Are you ready to pack up your things and come to the U.S. to practice nursing?
The United States is facing a significant nursing shortage, which creates a strong need for qualified nurses—the backbone of the healthcare system.
If you are a licensed nurse trained outside the United States and want to know the steps foreigners take to obtain U.S. nursing licensure, this article is for you.
There are several processes you need to do to secure your U.S. nursing licensure. This article breaks down the requirements for U.S. nursing licensure for foreigners, from taking the NCLEX-RN to what you need to do post-arrival.
Can a foreigner become a nurse in the USA?
Yes, a foreigner can become a nurse in the USA, but not by simply arriving with a foreign license.
A foreign nursing license allows you to practice only in the country that issued it. To work in the United States, you must obtain a U.S. nursing license from a state board of nursing.
You must pass a mandatory U.S. nursing exam called the National Council Licensure Examination [for] Registered Nurses (NCLEX‑RN) and meet state and federal requirements to obtain a U.S. nursing license.
Here is a quick overview of the processes you need to complete to obtain a U.S. nursing license as a foreigner.
Educational credential evaluation
Before any state board will process your application, you must prove your foreign nursing program is equivalent to a U.S. nursing degree. This is the first major step in international nurse credentialing.
What is a CES report, and which agencies qualify?
The Credentials Evaluation Service (CES) report compares your foreign nursing program to a U.S. Associate Degree in Nursing (ADN) or Bachelor of Science in Nursing (BSN).
The most widely used agency is the Commission on Graduates of Foreign Nursing Schools (CGFNS), but some states also accept evaluations from:
- International Credential Evaluation Services (ICES)
- Educational Credential Evaluators (ECE)
- Josef Silny & Associates, Inc. International Education Consultants
Check your target state board’s website before applying to see which services it accepts. CGFNS is often the default baseline for U.S. nursing licensure for foreigners.
What documents do you need to submit?
Most agencies require similar core documents:
- Official transcripts from your nursing program
- A copy of your nursing diploma or degree
- Proof of current or past nursing licensure in your home country
- Secondary‑school diploma or certificate
- Valid passport or national ID
If you have multiple degrees or licenses, include them, but expect longer turnaround times.
English proficiency and accepted tests
English‑proficiency testing is one of the basic requirements for foreigners to obtain U.S. nursing licensure. Even if your program was taught in English, many state boards require standardized proof of proficiency.
Which tests are accepted?
Most states accept:
- TOEFL iBT (Test of English as a Foreign Language Internet-Based Test)
- IELTS (International English Language Testing System)
- Pearson Test of English Academic
Typical minimums fall around the mid‑80s for the TOEFL iBT and 6.5–7.0 on the IELTS. Some states also accept the Occupational English Test (OET) for healthcare professionals.
Common issues with these exams include submitting outdated scores, using the wrong test version, or failing to request that scores be sent to CGFNS or the state board.
Exemptions
If your primary education and nursing training occurred in an English‑speaking country such as the United Kingdom, Australia, Canada (except Quebec), Ireland, or New Zealand, you may be exempt from the TOEFL/IELTS requirement. However, the state board must approve the exemption; it is not automatic.
NCLEX‑RN and state‑specific requirements
Passing the NCLEX‑RN is the next major milestone. The exam is the same for everyone, but the NCLEX‑RN for international nurses has additional prerequisites.
NCLEX‑RN for international nurses: Core steps
Can a foreigner take the NCLEX in the U.S.?
The simple answer is yes. Foreigners can take this exam after they choose the place in the USA where they want to apply, the state board approves their application, and they meet the NCLEX requirements for identity and legal presence.
To sit for the NCLEX‑RN as a foreigner, you may need to:
- Complete an approved credentials evaluation (often CGFNS CES)
- Apply for licensure with a state board of nursing
- Pass English‑proficiency testing, if required
- Pay state application and NCLEX fees
Once the board approves your application, Pearson VUE issues an Authorization to Test (ATT), and you can schedule your exam.
Another question that may arise is, which U.S. state has the easiest requirements for the NCLEX‑RN application for foreign nurses?
No state is universally “easy,” but some offer more straightforward pathways. States such as New York, Texas, Illinois, Montana, and New Mexico are often cited as more accessible because they:
- Allow certain English‑proficiency waivers based on education history
- Offer multi‑state licensure options once you pass the NCLEX‑RN
Something to consider is that once you get your nursing license in one state, you may still be able to work in other states. After you obtain your license, you can apply to another board for a license by endorsement or obtain a multi-state license through the nursing licensure compact (NLC) if the state you move to is part of the NLC.
