How to Become a Foreign or International Nurse

Learn about the many opportunities available in foreign nursing in the U.S.

foreign nursing student

If you are a licensed nurse in another country, there are several steps to take in order to become a nurse in the United States. Should you plan to live here permanently, you need to obtain an Alien Registration Receipt Card, commonly known as a green card. The U.S. Citizenship and Immigration Services can help you through this process.

The first thing to remember is that licensure requirements differ with each state. The State Board of Nursing in the state where you plan to practice will be able to tell you what prerequisites you should fulfill to be licensed. You need to know where you will be working before you arrive in order to be sure that you meet all of the criteria.

Learn more by reading the information below on how to begin your foreign nursing career in the United States.

Commission on Graduated of Foreign Nursing Schools (CGNFS)

According to their website, the Commission on Graduates of Foreign Nursing Schools is "a non-profit, internationally recognized leader in the education, registration and licensure of health care professionals worldwide. CGFNS protects the public in relation to evolving health care policies and standards of professional practice for migrating health care professionals." CGFNS is federally-approved to certify nurses and other health care providers.

The CGFNS program is designed for first-level general, or registered nurses who have been educated in another country and wish to work as professional nurses in the United States.

There are three parts of the certification program: a credentials review, the CGFNS Qualifying Exam, and an English language proficiency exam . Most Boards of Nursing require foreign nurses to complete the certification program and the credentials evaluation. In addition, the Immigration and Naturalization Service (INS) requires all health care professionals who seek permanent occupational visas to obtain VisaScreen certificates.

Credentials Review

The credentials review looks at theoretical instruction and clinical practice in five major areas of nursing: adult medical nursing, adult surgical nursing, neonatal nursing, pediatric nursing, and psychiatric nursing. Generally, it does not examine additional education in the sciences, humanities, or other areas of study.

CGFNS Qualifying Exam

The test is designed to see if nurses with international educations are qualified to practice in the United States. To be eligible for the test, foreign nurses must have significant experience in a wide range of nursing fields. A minimum number of hours in classroom instruction and clinical practice are required in the fields of adult medical and surgical nursing, neonatal nursing, pediatric nursing, and psychiatric and mental health nursing.

The Qualifying Exam is offered three times each year in over 40 locations worldwide. To find a test center near you, contact the CGFNS Customer Service Department or consult the CGFNS Certification Program handbook. You can also visit the CGFNS website.

If you need to re-take the CGFNS qualifying exam you may, but remember that you must sit for the TOEFL and Qualifying Exam within two years of each other in order to have valid scores.

You also need to be a registered first-level nurse in the country where you were educated, and you must hold a current registration/license as a registered nurse.

English Language Proficiency Exam 

You need to take the Test of English as a Foreign Language (TOEFL). TOEFL scores are valid for two years.

CGFNS Qualifying Exam for RNs with Secondary-Level Training

Secondary-level training equates to "hospital based training" in the United States, which means that a greater emphasis is placed on hands-on experience instead of theory. As noted above, you must be an RN who has completed a required number of hours in theory and clinical courses to qualify.

VisaScreen Certificate

VisaScreen is administered by the International Commission on Health care Professions, which is a division of CGFNS. The screening program is federally-approved and is designed for all health care workers who want occupational visas, including RNs and LPNs. The VisaScreen certificate is required by the INS and must be obtained before you can receive a residency visa. When you receive the certificate, you can present it to your consular office with the rest of your visa application.

In order to receive a VisaScreen certificate, CGFNS must conduct credential reviews of your nursing education and licensure, and an assessment of your English language skills. You must also be able to pass either the CGFNS Qualifying Exam or the NCLEX exam. According to the CGFNS, when you receive the VisaScreen packet, you should:

  1. Complete the VisaScreen application.
  2. Complete the enclosed forms to send to your nursing school(s). Academic transcripts must come directly from the nursing school(s).
  3. Complete the enclosed forms to send to your licensing authority(ies). Validations of all licenses, past and present, must come directly from the licensing authorities.
  4. You must successfully complete an English language proficiency test and have the scores directly forwarded to ICHP from the testing agency.
  5. You must successfully pass either the CGFNS Qualifying Exam or the NCLEX-RN examination if you are a nurse.
  6. Enclose a copy of your high school diploma or equivalent.
  7. Enclose the application fee.

Credentials Review

The credentials review looks at theoretical instruction and clinical practice in five major areas of nursing: Adult Medical Nursing, Adult Surgical Nursing, Maternal / Infant Health Nursing (Obstetrics), Care of Children / Pediatrics, and Psychiatric / Mental Health Nursing. Generally, it does not examine additional education in the sciences, humanities or other areas of study.

Language Tests

You need to take the TOEFL, Test of Written English and Test of Spoken English or the Michigan English Language Assessment Battery and MELAB oral exams. The CGFNS site lists the scores required to pass these tests.

You can be exempted if:

  1. You graduated from a nursing program in Australia, Ireland, New Zealand, the United States, United Kingdom or Canada (except Quebec) AND
  2. The program's language of instruction was English AND
  3. The language of your textbooks was English.

Credentials Evaluation Service (CES)

The CES is prepared by CGFNS and will be sent to Boards of Registration, universities, employers, immigration offices and others who may require the information. The service compares your education and licensure to nursing standards in the United States. You do not need to take a test for the CES. There are different types of CES reports, and the recipient - the State Board of Nursing, if you wish to be licensed in the U.S., or a university, if you wish to attend an American school - will tell you which level of report is required.

The CES evaluation is more in-depth than those required by the CP and VisaScreen. The CES looks at the content of your entire professional program in order to confirm that it is comparable to a nursing/professional program of study in the United States.

Each report recipient may have different credentials they want to see. Be sure to check with them individually. After you know for certain, submit copies of appropriate documents - except for academic transcripts and registration/license validations, which must come from the issuing bodies.

CES Applications

After you request or download a CES application, you must first complete the application form and send it to CGFNS.

You must also include all requested documentation and the full payment for the service, which must be in U.S. Dollars - the CGFNS recommends an international money order or a credit card payment from Discover/Novus, Visa or Mastercard.

Requests for academic records and license validations must be sent to CGFNS by authorized institutions, like your professional school or your country's licensing authority. Do not send these yourself.

Non-English School Transcripts

According to the CGFNS Web site, certified word-for-word translations must accompany transcripts in their original languages. If your school cannot provide this service, CGFNS offers translation for a fee.

Closed Schools & Agencies

If your school closed, you need to contact the institution or agency (like the ministry of health) authorized to hold documents for your school. Likewise, regional or national licensing boards might be organizations to contact if your original licensing agency no longer operates. You must find out who has the authority to validate your records: CGFNS will not accept copies of licenses or school transcripts, only official validation from official issuers.

You must send documentation to the CGFNS. The agency does not accept documents via fax or email; you must send hard copies through regular postal mail.

Note: This Q&A has been developed in partnership with the Commission on Graduates of Foreign Nursing Schools. We are grateful for their assistance.