A Nurse’s Guide to Working in the United States


In this post, we discuss the different options available for foreign nurses to work in the United States.

First, let’s discuss licensure requirements.

Registered Nurse License Requirements by Examination Educated Outside the U.S.

  1. Educational Evaluation of Transcripts:

All applicants who graduated from nursing schools outside the United States must have their transcripts evaluated in a course by course evaluation by one of the following Nursing Commission approved service providers:

  • Graduates of Foreign Trained Nursing Schools (CGFNS), www.cgfns.org,
  • Education Records Evaluation Service (ERES) www.eres.com,
  • International Education Research Foundation, Inc. (IERF) www.ierf.org

*Please review the RN educational requirements of the state in which you wish to be licensed.

  1. English Proficiency Exam

An English Proficiency test is required for all LPN and RN license applicants who received their nursing education out of the United States except for Canada (Quebec requires the English Proficiency test), United Kingdom, Ireland, Australia, New Zealand, American Samoa, Guam, Northern Mariana Islands and Virgin Islands.

You must take and pass either the Test of English as a Foreign Language (TOEFL) www.toefl.com or International English Language Testing System (IELTS, academic version) www.ielts.org. This exam is required regardless of whether the program was taught in English.

  1. NCLEX:

Foreign nurses must take and pass the national licensure examination known as the NCLEX. Once the Nursing Commission approves your application you will need to register with Peasrsonvue at http://home.pearsonvue.com/ to take the national exam (NCLEX). Do not register for the NCLEX before the commission has approved your application. Once you register, our office will make you eligible on the Pearsonvue website. Pearsonvue will then email you the “authorization to test” (ATT). At that point you can schedule to take the NCLEX exam.

  1. State Licensure Examination:

In addition, foreign nurses must apply for licensure in the state they wish to work in. Please review your state’s requirements for more information.

Once you have completed these basic licensure requirements, you can explore your immigration options.

What are the most common ways to work in the United States as a nurse?

There are generally 3 ways in which a foreign nurse may work in the United States.

(1) TN Visa: The TN Visa is a great option for Canadian or Mexican nationals.

Fast Facts: The TN Visa is granted for an initial period of three years. Extensions are granted in time increments of one year. There is no limit on the number of years that a TN visa holder may work in the United States, however the TN visa is not suitable for permanent residence.

  • TN applicants must be Citizens of Canada or Mexico;
  • TN applicants must apply to work in a profession that is on the NAFTA list (such as a Registered nurse with a state/provincial license or Licenciatura Degree);
  • TN applicant’s position must fill an approved position in the U.S. that requires a NAFTA professional;
  • Mexican or Canadian applicants must work in a prearranged full-time or part-time job, for a U.S. employer;
  • Professional Canadian or Mexican citizens must have the qualifications required for the position;

(2) H-1B Visa: The H-1B visa is a great option for nurses with a bachelor’s degree or higher that seek to work in a specialty occupation such as a managerial position or nurse practitioner. The H-1B visa is a cap-subject visa that is issued for a period of 3 years, that may be extended for another 3 years. Only 65,000 H-1B visas are issued per fiscal year.

General Requirements:

  • an employer-employee relationship must exist. Only a U.S. employer can petition the entry of a foreign employee by filing USCIS Form I-129 Petition for Non-immigrant Worker. An employer-employee relationship exists if the U.S. employer has the right to hire, pay, fire, supervise or control the work of the employee;
  • the foreign worker must possess a bachelor’s degree, its foreign equivalent, or relevant work experience. If the foreign worker does not have formal education, but has at least 12 years of relevant work experience related to the specialty occupation, they may still qualify for an H-1B visa;
  • the foreign worker must be employed in a specialty occupation related to their field of study. A specialty occupation is an occupation that requires a bachelor’s degree or its equivalent;
  • the foreign worker must be paid at least the prevailing wage for the specialty occupation in the area of intended employment;
  • meet the licensure/state and or national requirements for the position sought.

(3) Green Card:

A U.S. employer may file a petition on behalf of a nurse specifically on Form I-140 Immigration Petition for Alien Worker.

Once the I-140 is approved, the nurse must wait for their priority date to become current on the visa bulletin. Once the priority date becomes current, the nurse may proceed and apply for an immigrant visa (permanent residence) under the EB-3 category for nurses. The nurse must attend an in-person interview at a U.S. consulate and provide documentation in support of the immigrant visa.

If you have any questions regarding these different options please visit our website.