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

You’ll need strong language skills and experience working as an RN.

nurse reviews medical chart with doctor
nurse reviews medical chart with doctor

If you’re a registered nurse (RN) in another country, there are several steps you need to take if you want to pursue a career as a nurse in the U.S. While exact requirements vary depending on the state in which you’ll live, there are five main steps that you’ll need to take before you can legally work.

Before you begin this process, you’ll need to meet basic criteria that apply to all foreign-educated nurses. You must have:

  • A degree from an accredited registered nursing program
  • A current RN license in your country
  • Two years of full-time work experience as an RN
  • Step 1:

Take an English-Language Proficiency Test

As a requirement for an RN license in the U.S., you’ll need to take an English-language proficiency exam. However, you can be exempted from the test if:

  • Your education was in English; this includes textbooks and instruction
  • You earned your degree or diploma in the UK, Ireland, Australia, New Zealand, South Africa, Jamaica, Barbados, Trinidad and Tobago, or Canada (excluding Quebec)

You can 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. You’ll need an 83 or higher on the TOEFL, with a 26 on the spoken section, or an overall 6.5 on the IELTS, with a 7.0 on the spoken section.

If you do need to take an English-language test, it’s best to do so early, since you’ll need to provide your scores during the next steps in the process. Your scores are valid for two years.

Depending on your English-language skills, you may benefit from taking an English-language course. In addition to a passing score on a proficiency test, most states also require you to pass the NCLEX-RN, a nursing licensing exam in English. This can be a challenge if your command of the language isn’t strong.

  • Step 2:

Credentials Evaluation

You’ll need to submit transcripts from the institutions where you earned your highest secondary education and your nursing degree to the Commission on Graduates of Foreign Nursing Schools (CGFNS). This nonprofit organization is federally approved to certify non-U.S. citizens to work in various positions in healthcare.

The CGFNS will verify that you’ve received a general high school-level education and postsecondary instruction in five key areas of nursing:

  • Adult medical
  • Adult surgical
  • Neonatal
  • Pediatrics
  • 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.

  • Step 3:

Qualifying Exams

Once you’ve completed the credentials evaluation, you’ll receive authorization to take the CGFNS Qualifying Exam. This test is designed to demonstrate that your education has prepared you to safely and effectively practice as a nurse. The exam is given four times each year in over 40 locations worldwide, so you don’t necessarily need to travel to the U.S. to take it.

The qualifying exam is primarily a multiple-choice test that covers key topics in the areas of:

  • Effective care management
  • Health promotion and maintenance
  • Psychosocial integrity
  • Physiological integrity

The test takes roughly three hours to complete, and you’ll be able to get your results in about two weeks.

If you pass, you’ll receive a CGFNS Certificate. If you don’t, you can retake the test, but keep in mind that you must pass the English-language test and the qualifying exam within two years of each other.

The CGFNS exam can predict your readiness for the NCLEX-RN, which is required by most states. Some states require that you take the CGFNS exam before qualifying to take the NCLEX-RN. Both exams meet the test requirement of the visa credentials assessment that comes next.

  • Step 4:

Visa Screen

You’ll need to apply for a visa to work in the U.S. To complete the visa screen administered by the CGFNS, you’ll need to submit:

  • Official transcripts of your secondary and postsecondary education
  • Current RN license and registration and all related licenses, registrations, and diplomas that you’ve held in the past in all foreign and domestic jurisdictions
  • Passport-style photo
  • Proof that you passed the English-language proficiency test or that you’re exempt from it
  • Passing scores on the CGFNS Qualifying Exam or the NCLEX-RN
  • An application fee

If you meet the requirements, you’ll receive a certificate that you can present to a U.S. consular office when completing your application for a visa. You’ll need to obtain a visa to work in the U.S., and they can be hard to get.

Understand the Types of Visas Available

The best way to earn entry into the U.S. for employment is to find a nurse recruiting agency, hospital, or other U.S.-based employer to provide a job offer and sponsor you for residency.

Your education and training can determine whether you qualify for an H1-B visa, which allows you to work in the U.S. temporarily in an advanced nursing position that requires a bachelor’s degree. You can also apply for an EB-3 visa or Green Card, which allows you to come to the U.S. as a permanent resident without a bachelor’s degree. If you enter the U.S. with an H1-B visa, you can apply for a Green Card after you arrive.

For expert guidance, consult with an immigration attorney or healthcare recruiting/staffing agency that specializes in placing foreign-educated nurses in the U.S.

  • Step 5:

Apply Through Your State Board

With verified credentials and passing test scores, you can apply for your RN license through your state’s board of nursing. It’s important to remember that state requirements vary, so there may be additional steps you have to take before you can start working.

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 if you didn’t take it as part of your visa screen in Step 4, submit to a background check, or include a character reference with your application.

How Long Does the Process Take?

If you’re starting the process to work in the U.S. from abroad, it can take several years, depending on the country in which you live, because the U.S. limits the number of Green Cards issued from any single birthplace. However, if you live in the U.S., you can usually begin working much faster than if you live abroad.

What if I’m Not Eligible to Work in the U.S.?

You could be ineligible for a few reasons, including low test scores or 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, you’ll need to get the necessary education, either in your home country or in the U.S. You can apply for a student visa, which allows you to stay in the U.S. while you’re in school. 

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.

Stay on Top of Potential Changes in Immigration Laws

It’s important to look into current U.S. immigration laws and your visa eligibility since these regulations change often and without notice. Global circumstances are always changing and can affect immigration policy and employment for non-U.S. citizens. Check the U.S. Immigration Services website for potential updates.

Taking Your Degree Further in the U.S.

Working as an RN in the United States can open the door to specializing in a field of your choice. Many nursing specialties offer certifications, and earning one can be a good way to advance your career. Most nurses find an area of specialty that they particularly enjoy after working in the field for a while. There are dozens of specialties to explore. Some popular ones include:

  • School nurse
  • Occupational health nurse
  • Rehabilitation nurse
  • Neonatal nurse

anna giorgi

Written and reported by:

Anna Giorgi

Contributing Writer