How to Work in the U.S. As a Foreign-Educated Nurse

If you’re a nurse planning to move to the U.S., you’ll need to obtain a license to continue your career. The great news is that many states are willing to approve nurses with foreign credentials and have clear steps to follow.

Of course, you might face challenges, and you could feel tempted to take a job outside of the field of nursing. But then, you wouldn’t be using your specialized skills and training. That’s why it’s important to realize that validating your foreign credentials is entirely possible and will allow you to start practicing as a nurse in the U.S. and earning a solid salary.

In this guide, we will answer the following questions:

Why Get Licensed as a Nurse in the U.S.?

Job Demand and Employment Growth

Nursing offers strong job growth, competitive pay, and lasting career opportunities in the U.S.

According to the National Library of Medicine, employment opportunities for nurses are projected to grow faster than any other profession in the United States through 2026.

This increased demand is driven in part by the fact that people in the U.S. are living longer thanks to medical advancements. Beyond that, many nurses currently working in the U.S. are expected to retire within the next decade, leaving significant gaps that the healthcare system will need to fill.

Salary Expectations

In addition to fulfilling a need, there’s a good chance you’ll earn a competitive salary. According to Indeed.com, the average pay for nurses nationwide is $46 an hour, which is around $95,000 annually if you work full-time. You could earn even more in other states like California, where the average pay for nurses is $53 an hour, or New York, where nurses make around $50 an hour.

Ok, so now that you know getting your nursing license is worthwhile, let’s look at how you can get started.

Who Grants Nursing Licenses in the U.S.?

American Nurses Association & American Association of Colleges of Nursing

One of the first things you’ll need to know is who will grant your nursing license.

Nurses carry out essential and delicate tasks every day, from monitoring vital signs to administering medications. Given the importance of these duties, it’s no surprise that nurses go through a rigorous review process before receiving their licenses.

Role of State Boards vs. National Organizations

While there are national organizations like the American Nurses Association and the American Association of Colleges of Nursing, your nursing license will ultimately come from the state where you plan to work.

For example:

• California: California Board of Registered Nursing
• New York: NY State Education Department, Office of the Professions

How to Find Your State’s Board of Nursing

To find your specific state board, the National Council of State Boards of Nursing, also called the “NCSBN”, has created an interactive map. There you’ll see the phone number, street address, and local time for each state nursing board.

We’ll provide contact information for nursing licensing boards in California, Florida, Illinois, Massachusetts, New Jersey, New York, and Texas—seven of the most popular states for people moving to the U.S. to find work. If you need contact information for a different state’s licensing board, you can usually find it quickly through a Google search.

How to Contact Your State’s Licensing Board

Tips for Written Communication

• If English isn’t your first language, write your message in your native language, then get it professionally translated.
• Include your full name, address, phone number, and email.
• Be mindful of time zones when calling. Offices typically operate Monday–Friday, 9 a.m. to 5 p.m.

Calling the Board

If you prefer to call the licensing board, remember that office hours are typically from 9 a.m. to 5 p.m., Monday through Friday, and that the U.S. has several different time zones.

Credential Evaluation for Foreign-Trained Nurses

Foreign-trained nurses must have their academic credentials professionally evaluated to meet U.S. licensing standards.

As a nurse who’s been educated in another country, you will need your foreign credentials evaluated by a professional service.

What Credential Evaluation Services Do

Credential evaluation services review the academic and professional qualifications of nurses from other countries, then translate them into a format that’s recognized and understood in the U.S. healthcare system. They then provide a report that explains how your foreign grades, degree, license, and qualifications compare to those in the U.S.

Recommended Services and Costs

The most common credential evaluation service for nurses relocating to the United States is the Commission on Graduates of Foreign Nursing Schools, or the “CGFNS.” In fact, many states like California, Florida, and New York prefer incoming nurses to use this specific service.

One great thing about the CGFNS is that they’re a non-profit organization with a specific mission to help nurses from abroad who want to work in the United States. So, they’ll be ready to answer your questions and give detailed guidance based on years of experience.

Of course, there are other credential evaluation companies you can work with as well. If you’re unsure which organization you should use, you can contact your state licensing board and ask them which credential evaluation service they suggest.

These services offer different levels of evaluations.

A basic service, often called a “general evaluation” or “course by course evaluation,” might cost between $70 and $200. A more comprehensive evaluation, which gathers additional information, could cost between $150 and $500.

