The US nursing licensure pathway for internationally-trained nurses is well-defined, expensive, and slow – typically 12–24 months from start to license, and roughly $1,300–$2,750 in fees and prep costs without VisaScreen, or $2,050–$3,500 for nurses who also need a VisaScreen certificate to work in the US. Whether that investment is worth making depends heavily on your visa situation, your country of origin’s nursing salary, and which state you are targeting first. This guide walks through the correct sequence and the real financial case for it.
Two-track summary: which pathway applies to you?
| Track | Who it applies to | Key additional requirement |
|---|---|---|
| Nurse who needs US work authorization as a nurse | Nurses sponsored for a green card (EB-3 route, including adjustment of status inside the US) and nurses seeking occupational nonimmigrant status such as TN (Canada/Mexico) or H-1B | VisaScreen certificate (or a TruMerit Certification Program certified statement) required for the visa, admission, or status change |
| US citizen or existing permanent resident, foreign nursing education | Foreign-born US citizens, green card holders trained abroad | No VisaScreen required – credentials evaluation + BON + NCLEX pathway only |
The most important thing to determine before you start is which track you are on. Under federal regulation (8 CFR 212.15), registered nurses, LPNs, and LVNs coming to perform nursing work must present a health care worker certificate – for nurses, usually the VisaScreen certificate issued by TruMerit (formerly CGFNS International). That applies to immigrant visas and adjustment of status and to occupational nonimmigrant categories such as TN and H-1B. Students and trainees in F, J, or H-3 status are exempt. US citizens and existing green card holders do not need VisaScreen, but they still need a credentials evaluation (or a state-specific equivalent) before their board of nursing will approve them for the NCLEX.
CGFNS credential evaluation: what it is and what slows it down
CGFNS International (the Commission on Graduates of Foreign Nursing Schools), which now operates as TruMerit, is an independent credentialing organization that evaluates whether a foreign-trained nurse’s education is comparable to US nursing education standards. Most state boards of nursing require a credentials evaluation as a prerequisite for NCLEX eligibility. TruMerit’s report is the most widely accepted; some boards also accept other approved evaluators, and a few (California, for example) review transcripts directly. New York uses a separate TruMerit Credentials Verification Service.
The CGFNS Credentials Evaluation Service (CES) Professional Report is the standard product for NCLEX eligibility. It involves:
- Submission of official transcripts directly from your nursing school
- Official verification of your home country nursing license
- CGFNS review against US nursing curriculum standards
Cost: $485 for the CES Professional Report application, plus add-ons such as $125 for each additional license evaluated and $425 for expedited review (TruMerit fee schedule). Translation costs are separate.
Processing time: often several months. The biggest variable is how quickly your home institution and home country licensing authority send documents to TruMerit. Schools in some countries are slow to provide official transcripts, and nursing boards in some countries verify licenses manually.
A common source of equivalency gaps: US boards of nursing generally expect theory and clinical instruction in each core area – medical-surgical, obstetric, pediatric, and psychiatric/mental health nursing. In some countries, one of these (often psychiatric or obstetric nursing) is a separate specialty rather than part of general nursing training. If your board finds a gap after reviewing the evaluation, it may require you to complete remedial coursework at a US nursing program before approving you for the NCLEX. That adds months and cost.
Request your transcripts from your nursing school early – before you even start the CGFNS application – to get a realistic sense of the document timeline from your institution.
VisaScreen: what it covers and when you need it
VisaScreen is a program administered by TruMerit (formerly CGFNS International) that satisfies the federal health care worker certification requirement for nurses seeking a green card or an occupational visa status such as TN or H-1B. It is separate from the NCLEX eligibility process, though some components overlap.
VisaScreen certification requires:
- An education review confirming your nursing education is comparable to a US graduate’s
- English language proficiency (see below)
- Verification of current licensure in your home country
- For registered nurses, proof of passing the NCLEX-RN or the TruMerit Nurse Qualifying Exam
The VisaScreen certificate is issued once all components are complete. Under 8 CFR 212.15 it must be used for admission, change of status, or adjustment of status within 5 years of issue.
Cost: $740 for the VisaScreen application, with an optional $650 expedited review (TruMerit fee schedule). This is charged separately from the CES Professional Report.
English language requirements
English proficiency requirements apply to VisaScreen and to many BON applications. For VisaScreen, the approved tests and minimum scores are set by HHS through HRSA, which published an updated list effective May 12, 2026. Tests on the current list include IELTS Academic, TOEFL iBT, the Occupational English Test (OET), and PTE Academic; TruMerit stopped accepting TOEIC under the update. Scores from exams taken before May 12, 2026 are assessed under the previous requirements. At-home versions of the tests are not accepted. Because the minimum scores changed in 2026, check TruMerit’s current score table before you book a test, and check your state board separately, since boards set their own requirements.
The VisaScreen English exemption is defined by regulation and is narrow. Under 8 CFR 212.15, nurses whose nursing education was completed in Australia, Canada (except Quebec), Ireland, New Zealand, South Africa, the United Kingdom, or the United States are exempt from the English test. Nurses educated elsewhere – including in the Philippines, India, Nigeria, Ghana, Kenya, and Jamaica – should plan to take an approved test, even if their program was taught in English.
NCLEX-RN eligibility: the sequence
The NCLEX-RN is the US nursing licensure examination. It is identical for all candidates regardless of where they trained – there is no separate version for internationally-trained nurses. What varies is the eligibility pathway.
The standard sequence:
- Choose your target state and submit a BON application. The BON issues eligibility to sit the NCLEX.
