NCLEX-RN and the US Green Card Route: Your Path to Nursing in America

Who Qualifies for the NCLEX-US Green Card Route

This pathway is designed for Registered Nurses (RNs) trained outside the United States who hold a recognised nursing qualification and current registration or licence in their home country. You'll generally need:

• A diploma, associate or bachelor's degree in nursing from an accredited or government-recognised institution
• Current, unrestricted registration as a nurse in your country of training
• A minimum of general clinical experience (requirements vary by US state board)
• English language proficiency evidenced by IELTS, OET or TOEFL iBT
• A clean disciplinary and criminal record, as this is checked at multiple stages

Nurses from the Philippines, India, Nigeria, Kenya, the UK, Ireland and the Caribbean are among the most common applicants on this route, though it is open to qualified nurses from almost any country.

Step 1: Credentials Evaluation with CGFNS

Before you can sit the NCLEX-RN, most US state boards of nursing require independent verification that your education and licensure are equivalent to a US nursing programme. This is done through the Commission on Graduates of Foreign Nursing Schools (CGFNS International), primarily via its Credentials Evaluation Service (CES).

CGFNS contacts your nursing school and licensing authority directly to verify your transcripts, clinical hours and registration status, then issues a report confirming whether your education is comparable to a US associate or bachelor's degree in nursing. Some state boards require the CGFNS Certification Program (which includes CES plus an additional credential review) rather than CES alone, so always check your target state's specific requirement before applying.

This stage typically takes 8–16 weeks once all documents are submitted, and is often the single biggest source of delay if paperwork from your nursing school is incomplete or slow to arrive.

Step 2: Choosing a State Board and Applying for Licensure

You must apply for licensure by examination to a specific state board of nursing — this is the state where you intend to work, or a state with efficient, foreign-graduate-friendly processing such as Texas, New York, California or Florida. Each board sets its own:

• Minimum education and clinical hour requirements
• Accepted English test scores (commonly IELTS 6.5+ overall, OET B, or TOEFL iBT 83+)
• Fingerprinting and criminal background check process
• Fees for licence application, typically USD 100–300

Once the board approves your application, it authorises Pearson VUE to issue an Authorization to Test (ATT) for the NCLEX-RN.

Step 3: Passing the NCLEX-RN

The NCLEX-RN is a computer-adaptive exam that tests clinical judgement and safe nursing practice across client needs categories: safe and effective care environment, health promotion, psychosocial integrity, and physiological integrity. It is administered by Pearson VUE at test centres worldwide, including many in the Philippines, India, UAE and the UK, so you often don't need to travel to the US to sit it.

• Format: computer adaptive testing, 85–150 items, up to 5 hours
• Pass standard: set by the National Council of State Boards of Nursing (NCSBN) using the Next Generation NCLEX (NGN) format
• Retakes: allowed after a 45-day wait if unsuccessful
• Cost: around USD 200 exam fee, plus international scheduling fees

Once you pass, your state board issues your RN licence — the legal qualification to practise nursing in that state.

Step 4: VisaScreen Certification

Under the Immigration and Nursing Relief Act 1999, any internationally educated nurse seeking an occupational immigrant or non-immigrant visa to work in the US must obtain a VisaScreen: Visa Credentials Assessment certificate from CGFNS. VisaScreen verifies your:

• Education (via a fresh or linked CES report)
• Licensure, with no restrictions or disciplinary actions
• NCLEX-RN pass result
• English language proficiency

VisaScreen is a separate step from CES and cannot be skipped — USCIS will not approve the visa petition without it. Processing generally takes 8–12 weeks and costs roughly USD 500–600.

Step 5: Employer Sponsorship and the EB-3 Immigrant Visa

With an RN licence and VisaScreen in hand, you're ready for employer-sponsored immigration. Most nurses enter the US on the EB-3 (Employment-Based, Third Preference) immigrant visa category, which covers skilled workers and professionals. Nursing is designated a Schedule A, Group I occupation, meaning your US employer does not need to complete the lengthy PERM labour certification process — a major advantage that shortens the route considerably.

Your sponsoring hospital or healthcare employer files Form I-140 (Immigrant Petition for Alien Worker) directly with USCIS. Once approved, you proceed to either:

• Consular processing — an immigrant visa interview at a US embassy or consulate in your home country, or
• Adjustment of Status — if you're already lawfully in the US on another visa

Approval of the immigrant visa or adjustment of status grants you a US green card (lawful permanent residence), allowing you and your immediate family to live and work in the US indefinitely.

Priority Dates and Retrogression

The EB-3 category is subject to annual per-country numerical limits set by US immigration law. Your priority date — generally the date your I-140 petition is filed — determines your place in the queue. For most countries, EB-3 visas move relatively quickly, often within 1–2 years. However, for nurses born in countries with high demand — notably the Philippines, India and China — the category is frequently retrogressed, meaning visa numbers are temporarily unavailable and priority dates can be years behind current filings.

Check the monthly Visa Bulletin published by the US Department of State to track your priority date against the current "Final Action Dates" for your country of chargeability. This is the single biggest variable in your overall timeline and worth discussing with your employer or immigration attorney early.

Realistic Timelines, Costs and Common Pitfalls

For nurses from countries without retrogression, a realistic end-to-end timeline is 18–36 months from starting CGFNS evaluation to green card in hand. For applicants from heavily backlogged countries, it can extend well beyond this. Indicative 2026 costs across the whole process typically total USD 1,500–4,000 in exam, evaluation and application fees, excluding immigration attorney fees which your employer often covers.

Common pitfalls to avoid

• Applying to a state board before confirming its specific CGFNS and English test requirements
• Letting your nursing school documentation lapse or go unanswered by CGFNS
• Assuming VisaScreen and CES are the same thing — they are not, and both are usually required
• Underestimating retrogression if you're from the Philippines, India or China
• Working with unlicensed recruiters who charge candidate fees — a WHO-code-compliant agency like Ava Medical never charges candidates

Ava Medical supports nurses through every stage of this journey — from your first CGFNS application to interview preparation and matching you with ethical, verified US healthcare employers who sponsor the full EB-3 process at no cost to you.

Frequently asked questions