The processing time for credential evaluations can range from a few days to 4 weeks. But, most evaluation companies offer expedited services for an added fee of somewhere between $80 to $150.

Required Documents

When using a credential evaluation service, you’ll need to gather several important documents including things like your original degree certificate or diploma, your original transcripts, and marksheets.

And if your education wasn’t in English, you’ll need official English translations of your documents. To ensure they’re accurate and will be accepted, it’s important to use a professional translation service.

Proving English Proficiency

Why English Skills Matter

Essential English Proficiency for Nurses – TOEFL and IELTS

As a nurse, your English skills will be crucial to your work.

Whether you’re administering medication, managing pain levels, or updating a patient’s records, you’ll be reading, speaking, and writing in English every day. Aside from your daily tasks, you’ll also need English skills to take continuing education courses to maintain your license.

Because of this, nearly every state board of nursing requires you to prove that you can speak English. For some states, showing that your nursing education was taught in English will be sufficient proof that your skills are adequate. However, other states might require you to take an exam to test your English proficiency.

Even if you choose to work in a state that doesn’t require an English test, passing a well-known English exam could increase your chances of getting hired at a hospital or private practice. So, it may be smart to take an exam and boost your chances of landing a job.

Accepted English Exams

There are three main English exams that state nursing boards typically accept.

If you’re unsure which exam to take, you can contact the licensing board in your desired state and ask for their recommendation.

State Licensing Requirements for Foreign Nurses

Many states have specific paths for internationally-trained nurses.

Often, this process is called something like “licensure by exam”, referring to the National Council Licensure Examination, which is informally referred to as the “NCLEX.” Fortunately, most states are well-prepared for nurses from other countries and already have a pre-planned path for licensure. These states often create a webpage or a PDF explaining their specific requirements for internationally trained nurses.

Let’s review the important information in the most popular states for nurses hoping to immigrate to the U.S.

California

State Licensing Requirements for Foreign Nurses in California

The California Board of Registered Nursing created a detailed document providing information for international nurses. For starters, you need to prove that your education is equivalent to the board’s minimum licensure requirements using a credential evaluation report. Then, you must pass a criminal background check, provide your social security number, submit official transcripts from your graduate nursing program, and provide a copy of your nursing license from your home country. It’s also worth noting that California’s Board of Nursing only mandates the TOEFL English exam if they have doubts about your English comprehension. However, it might be wise to pass the exam preemptively, just in case. After the board has accepted your application, you must take the NCLEX.

Florida

State Licensing Requirements for Foreign Nurses in Florida

In Florida, there are similar requirements for nurses educated outside the jurisdiction of the National Council of State Boards of Nursing. Firstly, if you’re planning to take the NCLEX, the Florida Board of Nursing requires your education to be evaluated by a credential evaluation service. The board also requires that an original copy of the report be sent directly to them from the agency. After that, you’ll need to fill out an application for licensure in Florida. Then you need to prove that you have a Social Security number. After that, you’ll have to demonstrate your English competency by showing that your nursing program was taught in English, or passing an exam like the TOEFL, MET, or IELTS.

Illinois

State Licensing Requirements for Foreign Nurses in Illinois

As for Illinois, the requirements are nearly identical to Florida. Candidates will need to pass the NCLEX and provide a credential evaluation report. If your nursing program wasn’t taught in English, you need to pass an English proficiency exam and have the results sent from the testing agency directly to the Illinois Department of Financial and Professional Regulation. Then, you’ll have to have your fingerprints scanned for a background check and prove you have a Social Security number.

Massachusetts

State Licensing Requirements for Foreign Nurses in Massachusetts

If you’re applying for a nursing license in Massachusetts, your first step should be to create an account with their eLicensing System. The next step, if your nursing education wasn’t conducted in English, is to prove your proficiency by passing a state-approved English test. After that, you must have your credentials evaluated by the Commission on Graduates of Foreign Nursing Schools. Finally, you’ll need to fill out Massachusetts’ specific application for foreign-educated nurses and pass the NCLEX.