How CGFNS fits into your NCLEX path
The CGFNS Certification Program can satisfy parts of both licensure and federal screening. The CGFNS certification guide explains how:
- CGFNS evaluates your education, licensure, and English proficiency.
- CGFNS issues a certificate that some states and VisaScreen accept.
CGFNS requirements for international nurses usually include a completed application, verified transcripts, a license‑verification request, and exam scores (if applicable).
VisaScreen and federal compliance
Licensure and immigration are separate processes, but a nurse cannot obtain a nursing license without a visa. The VisaScreen process is a federal requirement for foreign‑educated nurses seeking an occupational visa or Green Card.
What is VisaScreen?
VisaScreen is a credentialing program administered by CGFNS for non‑U.S. nurses applying for visas such as the employment‑based Green Card. The VisaScreen process includes:
- Credentials evaluation matching your degree to U.S. standards
- Verification of your nursing license
- English‑language‑proficiency assessment
- Nursing‑knowledge assessment (CGFNS Qualifying Exam or NCLEX‑RN)
Once approved, VisaScreen issues a 5‑year valid certificate. You must have this certificate before your visa petition can be approved.
Post‑arrival compliance and background checks
After you arrive in the United States, you still have to fulfill several compliance steps before your first shift.
Social Security Number and tax documentation
Most employers require a Social Security Number (SSN) for payroll and tax reporting. New arrivals can apply for an SSN at a local Social Security Administration office with a passport, visa, or I‑94, and employment documents. You will also complete IRS forms such as a W‑4 and, if relevant, an I‑9 to confirm work authorization.
Note: Some states allow you to take the NCLEX-RN exam but hold the license number until you provide an SSN post-arrival.
Fingerprinting and background checks
All states require nurses to undergo criminal‑history checks. Typical steps include:
- Submitting an online or paper background‑check application
- Scheduling an electronic or fingerprinting site appointment
- Paying the state’s fee
Some states integrate directly with the FBI’s criminal databases; others use physical fingerprint cards. If your record raises questions, the board may request additional documentation. Facilities may also require separate facility‑specific checks before onboarding.
From U.S. licensure to flexible PRN nursing roles
Once you hold a valid U.S. nursing license, you can choose from full‑time hospital roles, agency contracts, and flexible PRN positions.
Why does PRN work appeal to international nurses?
International nurses often arrive on 2‑ or 3‑year agency contracts. PRN roles can add flexibility and income to these contracts. PRN nursing can offer:
- Higher hourly rates than standard full‑time positions
- Control over shift selection and location
- An opportunity to work across multiple facilities
Be sure your contract allows you to work PRN shifts before considering this option.
How does Nursa support licensed international nurses?
Nursa is an open marketplace that connects licensed clinicians with facilities looking for short‑term coverage. Once you have a U.S. nursing license and valid work authorization, you can create a profile on the app and pick up PRN shifts that match your schedule and skills.
Understanding the U.S. nursing salary and expectations
The U.S. nursing salary can be attractive, but it varies by location, setting, and experience level. The median annual salary for registered nurses in the United States, according to the U.S. Bureau of Labor Statistics, is around $93,600.
Key factors that affect pay
- Location: States such as California, Hawaii, Oregon, and Washington tend toward higher average RN salaries.
- Setting: Hospital intensive care units and other specialty units often pay more than long‑term care or outpatient clinics.
- Shift type: Night shifts, overtime, holidays, and on‑call coverage can increase hourly rates.
- Experience and certifications: Nurses with several years of experience or specialty credentials may earn more.
Competency, vaccine, and screening requirements
Some facilities may require nurses to complete competency exams, meet vaccination requirements, and pass tuberculosis screening before being eligible to work.
How can Nursa fit into your U.S. nursing journey?
After completing all the steps to obtain your U.S. license, you can enjoy the professional and financial opportunities this opens up for you.
With PRN shifts, you can earn extra income on top of your regular contract with higher hourly rates and flexible scheduling.
Platforms like Nursa allow clinicians to find PRN jobs in their area and choose when and where they want to work.
Learn more about PRN nursing jobs with Nursa and pick up shifts here.
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