Every year, thousands of internationally educated nurses (IENs) pursue licensure in the United States. The process can seem overwhelming—between credential evaluation, English proficiency requirements, and the NCLEX exam itself, there’s a lot to navigate. This comprehensive guide breaks down everything international nurses need to know about obtaining U.S. nursing licensure in 2025.
Overview: The Path to U.S. Nursing Licensure for IENs
The general pathway for international nurses includes:
- Credential Evaluation: Have your nursing education verified
- English Proficiency: Demonstrate English language competency
- State Board Application: Apply to your chosen state’s nursing board
- NCLEX Registration: Register for the NCLEX exam
- Pass the NCLEX: Take and pass the nursing licensure exam
- VisaScreen (if applicable): Obtain immigration clearance if seeking employment visa
Step 1: Credential Evaluation
What is CGFNS?
CGFNS International, Inc. (Commission on Graduates of Foreign Nursing Schools) is the leading credentials evaluation organization for international nurses. Since 1977, CGFNS has been evaluating nursing education from around the world.
CGFNS Services
Credentials Evaluation Service (CES):
- Evaluates your nursing education against U.S. standards
- Required by many state boards of nursing
- Provides a detailed report of your qualifications
CGFNS Certification Program:
- Comprehensive certification including credential review
- CGFNS Qualifying Exam (nursing knowledge test)
- English proficiency verification
- Required by some states before NCLEX eligibility
VisaScreen:
- Required for healthcare workers seeking occupational visas
- Verifies credentials, English proficiency, and license
- Issued a VisaScreen Certificate valid for 5 years
State Requirements Vary
Each U.S. state has different requirements for international nurses:
- Some states require full CGFNS Certification before allowing NCLEX
- Some states accept CES evaluation only
- Some states evaluate credentials independently
Popular states for international nurses:
- California: Requires CGFNS CES or evaluation from approved agency
- New York: Has own credential evaluation process (CVS)
- Texas: Accepts CGFNS CES or other approved evaluations
- Florida: Requires CGFNS or state-approved evaluation
Step 2: English Language Proficiency
International nurses must demonstrate English proficiency through approved tests:
Accepted English Proficiency Exams
IELTS Academic:
- Minimum scores vary by state (typically 6.5-7.0 overall)
- Usually requires minimum of 7.0 in speaking
TOEFL iBT:
- Typically requires 83+ overall
- Minimum scores in each section may apply
PTE Academic:
- Accepted by most states
- Score requirements similar to TOEFL
Exemptions
Some nurses may be exempt from English testing if:
- They completed nursing education in English in certain countries
- They are from English-speaking countries (varies by state)
- They have practiced in the U.S. for a specified period
Step 3: State Board Application
Choosing Your State
Consider these factors when choosing where to apply:
- Requirements: Some states have more streamlined processes for IENs
- Compact State: Nursing Licensure Compact states offer multi-state practice
- Job Market: Where do you want to work?
- Processing Time: Some states process applications faster
Required Documents (Typically)
- Completed state application
- Credential evaluation report
- English proficiency scores
- Nursing school transcripts
- License verification from home country
- Background check/fingerprints
- Application fees
Step 4: NCLEX Registration and Preparation
Registering for NCLEX
- Receive Authorization to Test (ATT) from your state board
- Register with Pearson VUE
- Pay the NCLEX fee ($200)
- Schedule your exam at a Pearson VUE testing center
Testing Locations
NCLEX is available at Pearson VUE testing centers worldwide, including:
- United States and U.S. territories
- Canada, Mexico
- United Kingdom, Australia
- India, Philippines
- Many other international locations
NCLEX Preparation for IENs
International nurses face unique challenges:
- Different healthcare systems: U.S. nursing practice may differ from your home country
- Medication names: Brand names and some generics differ
- Nursing scope: Roles and responsibilities may vary
- Cultural differences: Patient communication styles in the U.S.
Tips for IEN NCLEX Prep:
- Focus on U.S. nursing standards and practices
- Learn U.S. medication names (both generic and brand)
- Understand U.S. healthcare systems (hospitals, insurance, etc.)
- Practice with NCLEX-style questions extensively
- Study the NGN format and clinical judgment model
Step 5: After Passing the NCLEX
Obtaining Your License
After passing NCLEX:
- Your state board will issue your RN license
- Verify your license on your state’s nursing board website
- Apply for licenses in other states if needed (endorsement)
VisaScreen for Employment
If you need a work visa (H-1B, EB-3, etc.), you’ll need a VisaScreen certificate from CGFNS, which requires:
- Valid U.S. nursing license
- Credential evaluation
- English proficiency verification
Timeline Expectations
The entire process can take 6-18 months:
- Credential Evaluation: 4-12 weeks
- State Board Processing: 4-12 weeks
- NCLEX Preparation: 1-3 months
- Post-NCLEX Licensing: 2-6 weeks
Common Challenges and Solutions
Challenge: Difficulty Obtaining Documents
Solution: Start document collection early. Contact your nursing school and licensing authority well in advance.
Challenge: Educational Deficiencies
Solution: Some states allow you to complete additional coursework to meet requirements.
Challenge: NCLEX Content Differences
Solution: Use U.S.-based NCLEX prep resources. Focus on understanding the U.S. healthcare context.
Resources for International Nurses
- CGFNS International: cgfns.org
- NCSBN (NCLEX): ncsbn.org
- State Boards of Nursing: Find your state at ncsbn.org
- Pearson VUE (Testing): pearsonvue.com
The path to U.S. nursing licensure requires patience and persistence, but thousands of international nurses successfully complete it every year. With proper preparation, you can join them.
