Education to Work as a Foreign Nurse in the U.S.

If you trained and licensed as a registered nurse in another country, you can practice in the United States, but you have to clear a fixed set of hurdles first: language proficiency, credential verification, a qualifying exam, the NCLEX-RN, a state license, and a work visa. The ongoing U.S. nursing shortage makes this a practical time to make the move. Requirements vary by state, so confirm the specifics with the Board of Nursing where you plan to live.

Steps for becoming a foreign nurse in the U.S.

Meet the education requirements. Before you start, make sure you qualify: a degree from an accredited registered nursing program, a current RN license in your home country, and two years of full-time work experience as an RN.

Submit your credentials. Send transcripts from your highest secondary education and your nursing degree to the Commission on Graduates of Foreign Nursing Schools (CGFNS), the federally approved nonprofit that certifies foreign-educated nurses for U.S. healthcare roles. CGFNS verifies a general high school education plus postsecondary instruction in five areas: adult medical, adult surgical, neonatal, pediatrics, and psychiatric. If your transcripts are not in English, submit translated copies of the originals. If your school cannot translate them, CGFNS will, for a fee.

Take an English-language proficiency test. This is not required for everyone, but CGFNS often requires it. You can take the Test of English as a Foreign Language (TOEFL) or the International English Language Testing System (IELTS); TOEFL is more common. Test early, because you will need your scores for later steps. Scores are valid for two years.

Get certified with CGFNS. Beyond credential approval, most states require additional steps for licensure. The CGFNS Certification Program bundles credential verification, proof of English proficiency, and a passing CGFNS Qualifying Exam score into one package that satisfies State Board of Nursing criteria. CGFNS also offers VisaScreen, which does everything the certification program does and satisfies the federal screening requirement for a work visa. CGFNS is the most recognized option, but cheaper alternatives exist, including the International Educational Research Foundation and the Educational Records Evaluation. Check with your State Board of Nursing to confirm which they accept.

Pass the NCLEX-RN. Every state requires this exam to practice as an RN, with no exception for foreign-educated nurses. You register through Pearson VUE and pay a $200 fee. The test is administered internationally in Australia, Brazil, Canada, England, Hong Kong, India, Israel, Japan, Mexico, the Philippines, Puerto Rico, South Africa, South Korea, Taiwan, and Turkey.

Apply for your nursing license. With verified credentials and passing scores, apply for your RN license through your state board. Requirements vary, so expect additional steps before you can start working.

Find a nursing job. CGFNS encourages foreign-educated nurses to work with a staffing agency, which helps with the next step of securing a work visa. CGFNS maintains a list of certified recruiters.

Obtain your work visa. To work legally in the U.S., you need one of these: a TN visa (for Mexican and Canadian nurses), an H-1B temporary work visa, or a permanent work visa.

How long does the process take?

Starting from abroad, expect several years, partly because the U.S. caps the number of green cards issued to people from any single country. If you already live in the U.S., you can usually start working much faster. Scheduling the CGFNS Qualifying Exam, the NCLEX-RN, and any English proficiency tests as early as possible shortens the timeline. Set realistic expectations based on your experience and circumstances, and map out what you need to complete and how long each step takes.

How much can foreign-educated nurses earn in the U.S.?

There is no public data isolating foreign-educated nurse pay, but the median salary for registered nurses was $93,600 in May 2024 (BLS). Your pay depends on experience, education level, and location.

What is the CGFNS Qualifying Exam?

This exam shows that your education prepared you to practice safely and effectively. It runs four times a year in over 40 locations worldwide, so you do not necessarily have to travel to the U.S. to take it. It is primarily multiple choice and covers effective care management, health promotion and maintenance, psychosocial integrity, and physiological integrity. The test takes about three hours, and results come in roughly two weeks. Pass and you receive a CGFNS Certificate. Fail and you can retake it, but you must pass both the English-language test and the qualifying exam within two years of each other.

The qualifying exam predicts your readiness for the NCLEX-RN, which most states require. Some states require the CGFNS exam before you can sit for the NCLEX-RN. Both exams meet the testing requirement for the visa credentials assessment.

What is the CGFNS VisaScreen?

To complete the VisaScreen administered by CGFNS, submit official transcripts of your secondary and postsecondary education; your current RN license and registration plus every related license, registration, and diploma you have held in any jurisdiction; a passport-style photo; proof that you passed the English-language proficiency test or qualify for exemption; passing scores on the CGFNS Qualifying Exam or the NCLEX-RN; and an application fee. If you qualify, you receive a certificate to present to a U.S. consular office with your visa application. Visas can be hard to get.

Types of visas available

The most reliable route is a job offer and residency sponsorship from a nurse recruiting agency, hospital, or other U.S.-based employer. Your education and training determine whether you qualify for an H-1B visa, which lets you work temporarily in an advanced nursing role that requires a bachelor's degree. You can also apply for an EB-3 visa or green card, which admits you as a permanent resident without a bachelor's degree. If you enter on an H-1B, you can apply for a green card after you arrive. For complex cases, consult an immigration attorney or a recruiting agency that specializes in placing foreign-educated nurses.

What if I am not eligible to work in the U.S.?

You can be ineligible for a few reasons, usually low test scores or education that does not meet U.S. requirements. You can retake the CGFNS and English-language tests as often as you want, but each attempt costs hundreds of dollars. If your education falls short, you will need to add coursework, either at home or in the U.S. A student visa lets you stay in the country while you study. You may need a Foreign Educated Nurses (FEN) program, which runs 120 classroom hours plus 120 clinical hours supervised by an RN.

Stay on top of immigration law changes

U.S. immigration law and visa eligibility change often and without notice. Global events can shift policy and employment rules for non-citizens, so check current regulations and the U.S. Citizenship and Immigration Services website before you commit to a timeline.

Taking your degree further

Once you are working as an RN, you can specialize. Most nurses settle into a specialty they enjoy after some time on the floor, and certifications in those areas help you advance. Popular options include school nurse, occupational health nurse, rehabilitation nurse, and neonatal nurse.

Frequently Asked Questions

What are the main steps to practice as a foreign-educated nurse in the U.S.? Clear English-language proficiency, verify your credentials through CGFNS, pass a qualifying exam, pass the NCLEX-RN, obtain a state license, and secure a work visa. Requirements vary by state, so confirm the specifics with the Board of Nursing where you plan to live.

Do foreign-educated nurses have to take the NCLEX-RN? Yes. Every state requires the NCLEX-RN to practice as an RN, with no exception for internationally educated nurses (NCSBN). You register through Pearson VUE, and the exam is offered at international test centers as well as in the U.S.

Who is exempt from English-language proficiency tests? You are exempt if your education was in English, including textbooks and instruction, or if you earned your degree or diploma in the UK, Ireland, Australia, New Zealand, South Africa, Jamaica, Barbados, Trinidad and Tobago, or Canada (excluding Quebec).

What other certifications do foreign-educated nurses need? If you do not already hold basic life support, advanced cardiac life support, and CPR certifications, complete those courses before you can earn your license. You may also need a background check or a character reference with your application.

What are Foreign Educated Nurses (FEN) courses? These refresh nursing knowledge and skills for RNs who need it, sometimes called RN refresher courses. They usually run 120 classroom hours plus 120 clinical hours. Check with your State Board of Nursing to find out whether a FEN refresher is recommended or required and which institutions offer accredited courses.

How much can foreign-educated nurses earn? There is no public data isolating their pay, but the median RN wage was $93,600 in May 2024 (BLS). Earnings depend on experience, education, and location.