- Complete the credentials evaluation your BON requires (usually the TruMerit CES Professional Report).
- Once BON approves your application, register with Pearson VUE to schedule your NCLEX exam.
- Pass NCLEX-RN.
- Receive your RN license from the BON.
Each BON has its own application requirements, fees, and processing timelines. The application is to the BON of the state where you want to be licensed – this is your “first license.” You can later obtain endorsement licenses in additional states once you are licensed in one.
Which state to apply to first
Not all BONs are equally accessible for internationally-trained nurses. Some have additional requirements that create delays; others have streamlined processes.
States commonly chosen by internationally-trained nurses:
- Florida: Accepts a TruMerit certificate or equivalent credentials evaluation; requires certified translations of non-English documents; no additional state-specific exam.
- Texas: Accepts TruMerit credentials evaluation; large volume of internationally-educated applicants.
- Nurse Licensure Compact (NLC) states: A multistate license is issued only by the compact state that is your primary state of residence, and compact rules add uniform requirements for internationally educated nurses (a credentials evaluation and English proficiency). If you will live in a compact state, licensing there gives you multistate practice privileges; check the current member list at nursecompact.com, since membership changes.
States with additional requirements:
- California: Evaluates international transcripts directly, requires fingerprinting (with a separate process for applicants outside California), does not participate in the NLC, and has historically had longer processing times for internationally-trained nurses. Unless you specifically want to practice in California, it is generally not recommended as a first-application state for international nurses.
- New York: Does not participate in the NLC. Requires the TruMerit Credentials Verification Service ($425) for nurses educated outside the US.
If your goal is to practice in a specific state, apply there directly. If you have flexibility, compare each board’s published processing times and requirements before choosing.
The financial case: is the investment worth making?
The total cost of the US RN licensure pathway for an internationally-trained nurse runs roughly $1,300–$3,500 depending on whether VisaScreen and an English test are required, broken down as follows:
| Component | Approximate cost |
|---|---|
| TruMerit CES Professional Report | $485 (plus add-ons) |
| VisaScreen (if applicable) | $740 |
| English language testing (if required) | $200–$350 |
| BON application fee | Varies by state, commonly $100–$300 |
| NCLEX registration (Pearson VUE) | $200 |
| NCLEX prep course/materials | $300–$800 |
| Document translation and notarization | $200–$600 |
| Total | About $1,300–$2,750 without VisaScreen / $2,050–$3,500 with VisaScreen |
The income differential is the other side of the calculation. The median US RN salary (BLS OEWS, SOC 29-1141, May 2025) is $97,550 annually. In comparison, an NHS Band 5 staff nurse in England earns £32,073–£39,043 under the 2026/27 Agenda for Change pay scale (roughly $43,000–$53,000 at recent exchange rates), and nurse pay in the Philippines and India is a small fraction of that. For nurses coming from most countries of origin, the 3–5 year career earnings differential versus staying home exceeds $100,000 – making the upfront investment economically compelling in nearly all cases.
The caveat is the non-financial costs: the 12–24 month wait, the disruption of relocating, the credential gap period during processing when you may be working in a lower-skilled role to maintain income. For nurses with family obligations or who are close to senior clinical roles in their home country, these factors can change the calculation.
For nurses who are already US-licensed and looking to transfer their license to a new state, see nursing license by endorsement, which covers the US-to-US interstate transfer process. For US nurses considering international practice opportunities, nursing jobs abroad addresses the reverse pathway. Once you have your US license and are starting your job search, new grad nurse job search covers the application and interview process, including how to present an internationally-trained background to US employers.
References
- Commission on Graduates of Foreign Nursing Schools (CGFNS International / TruMerit), “CGFNS Certification Program,” cgfns.org, 2025.
- CGFNS International (TruMerit), “Credentials Evaluation Service (CES) Professional Report,” cgfns.org, 2025.
- TruMerit (formerly CGFNS International), “VisaScreen: Visa Credentials Assessment.” https://www.trumerit.org/services/certification/visascreen-visa-credentials-assessment/
- TruMerit, “Fee Schedule and Policies” (CES Professional Report $485; VisaScreen $740; NY CVS $425). https://www.trumerit.org/support/fee-schedule/
- TruMerit, “Updated English Language Proficiency (ELP) exams and score requirements by the Health Resources and Services Administration (HRSA)” (effective May 12, 2026). https://www.trumerit.org/updated-english-language-proficiency-elp-exams-and-score-requirements-by-the-health-resources-and-services-administration-hrsa/
- Code of Federal Regulations, 8 CFR 212.15, “Certificates for foreign health care workers.” https://www.law.cornell.edu/cfr/text/8/212.15
- National Council of State Boards of Nursing, “NCLEX-RN Examination: Candidate Bulletin,” ncsbn.org, 2025.
- U.S. Citizenship and Immigration Services, “Health Care Worker Certification.” https://www.uscis.gov/working-in-the-united-states/temporary-workers/health-care-worker-certification
- U.S. Bureau of Labor Statistics, “Occupational Employment and Wage Statistics: Registered Nurses (SOC 29-1141),” OEWS, May 2025. National median annual wage $97,550.
- Nurse Licensure Compact / NCSBN, “Nurse Licensure Compact (NLC): Member States and Multistate Licensure,” nursecompact.com, 2025.
- NHS Employers, “Pay scales for 2026/27” (Band 5: £32,073 / £34,592 / £39,043). https://www.nhsemployers.org/articles/pay-scales-202627
- National Council of State Boards of Nursing, “Licensure by Endorsement and International Applicant Requirements by State Board of Nursing,” ncsbn.org, 2025.