How to Work as a Nurse in the USA:
IEN Licensing, NCLEX & EB-3 Visa
— 2026 Ultimate Guide
Becoming a licensed registered nurse in the United States is a multi-step but rewarding journey for internationally educated nurses (IENs). With an ongoing national nursing shortage, qualified foreign nurses are in strong demand. This guide walks you through each stage — credential evaluation, English testing, state board application, NCLEX-RN, VisaScreen, and EB-3 employer sponsorship — so you can plan realistically. Popular starting points include nurses from the Philippines, India, Nigeria, the UK, South Africa, Australia, Canada, and the Middle East.
US Nurse Licensing at a Glance
Key figures every internationally educated nurse should know
On This Page
- 01 US Licensure Landscape
- 02 Step 1 · Verify Eligibility
- 03 Step 2 · Credential Evaluation
- 04 Step 3 · English Test
- 05 Step 4 · State Board Application
- 06 Step 5 · ATT & NCLEX-RN
- 07 Step 6 · VisaScreen
- 08 Step 7 · Work Visa & Sponsorship
- 09 Step 8 · Arrival & Integration
- 10 Timeline & Cost
- 11 Checklist
- 12 Final Advice
- 13 References
- 14 FAQ
🧭 Understanding the US Nursing Licensure Landscape
Before you start spending on exams and evaluations, understand how licensure in the United States actually works. These four points catch out most IENs on their first attempt.
🏛️ No Federal Nursing Licence
The US does not issue a single national nursing licence. Each state (and territory) has its own Board of Nursing (BON) with its own application forms, fees, and acceptance rules for international education.
📝 NCLEX-RN is Nationwide
Although licensure is state-based, the NCLEX-RN is the single examination used across every US jurisdiction. Passing NCLEX-RN is non-negotiable for becoming a registered nurse.
🎓 Credential Evaluation
Many state boards require a credential evaluation report from an approved agency to verify that your foreign nursing education is equivalent to US standards, while others (such as New York) conduct their own evaluation process instead.
🗣️ English Proficiency
English proficiency is usually mandatory unless your nursing education was delivered entirely in English in a recognised country. Rules vary by state.
✅ Verify Basic Eligibility
Before spending money on evaluations or exams, confirm you meet the common baseline most US state boards expect.
Confirm You Meet the Common Baseline
Most state boards of nursing expect internationally educated nurses to meet several baseline requirements before they’ll even accept an application.
- Recognised nursing qualification. Graduated from a nursing programme that meets international standards, with a diploma or degree recognised by your country’s nursing regulatory body. If you’re unsure who that is, the International Council of Nurses member directory is a good starting point.
- Active, unrestricted home licence. Hold a current and unrestricted nursing licence in your home country — with no active disciplinary action.
- Recent clinical experience. Employers often prefer 1–2 years of recent bedside nursing experience, although most state boards do not require it for licensure.
- English proficiency. Meet minimum English language standards if you weren’t educated in English in a recognised country.
🎓 Credential Evaluation — your first major step
Many state boards require a formal evaluation report from an approved agency confirming that your international nursing education meets US standards. Some boards (notably New York) conduct their own in-house evaluation instead — always confirm which route applies before paying an agency.
Order a Credential Evaluation Report
Approved credential evaluation agencies
- CGFNS International (Commission on Graduates of Foreign Nursing Schools) — now branded as TruMerit. Their Credentials Evaluation Service (CES) is the most widely accepted report for nursing licensure.
- Josef Silny & Associates (JSA) — accepted by many state boards.
- Educational Records Evaluation Service (ERES) — accepted by some state boards.
What the evaluation actually checks
- Authenticity of your nursing diploma and academic transcripts.
- Comparison of your course content against US nursing education standards.
- Verification of your home-country nursing licence status.
- A certification of equivalency — or a recommendation for bridging if gaps are identified.
Documents you’ll typically need to submit
- Nursing diploma and official transcripts — these must be sent directly from your school to the agency (not by you).
- Nursing licence verification from your regulatory council.
- Passport copy and any additional documents requested by the agency.
🗣️ English Proficiency Testing
English proficiency is essential in most states for patient-safety reasons. Start this early — results are needed for both licensure and visa processes.
Book an Accepted English Test
Commonly accepted tests and typical minimum scores
- TOEFL iBT — minimum total scores often in the 83–100 range, with set minimum sub-test scores.
- IELTS Academic — overall 6.5–7.0, with no section usually below 6.0–6.5.
- Pearson Test of English (PTE) Academic — accepted by several states.
Who may be exempt
- Nurses whose nursing education was completed in recognised English-speaking countries — including the US, Canada (except Québec), the UK, Ireland, Australia, and New Zealand — may be exempt in some states.
- Even in these countries, some state boards may still require formal proof of English proficiency — always verify with the specific board before assuming you’re exempt.
🏛️ Apply to Your US State Board of Nursing
Choose a state carefully. Job market, licensure friendliness, and the Nurse Licensure Compact should all influence your decision — not just salary headlines.