New Jersey

State Licensing Requirements for Foreign Nurses in New Jersey

New Jersey’s Division of Consumer Affairs requires five steps for graduates of foreign nursing programs. First, you must have your credentials reviewed by the Commission on Graduates of Foreign Nursing Schools. Specifically, New Jersey requires that you order the CGFNS’ “Full Education Course by Course Report” from them. Second, you must provide proof of a passing score on the TOEFL exam. Then, you must also have your TOEFL results evaluated by the CGFNS. Third, you’ll need to submit a completed licensure application. Fourth, you must obtain clearance from a criminal history background check. The fifth and final step is to pass the NCLEX.

New York

State Licensing Requirements for Foreign Nurses in New York

New York has unique instructions for nurses who’ve graduated from nursing school in a foreign country. For one thing, New York requires that you pass approved courses in infection control and child abuse identification and reporting. Like many other states, New York suggests that you have your credentials evaluated using CGFNS. However, be sure to select a specific report called the “Credential Verification Service for New York State.” Then, the New York State Education Department mandates that the organization that granted your foreign nursing license send a verification of that license directly to them. After those steps are completed, candidates will need to take the NCLEX.

Texas

State Licensing Requirements for Foreign Nurses in Texas

If you’re applying in Texas, there is a specific application called the “Endorsement application for graduates of international programs.” On the application, you’ll see that you need to submit a credential evaluation service report and a criminal background check. You’ll also need to submit proof you passed an English proficiency exam and send verification of your nursing license from your home country. Lastly, you must pass the NCLEX.

One final thing worth noting is that Texas is one of the few places where nurses must pass a state-specific exam. That exam is the Texas Nursing Jurisprudence Exam which has a fee of $25.

This exam has 50 multiple-choice questions, and you will have 2 hours to complete it. To pass, you must answer 75% of the questions, or 38 questions to be exact, correctly.

Luckily, test-takers are allowed to access the Texas Board of Nursing website to help them find answers during the exam. Beyond that, the Texas Board of Nursing created an online prep course for $25 to make studying easier.

When you pass the exam, the result will be recorded and posted to the Texas Board of Nursing online system. Your results will be recorded electronically within the Board of Nursing system, and a certificate will be available to print at the end of the exam. If you do not pass the exam, you can retake it after 24 hours, although you’ll need to pay the $25 fee again.

Aside from those seven states, the requirements are likely similar across the United States, so this will at least give you a good starting point.

We’ve summarized the above information in a table for easier reference.

What to Know About the NCLEX

NCLEX-PN vs. NCLEX-RN

No matter what state you plan to work in, you need to pass the NCLEX.

Before we dive in, let’s clarify that there are actually two different versions of the NCLEX, and the term “NCLEX” is used by the nursing community to refer to both. The lower-level version of the exam is the NCLEX-PN, which stands for the National Council Licensure Examination for Practical Nurses. This exam is for people who want to become Licensed Practical Nurses, or LPNs. This exam focuses on the basic patient care skills you’d need as a practical nurse who works under the supervision of a Registered Nurse or a doctor.

However, the more common NCLEX that people take is the NCLEX-RN, which stands for the National Council Licensure Examination for Registered Nurses. This exam is essential for those who want to become Registered Nurses, or RNs. The Registered Nurse role opens many more career opportunities because it involves a higher level of responsibility and a broader range of tasks than what you’d do as an LPN. Plus, if you pass the NCLEX-RN, you’ll likely still qualify for practical nurse job openings.

In this guide, we’ll focus on the NCLEX-RN since it’s the most widely taken version of the exam. We’ll still refer to the exam simply as the “NCLEX.”

Structure and Cost of the NCLEX

Every state nursing board in the U.S. requires nurse candidates to take the NCLEX. The NCLEX is overseen by the National Council of State Boards of Nursing, which has partnered with Pearson VUE to administer the test.

To schedule your exam date and pay the fees, you must create an online account with Pearson VUE. The NCLEX will be administered at one of Pearson’s Professional Centers. These are physical testing locations spread all across the U.S. and even overseas.

The fee to take the exam is $200, and if you decide to take the exam at one of Pearson VUE’s international testing locations, there’s an additional $150 fee. However, it’s wise to ask the state nursing board where you hope to work if you can take the NCLEX abroad. This is because, as mentioned earlier, places like Florida and California require you to have a Social Security number when applying to be a nurse. However, depending on your situation, international test centers could be a great option.

