8 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

With the current nursing shortage in the United States—well documented by news and industry resources such as U.S. News & World Report and Nurse Journal among others—this may be good time for foreign-educated nurses to consider becoming a nurse in the U.S. While requirements and immigration laws can be strict, making the switch can be a fulfilling experience.

If you’re a registered nurse (RN) in another country, there are several factors to take into account 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 eight steps you’ll need to address before working as a foreign nurse in the U.S.

Steps for becoming a foreign nurse in the U.S.

Meet education requirements.

nurse posing outside of school

Before pursuing your career as a foreign-educated nurse, ensure you qualify to work in the U.S.:

• 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

Submit your prior credentials.

nurse smiling while working on laptop

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.

Take an English-language proficiency test.

group of nurses studying for exams

While it’s not required for everyone, passing an English-language proficiency test is sometimes required for CFGNS approval.

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.

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.

Become certified with the CGFNS.

male nurse standing in front of a white background

In addition to having your credentials approved by the CGFNS, there are other prerequisites many states require in order to pursue a nursing license.

Foreign nurses may pursue the CGFNS Certification Program is an all-encompassing solution to fulfilling the criteria for State Boards of Nursing. This certification demonstrates your credentials, evidence of English language proficiency and passing of the CGNFS Qualifying Exam.

The CGFNS also offers “VisaScreen,” which provides the same value as the certification program but also satisfies the U.S. Federal screening requirements for a work visa.

Note: the CGFNS is the most prominent, but there are alternatives available that are cheaper. Those include the International Educational Research Foundation and the Educational Records Evaluation. It’s important to check with your State Board of Nursing to determine which certifications they will approve.

Pass the NCLEX-RN.

five nurses take NCLEX exam in a school

This national exam is a requirement to practice as a registered nurse in all states, and it’s not an exception for foreign nurses. Registration with Pearson Vue and a $200 fee are needed to take the test, which is administered internationally in Australia, Brazil, Canada, England, Hong Kong, India, Israel, Japan, Mexico, Philippines, Puerto Rico, South Africa, South Korea, Taiwan and Turkey.

Apply for your nursing license.

nurse browsing on her laptop and applying for her nursing license

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.

Find a nursing job.

female nurse with clipboard posing in front of a hospital room

Finally, it’s time to start working as a registered nurse. It’s not a must, but the CGFNS encourages foreign-educated nurses to work with a staffing agency, which can help immensely in achieving the next step in acquiring your work visa. The CGFNS offers a list of certified recruiters, for reference.

Obtain your work visa.

group of nurses smiling and posing for the camera

To ensure you’re eligible to work in the U.S., acquiring one of the following visas is a necessity: TN Visa (for Mexican and Canadian nurses), an H-1B Temporary Work Visa or a Permanent Work Visa.

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.

Being proactive, especially in scheduling the CGFNS Qualifying Exam, the NCLEX-RN, and any necessary English proficiency tests ahead of time will expedite the process. Make sure and set your expectations with your prior experience and circumstances and map out what you will need to complete and how long it will take.

How much can foreign-educated nurses earn in the U.S.?

There isn’t any public data about how much foreign-educated nurses make explicitly, but the median salary for registered nurses is $81,220.

Registered Nurses

National data

Median Salary: $81,220

Projected job growth: 5.6%

10th Percentile: $61,250

25th Percentile: $66,680

75th Percentile: $101,100

90th Percentile: $129,400

Projected job growth: 5.6%

State data

State Median Salary Bottom 10% Top 10%
Alabama $63,090 $48,820 $82,760
Alaska $102,260 $80,950 $127,280
Arizona $82,330 $66,040 $105,520
Arkansas $64,130 $37,630 $83,700
California $132,660 $84,700 $177,670
Colorado $82,430 $66,130 $107,260
Connecticut $95,210 $71,050 $119,600
Delaware $82,230 $64,100 $101,110
District of Columbia $98,970 $66,260 $135,260
Florida $77,710 $61,190 $100,060
Georgia $79,440 $60,400 $118,270
Hawaii $120,100 $76,640 $137,710
Idaho $77,940 $61,530 $100,440
Illinois $78,980 $62,180 $102,080
Indiana $73,290 $55,200 $95,600
Iowa $65,000 $56,330 $83,360
Kansas $66,460 $52,010 $93,120
Kentucky $75,800 $56,120 $98,540
Louisiana $73,180 $57,500 $95,540
Maine $77,340 $61,170 $100,910
Maryland $83,850 $64,680 $106,910
Massachusetts $98,520 $67,480 $154,160
Michigan $79,180 $64,270 $100,920
Minnesota $84,060 $65,500 $107,960
Mississippi $63,330 $49,980 $84,030
Missouri $71,460 $51,440 $94,340
Montana $76,550 $62,930 $98,970
Nebraska $74,990 $58,900 $93,230
Nevada $94,930 $74,200 $130,200
New Hampshire $80,550 $62,790 $104,270
New Jersey $98,090 $76,650 $118,150
New Mexico $81,990 $64,510 $106,300
New York $100,370 $64,840 $132,950
North Carolina $76,430 $59,580 $100,430
North Dakota $69,640 $60,780 $91,150
Ohio $76,810 $61,860 $98,380
Oklahoma $74,520 $53,560 $97,520
Oregon $106,680 $81,470 $131,210
Pennsylvania $78,740 $61,450 $101,450
Rhode Island $85,960 $65,260 $104,790
South Carolina $75,610 $52,620 $93,190
South Dakota $62,920 $51,240 $80,860
Tennessee $65,800 $51,270 $95,490
Texas $79,830 $61,950 $105,270
Utah $77,240 $61,850 $98,000
Vermont $77,230 $60,900 $101,570
Virginia $79,700 $61,970 $104,410
Washington $101,230 $77,460 $131,230
West Virginia $74,160 $47,640 $96,470
Wisconsin $79,750 $65,110 $100,820
Wyoming $77,730 $60,910 $102,010

Source: U.S. Bureau of Labor Statistics (BLS) 2022 median salary; projected job growth through 2032. Actual salaries vary depending on location, level of education, years of experience, work environment, and other factors. Salaries may differ even more for those who are self-employed or work part time.

Unlike domestically-educated nurses, your salary is dependent on your work experience, education level and location, among other factors.

What is 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.

Find out how to become a nurse in your state

The process of becoming a nurse is different depending on the state in which you are seeking licensure. Each state has different requirements and standards that you should be aware of.

Here are some of the top states for nurses in the U.S.:

What is the CGFNS VisaScreen?

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.

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


Who is exempt from English-language proficiency tests?

You’re exempt from taking any English-language proficiency test if either:

  • 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)

What other certifications are necessary for foreign-educated nurses?

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 have to submit to a background check, or include a character reference with your application.

What are Foreign-Educated Nurses (FEN) courses?

These courses are offered for RNs who need their nursing knowledge or skills refreshed. Sometimes referred to as “RN refresher courses,” they usually consist of 120 hours in the classroom and 120 clinical hours.

Check with your State Board of Nursing to determine whether a FEN refresher course is recommended or required, and which institutions offer accredited courses.

anna giorgi

Written and reported by:

Anna Giorgi

Contributing Writer