How Internationally Educated Nurses Get a US License

Internationally educated nurses get a US license by applying to a state board of nursing, having their education evaluated as comparable to a US program, meeting English proficiency requirements and passing the NCLEX. Licensure is handled state by state, so the exact documents, evaluation reports and fees depend on the board you choose. Immigration is a separate process with its own requirements.

How US nursing licensure works

There is no national nursing license in the United States. Each state and territory has a board of nursing that licenses nurses under its own nurse practice act. A license from another country does not transfer directly. Instead, you apply for licensure by examination, the same route US graduates use, and pass the NCLEX-RN (or the NCLEX-PN for practical nursing).

Once you hold one US license, moving to another state is simpler. You can apply by endorsement, which our guide on getting a license by endorsement explains, or hold a multistate license if your primary residence is in a compact state.

Step 1: Choose a state board

Requirements differ, so research before you apply. Look at:

• Which credentials evaluation agencies and report types the board accepts
• English proficiency requirements and accepted tests
• Whether a US Social Security number is required before a license is issued
• Whether you can apply from outside the US
• Processing times and fees

Many nurses choose the state where they plan to work or where an employer has offered sponsorship.

Step 2: Have your credentials evaluated

Most boards require a credentials evaluation that compares your nursing education and license to US standards. CGFNS International is the best-known organization for this, and some boards accept other evaluation agencies. Your board will tell you which agency and which type of report it accepts.

Expect to arrange for:

• Official transcripts sent directly from your nursing school
• Verification of your nursing license or registration from the country where you were educated
• Course descriptions or clinical hour details, if requested

Boards typically look for theory and clinical experience across core areas, such as adult medical-surgical, maternal and newborn, pediatric and mental health nursing. If your program didn't cover an area to the board's standard, you may need extra coursework before you're approved to test.

Step 3: Meet English proficiency requirements

If your nursing education wasn't in English, and in some cases even if it was, you'll likely need an English test. Commonly accepted tests include IELTS, TOEFL and OET. Boards and immigration requirements set their own minimum scores, which can differ, so check both before you book a test.

Step 4: Apply and register for the NCLEX

Apply to the board for licensure by examination and register with Pearson VUE. When the board approves you, you'll receive an Authorization to Test. The NCLEX is offered at Pearson VUE test centers in the US and in a number of other countries. Our guide on registering for the NCLEX-RN covers registration, scheduling and test day.

Step 5: Prepare for and pass the NCLEX

The exam uses the Next Generation format, which tests clinical judgment through case studies and newer item types. Our overview of what changed with the Next Generation NCLEX explains the format. Questions reflect US practice, so review areas that may differ from your training, such as delegation to assistive personnel, scope of practice, patient rights and medication safety practices.

Study partners help here too. You can ask questions in the nursing students study group, including about preparing for the NCLEX as an internationally educated nurse.

Common delays and how to avoid them

The process often takes longer than nurses expect, and much of the delay comes from paperwork. A few habits help:

• Start document requests early. Schools and licensing bodies in some countries take a long time to send transcripts and verifications.
• Keep your name consistent. Make sure the name on your passport, transcripts, license verification and applications matches, and keep proof of any legal name change.
• Order the right report. Requesting the wrong type of evaluation can mean paying for a second one.
• Track every submission. Keep copies, receipts and tracking numbers, and note the date each item was sent.
• Check your account often. Boards and evaluation agencies may post requests for more information online, and a missed request can stall your file.
• Answer every question fully. Unexplained gaps or incomplete answers about prior discipline or criminal history usually slow things down.

Planning for the costs

Expect to pay separately for the credentials evaluation, English test, board application, NCLEX registration and, if you need one, VisaScreen. Each organization sets its own fees, and they change, so check current amounts with each one and budget for the possibility of retaking a test.

The immigration side

Licensure and immigration overlap, but they are separate processes. A few general points:

• Many nurses come to the US through employer-sponsored immigrant visas.
• Canadian and Mexican nurses may be eligible for TN status under the United States-Mexico-Canada Agreement.
• Foreign-educated nurses seeking certain visas generally need a VisaScreen certificate, issued through CGFNS, which reviews education, licensure and English proficiency.

Visa availability and processing times change, so work with a qualified immigration attorney rather than relying on a recruiter's estimate.

If a recruitment agency is involved, read the contract carefully before you sign. Check how long you're committing, what you would owe if you leave early, and who pays for travel, housing and exam fees. Have someone independent review it.

Starting work in the US

Your first US job may feel different even if you have years of experience. Documentation systems, delegation, patient expectations and unit routines may all be new. Ask employers about orientation length and support. Some nurses who are new to US practice join a residency or transition program; our article on nurse residency programs explains what those typically include.

Once you're licensed, add your license through Get Verified to put a verified license badge on your NurseTide profile. For advice from nurses already working in the US, you can ask about units, employers and settling in through the working nurses group.

Next step

When your license is issued, compare positions and pay in the state you chose. Jobs on NurseTide show the pay, so start with registered nurse jobs.

General information for nurses, not medical, legal, tax or financial advice. Follow your facility's policies, your state board of nursing and the terms of your employer or contract.