Adaptive Testing Format

No matter where you take your exam, the NCLEX is administered on a computer using a software called “computer adaptive testing,” a testing format that interactively adjusts your exam as you answer the questions. Computer adaptive testing aims to ensure that the questions you receive match your skill level, so they’re not too difficult or too easy.

Basically, it works like this: you’ll start with a relatively easy question, and if you answer it correctly, the next question will be slightly more difficult. On the other hand, if you answer an item incorrectly, the following question will be a bit easier.

This process continues throughout the exam, allowing the computer to gauge your level of competence.

Everyone answers between 75 and 145 questions on the exam. Regardless of the number of questions you receive, 15 will be experimental and won’t impact your score. The exam administrators use these experimental questions to evaluate potential questions for future exams.

You’ll have up to six hours to finish the exam, which includes an introductory tutorial. Breaks are not mandatory, but you can take an optional break after two hours of testing and another after three and a half hours.

Results and Retesting

There are three possible outcomes for the NCLEX exam. First, the computer could stop when it’s 95% sure your ability is clearly above or clearly below the passing standard. Second, if your ability is close to the passing standard, the exam can continue until you’ve answered all the questions, and then your final score is assessed afterwards. Third, if you run out of time, the computer uses your responses to decide if you pass or fail.

Whether you pass or fail, you will receive your official results from the nursing board of the state you intend to work in, not Pearson VUE. Your chosen state might email you, post the result online, or mail a physical report to you. According to Pearson VUE, you should receive your exam results in six weeks or less.

If a candidate doesn’t pass, the NCSBN provides a Candidate Performance Report called a “CPR.” The CPR will say the exam was failed, list the number of questions answered, and highlight the candidate’s strengths and weaknesses. The CPR is designed to help candidates figure out what to study before retaking the exam.

Candidates who do not pass can retake the NCLEX 45 days after their attempt, and can take the exam up to 8 times per year. Each time a person takes the exam, they must pay the $200 fee again.

However, by studying and passing on your first attempt, you can hopefully avoid retaking the exam or paying additional fees.

Content Areas of the NCLEX

The content areas of the NCLEX are divided into four basic categories: Safe and Effective Care Environment, Health Promotion and Maintenance, Psychosocial Integrity, and Physiological Integrity.

Study Resources for the NCLEX

Books, Guides, Online Courses, and Apps

Prepare for the NCLEX

A great place to begin is by reviewing a webpage called “Prepare for Success,” which presents candidates with a candidate bulletin, an information flyer, and an NCLEX Candidate Tutorial – designed to help testing candidates get acquainted with the Pearson VUE exam software.

After that, you can explore some study resources that are popular among the nursing community. On Amazon, you can find a very well-known book called the “Saunders Comprehensive Review for the NCLEX-RN,” which has over 2,800 customer ratings averaging 4.7 out of 5 stars. Needless to say, nurses truly value the Saunders study guide. You should be able to get a paperback copy for about $45, or a Kindle version for the same price if you want to start reading right away. The review’s latest edition even includes 5,700 NCLEX exam-style questions through an online portal you can only access after purchasing the book.

If you buy the Saunders Review directly from Evolve, the company that created the book, it will be slightly more expensive. However, the upside is that by purchasing the book through the website, you’ll immediately have 30 days of free access to an eBook version of the study guide while you wait for the physical copy to be delivered.

Another resource that’s actually free, is a comprehensive YouTube channel called “NCLEX Crusade International,” featuring instructional videos. The channel was created by a registered nurse who has now made over 180 videos dedicated entirely to teaching nursing students how to pass the NCLEX. The channel has over 90,000 subscribers, and it has videos that discuss how the exam is organized, the types of questions you’ll see, and the subject matter you should know.

Kaplan NCLEX-RN Prep

People seeking a multifaceted approach to preparing for the NCLEX can look into Kaplan Test Prep. Kaplan offers four levels of prep courses, ranging from $75 to $1,000. Luckily, Kaplan provides a 7-day free trial so you can decide if it’s worth it to you. But, even the $75 course offers three full-length computer adaptive tests that simulate the NCLEX. You’ll also have access to over 2,200 practice questions accompanied by answers, detailed explanations, and pharmaceutical flashcards. Plus, Kaplan offers mobile apps for both Apple and Android phones so you can study on the go.

