January 27, 2023

How to Work in the US as a Foreign-Educated Nurse

Young nurse taking notes in hospital room

While there is a well-known shortage of registered nurses and healthcare professionals, current U.S. immigration laws can make it difficult for foreign nurses in the US to obtain jobs. It is important for those interested in pursuing this avenue to obtain the proper visas and paperwork from the U.S. Citizenship and Immigration Services department.

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How to Work in the U.S. as a Nurse From Another Country

There are eight key steps foreign-educated nurses will need to take in order to obtain a position as an RN in a U.S. hospital. 

  1. Meet the educational requirements
  2. Complete a foreign-educated nurses (FEN) course
  3. Take and pass an English language proficiency test, if mandated
  4. Pass your National Council Licensing Examination-Registered Nurse (NCLEX – RN)
  5. Obtain credential evaluation  
  6. Find a nursing recruiting agency or US-based employer
  7. Apply and obtain an RN immigrant visa/green card
  8. Accept an RN position

Step 1. Meet the US Education Requirements for Nurses

First and foremost, internationally educated nurses must meet basic education requirements. These include: 

Step 2. Complete a Foreign-Educated Nurses (FEN) Course

While the aforementioned are required, most states also require foreign-educated nurses to complete a Foreign-Educated Nurses (FEN) refresher course.

The course consists of 120 hours in the classroom and 120 hours of clinical practice under the supervision of a licensed Registered Nurse.

Step 3. Pass English Language Proficiency Tests

After meeting the initial education requirements, some foreign-educated nurses must take and pass the Test of English as a Foreign Language (TOEFL), the Test of English for International Communication (TOEIC) or the International English Language Testing System (IELTS). This will vary depending on the country of origin and results are sent directly to the state nursing board. 

Nurses who went to nursing school in the United Kingdom, Australia, New Zealand, Canada (except Quebec), or Ireland are exempt as are those whose spoken language in nursing school was English and/or the nursing school textbooks were written in English.

Step 4. Pass the NCLEX-RN Examination

After ensuring you meet the education and language requirements it’s time to apply for the NCLEX  in the state of intended employment. Registration with Pearson Vue is required and costs $200 plus additional foreign fees.

According to the webpage, NCLEX examinations are currently administered in Australia, Canada, England, Germany, Hong Kong, India, Japan, Mexico, Philippines, Puerto Rico, and Taiwan. 

Step 5. Have the CGFNS or Another Credentialing Organization Evaluate Your Credentials

The Commission on Graduates of Foreign Nursing Schools (CGFNS) is a company that is employed by State Boards of Nursing to ensure that applicants meet the basic requirements and are fit to take the NCLEX.

Established in 1977 after a thorough investigation of the immigration of foreign-born and educated registered nurses, the U.S. Department of State and Labor developed the Commission with a dual purpose: to ensure safe patient care to Americans and to help prevent the exploitation of graduates from foreign nursing schools who are employed in the United States to practice.

This company specifically will go through all nursing school transcripts and education history from your home country. While this company is the most popular and most well known - it is expensive and each state requires different levels of credentialing. 

There are three main credentialing reports: 

  1. Credentials Evaluation Service Professional Report
  2. CGFNS Certification Program
  3. Visa Credentials Assessment

Credentials Evaluation Service Professional Report

This report is less involved and cheaper than the Certificate Program or VisaScreen. It provides the basic information for the State Board of Nursing and only a handful of states accept this. 

Below are the requirements you’ll need to meet:

  • English Requirement
  • Secondary School Documents
  • Licensure Documents from your Home Country
  • Nursing Education Documents from your Home Country
  • $350 Fee

CGFNS Certification Program

This evaluation is the same as above but requires the applicant to take the CGFNS Qualifying Exam.

Here are some specifics:

  • Everything in a Credentials Evaluation Service Professional Report
  • CGFNS Qualifying Exam 
  • $445 Fee

The CGFNS Qualifying Exam helps states determine if foreign-educated nurses are well suited to care for patients in America. According to the CGFNS web page, individuals must possess a wide variety of nursing knowledge.

Applicants are required to have a minimum number of classroom and clinical hours in required fields such as pediatric nursing, psychiatric nursing, neonatal nursing, and adult medical/surgical nursing. 

The examination is held three times a year at over 40 testing centers across the globe. Individuals may travel to other countries, if needed, in order to take the exam. 

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VisaScreen: Visa Credentials Assessment

The same requirements as the CGFNS Certification Program but will qualify the individual for a Work Visa after successful completion of the NCLEX. 

You’ll also need to pay a $540 fee.

Other credentialing services could potentially be cheaper and still accepted by the State Boards of Nursing. It is important to check with the State Board before using a different credential service. Alternatives to CGFNS include:

  • International Education Research Foundation 
  • Educational Records Evaluation Service

Step 6: Find a Nursing Recruiting Agency or US-Based Employer

The next step is to obtain an employment visa. There are several options for these nurses but nurses must have sponsorship from a staffing agency. It is easier for foreign nurses to work with an independent staffing recruiter and agency than directly with a hospital.