File Your State Board Application
Key steps in a state board application
- Choose a state. Consider job market, licensure friendliness, cost of living, and processing times. Popular states with international nurses include New York, Texas, California, Florida, and Illinois. Use the NCSBN directory to find each state’s Board of Nursing.
- Submit your credential evaluation report, English proficiency proof, application forms, and fees (typically $100–$400, depending on the state).
- Complete a criminal background check and provide fingerprints.
- Explore provisional permits. Some states may offer limited or temporary permits allowing supervised practice while your full application is being processed — availability and scope vary significantly and many states do not offer them at all.
Nurse Licensure Compact (NLC)
- The Nurse Licensure Compact lets nurses holding a multistate licence practise in multiple participating states with a single licence.
- To qualify for a multistate licence, you must declare a Compact state as your primary state of residence.
- Even if you later move, strategic choice of your first state can save time and fees later.
📝 Authorization to Test and the NCLEX-RN
Once your state board approves your application, you’ll receive an Authorization to Test (ATT) letter. Your NCLEX-RN journey begins here.
Register, Prepare, and Pass the NCLEX-RN
The ATT letter allows you to schedule the NCLEX-RN at a Pearson VUE testing centre. Don’t delay — most ATTs come with an expiry window.
About the NCLEX-RN
- Computerised adaptive test that evaluates safe, effective nursing practice.
- Covers health promotion, psychosocial integrity, physiological integrity, and safe care environment.
- The number of questions varies depending on performance under the adaptive testing model, with up to around five hours allowed.
- Uses the Next Generation NCLEX (NGN) format, including case studies and new item types that test clinical judgement.
How to prepare
- Use a reputable NCLEX question bank (UWorld, Kaplan, or similar) and focus on rationale-based learning — not just memorisation.
- Take at least one full-length practice test under timed conditions before your real exam.
- Consider a structured review course if you struggle with US-style question formats or NGN case studies.
🛂 VisaScreen® Certificate — US immigration requirement
The VisaScreen certificate is effectively a “healthcare passport” for US immigration and is required for most healthcare-worker immigration pathways before a foreign nurse can receive a work-based visa or green card.
Obtain Your VisaScreen Certificate from CGFNS
What VisaScreen actually certifies
- Your nursing education meets US standards (credential evaluation confirmation).
- Your English proficiency meets required thresholds (where applicable).
- You have passed the NCLEX-RN.
- Your home-country nursing licence is valid and in good standing.
Key things to know
- VisaScreen is issued by CGFNS / TruMerit.
- It is required by the US Department of Homeland Security for most healthcare-worker immigration pathways, though the specific requirement depends on visa category and role.
- Each certificate is valid for five years.
- Processing usually takes several weeks to a few months — plan accordingly.
✈️ Securing a US Work Visa & Employer Sponsorship
Most IENs enter the US on an EB-3 immigrant visa with employer sponsorship. A smaller number use H-1B or TN visas in specific circumstances.
🟢 EB-3 Immigrant Visa
The mainstream immigrant-visa route for bedside registered nurses. Your US employer files a Form I-140 immigrant petition with USCIS. Professional nurses are often Schedule A pre-certified, which skips the separate labour-certification step.
- Leads to a green card (lawful permanent residency).
- Employer sponsorship required.
- Processing times vary and may change depending on Visa Bulletin movements — historically shorter for most countries of birth, but with multi-year backlogs for nurses born in India and the Philippines.
🔵 H-1B Visa
A non-immigrant “specialty occupation” visa, rarely granted for typical bedside RN roles. More common for advanced practice roles (e.g., NP, CRNA) or specialist RN positions that clearly require a bachelor’s-plus level of expertise.
- Temporary status (dual-intent possible).
- Employer sponsorship required.
- Annual cap applies — lottery-based selection.
🟡 TN Visa
Available to Canadian and Mexican nurses under the USMCA (former NAFTA) TN framework. Processing is typically fast, but this is a non-immigrant classification.
- Available to Canadian and Mexican citizens.
- Requires a US job offer in a qualifying profession.
- Renewable, but not a direct path to permanent residency.
🏥 Arrival and Workforce Integration
Landing in the US is not the last step. The first months on the ground are critical for licensure maintenance, employer onboarding, and clinical adjustment.
Settle In and Set Up for Long-Term Success
- Social Security Number (SSN). Apply with the Social Security Administration as soon as you arrive — it’s needed for payroll, tax, and many employer systems.
- Employer orientation and onboarding. Most US hospitals run multi-week orientation programmes for new RNs, including competency testing, EHR training, and shadow shifts.
- Maintain your licence. State boards require periodic renewal and, in most states, ongoing Continuing Nursing Education (CNE) or Continuing Professional Development (CPD) hours.
- Adapt to US clinical practice. US nursing puts strong emphasis on documentation, standardised protocols, interdisciplinary teamwork, and patient advocacy. Expect a learning curve even with strong bedside experience from home.
