Work as a nurse in the USA: NCLEX-RN for foreign nurses

• Graduation from a nursing program comparable to a board-approved US RN program, approved by the authority that approves nursing programs in your country.
• A credentials evaluation from an agency your board accepts, for example TruMerit's CES Professional Report, which TruMerit says all 50 state boards accept. New York uses TruMerit's Credentials Verification Service.
• Verification of every nursing license you hold or have held, sent directly by each licensing authority. Texas says these verifications are valid for one year after they are signed and sealed.
• An English test at your board's scores if your nursing education was not in English or not in an exempt country. For VisaScreen, RNs need IELTS 6.5 overall with 7 speaking, or OET 360 speaking, 340 reading, 350 writing and 320 listening, among other options.
• State and federal fingerprint-based criminal background checks, and disclosure of any criminal history, substance use and license discipline.
• A pass in the NCLEX-RN.
• Board-specific rules: for example, Texas requires the Nursing Jurisprudence Exam and says first-time international applicants must have worked as a nurse within the last 4 years or be within 4 years of graduating; New York requires approved infection control and child abuse reporting coursework.
• For immigration: a US employer to sponsor you, and a VisaScreen certificate (or a 212(r) Certified Statement if you qualify).

Check your route with the route finder

• NCSBNNCSBN and state boards of nursing

  Nurses (NCLEX)

  How to register with the NCSBN

• CGFNSCGFNS International

  Credentials evaluation and VisaScreen for nurses and allied health

  How to register with the CGFNS

1. 1

   Choose a state board of nursing

   Pick the state where you plan to work, or the employer's state if you already have an offer. Read that board's page for internationally educated applicants: accepted evaluation agencies, English scores, time limits and extra courses differ. Changing your board on your NCLEX registration costs $50 and may mean new paperwork, so decide before you start.
2. 2

   Order your credentials evaluation

   Order the report your board names, such as TruMerit's CES Professional Report ($485) or, in states that require it, the TruMerit Certification Program ($495). Your nursing school sends transcripts and every licensing authority sends a license verification directly to the agency. Ask your school and regulators early, because their response is usually the slowest part.
3. 3

   Take an English test that meets every requirement

   Choose IELTS, OET, TOEFL iBT, PTE Academic or another test your board and VisaScreen both accept, and aim for the higher of the two score sets. Have the testing agency send scores directly; applicant copies are refused. TruMerit's CES needs scores less than two years old, so time your test.
4. 4

   Apply to the board and complete fingerprints

   Submit the board's application for licensure by examination as an internationally educated applicant and pay its fee: for example $75 in Texas or $143 in New York. Follow the board's fingerprint instructions; Texas has a separate process for applicants without a US Social Security number. Complete any extra exam or coursework the board requires.
5. 5

   Register for the NCLEX-RN with Pearson VUE

   Register online and pay $200 (NCLEX says this rises to $350 from February 1, 2027). Use your name exactly as on your passport, which is the only ID accepted at international centers. Once the board makes you eligible, you receive your Authorization to Test, valid on average for 90 days and not extendable.
6. 6

   Pass the NCLEX-RN

   Book a date: first-time candidates are offered a slot within 30 days. Testing outside the US adds a $150 fee and is not available in any Gulf country at present. You answer 85 to 150 items within five hours; official results come from the board within six weeks, and if you fail you must wait at least 45 days to retest.
7. 7

   Find a sponsoring employer

   Apply to hospitals and health systems that sponsor internationally educated nurses, either directly or through recruiters. For a green card, the employer gets a prevailing wage determination, posts a notice of filing for 10 business days and files Form I-140 with an uncertified ETA-9089. Read the contract: length of commitment, repayment terms and who pays which fees vary between employers.
8. 8

   Get your VisaScreen certificate

   Apply to TruMerit for VisaScreen ($740). It checks your education, all your licenses, your English and, for RNs, your NCLEX-RN pass. TruMerit says 90% of certificates are issued within 3.5 business days once documents are validated, and the certificate lasts five years.
9. 9

   Wait for your priority date, then complete the visa

   After the I-140 is approved, follow the monthly Visa Bulletin for EB-3 and your country of birth. When your date is current, you complete the immigrant visa through consular processing, or adjustment of status if you are lawfully in the US. Keep your VisaScreen, license and passport valid during the wait, since EB-3 queues can be long.

