How to Hire International Nurses to Your Workforce

The U.S. Department of Labor (DOL) has classified professional nursing as a Schedule A occupation since there “are not sufficient U.S. workers who are able, willing, qualified, and available pursuant to regulation.”

Schedule A professionals automatically meet the permanent labor certification requirement, simplifying the immigration process and making international nurses easier to bring into staff care teams.

Only 2 groups fall under Schedule A occupations:

Professional nurses and physical therapists
Immigrants of exceptional ability in the sciences or arts (including the performing arts)

So, why is the Department of Labor simplifying the immigration process for international nurses?

Well, let’s break it down. Projections indicate that by 2030, there will be an estimated shortage of 250,970 registered nurses (RNs) nationwide. California alone will have a shortage of 55,870 RNs.

Throw into the mix how understaffing feeds cycles of burnout and turnover, and you have a serious nurse staffing crisis on your hands.

Hiring international nurses is not simple or cheap. However, amid domestic shortages and exorbitant agency fees for travel nurses, sourcing international nurses is an effective long-term workforce strategy.

What does it mean to hire international nurses?

Hiring overseas nurses involves recruiting licensed professionals from outside the U.S. or employing internationally trained nurses already authorized to work. This can be done through direct hire staffing solutions or with the help of international nurse recruitment agencies.

Unlike temporary staffing, international nurse recruitment focuses on long-term employment. Many facilities use this approach to reduce vacancy rates and strengthen workforce planning.

Some of the best countries for hiring nurses include the Philippines, India, Nigeria, and Caribbean nations like Jamaica. These regions have robust nursing education systems producing English-proficient, NCLEX-ready graduates.

Note: Your facility can also look for international nurses who are already in the U.S. with valid work permits, which can significantly speed up the hiring process.

Benefits of international nurses

It may cost more money, but hiring international nurses offers both operational and cultural advantages:

Improves staffing stability and fills nursing shortages
Reduces day-to-day dependency on agency staffing for expensive travel nursing and other temp contracts
Brings experienced, highly trained clinicians into your workforce
Enhances diversity in nursing staff, improving patient care in multicultural communities

Key requirements to hire international nurses

Before recruiting foreign nurses, facilities must ensure candidates meet U.S. legal requirements. These include:

Holding a valid RN license (state-specific requirements apply)
Passing the NCLEX-RN for international nurses
Passing English proficiency exams such as IELTS or TOEFL
Holding a VisaScreen certificate issued by the Commission on Graduates of Foreign Nursing Schools (CGFNS or TruMerit)
Completing credential evaluation and verification

Example of hiring an international nurse

An international nurse from the Philippines typically needs to pass the NCLEX, complete the credentialing processes, obtain a VisaScreen certificate, and meet state licensing requirements before beginning employment.

An English proficiency exam would not be necessary if the nursing program were taught in English and with English textbooks.

Visa options for hiring international nurses

Understanding visa requirements for foreign nurses is critical when building your nurse recruitment strategy.

EB-3 visa

This is the most common visa used for this purpose:

It is an employer-sponsored nurse visa that leads to permanent residency
This visa is designed for Schedule A nurses, including RNs
The duration of this visa is typically 1.5 to 3 years

Schedule A occupations do not require a DOL-approved labor certification because the Department of Labor has already determined that they are needed to fill those roles. As a result, employers can bypass the usual labor market test and move directly into the immigrant petition process.

TN visa

This is a visa typically issued for nurses from Canada and Mexico:

Faster processing, often completed within months
Renewable every 3 years
Does not directly lead to a green card

H-1B visa

This kind of visa has a limited use:

It is reserved for specialty roles such as nurse practitioners or certified registered nurse anesthetists (CRNAs)
This visa requires proof that the role demands a bachelor's or higher degree

Step-by-step process for hiring international nurses

The international nurse recruitment process involves several stages:

Assess staffing needs and hiring timeline.
Choose between direct hire or working with global nurse recruitment agencies.
Begin sourcing international nurses and screening candidates.
Verify credentials, exams, and licensing for international nurses.
File immigration petitions (typically for an EB-3 nurse visa).
Wait for visa approval and work permits for nurses.
Coordinate relocation, onboarding new nurses, and training.

How long will it take to onboard an international nurse?

