How TN Visas Can Help with RN Labor Shortage

The United States has been experiencing a nursing shortage for over a decade and in the last couple of years the problem has reached a critical state.

The Covid19 pandemic has only compounded the nursing problem. Allowing registered nurses to enter the workforce from Canada and Mexico using TN visas may ultimately assist in alleviating the deficit and meet the needs of specialty niches.

Nurses play a crucial role in the healthcare system. Reports show that healthcare facilities and hospitals experience improved safety, better patient outcomes and lower mortality rates when they employ a sufficient number of nurses.

The need for skilled nursing seems almost insurmountable with projections showing by 2030, over 1 million registered nurses (RNs) will be needed to even come close to meeting the demands of the growing healthcare industry. The United States Bureau of Labor Statistics (BLS) has reported that approximately 175,900 job openings for RNs will occur each year until 2029. 
While there is no shortage of great nursing programs in the United States, the TN visa for registered nurses (RNs) is a valuable resource in addressing the nursing shortage faced by the United States. 
These days, RNs across the country are working unbearably long hours, sometimes 60-hour weeks or more, caring for patients in hospitals, while bearing the brunt of what is now called the fourth wave of coronavirus. Even before the pandemic, the U.S. Bureau of Labor Statistics reported RNs are in high demand, with the occupation expected to grow faster than average

Read on for more information about how the TN visa program can provide an opportunity for RNs from Canada and Mexico to work and live in the U.S., providing a pathway for their families and greater access to healthcare for all Americans.

What is a TN Visa?

The TN visa category is a type of employment-based work visa created by the North American Free Trade Agreement’s (NAFTA) special economic relationships between Canada, United States, and Mexico. Under the TN visa, certain workers from Canada and Mexico may come to the United States to work. These professionals include, among others, professionals like:

  • Accountants
  • Engineers
  • Lawyers
  • Pharmacists
  • Scientists
  • Teachers
  • Nurses

The TN visa for nurses is just one of many kinds of professions addressed in the NAFTA agreement, but it is an invaluable one for the American healthcare system.

History of the TN Visa

The TN nonimmigrant visa was formed as a way to facilitate temporary employment within the United States under the North American Free Trade Agreement (NAFTA). The visa program was created for Mexicans and Canadians in an effort to strengthen both business and trade relations between Canada, Mexico, and the United States. Two classifications were developed. The TN-1 for Canadian citizens and TN-2 for Mexican citizens.

Using the TN visa program, thousands of Mexicans and Canadians have been able to develop long-term working relationships as beneficial and productive professionals in the United States.
All TN visa applicants have to have qualified with one of the approved professions as outlined on the NAFTA list such as an RN.
How bad is the RN shortage?
Reports show that the RN shortage is only going to become more dire with 1.2 million new registered nurses (RNs) needed by 2030 just to balance the shortage. As of 2021, RNs were the fifth most in demand job in the United States.
The shortages are a result of population growth, an increase in RNs reaching retirement age, and a lack of new nursing school graduates. That was before the COVID-19 pandemic hit.CNN reported that, of the 418,000 RNs across the U.S. who resigned from their jobs in 2017 30 percent of them attributed it to burnout. Now, healthcare systems across the state are reporting double digits staffing shortages, with the nurses who are on staff experiencing serious burnout, an existing problem worsened by the pandemic.
Non-Immigrant TN Visa for Canadian and Mexican Registered Nurses
