With the immigrant visa ("green card") annual quota being severely backlogged thereby resulting in a long and unpredictable waiting list and H-1B visas generally being unavailable for nurses, the search continues for faster ways for nurses to enter the United States to commence employment in their professions. Fortunately, under the North American Free Trade Agreement ("NAFTA"), nurses and physical therapists who are citizens of Canada and Mexico have a possible solution. The TN classification or visa pursuant to NAFTA is quicker and easier than the green card process, is not subject to annual quotas and is not subject to prevailing wage and other labor condition application ("LCA") requirements.

A registered nurse requires a state/provincial license or Licenciatura Degree. A physical therapist requires a Baccalaureate or Licenciatura Degree or a state/provincial license. In addition to the above credentials, the applicant must present a Canadian or Mexican passport and a letter from the prospective employer in the US which contains a job description, the anticipated length of stay and the salary. A VisaScreen certificate is required in all cases. All TN non-immigrants are subject to the laws of the state of intended employment regarding professional licenses but will not need to acquire the relevant license prior to admission to the US. However, the nurse or physical therapist must obtain the appropriate professional license from the state of intended employment prior to commencing employment.

A Canadian citizen may present the application package described above directly to an immigration officer at a US port of entry at the time of entry. The immigration officer will make the determination as to whether the applicant is admissible as a TN. No prior petition approval is required. No visa is required from a US consulate. Upon admission to the US, the Canadian citizen will be issued a Form I-94 for a period not exceeding 1 year which will be marked "multiple entry" and can be used for future entries to the US during its validity.

A Mexican citizen submits the application package described above directly to a US consulate as part of an application for a TN visa. The consul makes the determination as to whether the applicant is eligible for a TN visa. Upon admission to the US, the applicant will be given a "multiple entry" Form I-94 for a period not exceeding one year.

Spouses and unmarried children under 21 of the TN can be issued TD status or TD visas to accompany or follow to join the TN. A TD dependant is not permitted to work in the US but may attend school.

TN classification or a TN visa requires non-immigrant intent. As long as nonimmigrant intent continues to exist, the TN classification or TN visa can be extended in 1 year increments.

Obtaining permanent resident ("green card") status for a TN can be challenging. Because of the strict non-immigrant intent requirement of a TN, the limited validity period of 1 year for a TN and the lengthy immigrant visa quota waiting period, there generally is not enough time to complete the green card process before it becomes necessary to extend the TN for another year. If the green card process is started for a TN, there very likely will be problems extending the TN and/or re-entering the US after travel abroad. TN physical therapists may be able to resolve this issue by changing status to H-1B (a dual intent status) before starting the green card process.

A late April 2008 proposal to increase the period of stay for TN status from one year to three years has made its way through the OMB.  If this takes effect, Canadian and Mexican citizens who have TN status or visas pursuant to NAFTA as nurses, physical therapists and other allied healthcare professionals, may find it easier to move from nonimmigrant TN status to immigrant without adversely affecting their TN status, especially if one or both of the proposed laws to increase immigrant visa quotas is passed.