and Credentialing

To practice in the U.S., ITNs must:

• Pass the NCLEX-RN: A standardized exam required for nursing licensure across all states.

  
  

• Meet State-Specific Requirements: Each state’s board of nursing sets additional requirements, such as background checks or additional exams. Some states require CGFNS certification before allowing nurses to take the NCLEX.

Canada: Robust and Streamlined Pathways

Express Entry System

• Federal Skilled Worker Program (FSWP):

  
  

  • ITNs apply through the Express Entry system, where they are scored on factors like age, education, language proficiency (IELTS/CELPIP), and work experience under the Comprehensive Ranking System (CRS).

    
    

  • Securing a provincial nomination (PNP) adds 600 points to the CRS score, guaranteeing an invitation to apply for permanent residency.

    
    

• Advantages: Direct pathway to permanent residency with access to full healthcare and social benefits. No employer sponsorship is required, though a job offer improves CRS scores​

Provincial Nominee Programs (PNPs)

• Provinces such as British Columbia, Alberta, and Ontario have healthcare-specific immigration streams. Examples include:

  
  

  • British Columbia Health Authority Pathway: Fast-tracks ITNs sponsored by provincial health authorities.

    
    

  • Alberta Advantage Immigration Program (AAIP): Prioritizes nurses with valid job offers.

Temporary Foreign Worker Program (TFWP)

• Employers hire nurses temporarily under the TFWP, often requiring a Labor Market Impact Assessment (LMIA) to demonstrate the need for foreign labor.

  
  

• Leads to employer-specific work permits, with potential for transitioning to permanent residency through Express Entry or PNPs.

Licensing and Credentialing

1. NNAS Evaluation:

   
   

   • Conducted by the National Nursing Assessment Service (NNAS), which evaluates nursing education, professional history, and language proficiency.

     
     

2. Provincial Registration:

   
   

   • Nurses apply for licensure with provincial bodies like the College of Nurses of Ontario.

     
     

   • Requirements may include the NCLEX-RN exam, jurisprudence tests, and proof of practice hours.

   
   

Support and Integration Programs

• The Canadian government has invested $115 million to enhance the Foreign Credential Recognition Program, expediting the credentialing process for 6,600 internationally educated healthcare workers.

  
  

• Bridging programs across provinces help ITNs fill gaps in their qualifications and adapt to Canadian healthcare standards

Challenges and Solutions

Challenges Faced by ITNs

• Credentialing Delays: Lengthy evaluation processes can delay workforce entry.

  
  

• Financial Barriers: Costs for exams, licensing, and immigration processes can be high.

  
  

• Cultural Adaptation: Adjusting to new healthcare systems and professional environments requires support.

Check out this "Navigating the Complexities: Challenges Faced by Internationally Educated Nurses" article to see more detailed examples and scenarios that can delay your journey.

Ongoing Solutions

• In the U.S., healthcare employers and recruitment agencies often sponsor visa and credentialing fees.

  
  

• In Canada, federal and provincial governments are funding bridging programs and providing financial support for childcare, transportation, and credentialing costs

Both the United States and Canada recognize the immense value that ITNs bring to their healthcare systems.

Through streamlined immigration pathways, enhanced credentialing processes, and targeted support programs, these nations are addressing critical workforce shortages while offering ITNs promising career opportunities.

These developments not only strengthen healthcare delivery but also underscore the importance of global talent in meeting local healthcare demands.

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