International Nurse License Guide

If you trained as a nurse outside the US and want to work here, you’re looking at a process that’s more complex than most people expect. It’s not just about passing an exam—you’ll deal with credential evaluations, immigration bureaucracy, and state licensing boards, often simultaneously.

Here’s the honest picture of what’s involved.

The Big Picture

Getting licensed involves five interconnected pieces. Some can happen in parallel; others have strict dependencies. Understanding this upfront saves frustration later.

Credential evaluation (CGFNS) → NCLEX exam → State license → VisaScreen → Work visa

CGFNS and NCLEX prep can happen simultaneously. VisaScreen needs your NCLEX pass before it completes. Immigration depends on everything else being done. Timeline: 12-24 months if things go smoothly, longer if they don’t.

CGFNS: The Credential Evaluation

Most states require CGFNS evaluation before they’ll even consider your license application. Start this first—it takes months and everything else depends on it.

Which Program Do You Need?

CGFNS runs several programs. The one you need depends on which state you’re targeting:

CGFNS Certification Program (~$445): Full credential evaluation plus a qualifying exam. Most states accept this.

Credentials Evaluation Service (CES) (~$350): Evaluation only, no exam. Fewer states accept CES alone—check your target state’s requirements before choosing this route.

VisaScreen: You’ll need this for immigration regardless. Can be done alongside either program above.

What They’re Looking For

CGFNS verifies that your nursing education is equivalent to US standards. They’ll check:

• Your nursing program’s curriculum and hours
• That your license in your home country is valid and unrestricted
• Your English proficiency scores
• Your high school credentials (yes, really)

Getting Your Documents Together

This is where many people hit delays. You need:

• Official transcripts from your nursing school
• A copy of your nursing curriculum
• License verification from your country’s licensing authority
• Passport copy and photos
• English test scores (IELTS, TOEFL, or PTE)

The frustrating part: documents must come directly from the issuing institution. You can’t just send copies yourself. If your nursing school is slow to respond or your country’s licensing board has bureaucratic delays, your timeline extends.

Timeline Reality

CGFNS says 4-8 months. Some countries process faster; others (particularly those with high volume like the Philippines) can take longer. Factor in document delays and you might be looking at 6-10 months.

The NCLEX: Everyone Takes It

There are no shortcuts here. Every nurse who wants to practice in the US takes the NCLEX, regardless of credentials or experience elsewhere. It’s the great equalizer.

Getting Authorized to Test

Before you can schedule the NCLEX, you need an Authorization to Test (ATT). This comes from the state where you’re applying for licensure. Apply to your target state, pay their fee, and wait for them to confirm you’re eligible.

Once you have your ATT, register with Pearson VUE and schedule your exam.

You can take the NCLEX outside the US at Pearson VUE centers in the Philippines, India, UK, Canada, Australia, Japan, and several other countries. Check Pearson VUE’s international locations for current availability.

What Makes the NCLEX Hard for International Nurses

The nursing knowledge is similar worldwide. What trips up international nurses:

Priority and delegation questions: US nursing emphasizes who should do what first, and what can be delegated to unlicensed staff. This framework may differ from how you were trained.

Medication names: Drug names vary by country. You’ll need to learn US generic and brand names.

The testing format: Computerized adaptive testing feels different. The test gets harder as you answer correctly, which can be disorienting.

Invest in quality NCLEX prep materials designed for international nurses. This is not where you want to save money.

There’s No Magic Score

The NCLEX uses adaptive testing—there’s no percentage or number to hit. You pass when the algorithm determines you’ve demonstrated consistent competence above the passing standard. You could pass with 75 questions or need all 145.

State Licensure

Once you pass the NCLEX, the state that authorized your test will issue your license—assuming you’ve met their other requirements (CGFNS evaluation, background check, fees).

Which State Should You Target?

This matters more than you might think:

Go where you have a job offer. If a hospital is sponsoring your visa, that’s your state. Simple.

Consider compact states. 43 states participate in the Nurse Licensure Compact. A license from a compact state lets you practice in all other compact states without additional applications. If you’re not sure where you’ll end up, a compact state gives you flexibility.

