Work abroad as a nurse: UK, Ireland, EU and US routes (2026)

1. 1

   Choose your country and confirm you are a nurse in its terms

   Check that your qualification matches the protected title in the country you want: one field of nursing on the NMC register, a division of the NMBI register, Pflegefachfrau or Pflegefachmann in Germany, verpleegkundige in the Netherlands, or RN in a US state. If you are dual qualified, decide which register you want first, because some regulators charge for each extra field or division.
2. 2

   Collect your education and registration documents

   Request your transcript with theory and clinical hours, your course outline, your diploma and your registration certificate. Ask every regulator you have been registered with for a certificate of good standing or verification. This stage causes most delays, because schools and regulators abroad can take weeks to reply, so start it first.
3. 3

   Reach the language level

   For the UK, Ireland and most US routes you need IELTS Academic or OET at the regulator's scores, in one sitting for NMBI. For Germany you need German at B2, and for the Netherlands Dutch at the level for your qualification plus English reading skills. Book the test only when practice scores are clearly above the minimum, as a near miss means paying again.
4. 4

   Apply to the regulator for assessment

   Submit your application online with the fee: the NMC qualification evaluation, the NMBI qualifications recognition, a German state authority's recognition procedure, the BIG register's certificate of professional competence, or a US state board application with a credentials evaluation. Upload exactly what the checklist asks for, with certified translations where required.
5. 5

   Pass the competence test or compensation measure

   Each country tests competence in its own way: the NMC's CBT and OSCE, NMBI's adaptation period or RCSI aptitude test, Germany's knowledge test or adaptation course, the Dutch BI test, or the NCLEX-RN. Read the official test guide, practise under timed conditions and note the attempt limits, because a failed final attempt can close your application.
6. 6

   Secure a job offer and the right visa

   Most nurses need an employer sponsor: a Health and Care Worker visa in the UK, an employment permit such as the Critical Skills Employment Permit in Ireland, a German skilled worker or recognition route, a Dutch residence permit, or a US immigrant visa as a Schedule A occupation. Check what your employer pays for, such as the OSCE, travel or the adaptation period.
7. 7

   Complete registration and start work

   Once you have passed every stage, pay the registration fee and confirm your identity where asked. Do not work as a registered nurse until your name is on the register or your licence is issued; until then, use only the pre-registration job title your employer gives you.

Nurse pay in the UK and Ireland follows national public sector scales, which we quote from the official tables. Germany and the Netherlands set nurse pay through collective agreements that vary by employer, and the USA has no national scale, so we give the federal median wage. Figures are basic annual pay before overtime, shift and location allowances.

• UK£32,073 to £39,043 (band 5); £39,959 to £48,117 (band 6), 2026/27NHS Agenda for Change rates from 1 April 2026, published by NHS Employers. Newly registered nurses usually start at band 5.
• Ireland€38,166 to €56,592 (staff nurse), from 1 June 2026HSE consolidated pay scales, 13-point staff nurse scale. Nurses on an adaptation placement or awaiting registration are paid €33,370; senior staff nurse is €59,278.
• GermanySet by collective agreement or employerPublic and municipal hospitals pay nurses under collective agreements such as the TVöD nursing tables; private and church employers have their own agreements. We could not confirm a current official table, so check the job offer.
• NetherlandsSet by collective agreement (CAO)Pay depends on the sector's CAO, such as hospitals or care, and your grade. Check the scale named in your contract.
• USA$97,550 median (May 2025)Bureau of Labor Statistics: the lowest 10 percent earned less than $68,940 and the highest 10 percent more than $137,470. Pay is set by employers and varies by state.

See your NHS band and annual pay

Registration is the starting point. In each country you can move into more senior, specialist or advanced roles, usually by gaining experience and further qualifications after you register. Titles differ, but the pathways are similar.

1. 1

   Senior and specialist clinical roles

   With experience you can move from a newly registered post to a senior or specialist role: band 6 in the NHS, senior staff nurse or clinical nurse manager in the HSE, or a charge nurse post in the USA. Specialist areas include critical care, theatres, emergency care and oncology.
2. 2

   Advanced practice

   Advanced practice roles let you assess, diagnose and prescribe within a defined scope. In Ireland NMBI keeps a register of advanced nurse practitioners, and in the USA nurse practitioners are licensed as advanced practice registered nurses after a graduate programme and national certification.
3. 3

   Management and leadership

   Ward and unit management posts, such as clinical nurse manager in Ireland or matron in the UK, combine clinical work with staffing, budgets and quality. Most employers expect leadership training and several years in the specialty.
4. 4

   Education and practice development

   Clinical educators, practice development nurses and university lecturers support new staff and students. Many international nurses also move into roles that help the next group of overseas recruits through OSCE preparation and induction.
5. 5

   Moving between countries

   Once registered in one country, you can apply to another. Your good standing and post-registration experience help, but each regulator still assesses your original qualification, so keep full records of your training and every registration.

1. 1

   Booking the language test too early: NMBI accepts only one sitting, and a result more than two years old is no longer accepted by the NMC or NMBI.

2. 2

   Taking a test version the regulator does not accept, such as IELTS General Training, IELTS Online or OET at home for NMBI, or at-home tests for VisaScreen.

3. 3

   Applying before your documents are complete; the BIG register says incomplete applications are put on hold, and missing transcripts delay every country.

4. 4

   Applying to the wrong field or division of the register, which can mean paying for a second assessment.

5. 5

   Not declaring a previous registration, a gap in practice or a fitness to practise matter; regulators check with every body you have been registered with.

6. 6

   Underestimating German or Dutch: the required level must be reached before recognition is complete, and learning a language to B2 usually takes far longer than the paperwork.

7. 7

   Missing a deadline, such as the NMC's two years to complete registration or NMBI's 12 months to secure an adaptation period.

8. 8

   Working as a registered nurse, or using the protected title, before your registration or licence is granted.

• Review of your qualifications, transcripts, experience and current registration

• Check against the published requirements of the regulators you choose

• Check of how recent your practice is and whether any gap in practice affects your route

• English or other language requirement for each route, with any exemption you may qualify for

• Comparison of routes and countries, with the trade-offs explained

• List of the exams, aptitude tests or adaptation periods each route is likely to involve

• Written roadmap: exams, English test, documents, fees and timeline

• Budget built from the official regulator, exam and verification fees, kept separate from our own fee

• Flags for slow steps to start first, such as primary source verification and language learning

• A call to walk you through the plan and answer your questions

What our eligibility assessment includesPackages and fees