The least complicated pathway into the United States for a registered nurse to work is the TN visa for Canadian and Mexican nationals. The TN visa classification for the United States-Mexico-Canada Agreement (USMCA) allows nurses with non-immigrant intentions to work in the U.S.,
Visa-exempt Canadian nationals are allowed to apply for a TN-1 admission with documentation at a U.S. port of entry or during a preflight inspection. Mexican nationals must apply for the TN-2 stamp via the U.S. Consulate before entering the U.S.
Mexican and Canadian registered nurses seeking entrance into the U.S. with a TN visa must have a valid passport from their country of origin. They also must possess a provincial or state nursing license or possess a Licenciatura Degree.
All RNs are required to show where they intend to work along with a valid job offer from a U.S. employer. They also must agree to acquire Visa Screen credentials from the CGFNS (Commission on Graduates of Foreign Nursing Schools) which clearly shows they possess the required education, licenses, and exam scores. They also must display proficiency in the English language.
How can the TN visa program help with the RN shortage?
The TN visa category is an indispensable tool that can help resolve the RN shortage because it addresses one widespread problem RNs face when trying to get work permits to come to the United States. Many RNs do not qualify for a work visa under the H-1B program because their nursing license does not require a bachelor’s degree. For nurses with Mexican or Canadian citizenship, however, the TN program offers a special pathway.
Unlike the H-1B visa category, there is no limit on the amount of TN visas that may be issued. This means that there is an unlimited potential for qualified nurses to enter the United States and help close the gap in healthcare. In July of 2021 alone, 2,862 TN visas were issued in total to qualifying temporary workers; of those, 2,855 originated in Mexico, five in Canada, and two at European consulates.
Who qualifies for a TN visa?
The TN visa category provides nonimmigrant status to qualified Canadian and Mexican citizens to enter into the United States to work. In order to qualify, visa applicants must:
  • Be a citizen of Canada or Mexico.
  • Be a member of a qualified profession under Section 214.6 of the Immigration and Naturalization Act
  • Have a pre-arranged full- or part-time job that requires a NAFTA professional with a U.S. employer; and
  • Prove the qualifications to practice in the profession.
There is not a separate application or category for different professions, but each visa applicant must show they meet the qualifications to practice their profession in the United States. For RNs, which means:
  • Holding a valid Canadian or Mexican passport.
  • Possessing a valid state or provincial nursing license, or holding a Licenciatura Degree (the equivalent of a bachelor’s degree); and
  • Providing proof of the job offer in the form of a letter from the employer
What’s the process for getting a TN visa?
The process of obtaining work authorization under the TN visa program varies depending on the applicant. Because Canadian citizens are not required to have a visa in order to enter or stay in the United States, the process may begin at the border.
The RN will need to show proof that they have secured potential placement with a U.S. based employer. Canadian RNs may submit their proof of eligibility for the temporary work authorization under the TN category directly to Customs and Border Patrol (CBP) agents at a port of entry, pay the TN processing fee and be admitted upon approval.
Because Mexican nationals require a visa in order to enter the United States as a TN nonimmigrant, the process must begin before arriving in the United States. Mexican nationals must:
While providing proof of RN licensure is not required for the TN visa classification, it is required for the job itself, and it makes TN nonimmigrants even stronger candidates. Because strong candidates without any disqualifications are rarely denied, providing the best evidence possible is always a clever idea.