A similar online study platform called NCLEX Mastery also offers its services through Apple and Android apps for only $36 a month. If you pay for the subscription, you’ll have access to more than 3,000 practice questions based on past exams. When you check out the platform’s ratings in the app store, you’ll see they have a 4.8 out of 5-star rating from over 28,000 users. So, it could be a great option if you want something more affordable.

Community Groups

If you’re looking for an online nursing community, check out the subreddit “r/PassNclex.” The group has over 23,000 members, including nurses who have already passed the NCLEX and other nurse candidates, and everyone shares their experiences. If you have a question or concern, you can post it there and you’ll almost certainly receive a response within 1 or 2 days.

Reddit r/PassNclex

If you’re searching for more online support, a Facebook group called “NCLEX 2024” has over 80,000 members. The group is private and has more than 1,000 weekly posts, so members can count on help from like-minded people. The group is a mixture of nurses who’ve already passed the NCLEX and people who still haven’t taken the exam, so you benefit from the perspective of people in every part of their nursing journey.

Facebook Groups for Nurses

Hopefully, these study resources will help you pass your NCLEX and receive your nursing license so you can start working!

Maintaining Your Nursing License

After you receive your initial license, you’ll need to renew it every two or three years.

Each state has its own guidelines, fees, and continuing education requirements for nursing license renewals, so it’s important to research the specific criteria for the state where you plan to practice.

With that said, let’s explore the requirements nurses need to maintain their licenses in some of the most popular states for immigrants.

Continuing Education and Renewal by State

Continuing education is essential for nurses to maintain licensure and stay current in their field.

California requires nurses to complete 30 hours of continuing education for each 2-year licensure period, with a renewal fee of $190. One great thing about California is that the Board of Registered Nursing explicitly states that “there’s no limit to the number of contact hours that can be completed through independent or home study courses,” which is perfect for people with busy schedules. It’s also worth noting that in California, you might be required to submit new fingerprints each time you renew your license.

Nurses in Florida are required to complete 24 hours of continuing education each 2-year renewal cycle, which Florida calls a “biennium.” The fee for each biennium will be $75 and nurses will be required to fulfill specific course requirements which you can learn about on the Florida Nursing Frequently Asked Questions page.

As for Illinois, nurses need to complete 20 Hours of continuing education every 2-year license renewal period and the fee to renew is calculated at $40 per year, which means $80 every 2 years.

To maintain a license in Massachusetts, nurses will need 15 hours of continuing education for every 2-year licensing period, and you’ll need to pay a $120 fee. The Massachusetts Board of Registration in Nursing doesn’t have a list of approved courses, but instead provides a PDF outlining the criteria for continuing education.

Folks who practice in New Jersey will need 30 hours of continuing education every 2 years for a fee of $120. Also, New Jersey requires that continuing education courses are approved by an organization that is accredited by the American Nurses Credentialing Center.

Unlike most states, in New York, your nursing license needs to be updated every 3 years. However, the first time you renew it, your license period will be shortened to match your birth month. Don’t worry, though, the New York Office of Professions will adjust your payment so you only pay for the time you can actually practice. After that, you’ll pay a fee of $35 every 3 years. New York doesn’t have continuing education requirements like other states because their licenses are valid for life unless the license is revoked for a specific reason. The only class you need is a short course regarding infection control, which you should take every 4 years.

Finally, in Texas, you’ll need to renew your license every 2 years and pay a fee of $68. Within the licensing period, you must complete 20 hours of continuing education. You can also demonstrate that you’ve achieved or renewed a Board-approved nursing certification in your practice area. To help you find those certification programs, the Texas Board of Nursing provides a comprehensive list.

The table below summarizes the information above.

Final Thoughts

Alright! That wraps up a few of the most popular states for immigrants in the U.S., but keep in mind that many states have similar requirements for nurses. So, the processes and requirements we focused on in this article are likely similar to those across most of the United States.

As you prepare to move to the U.S., remember that there’s a growing demand for nurses. The journey might be difficult at times, but if you get your nursing license in the U.S., you should be able to earn a great income using the education and experience you already have while bringing valuable skills to your new community.

No matter what country you’re coming from, relocating to the United States often requires official English translations of your important documents. You could need translations of college transcripts, your marriage license, your birth certificate, or your original nursing license. In any case, having certified translations is essential. Just reach out to us, and we’ll be happy to provide you with the translations you need!

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Author: Aaron Randolph | LinkedIn