Nursing is one of the noblest professions in the world and remains in demand in the United States. Registered nurses care for patients, coordinate care, collaborate with doctors and other health professionals, administer treatments, and monitor medical equipment. The U.S. Bureau of Labor Statistics projects about 189,100 openings for registered nurses each year, on average, from 2024 to 2034.
Pay is another reason nurses may want to work in the United States. According to the latest U.S. Bureau of Labor Statistics state wage estimates, annual mean wages for registered nurses ranged from approximately $77,000 in Alabama and South Dakota to $150,280 in California. Some foreign-educated nurses may also pursue an employment-based immigration pathway, but nursing licensure and immigration are separate processes, and neither is automatic.
Studying nursing in the U.S. can be one pathway to a nursing career, but it is not the only one. Foreign-educated nurses may apply for U.S. licensure without repeating an entire nursing degree in the country. However, each state board of nursing sets its own requirements. This article outlines the main steps of becoming a nurse in the US and highlights issues that foreign-educated nurses should confirm with the board of nursing in the state where they plan to practice.
How to Become a Nurse in the U.S.
Step 1. Study Nursing and Gain Work Experience
The first step is to complete a nursing education program. A bachelor’s degree is not always necessary. In the United States, registered nurses commonly enter the profession through a bachelor’s degree, an associate degree, or a diploma from an approved nursing program. For foreign-educated nurses, the important issue is whether the credential-evaluation process accepted by the relevant state board finds the nursing education comparable to U.S. nursing education.
You should also expect to provide evidence of the nursing license or registration you hold in your country of education or another jurisdiction. A foreign license does not authorize you to work as a nurse in the United States. Prior RN experience can also be relevant to employers and some pathways. However, two years of work experience is not a universal U.S. licensure rule, so check the requirements of your state board of nursing and prospective employer.
Step 2. Take an English Proficiency Test
Nurses regularly communicate with patients, doctors, and other health professionals, so English proficiency is important. State boards of nursing set their own English-language requirements, and accepted exams can vary. For federal health care worker screening, check the current approved list. As of May 2026, it includes Cambridge English, TOEFL iBT, IELTS, MET, OET, and PTE.
Some applicants may qualify for an exemption based on where they completed their entry-level nursing education and whether English was the language of instruction, including the language of textbooks. Exemption rules differ depending on whether you are meeting a state licensure requirement, completing a TruMerit program, or satisfying federal screening requirements. Check the rules for your state and immigration pathway before booking a test. You may also find a general English-language course or a test-specific course helpful.
Step 3. Evaluate Your Credentials
The next step is to evaluate your qualifications against U.S. nursing education standards. Credential evaluation helps a state board confirm that your documents are authentic and that your education is comparable to nursing education in the United States.
TruMerit, formerly CGFNS International, offers nursing-specific services such as the Credentials Evaluation Service Professional Report, the TruMerit Certification Program, and VisaScreen. The Certification Program includes a credentials evaluation, the TruMerit Nurse Qualifying Exam, formerly the CGFNS Qualifying Exam, and an English-language proficiency component. Some state boards require the qualifying exam before an applicant can take the NCLEX-RN. VisaScreen is a separate screening service used for U.S. occupational visa requirements; it does not itself grant a visa.
Requirements vary by state. Use the state board of nursing’s instructions or the NCSBN Nurse Licensure Guidance tool to determine which credential-evaluation service and report you need. Do not assume that a general academic credential evaluation is sufficient for nursing licensure.
Step 4. Take the NCLEX-RN Exam
Like other regulated professionals, nurses must pass a standardized test. All U.S. boards of nursing require licensure candidates to pass an exam, and they use the National Council Licensure Examination for Registered Nurses (NCLEX-RN) for RN licensure. The NCLEX measures entry-level nursing competence and includes clinical judgment. It is administered by Pearson at testing centers around the world.
The NCLEX is pass-or-fail and uses computerized adaptive testing. After the minimum number of items has been answered, the exam commonly ends when the computer is 95% certain that a candidate’s ability is clearly above or below the passing standard. Other stopping rules apply if the maximum number of items is reached or time runs out. Some state boards require foreign-educated nurses to pass the TruMerit Nurse Qualifying Exam, formerly the CGFNS Qualifying Exam, before taking the NCLEX-RN. Check the requirements of the state where you want to practice.
Step 5. Find a Job
If you have reached this stage, you can pat yourself on the back for completing several important steps. To work as an RN, you must meet the requirements of your state board of nursing and complete the applicable immigration process.
You may apply directly to hospitals and other health care employers or work with a nursing recruiter. A recruiter is optional. Depending on the arrangement, a recruiter may also act as the U.S.-based employer for an immigrant visa. Review the contract carefully and look for ethical international recruitment practices before accepting an offer.
Once you have secured a qualifying job offer, your work visa or immigration pathway depends on your circumstances. A U.S.-based employer generally serves as the petitioner. Professional nurses may be eligible for an employment-based permanent residence pathway under Schedule A. An H-1B visa may be possible only when the specific nursing position meets the specialty-occupation requirements. The H-1C nurse visa is no longer available because that classification expired in 2009. Qualified Canadian and Mexican citizens may be eligible for temporary TN status as registered nurses. Foreign health care workers may also need an approved health care worker certification, such as VisaScreen. Because immigration rules are separate from nursing licensure rules, confirm your case with official USCIS guidance or a qualified immigration professional.
Nurses contribute substantially to society by delivering critical care, promoting health and well-being, and helping meet changing health care needs. The United States can offer nurses substantial employment opportunities and competitive wages. If you want to pursue this career in the country, use the steps in this article as a starting point and verify your state-specific requirements.
We hope this article on steps to become a nurse in the U.S. was helpful. To learn more about studying in the United States, check out the Study in the USA and Available Programs for International Students sections!