All TN nonimmigrant RNs should be aware of a few key points and tips to keep their employment and entry into the United States going smoothly.

  • Use optimized POEs: While they can go to any port of entry (POE), CBP recommends that all Canadian RNs apply during regular business hours, and applicants should use these optimized POEs, especially if they are first-time applicants.
  • Bring original documents: Whether applicants are entering from Canada or applying south of the border, United States officials will expect to see original documents as evidence. Know what is needed before attempting to cross the northern border or attending a visa interview in Mexico.
  • Request a PED date notation: TN nonimmigrant visas can be valid for up to three years at a time, but the visa stamps issued to Mexican nationals might indicate a period of twelve months without the additional notation of the full duration requested on the DS-160 application. At the visa interview, this notation can be requested, which will let CBP officials know what to include on the I-94 record issued at the time of entry into the United States.
Additional TN Visa Considerations
Below are a few common considerations concerning TN visas and RNs.
  • Family Members: The spouse and any children under the age of 21 are allowed to accompany the TN holder. They are allowed to apply for a TD (Trade Dependents) visa status. When the RN applies for a TN visa, the spouse and children should show their proof of relationship to the nurse along with valid passports.
If the spouse or children apply for a TD visa at a different time than the nurse applies for the TN visa, then they will be required to show proof of the RN’s TN status such as a copy of the I-94.
Non-Canadian spouses and children are required to apply at the U.S. consulate for a TD visa even if the nurse is not Canadian.
Proof of relationship can include:
  • Marriage certificate for the spouse
  • Birth certificates for the children
  • Nurse Practitioner:  Nurse practitioners are classified within the Registered Nurse TN category. CBP officers are notorious for being inconsistent in many cases so a Nurse Practitioner might be faced with a bevy of additional questions that a RN doesn’t face.
  • Tips for Border Application: Canadians should apply for their TN status during regular business hours. Applicants can also visit the CBP website for a list of optimized ports.
  • Documents: Always provide original documents and no photocopies.
  • Visa stamps: Visa stamps issued to Mexican applicants are valid for 12 months, but make sure the visa stamp has a PED date which lists time allotment of up to three years as requested by the employer. If the vis does not have the stamp, then the applicant should request the stamp notation be added. Upon insurance into the U.S. the I-94 dictates the length of stay and not the visa stamp.
  • Changing employers:  If the nurse changes employer, then she will need to obtain a new letter from the next employer. A new certification from CGFNS might also need to be obtained before returning to the point of application.
What must employers do to hire TN visa RNs?
Employers only need to find the best people for the jobs available and provide them with official offers of employment. Because of existing agreements under NAFTA, employers do not need to file petitions with the Department of Labor or United States Citizenship and Immigration Service (USCIS) to hire TN nonimmigrant nurses. However, employers or their attorneys, may need to submit a petition to extend the status of their TN employees or request a change to TN status for nonimmigrants already in the United States under a different classification.
Consider, for example, the exceptions to the student visa off-campus employment restrictions. A healthcare facility may employ a nursing student in Curricular Practice Training (CPT) or Optional Practice Training (OPT) capacity and want to hire that student after graduation and licensure. At this time, the visa holder would apply to adjust status from a student visa to a TN nonimmigrant visa, and the employer will need to file their petition.
Only one I-129 needs to be filed if the RNs will all be employed for the same period of time, which, considering the long-term projected need of the healthcare profession for RNs, is for the three years admission allowed by the TN classification. In order to strategically plan for the future, employers who are seeking to fill gaps in their RN labor force may want to consider how an experienced business immigration attorney can help them streamline their employment processes to avoid unnecessary paperwork and fees.
What’s the timeline to get a TN visa?
Current administrative processing times for Form I-129, as of August 2021, areabout one month, while the wait time for a visa interview at most U.S consular offices in Mexico is about two weeks. Once approved and allowed entry into the U.S. to work, all TN nonimmigrant RNs are ready, from an immigration standpoint, to begin work!
What are the conditions and limitations of a TN visa?
There are far more advantages to RNs from Canada and Mexico entering the United States on a TN nonimmigrant visa classification than there are disadvantages. However, employers with significant gaps to fill, such as county health systems in large, urban areas, will likely want to apply strategic, long-term planning in order to reduce administrative costs and leverage the full benefit of the program.
For visa beneficiaries, it is important to consider that the TN visa program is not a dual intent visa, and so it will be necessary to continue to demonstrate the intent to return to the home country at the end of the employment period. The spouse and eligible children of TN visa beneficiaries can also apply for TD visa status, which will allow them to live in the United States for the duration of the TN visa holder’s I-94.
Can you change employers with a TN visa?
If you are an RN in the country on a TN visa, then your visa is employer specific and only good with your current employer who must satisfy all of the requirements to employ TN visa holders. If you need to change employers, then you’ll want to make sure that the new applicant is approved for TN status . Remember, it is a violation of the immigration law to work for a different employer than the one listed on your I-94 card.
If you wish to change employers while in the U.S. on a TN visa, then you can handle the process in one of two ways:
1. Form I-129
TN visa holders who want to change employers but continue working as a registered nurse for the new employer can file a form I-129 with the USCIS. The TN visa holder can remain in the U.S. as the paperwork for the new employer is processed. The processing time is often lengthy, especially if the processing service center is backlogged. A foreign worker employment agency can help with the paperwork to help ensure a smooth transition.

