Can you work as a nurse in the USA without passing the NCLEX? 

As an international nurse looking to work in the USA, you may be wondering how necessary it is to pass the NCLEX exam as part of your licensure process and visa application. Whether you’ve had trouble passing it in the past or you’re not eligible to take it, this blog will go through the key points to help you make an informed decision. 

What is the NCLEX? 

The National Council Licensure Examination (NCLEX) is an exam that all aspiring registered nurses (RNs) and licensed practical nurses (LPNs) must pass to practice in the United States. This includes foreign-educated nurses as well as nurses who trained in the USA.  

It’s a computerised adaptive test (CAT) that determines if a nurse has the knowledge, skills and critical thinking abilities to practice safely. The NCLEX is developed and maintained by the National Council of State Boards of Nursing (NCSBN). 

There are two versions of the NCLEX:

• NCLEX-RN is required for RNs
• NCLEX-PN is for LPN licensure

Why is it important? 

The NCLEX is essential for nurses moving to the United States, as passing it is required for licensure and visa eligibility. It serves as a benchmark for professional competence and helps streamline both the visa and licencing process. 

Without passing the NCLEX, nurses may find themselves limited to non-clinical roles that don’t fully reflect their training or capabilities. These positions are often administrative or educational in nature and lack the direct patient care responsibilities that defines professional nursing practice in the US.  

Nursing jobs without passing the NCLEX 

If you’re not eligible to take the NCLEX or want to work in a nursing or nursing-related role without taking the exam, there are various roles you can pursue depending on your educational background, qualifications and experience.  

Nursing jobs you could do without passing the NCELX include: 

1. Certified nursing assistant 
2. Medical assistant 
3. Patient care technician 
4. Health information technician 
5. Medical billing and coding specialist 
6. Home health aide
7. Health coach
8. Nurse educator   

1. Certified nursing assistant (CNA) 

CNAs support patients with daily living tasks like bathing, feeding and mobility, often working in hospitals or care homes. Individuals hoping to become CNAs typically need to complete a state-approved training programme and successfully pass a certification exam that includes both a written test and a hands-on skills assessment.  

2. Medical assistant (MA) 

Medical assistants perform both administrative and clinical tasks in clinics and doctors’ offices, such as taking vital signs, scheduling appointments and preparing patients for examinations. You won’t need to pass the NCLEX to work as a medical assistant. However, most positions do expect candidates to have completed a recognised medical assistance programme, and some positions require candidates to have the American Association of Medical Assistants (AAMA) certification.  

3. Patient care technician (PCT) 

PCTs assist with patient care tasks similar to CNAs but may also perform more advanced duties like drawing blood or using patient monitoring machines. Candidates often need to complete a PCT training course and obtain certification. Prior healthcare experience or CNA certification can be helpful to get you into this role. 

4. Health information technician 

Health information technicians manage and organise medical records, ensuring accuracy and confidentiality in healthcare data systems. A degree in health information management or a related field is usually required. Certification such as Registered Health Information Technician (RHIT) credentials can improve job prospects. And those wishing to develop their career options are encouraged to get certification in health data analysis, for example, the Certified Health Data Analyst (CHDA) credentials.  

5. Medical billing and coding specialist 

Medical billing and coding specialists translate medical procedures into codes for insurance billing and ensure accurate processing of healthcare claims. Completing a medical coding course and earning certification, such as the Certified Professional Coder (CPC) or Certified Coding Associate (CCA), is typically required. Applicants can enrol in focused training programme that teach medical terminology, coding systems and insurance billing procedures. These programs usually take only a few months to complete and do not require passing the NCLEX, since they’re separate from clinical nursing qualifications. 

6. Home health aide (HHA) 

HHAs provide personal care to patients in their homes, assisting with hygiene, mobility and basic health monitoring. Training requirements vary by state, but most require completion of a state-approved training programme and passing a competency evaluation. Each state has its own requirements for the training and qualifications needed.  

7. Health coach 

Health coaches support individuals in achieving wellness goals through lifestyle changes, nutrition advice and behaviour coaching. While not strictly regulated, many health coaches complete a certified health coach programme (e.g. NBHWC-approved) or have a background in healthcare or wellness is beneficial. 

8. Nurse educator (for LPNs or CNAs) 

These professionals train and mentor aspiring LPNs and CNAs in both academic and clinical settings. To qualify for these roles, individuals typically need a nursing degree, relevant field certification and hands-on clinical experience. While a master’s or doctoral degree in nursing education is often required for teaching at the RN level, LPN and CNA instructor positions may accept candidates with strong work experience and teaching credentials instead.  

Is passing the NCLEX necessary for international nurses? 

To legally practise as a registered nurse in the United States, passing the NCLEX-RN is essential. This exam is a core requirement for state licensure. For international nurses, passing the NCLEX is also typically required to qualify for a US work visa, as it demonstrates the level of competence, skills and knowledge expected in US healthcare settings. Knowing what to do after passing the NCLEX can help you during your relocation journey. 

Currently, only certain nursing roles are eligible for US work visas, including: 

• Registered nurses 
• Advanced practice registered nurses (APRNs) 

Licensed vocational nurses (LVNs), licensed practical nurses (LPNs) and certified nursing assistants (CNAs) are not eligible for US work visas. 

Holding an RN licence not only opens the door to visa sponsorship but also enhances a nurse’s professional credibility and trust among colleagues and patients. The NCLEX is widely recognised as a benchmark of nursing competence and commitment to high standards of care. 

While there may be limited roles available for international nurses without NCLEX certification, our focus is on supporting candidates who are prepared to take and pass the exam. This approach aligns with US licensure requirements and significantly improves the chances of successful employment and relocation. 

In some cases, healthcare organisations may sponsor international nurses while they prepare for the NCLEX. However, passing the exam remains a critical milestone for those aiming to practise as registered nurses in the United States. 

What happens if I fail the NCLEX? 

If you’ve taken the NCLEX to obtain your visa but have failed the exam, don’t stress. Most states allow you to retake the NCLEX after 45 days. Your visa timeline could be affected, so it’s important to check with the state board and an immigration attorney. 

We recommend you focus on practice and preparation while waiting to retake the exam. You’ll receive a Candidate Performance Report (CPR) highlighting areas for improvement, which can guide your study plan. In our blog on the topic, you can find further advice on what to do next after failing the NCLEX.  

Can you work as a nurse in the US before passing the NCLEX? 

In short, you can’t work in the US as a registered nurse before passing the NCLEX. All nurses, including internationally educated ones, must pass the NCLEX-RN to obtain a US nursing license to practice. This is a mandatory requirement set by every state’s Board of Nursing to ensure safe and competent care. 

For international nurses, passing the NCLEX is also a critical step in the immigration process. It’s typically required before you can be considered for a work visa or employment sponsorship. The US immigration system favours skilled roles, often requiring nurses to specialise or hold specific qualifications to be eligible for a visa.