Check SSN requirements. Some states won’t issue a license without a Social Security Number, which you won’t have until you’re in the US with work authorization. Other states will issue the license first. This matters for your timeline—you may need to coordinate with your employer and immigration attorney.

Processing times vary wildly. Texas is generally fast. California is notoriously slow. Ask your employer if they have experience with specific states.

VisaScreen: The Immigration Requirement

This is the document US immigration requires to prove you’re qualified to work as a nurse. It’s separate from your state license and managed by CGFNS.

VisaScreen verifies:

• Your credentials are legitimate
• You passed the NCLEX
• You meet English requirements
• Your license is valid and unrestricted

English Proficiency Scores

You need to pass one of these tests with the following minimums:

IELTS Academic: Speaking 7.0, Listening 7.0, Reading 6.5, Writing 7.0

TOEFL iBT: Speaking 26, Listening 26, Reading 22, Writing 24

PTE Academic: Speaking 65, Listening 65, Reading 58, Writing 65

If you completed nursing school in an English-speaking country (UK, Australia, Ireland, etc.), you might be exempt. Check with CGFNS—the exemption isn’t automatic.

Cost and Timeline

VisaScreen costs around $540. Once you’ve passed the NCLEX and submitted everything else, the certificate usually comes within 2-4 weeks. It’s valid indefinitely, but you’re required to notify CGFNS if your license status changes.

Immigration: The Final (and Often Longest) Step

With VisaScreen in hand, you can finally work on the visa. This is often the most frustrating part—it’s largely outside your control and dependent on your country of origin.

The Main Options

EB-3 Immigrant Visa (Green Card): Permanent residence. Requires employer sponsorship. This is what most international nurses aim for, but wait times depend on your nationality. Nurses from the Philippines and India face significant backlogs—sometimes years. Nurses from most other countries typically have shorter waits.

H-1B Visa: Temporary work visa. Requires a bachelor’s degree (which not all nursing programs provide). Subject to an annual cap, though non-profit hospitals may be exempt. Talk to your employer about whether this is an option.

TN Visa (Canada and Mexico only): If you’re Canadian or Mexican, this is your fastest path. Under the USMCA trade agreement, you can get work authorization in days rather than years.

The Uncomfortable Truth About Backlogs

If you’re from the Philippines or India, you need to plan for a long wait. EB-3 visa backlogs for these countries can extend several years. Some nurses apply from abroad, wait, and continue working at home until their priority date becomes current.

Others look for creative solutions: different visa categories, positions with cap-exempt employers, or jobs in countries with shorter waits while they’re in the queue.

An immigration attorney who specializes in healthcare workers is worth the investment here.

What Your Country of Origin Means

Your experience will differ based on where you trained:

Philippines: The largest source of international nurses in the US, which means well-established CGFNS processing infrastructure—but also the longest visa backlogs. Many US hospitals have active recruitment programs in the Philippines.

India: Strong nursing programs, but you may need additional coursework if your education doesn’t map to US requirements. EB-3 backlogs are substantial, similar to the Philippines.

Canada: The easiest path. TN visa processing is fast, and your education is closely aligned with US standards. Many border-state hospitals actively recruit Canadian nurses.

UK: Your education is generally well-regarded, and you may qualify for the English test exemption. If you have Canadian dual citizenship, you might qualify for TN visa status.

Other countries: The process is the same, but processing times and equivalency evaluations vary. Countries with nursing programs closely aligned to US standards tend to have smoother CGFNS evaluations.

Where Things Go Wrong

CGFNS delays: Usually caused by documents that don’t arrive from institutions. Stay on top of your nursing school and licensing authority. Some countries have notoriously slow bureaucracies—start early and follow up relentlessly.

NCLEX failure: It happens. International nurses sometimes struggle with the US-specific clinical reasoning questions. If you fail, you’ll need to wait before retesting. Invest in serious prep the first time.

Visa retrogression: For high-demand countries, your priority date might become current and then “retrogress” (move backward) if demand exceeds supply. This is outside your control but worth understanding.

The Bottom Line

This process takes 12-24 months in the best case, and longer if you’re from a country with visa backlogs. Start with CGFNS immediately—everything else depends on it. Take the NCLEX seriously and invest in good prep. And if you’re from the Philippines or India, plan for a longer immigration timeline and consider an attorney who knows healthcare immigration.

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