• NCLEX-RN

  A computerized adaptive test delivered by Pearson VUE. Under the 2026 NCLEX-RN Test Plan (April 1, 2026 to March 31, 2029) you answer 85 to 150 items within five hours, including three clinical judgment case studies of six items each and 15 unscored pretest items. Management of Care (15 to 21%) and Pharmacological and Parenteral Therapies (13 to 19%) are the largest content areas.

  Read the guide

• Where to take the NCLEX-RN

  In the US, or for an extra $150 at international centers in Australia, Brazil, France, Hong Kong, India, Israel, Japan, Jordan, Kenya, Malaysia, Mexico, Pakistan, the Philippines, Puerto Rico, South Africa, Spain, Taiwan, Türkiye and the UK. Bring your passport.

  Read the guide

• TruMerit Nurse Qualifying Exam

  Part of the TruMerit Certification Program, which TruMerit says about two-thirds of state boards require before the NCLEX-RN. It is taken at Kryterion test centers and also satisfies the exam requirement for VisaScreen.

• English language test

  IELTS, OET, TOEFL iBT, PTE Academic, MET or Cambridge English, at the scores your board and VisaScreen set. No at-home versions for VisaScreen.

• State jurisprudence exams

  Some boards require a law and rules exam. Texas requires its Nursing Jurisprudence Exam, included in its $75 examination fee.

• VisaScreen for RNs (TruMerit, from May 12, 2026): IELTS 6.5 overall with 7 in speaking.
• OET: 360 speaking, 340 reading, 350 writing and 320 listening.
• TOEFL iBT: 4.5 overall and 4.5 speaking, with 3.5 in reading, listening and writing. PTE Academic: 55 overall, 76 speaking and 62 in reading, writing and listening. MET: 58 overall, 59 speaking.
• State boards set their own scores. The Texas Board of Nursing uses the same figures for RN applicants whose nursing education was not in English, and stopped accepting paper and computer-based TOEFL, TSE and TWE from September 1, 2026.
• Exempt from the VisaScreen test: nurses whose entry-level education was in the UK, Australia, Canada (except Quebec), New Zealand, Ireland or the US, taught in English with English textbooks.
• English-taught nursing degrees from other countries, including the Gulf, India and the Philippines, do not exempt you from the VisaScreen test.
• Scores must reach the board and TruMerit directly from the testing agency, and the CES needs scores under two years old.

Estimate your total cost

• Documents and English: the stage that varies most, from weeks to months, depending on how fast your school and regulators send verifications and when you reach your scores.
• Credentials evaluation: TruMerit says 70% of CES reports are issued within 7 business days once primary-source documents are validated.
• Board review and ATT: depends on the state and your background check; your ATT is valid on average for 90 days, and first-time candidates are offered a test date within 30 days.
• NCLEX results: unofficial Quick Results after two business days; official results from the board within six weeks. Retakes need at least 45 days between attempts.
• VisaScreen: TruMerit says 90% are issued within 3.5 business days once documents are validated.
• Green card: after the I-140, the wait depends on the EB-3 Visa Bulletin for your country of birth and can be the longest part of the route.

There is no national nursing pay scale in the US. These figures are national medians from the Bureau of Labor Statistics, based on May 2025 data. Employers set pay, which varies by state, metro area, setting, shift differentials and experience. Your sponsoring employer must meet Department of Labor prevailing wage rules.

• Registered nurses, median

  $97,550 a year

  May 2025. $46.90 an hour.

• Registered nurses, lowest 10%

  Under $68,940

  May 2025.

• Registered nurses, highest 10%

  Over $137,470

  May 2025.

• Government

  $110,780

  Median, May 2025. Excludes state and local education and hospitals.

• Hospitals (state, local and private)

  $100,220

  Median, May 2025.