⏱️ Detailed Timeline & Cost Breakdown
Ranges are typical, not guaranteed. Country-of-birth EB-3 backlogs are the single largest driver of the upper bound.
| Step | Typical Duration | Approx. Cost (USD) |
|---|---|---|
| Credential evaluation | 3–6 months | $350–$700 |
| English proficiency test | As needed | $150–$250 |
| State board application | 1–3 months | $100–$400 |
| NCLEX exam preparation & testing | As needed | $200–$500 |
| VisaScreen certification | 4–8 weeks | ~$560 |
| Visa & immigration processing | Varies (see below) | Varies |
| Typical end-to-end: 2 years to 10+ years · Approximate out-of-pocket (pre-visa): $1,500–$3,000+ depending on pathway and preparation costs | ||
The wide upper bound on the total timeline is driven almost entirely by EB-3 visa backlogs for nurses born in India and the Philippines. Wait times for most other countries are much shorter. Always consult the current US Visa Bulletin and, ideally, a qualified immigration attorney for a personalised estimate.
✅ Checklist for US Nurse Registration
A sequential checklist you can work through. Download it as a PDF, print it, or save this page and tick items off as you progress.
🇺🇸 Full IEN to RN checklist
Your step-by-step progress tracker from credential evaluation to US employment.
- Verify nursing education meets US standards.
- Obtain credential evaluation report (CGFNS/TruMerit, JSA, or ERES).
- Take and pass required English test (TOEFL iBT, IELTS Academic, or PTE Academic).
- Choose a state and apply to its Board of Nursing.
- Complete background check and fingerprinting.
- Receive Authorization to Test (ATT) from state board.
- Register for and pass the NCLEX-RN examination.
- Apply for and receive the VisaScreen certificate.
- Secure US employment with a sponsoring employer.
- File your visa petition (EB-3, H-1B, or TN).
- Arrive in the US and obtain a Social Security Number.
- Complete hospital onboarding and preceptorship.
- Maintain licensure with state-mandated continuing education.
💡 Final Advice & Resources
Four principles that separate IENs who get to the US in a few years from those who get stuck for a decade.
Start early
Begin credential evaluation and English testing well before you plan to move. Nothing on this pathway happens quickly — early starts compound.
Stay organised
Keep meticulous records and copies of every document, email, and receipt. When boards or USCIS ask for something, you need it in hand the same day.
Use official resources
CGFNS/TruMerit, NCSBN, USCIS, and Pearson VUE are your primary contacts. Avoid informal “agents” promising shortcuts — the official routes are the only safe ones.
Be patient
US immigration is slow and inflexible. Plan your career timeline accordingly and keep working in your home country on skills that transfer well (ICU, ED, paediatrics).
📚 Official References & Sources
Authorities used to build this guide. Requirements change often — always verify directly with these primary sources before paying fees or booking exams.
- National Council of State Boards of Nursing (NCSBN) — directory of every US state/territory board of nursing and the authority behind the NCLEX-RN.
- NCSBN — Nurse Licensure Guidance — foundational source for how US nursing licensure is regulated at the state level.
- NCSBN — Nurse Licensure Compact (NLC) — current list of Compact states and multistate licensing rules.
- Pearson VUE — NCLEX — official registration and testing-centre portal.
- CGFNS International (TruMerit) — primary credential evaluation and VisaScreen authority for internationally educated nurses.
- CGFNS — VisaScreen Visa Credentials Assessment — official VisaScreen information page.
- Josef Silny & Associates (JSA) — alternative credential evaluation agency accepted by many state boards.
- Educational Records Evaluation Service (ERES) — additional credential evaluation agency accepted by some state boards.
- US Citizenship and Immigration Services (USCIS) — primary source for visa petitions, Form I-140, and adjudication status.
- USCIS — Employment-Based Immigration: Third Preference (EB-3) — official reference for the mainstream nurse immigrant-visa category and Schedule A pre-certification.
- USCIS — H-1B Specialty Occupations — source for the specialty-occupation framework referenced for APRN and specialist roles.
- US Department of State — Visa Bulletin — monthly bulletin that drives EB-3 wait-time calculations by country of birth.
- USTR — USMCA (TN visa framework) — basis for TN visa eligibility for Canadian and Mexican nurses.
- ETS — TOEFL iBT — official TOEFL registration and score information.
- IELTS — Academic test — official IELTS Academic information for licensure applicants.
- Pearson Test of English Academic (PTE Academic) — official information on the PTE test accepted by several state boards.
- NurseOnShift — How to Work In (hub) — parent hub linking this US guide to the UK, Australia, Canada, and Spain pathways.
- NurseOnShift Editorial Policy and Medical Review Process — editorial and clinical-review standards.
Important: licensure requirements, accepted language tests, exam fees, and visa wait times all change. The sources above are authoritative but may update at any time. Always verify current details directly with the regulator or immigration authority, and consider speaking with a qualified immigration attorney before committing to any visa route.
❓ Frequently Asked Questions
Answers to the questions we get most from internationally educated nurses planning to work in the US.