2. Port of Entry Application
Applying at a port of entry is basically like applying for a new TN. The process is the same except that the RN can present their job offer and a letter from the new employer combined with all other documents directly to the CBP officer.
The application is always subject to the same scrutiny as any other TN visa application so always pay close attention to detail to ensure that everything is correct, and you have all documentation on-hand. You’ll receive a decision about the TN visa the same day when you conduct the process at the port of entry. In addition, you avoid having to pay the USCIS filing fee by taking care of the process at the port of entry.
Do TN Visa Holders Pay Federal Taxes?
As a registered nurse with a TN visa working in the U.S., you’ll need to pay three main tax categories: Federal Income Tax, Medicare/Social Security, and Federal Unemployment Tax. How you file and which you pay depends on tax treated and totalization agreements that exist between the United States and your home country.
Federal Income Tax
If you are considered a resident alien, then you have the same obligations of any U.S. citizen which means that each year you must file Federal income tax. You’ll need to file a form W-4 which is an Employee’s Withholding Certification with your employer. However, if you are considered a nonresident alien then your taxes fall under certain guidelines that are outlined in Chapter 9 of theIRS Publication 15 Circular E Employer’s Tax Guide
Social Security and Medicare
Whether or not a TN visa holder will pay Social Security and Medicare taxes will depend on the Totalization Agreement between their country and the United States.
Canada has a Totalization Agreement with the U.S. so any Canadian with a TN visa is not required to pay Social Security taxes.
Mexico’s Social Security Totalization Agreement is not currently in effect so Mexican citizens who are in the U.S. on a TN visa must pay Social Security taxes.
In some situations, your TN profession might not be subject to Social Security and Medicare taxes. You’ll want to check out the IRS Employer’s Tax Guide to determine your particular profession’s status.
Federal Unemployment Tax
The Federal Unemployment Tax Act (FUTA) requires that employers cover unemployment compensation at both the state and federal levels. The FUTA rate is 6% but the wage base does vary between states. The unemployment tax is never withheld from the wages of a TN visa holder. It is the responsibility of the employer to pay the federal unemployment tax.
Do You Pay State Taxes on a TN Visa?
States within the U.S. have individual income tax systems. If you earn wages, then you can typically expect to pay a state tax. Depending on the state, they usually follow the federal tax income rate, but TN visa holders usually pay slightly more. Many of the states do not recognize any taxes paid outside the U.S. when imposing taxes.
Does Hiring Foreign RNs Impact American Nurses?
The U.S. population is aging and increasing. It is forecast that the number of U.S. citizens aged 65 and older will reach 87.5 million by 2050. The workforce is also shrinking. The COVID19 pandemic has even impacted those numbers more dramatically in the last two years. Hiring foreign nurses promises to help fill the healthcare gaps without negatively impacting American nursing jobs. Despite the proponents, some do oppose the influence of foreign nurses due to a belief that they will lower the wages of the current domestic nurses.
The University of Illinois recently carried out a study that found no effect on American nurses. Hyeran Chung, a doctoral student at the Department of Agriculture Consumer Economics at U of I and Mary Arends-Kuenning, an associate professor at ACE analyzed data they collected from the U.S. Census and the American Community Survey from 1980 to 2015. The researchers found that foreign nurses did not impact native nurses either short term or long term. There was no displacement of American nurses. The foreign educated nurses also did not lower U.S. wages.
Denial of the TN Visa
The CBDP or USCIS can deny a TN visa application for a variety of reasons.

In admissibility can occur due to:
  • A criminal conviction
  • The job offers, TN application and the RN’s degree do not match.
  • A combination of education and experience cannot substitute for a bachelor’s degree or specific required license – any applicant who wants to use such a combination should consider applying for an H-1B visa instead of the TN.
If a TN visa is denied then the applicant can reapply, but things might not be as clear cut the second time. Returning applicants usually have their applications more precisely reviewed with even greater scrutiny.
A CBP officer is often reluctant to rule against a previous application denial. Such a situation is especially true if the applicant is unable to satisfactorily overcome the first denial’s issues.

A returning applicant must address all problems from the first application in order to overcome a denial and obtain admission into the U.S. A TN visa management consultant can collaborate closely with the applicant to help resolve any problems that caused the initial first denial.

TN Visa Extension/Renewal

An TN visa holder can extend or renew their visa using Form I-129 from the USCIS while providing proof of citizenship and education along with a complete letter outlining the reason for the extension.

It should be noted that when the job ends, or the TN visa expires then the visa holder must leave the U.S. No grace period is given, unlike with the H-1B which does have a certain leeway time span.

If, after applying for an extension, it is granted then the visa holder’s TN status is approved for another three years.

There are specific time periods coupled with processing time that are put in place for petitions with extensions. A TN employer has only six months to file an extension before the current TN expires. Processing times for extensions do vary, but typically take from two to four months to complete. When working with a foreign worker agency, they can often streamline the process and are prepared to meet the needs of any requests by the USCIS for additional documentation or evidence.

Via Form I-129
For those changing their TN employers but working under the same professional occupation, they can reapply by filing Form I-129 with the USCIS. This option allows the TN visa holders to remain in the U.S. while processing. The downside, however, is that the processing time may be lengthy, especially if the particular service center handling the application has a lot of backlogs. There’s also the Form I-129 filing fee. Still, the TN visa holder and the prospective employer could always opt for premium processing.
At a port of entry

A TN visa holder can return to their home country and then reapply for the TN visa at any U.S. port of entry. For Canadian nurses, this option is an easy and quick way to extend any authorized stay because they can bypass waiting for the USCIS to adjudicate on their I-129 petition. As with any visa application process, all required documents are needed for the current employer but also completely satisfy the TN visa requirements.

Conclusion

The nation is in the grips of a healthcare shortage crisis and the need for RNs across all sectors has never been greater. Many would say that America has hit a code red situation due to the limited number of nurses available.

Registered nurses work in a variety of settings serving families and individuals in need. If you are a registered nurse interested in entering the United States to pursue a position as an RN, please contact AW Labor Solutions to learn more about potential job openings. If you are a healthcare service provider and are seeking qualified, English-speaking Registered Nurse applicants, please contact AW Labor Solutions to help you match the right candidate with the right job.

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