• Ambulatory health care services

  $91,230

  Median, May 2025.

• Nursing care facilities

  $84,300

  Median, May 2025.

• Hospitals and health systems are the main sponsors of internationally educated nurses; BLS counts about 3.5 million RN jobs in 2025, with employment projected to grow 6% from 2025 to 2035.
• You can check whether an employer has sponsored before: the USCIS H-1B Employer Data Hub lists H-1B petitions by employer, and the Department of Labor publishes PERM and LCA disclosure data by employer.
• Universities and their affiliated nonprofit hospitals are exempt from the H-1B cap, which matters for nurses in specialty roles that require a degree.
• Many nurses are hired through international recruiters or staffing firms that act as the sponsoring employer and place you at client hospitals. Ask who your legal employer is and where you will work.
• Contracts vary widely. Ask in writing about the length of commitment, any repayment or breach terms if you leave early, which fees the employer pays (VisaScreen, NCLEX, legal fees), relocation support, and pay and shift differentials.
• Ask about orientation or residency programs for newly arrived nurses and how long before you can work independently.

• Most internationally educated nurses immigrate on an EB-3 employment-based green card. USCIS lists professional nurses as a Schedule A occupation, so the employer files an uncertified Form ETA-9089 with Form I-140 instead of getting labor certification first.
• For the I-140, USCIS needs evidence that you hold a full, unrestricted license in the state of intended employment, have passed the NCLEX-RN, or hold a TruMerit (CGFNS) certificate.
• The employer must also have a prevailing wage determination from the Department of Labor and post a notice of filing for at least 10 consecutive business days, between 30 and 180 days before filing.
• Your priority date then has to be current in the State Department's monthly Visa Bulletin for EB-3 and your country of birth; USCIS says to use the Final Action Dates chart unless it announces otherwise.
• You need a VisaScreen certificate (INA 212(a)(5)(C)) or, if you qualify, a 212(r) Certified Statement. Your spouse and unmarried children under 21 may immigrate with you.
• H-1B is possible only for nursing roles that require a bachelor's degree, and a 2025 proclamation added a $100,000 payment for certain new petitions for workers outside the US. This is a summary of official guidance, not legal advice; ask an immigration attorney about your case.

1. 1

   Your DHA, DOH, MOHAP, SCFHS, QCHP or other Gulf license does not replace a US state license, and Gulf experience does not exempt you from the NCLEX-RN. You follow the same route as any internationally educated nurse.

2. 2

   Declare every license you have held. TruMerit validates all current and past licenses, and Texas wants a verification from every country where you have held one, sent directly by the regulator and valid for one year. Request verifications from your Gulf regulator and your home-country regulator early.

3. 3

   Recent Gulf practice can matter. Texas, for example, says first-time international applicants must have worked as a nurse in the last 4 years or be within 4 years of graduating, and may ask for a statement of practice on letterhead sent directly by your employer.

4. 4

   Gulf practice and English-taught Gulf or Indian programs do not exempt you from the VisaScreen English test, so most Gulf-based nurses need IELTS, OET or another accepted test.

5. 5

   There is no NCLEX test center in the GCC at present. The nearest listed locations include Jordan, Türkiye, India and Pakistan, so plan travel and leave around your Gulf contract and your 90-day average ATT window.

6. 6

   Detailed experience letters (dates, unit, bed count, hours) help with US employers and recruiters, especially for specialty roles such as ICU, ER or OR.

• Application plan with every step, fee and deadline

• Document checklist tailored to you, and a review of each document before upload

• Timeline built around the regulator's closure windows and document validity periods

• Help completing the application forms accurately and consistently

• Support with profession-specific evidence, such as the HCPC standards of proficiency mapping

• Guidance on certificates of good standing, references and certified translations

• Preparation for identity checks and declarations on health and character

• Tracking your application and help responding to regulator requests

• Next steps after the decision: exams, adaptation, PIN or licence and your first job

Regulators make all registration decisions and set all fees. Our fee is separate from the regulator's fees, exam fees and translation costs.

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