The timeline to hire international nurses varies based on visa type and candidate readiness:

EB-3 visa: Typically 1.5 to 3+ years
TN visa: A few months
Credentialing and international nurse licensing: Several months

Timelines for nurses to work with you

Timelines can vary significantly due to several factors:

Some nurses may be ready to take the NCLEX, whereas others may need several months to prepare. Once a nurse takes the exam, they can expect their results within 45 days.
Nurses from English-speaking countries or those who completed nursing programs in English can skip the language proficiency exam.
Through TruMerit, most VisaScreen certificates (90%) are issued within 3.5 business days. Most Credentials Evaluation Service (CES) reports (70%) are issued within 7 business days of receipt and validation of all primary source documentation. However, the average time it takes to receive primary source documents (transcripts, credentials, etc.) is 14 weeks.
Processing times for licensure also vary by state. In California, the initial evaluation of an application must be completed within 90 days of its receipt.

Cost of hiring international nurses

The cost of hiring international nurses varies significantly depending on whether employers choose to cover expenses as sponsorship benefits or negotiate cost-sharing with candidates. However, market practice typically places most of the costs on employers to attract qualified international talent.

Legal and immigration filing fees ($2,000–$10,000+ total)

The employer typically pays the Form I-140 filing fee ($715) and attorney fees ($1,500-$8,000). Some reasons for it to vary include:

Some facilities ask nurses to cover personal attorney costs.
Premium processing ($2,805) is optional but speeds up cases.
Outsourcing to immigration counsel is standard.

Recruitment agency fees (~$16,000–$36,000 for $80k RN)

Employers always pay recruitment fees; agencies bill the hiring facility directly.

The percentage depends on the agency, typically 20–30% of first-year salary, the nurse's experience level, and contract terms.

Credentialing and licensing expenses ($1,000–$3,000)

This is often a split responsibility. CGFNS/VisaScreen fees ($350–$800) are usually paid by the nurse as personal licensure costs, but many employers reimburse them as a sponsorship perk.

Relocation and onboarding costs ($5,000–$15,000)

Employers typically pay for flights, housing, temporary accommodations, and orientation. Some other variable costs might include:

Rural hospitals may offer higher packages ($15k+) vs. urban facilities ($5k basic travel).
Qualified moving expenses are tax-free up to IRS limits (typically $3,000–$8,000, depending on distance), but amounts exceeding this threshold are considered taxable income to the nurse and must be reported on their W-2.

Facilities should consult HR/payroll for proper tax withholding on relocation packages exceeding the qualified threshold.

Salary and benefits

International nurse salaries are generally competitive with domestic RN rates. Domestic rates typically fall within the $66,030–$135,320 range, according to the U.S. Bureau of Labor Statistics, plus health/retirement benefits.

Total first-year investment

Typical costs range from $25,000–$65,000 beyond salary for agency-heavy recruitment to $8,000–$25,000 for direct hire.

Long-term ROI comes from retention vs. travel nurse premiums.

Common challenges for facilities

If you are convinced to bring an international nurse into your facility, here’s how you can manage common challenges in hiring foreign nurses:

Long visa timelines: Start early and build a hiring pipeline.
Regulatory complexity: Partner with experienced legal teams or international nurse recruitment agencies.
Cultural transition: Provide onboarding programs and mentorship.

Should I use an international nurse staffing agency?

International nurse staffing agencies streamline credentialing international nurses, handle complex immigration processes, and provide access to pre-vetted global talent pools.

Direct hire offers greater control over the international nurse recruitment process but demands significant internal expertise in:

Visa requirements
Legal requirements
Compliance

The best option depends on your recruitment staff's bandwidth and experience.

Whatever solution you choose, it will take time. Nursa can help you meet your short-term needs by covering immediate gaps with flexible per diem staffing options.

When international hiring makes the most sense

Hiring overseas nurses excels when facing:

Persistent vacancy rates (15%+ for 6+ months)
High travel nurse spend ($120+/hour)
Rural healthcare staffing challenges
Hospital workforce planning for 3–5 year horizons

Building your resilient staffing strategy

Healthcare facilities in the United States must think outside the box.

Gone are the days when hosting hiring events or posting openings on job boards were enough to recruit nursing talent.

In today's market, health systems need a multipronged approach:

Attracting and training new grads
Retaining experienced staff
Hiring international nurses
Relying on travel nurses for specialized medium-term needs
Filling last-minute staffing gaps with per diem clinicians

A resilient staffing strategy proactively prepares for future demands while addressing immediate needs.

For local staffing needs, Nursa helps healthcare facilities solve short-term staffing gaps, build resilient staffing pipelines, and optimize external staffing spend.

Sources:

How to hire international nurses to build a stable workforce

Add Your Credit Card

Key takeaways:

What does it mean to hire international nurses?

Benefits of international nurses