Agencies are well versed in helping nurses work in the U.S. and have systems in place in order to ensure all information and paperwork is completed accurately. 

Step 7. Obtain Your Nursing Employment Visa or “Work Visa”

Types of Work Visas for Nurses

Mexican And Canadian Nurses - TN Visa

Mexican and Canadian nurses may work in the United States with a special TN visa if the individual has an offer of employment, a license to practice in their home country, and pass the NCLEX and state licensure requirements. 

H-1B Temporary Work Visa

Nurses who hold a four-year degree and fulfill a specialized nursing role may qualify for an H-1B temporary work visa and then apply for a green card once stateside. These specialized roles include critical care nurses, emergency room nurses, and/or cardiology nurses.

It is important to note that there is a very limited number of H-1C visas available to nurses who want to work in very specific hospitals in underserved communities. 

Permanent Work Visa

The majority of foreign-trained nurses will need to obtain a permanent work visa, otherwise known as a green card. This application needs to be completed prior to travel to the United States and the visa must be obtained before immigrating legally. 

Step 8. Find a Registered Nursing Job in the US

Many career experts advise nurses to conduct targeted job searches through job boards specific to their area of expertise. You can start by checking out the available positions on the job board. If there is a particular hospital you’re interested in, you may want to look on their site to see if they have any openings.

Can I Work in the U.S. as an LPN From Another Country?

Many LPNs from foreign countries want to know if they can practice in the U.S. Unfortunately, U.S. work visas are only issued to foreign RNs and APRNs. Licensed Vocational Nurses (LVNs) and Licensed Practical Nurses (LPNs) are not eligible for work visas in the U.S.

According to CGFNS International, a non-profit organization that helps foreign-educated healthcare professionals live and work in their country of choice, only nurses with a first-level degree or RN credentials (as defined by the International Council of Nurses) have nursing license transferability in the US.  Per CGFNS, at this time, practical and vocational nurses are unfortunately ineligible for licensure in the U.S.

CGFNS reports that the minimum requirements needed to work in the U.S. as a nurse are graduation from an accredited RN program, an unencumbered RN licensure, and two years of working experience in the profession. 

Foreign Educated LPN Requirements by State

However, some US state nursing websites have varying degrees of information on how LPNs can obtain work if they are licensed in a foreign country and living in the U.S. with a non-work visa. Unfortunately, much of the information is unclear.

The New York State Education Department (NYSED) website states there is an option for obtaining licensure as a foreign-trained LPN in New York, however, the Nursing Board Office at the New York State Education Department was unable to confirm that, and instead advised LPNs to see the requirements to apply for a NYS license and to take the NCLEX via email message.

Per the NYSED website, these are the instructions to apply for licensure as an LPN who graduated from a nursing school in a foreign country (outside of the U.S. and U.S. territories).

STEP 1: Complete New York State’s infection control coursework requirement.

You can find an NYSED-approved infection control course here.

STEP 2: Submit an online application for LPNnlicensure.

There is also a limited permit application option for those who have not taken the NCEX-PN.

STEP 3: Have your foreign nursing credentials verified.

There are two options:

  • Arrange to have the Commission on Graduates of Foreign Nursing Schools (CGFNS) verify your nursing education credentials to the NYSED using CGFNS’ Credential Verification Service for New York State. You must also arrange for NYSED to receive verification of your nursing license from the licensing authority that issued it using a Verification of Foreign Professional Licensure/Certification form.

  • You must arrange to have your credentials verified by your foreign nursing school using a Certification of Professional Education form.

STEP 4: Pass the NCLEX if you haven’t already.

If you haven’t passed NCLEX-PN, you must register to take the NCLEX-PN with Pearson VUE.

The California Department of Consumer Affairs website offers applications for vocational nurse licensure by endorsement for foreign-educated LPNs. However, eligibility appears to be for LVNs with Special Immigrant Visas or those who are refugees and asylum seekers.

Contact your state’s individual nursing board for more information on foreign-educated LPN work if you are a foreign-educated LVN in the US with a non-work visa.

Nurses NOT Eligible To Work In The United States

Unfortunately, not all foreign-educated nurses are eligible to work in the United States. These include but are not limited to:

  • Nurses with less than two years experience
  • Nurses lacking a four-year nursing degree (state dependent)
  • Individuals who have committed a crime
  • Nurses who lack sponsorship from a reputable nursing agency

Next Steps for Nurses Who Want to Work in the U.S.

Due to ever-changing immigration laws, it is important for potential nurse immigrants to speak directly to staffing agencies or immigration lawyers to ensure all laws are followed. Most foreign-educated nurses work closely for several years prior to working in the United States as a registered nurse.

Those seeking additional information regarding specific immigration laws should search the U.S. Department of Homeland Services and U.S. Department of Labor.

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