How to work as an international nurse in the U.S.

USA

Published 13 June 2024

Embarking on a nursing career in the United States as an international nurse can be both an exciting and challenging journey. With the U.S. healthcare system offering diverse opportunities and a high demand for skilled nurses, understanding the necessary steps to navigate visa requirements, certification processes and cultural adjustments is crucial.

In this guide, we’ll walk you through everything you need to know to successfully transition into a nursing role in the U.S., ensuring you are well-prepared to make a meaningful impact in your new workplace.

8 steps to become a nurse in the U.S.

We’ve broken the processes of becoming a nurse in the United States into eight key steps for you:

Find a nursing agency
Check your nursing credentials
Complete an English language proficiency exam
Apply to a state board of nursing
Take the NCLEX exam
Find an employer
Apply for your nursing work visa
Relocate to the U.S.

1. Find a nursing recruitment agency

Finding a U.S.-based staffing agency to support you through the licensure and visa process will provide you with the best chance to realise your dream of working as a nurse in the U.S.

You must have the following to apply with Espirita:

Evidence of completion of your nursing qualifications
Minimum level of experience for your specialty, for example Emergency Room (ER) nurses must have a minimum of 12 months’ experience in the last 18 months

We provide one-to-one mentoring and financial assistance to obtain your U.S. Registered Nurse (RN) license and with the NCLEX-RN exam. Our immigration lawyers will provide financial guidance and support you through the visa process, making it as easy as possible for you and your family.

2. Check your nursing credentials

You must have evidence of completing an accredited nursing qualification that is comparable to a U.S. educational programme for registered nursing. Our relocation experts will be able to help you understand your credentials and how they compare to those in the U.S. Your education program institution will need to forward a transcript of your training to a credentials evaluation agency (usually to CGFNS or another credential evaluation service approved by the state board you’re applying to) to determine equivalency.

In some instances, you’ll need to complete a CGFNS Qualifying Exam® and/or get a certificate to prove your eligibility for NCLEX-RN exam. We’ve compiled a list of all states that do and don’t require the CGFNS Qualifying Exam® for NCLEX.

3. Complete an English language proficiency test

Most foreign-educated nurses must demonstrate English proficiency as part of the CGFNS certification. This is required before taking the NCLEX exam to gain a nursing license in their chosen state. Although not all states require nurses to get CGFNS certification, you must be able to prove you can effectively communicate in English in most states. They typically require nurses to pass an English language proficiency test.

Ways nurses can prove their English-speaking skills include passing:

The Test of English as a Foreign Language (TOEFL)
The Test of English for International Communication (TOEIC)
The International English Language Testing System (IELTS)

Nurses who completed their qualifications in English-speaking countries where their courses were delivered in English are exempt.

Some examples of these countries include:

The United Kingdom
Ireland
New Zealand
Canada (except Quebec)

Not all states require nurses to pass an English proficiency test. Each state has its own licensure requirements, so research before applying to see if an English exam is needed.

4. Apply to a state board of nursing

In the United States, nursing practice is regulated at state level. Each state has its own board of nursing, which sets the standards for licensure and practice within the state. This means that nurses must obtain a licence for the state in which they wish to practice, unlike in other countries where a nationally recognised registration allows for practice across all regions.

For example, a registered nurse working in New York must have an RN licence which was issued by the New York Board of Nursing. If the same nurse wanted to work in California, they would need to apply for an RN licence with the California Board of Nursing. Changing states will require a different licence and possibly a new visa. Read more about the topic in our guide on how to change jobs as a nurse on a U.S. work visa.

5. Take the NCLEX exam

In order to become licenced in the U.S., all nurses must pass the NCLEX exam. This test proves a nurse’s competency and ensures they can practice safely. It tests application and analysis of the nursing knowledge you learnt in school through case studies on a computerised exam. Because passing this exam is a requirement for registering as a nurse in the United States, it’s important that you prepare. In our guide on NCLEX practice questions, we provide tips and tools to give you the best chance of passing the exam.

6. Find an employer

If you haven’t already, now is the time to secure a job offer from an U.S. employer. You’ll need this to apply for a work visa.

Working with a nursing agency is one of the best ways for you to secure a job in the United States. Recruiters have existing networks and industry insights that make it easy to match you to your dream role.

With a 99% retention rate, Espirita has the experience to find you a new role in the U.S. We place you in permanent roles or act as your employer to assist with your visa application while confirming a job offer. Espirita supports nurses relocating to the U.S. from across the globe for a minimum of three years once relocated or permanently. We can offer a variety of work opportunities across the states for all types of registered nurses.

7. Apply for your nursing work visa

A visa will give you the right to live and work in the United States. In some cases, it also allows your family to come with you.

The type of visa you need will depend on your citizenship. Here are some examples of common work visas for nurses, all of which need proof of a job offer and licensure:

EB-3 visa
TN visa
H-1B temporary work visa
Permanent work visa or green card (nurses can apply for a green card once they’ve held certain other work visas; if approved, it grants permanent residency in the U.S.)

Relocate to the U.S.

Finding an employer, obtaining licensure and securing a work visa are the trickiest steps on the path to living and working in the United States. Once that is completed, it’s time to start planning the logistics of relocation, such as:

Booking flights and transfers
Finding a place to live
Registering with schools and doctors
Becoming part of your new community

As always, Espirita is by your side, helping you book travel and find accommodation. We continue to support you once you’ve arrived in the U.S. with regular check-ins, advice on understanding local culture and signposting to important services and community organisations.

Hear from our international nurses

“I highly recommend Espirita to any nurse looking to relocate to the USA. Their expertise in processing applications for overseas nurses, visa facilitation, and overall support system makes them a top-tier recruitment agency. They provide not only career opportunities but also a strong foundation for long-term settlement in the USA.”

Fouzia Haneef, Registered Nurse

Pakistan

Are you interested in working as a nurse in the U.S.?

If you’re looking to relocate to the U.S., register for job opportunities and a member of our team will be in touch to discuss your application. Our team will be there to support you throughout the whole process, from looking for positions all the way to helping you even after you’ve moved.