H-1B visa and Immigration Process for Nurses in U.S.

These steps ( are a general overview for how a foreign educated nurse can work in the U.S., but some aspects of your journey may differ from this basic outline (Learn more about all the steps involved).

Step 1. Meet the Basic Requirements

As a foreign-educated nurse seeking to work in the United States, make sure you follow U.S. federal immigration law and that you meet the basic educational and/or professional requirements:

Immigration

In order to legally migrate to the United States, you must meet federal requirements.

You will need to obtain a Registered Nurse Immigrant Visa (“Green Card”) or H-1B visa.

• U.S. law requires nurses to complete a screening program before they can receive an occupational visa.
  • Credentials Evaluation Service (CES), Certification Program (CP) or VisaScreen Verification Letter from Commission on Graduates of Foreign Nursing Schools (CGFNS); or the Educational Record Evaluation Service (ERES) Evaluation.
    • CGFNS and ERES evaluates and certifies that:
      • Your education, training, license, and experience are comparable with that required for an American health care worker of the same type;
      • Your education, training, license, and experience are authentic and, in the case of a license, unencumbered;
      • Your education, training, license, and experience meet all applicable statutory and regulatory requirements for admission into the United States. This verification is not binding on the DHS; and
      • Either you have:
        • (a) passed a qualifying test predicting success on the occupation’s licensing or certification examination, provided such a test is recognized by a majority of states licensing the occupation for which the certification is issued; or
        • (b) passed the occupation’s licensing or certification examination.
• Your have the level of competence in oral and written English to be appropriate for health care work of the kind in which the you will be engaged, as shown by an appropriate score on one or more nationally recognized standardized assessments of the applicant’s ability to speak and write.
• You will need a “U.S.-based employer” that will serve as the petitioner for your visa. Your Registered Nurse license or the VisaScreen® certificate should be included on every visa or green card petition filed on your behalf.

Educational / Professional

In order to seek work as a foreign-educated nurse, you must demonstrate at least some of the following:

• You graduated from an accredited nursing education program in your country of education.
• You are licensed as a Registered Nurse in another country.
• You’ve practiced as a Registered Nurse for at least two years before.
• Some foreign educated nurses must demonstrate their proficiency with the English language by taking an exam such as TOEFL, IELTS, TOEIC or other. There are exemptions depending on your country of origin.

Step 2. CGFNS Evaluates your Credentials

State Boards of Nursing require that you first apply to CGFNS International, Inc. to have your academic and professional credentials evaluated to ensure that your documents are authentic and that what you’ve learned is comparable to U.S. nursing standards. You may also be required to take the CGFNS Qualifying Exam® to satisfy State Board requirements, to satisfy immigration requirements for obtaining an occupational visa, and to determine your readiness for a licensure exam. Find out what CGFNS program you need. Apply to CGFNS.

Step 3. Pass a Licensure Exam

In order to practice nursing in the United States, you will need to have a professional license from the state where you plan to work. Registered Nurse licenses are regulated by State Boards of Nursing with varying requirements.

You will likely need to pass a licensure exam to be registered as a nurse by your state board. Before taking the licensure exam, first-level, general nurses educated outside the U.S. may choose to apply to the CGFNS Certification Program®, which consists of:

• a credentials evaluation
• the CGFNS Qualifying Exam®, and
• an English language proficiency component.
  • You will need certification of passage of one of the English test (See required pass scores):
    • Cambridge English (B2 First, C1 Advanced, or C2 Proficiency exams), 176 overall and 185 Speaking.
    • TOEFL (Test of English as a Foreign Language) Paper-delivered Test: 540; TOEFL Internet-Based Test: 81 with minimum of 57 on Reading, Listening, and Writing and 24 on Speaking.
    • TOEIC (Test of English for International Communication)
    • IELTS (International English Language Testing System), 6.5 academic with minimum of 7 on Speaking.
    • MET (Michigan English Test).
    • OET (Occupational English Test).
    • Pearson PTE Academic.

The CGFNS Qualifying Exam® is a requirement by “some” state boards before you can sit for the NCLEX-RN, but it serves as an excellent predictor for how any nurse will do on that exam. Taking the Qualifying Exam may help gauge your readiness before committing to the licensure exam.

The Qualifying Exam also fulfills the U.S. federal government’s screening requirement for an occupational visa.

View the requirements for the board of nursing in the state where you seek to practice >>

Step 4. Find a Registered Nursing Position

After you meet all federal immigration requirements, have had your credentials evaluated by CGFNS, you meet your State Board of Nursing requirements, and you have passed a licensure exam, you are ready to begin working as a registered nurse in the United States!

While it’s not required, you may choose to work with a nursing recruiter to help you find a registered nurse job. These recruiters can also act as your “U.S.-based employer” for your immigrant visa.

Check to see if your recruiter uses ethical recruiting standards by looking for the Alliance for Ethical International Recruitment Practices Certified Ethical Recruiter seal on their website:

>>View CGFNS Alliance Certified Recruiters List>>

Questions or concerns about your recruitment process? Contact CGFNS’ Alliance for Ethical International Recruitment Practices.

Read the Alliance’s Health Care Code for Ethical International Recruitment and Employment Practices here.

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If you or your employer want to learn more about H-1B visa petition or employment-based permanent residency (green card) programs, do contact us at (+1) 202 600 7742, or email us at info@adhikarilaw.com