5 Steps to Working as a Foreign Nurse in the U.S.

If you’re a registered nurse in another country, there are several steps you need to take if you want to work as a nurse in the U.S. While exact requirements vary depending on the state where you live, there are 5 main parts of the process that you’ll need to complete before you can legally work.

Step 1: English Language Proficiency Test

As a requirement for earning your RN license in the U.S., you’ll need to take an English language proficiency exam or be exempt from the test due to completing an English-based education. To be considered exempt, 2 criteria must be met:

  • You’ll need to have earned your degree or diploma in the U.S., U.K., Ireland, Australia, New Zealand, South Africa, Jamaica, Barbados, Trinidad and Tobago, or Canada (excluding Quebec);


  • English must have been the language of your textbooks and instruction.

If you do need to take the test, it’s best to do this early, since proof of your results will be required during the next steps in the process. You can choose to take either the Test of English as a Foreign Language (TOEFL) or the International English Language Testing System (IELTS), though the first is more common. Results of each exam are valid for 2 years.

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Step 2: Credentials Evaluation

The Commission on Graduates of Foreign Nursing Schools (CGFNS) is a nonprofit organization that’s federally approved to certify non-U.S. citizens to work in various positions within the healthcare field.

Using the CGFNS Credentials Evaluation Service, nurses from outside the country can prove they have the knowledge and skill set that are equal to the U.S. standards of licensing.

Step 3: CGFNS Qualifying Exam

To complete the evaluation, you’ll need to submit transcripts from the institutions where you earned your highest secondary education and your nursing degree. They’ll verify that you’ve received a general high school-level education as well as undergone the proper instruction in 5 key areas of nursing: adult medical, adult surgical, neonatal, pediatrics, and psychiatric.

If your transcripts aren’t in English, you’ll need to submit translated documents of the original records. If your school can’t provide these, the CGFNS offers translation services for an additional fee.

Once you’ve completed the credentials evaluation, you’ll receive an Authorization to Test for the CGFNS Qualifying Exam. This demonstrates that your education has in fact given you the knowledge you need to safely and effectively practice as a nurse. The exam is administered 4 times each year in over 40 locations worldwide, so you don’t necessarily need to travel to the U.S. in order to take the test.

The Qualifying Exam is primarily a multiple-choice test that covers key topics in the areas of Effective Care Environment, Health Promotion and Maintenance, Psychosocial Integrity, and Physiological Integrity. The test takes roughly 3 hours to complete, after which you’ll be able to access your results within around 2 weeks.

If you pass the exam, you’ll be awarded your CGFNS Certificate. If you don’t pass, you can retake the test, but keep in mind that your English language test and Qualifying Exam must be passed within 2 years of each other.

Step 4: Visa Screen

In order to apply for your occupational visa to work in the U.S., you’ll need to complete the VisaScreen administered by the CGFNS. To do so, you’ll need to submit:

  • Official transcripts from secondary and postsecondary education
  • Current RN license and registration
  • Passport-style photo
  • Proof of exemption or passing English language proficiency test scores (At least an 83 total on the TOEFL, with a 26 on the spoken section; or an overall 6.5 on the IELTS with a 7.0 on spoken)
  • Passing scores on the CGFNS Qualifying Exam or the NCLEX-RN Exam
  • An application fee

If you meet the requirements, you’ll receive a certificate which you can present to the consular office when completing your application for a visa.

Step 5: Apply Through Your State Board

With credentials verified, passing test scores, and a visa in hand, you can officially apply for your RN license through your state’s board of nursing. It’s important to remember that each state has slightly different requirements, so there may be additional steps you have to take before you can begin work.

If you don’t already have certifications in basic life support, advanced cardiac life support, and CPR, you’ll need to complete these courses before you can earn your license. You might also be required to take the NCLEX-RN Exam, submit to a background check, or include a character reference with your application.

What If I’m Not Eligible?

You could be ineligible for a few different reasons, including low test scores and education that doesn’t meet U.S. requirements. You can take the CGFNS and English language tests as many times as you want, but keep in mind that it can cost hundreds of dollars every time you do so.

If you don’t meet the education requirements—for example, you’re a secondary level nurse, not an RN—you’ll need to get the necessary schooling either in your home country or the U.S. You can apply for a student visa, which allows you to stay in the U.S. for the duration of your education. You might need to complete a Foreign Educated Nurses (FEN) program, which consists of 120 classroom hours as well as 120 clinical hours under the supervision of an RN.

Need to Find a Nursing Program?

Looking to find a nursing program that can help you meet the requirements to earn your U.S. license? Use the Find Schools button to browse in-person and online options that can help you reach your goals.

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