In common with many European markets and elsewhere the United States suffers from a shortage of nurses

“The U.S. is projected to experience a shortage of Registered Nurses (RNs) that is expected to intensify as Baby Boomers age and the need for health care grows. Compounding the problem is the fact that nursing schools across the country are struggling to expand capacity to meet the rising demand for care given the national move toward healthcare reform. The American Association of Colleges of Nursing (AACN) is working with schools, policy makers, nursing organizations, and the media to bring attention to this healthcare concern. AACN is leveraging its resources to shape legislation, identify strategies, and form collaborations to address the shortage”

To Start

Contact the Commission on Graduates of Foreign Nursing Schools(CGFNS). They will pre-screen candidates with respect to their nurse education, and licensure in their home country, their English language proficiency and assess through a predictor test the nurse suitability to pass the NCLEX-RN.
Bear in mind that each state individually has their own nursing board. Some states also recognise the Canadian Nurses Association Testing Service (CNATS) accreditation. A few states may also accredit foreign qualifications directly, however this is subject to change and the information will need verification, at any given time.

NCLEX-RN Examination (National Council Licensure Examination for Registered Nurses)

This is a mandatory nursing examination required for the United States. There are testing centres both within the territory of the United States and internationally. As of January 2005, it became possible to take the NCLEX abroad in (1) Hong Kong; (2) London, England; or (3) Seoul, Korea.

Resources are available to aid preparation for the test.

Language Requirements (Non-native speakers of English)

IELTS: Academic Module or the General Training Module 6.5, Overall Band Score, 7.0 Speaking
TOEFL: Paper-Based 540; TOEFL Computer-Based 207; Test of Written English (TWE) 4.0; Test of Spoken English (TSE) 50.
TOEIC: 725; plus TWE: 4.0 and TSE: 50
Passing scores for the MELAB were as follows: Final Score 79+; Oral Interview 3+.

Permanent Residency Visas (Green Card).

Once you have your registered nurse (RN) license, the employer will begin the visa sponsorship process for you. They will sponsor you and your immediate family members. They will also apply for your Visa Screen™ certification, a credentialing program that confirms you have completed a required screening program for healthcare professionals.

Visa Process:

“RNs together with physical therapists are listed as shortage, or “Schedule A”, occupations in regulations issued by the Department of Labor. An employer who wishes to immigrate an RN is exempt from having to submit a PERM application to the Department of Labor.

The immigration process begins when an employer submits an immigrant visa petition (Form I-140) to the service center of the US Citizenship and Immigration Services having jurisdiction over the nurse’s place of intended employment. The petition must be accompanied by Labor Department form ETA-9089, by a posting notice, a prevailing wage determination and by various other documents. The petition should also be accompanied by a check for filing fees.

3. US Citizenship and Immigration Services sends the approved visa petition to the National Visa Center (NVC) in Portsmouth, New Hampshire. The nurse (or her attorney) receives a “fee bill” asking for all government processing fees to be paid in advance of processing her application and those of her immediate family members. After the fees are paid, the NVC forwards a packet to the nurse or her attorney containing biographical information forms to be completed by her and her family members, and a list of documents which must be submitted.

4. The RN, or her attorney, sends the signed and completed forms and documents to the NVC which then schedules an appointment for an Immigrant Visa for the RN and her family at the U.S. Consulate or Embassy where they will have their interviews for permanent residence. At this interview, the government will examine various documents including:

• Applications for Immigrant Visas

• Police Clearances

• Birth Certificates

• Marriage Certificate, if any

• Divorce or Death Certificate of Spouse, if any

• Valid Passports

• Medical Examinations

• Photographs

• Recent job offer letter (or employment contract)

• Financial information regarding employer

• Government filing fees

• VisaScreen Certificate

A VisaScreen Certificate is issued only after the RN has demonstrated that (1) her education, license and training in her country are equivalent to education, licensure and training in the U.S. and that (2) her level of competence in oral and written English are appropriate to practice professional nursing in the U.S.
The CIS regulations provide that the only organization authorized to issue VisaScreen certificates to RNs is the Commission on Graduates of Foreign Nursing Schools (CGFNS), the organization which is listed in §343. The CGFNS is located at 3600 Market Street, Philadelphia, PA, 19104-2651; telephone: (215) 349-8767; fax: (215) 349-0026; e-mail: (link sends e-mail)

The CIS’s VisaScreen regulations provide that even if a foreign-born RN is educated, licensed and trained in the U.S., she still must obtain a VisaScreen certificate. However, such RNs may be able to obtain a certificate on a streamlined basis. Obtaining such a certificate requires a significant expenditure of time, effort and money (over $300) on the part of the nurse.

Unless the nurse was educated in an English-speaking country (U.S., Australia, New Zealand, Ireland, United Kingdom or Canada – all provinces except Quebec), she must achieve a certain minimum score on tests in written and spoken English administered by TOEFL (Test Of English As A Foreign Language), IELTS (International English Language Testing Service) or the TOEIC (Test of English in International Communications). Also, if the RN registered for the MELAB (Michigan English Language Assessment Battery) before November 27, 2002, this result may be sent to the CGFNS for VisaScreen purposes.”

Nurse Salaries

Nurse Salaries are amongst the best by international comparison in the United States.

However, nurse demand and incomes vary considerably on a state by state basis. A lot of demand for medical staff in general is outside the main population centres. There is also a well-developed staffing sector providing nurses on a shorter-term basis. Some agencies are also geared towards bringing in International Nurses, and may retain their own in-house attorney to handle the immigration process in this regard.


Salaries are high, by international comparison, and a function not only of the demand-supply conditions locally, but are also related to living costs, which can vary markedly geographically. Overall, quality of life can be excellent. The immigration requirements are however onerous and require a degree of commitment and patience. A minimum timeline is generally 12 – 18 months.