Nursing in the USA: NCLEX, VisaScreen and the Green Card Queue (2026)

The shape of it

The American route is unusual in two ways. First, you do not arrive on a work visa — you arrive with a green card, as a permanent resident, with your spouse free to work from day one. Second, the licence comes from a state board of nursing rather than a national regulator, so "a US nursing licence" does not exist; a Texas licence does.

The exam work is front-loaded and the waiting is at the end. Most of an 18 to 36 month timeline is spent waiting for a visa number, not sitting exams.

The steps, in order

1. 1
   Credentials evaluation Your nursing education is assessed against US standards, usually by CGFNS (now TruMerit). Expect roughly USD $350–$540 and several months, depending on how quickly your school and regulator respond.
2. 2
   Apply to a state board and sit the NCLEX-RN Choose your state first, because requirements differ. The board issues your Authorization to Test, and you sit the NCLEX-RN — computer adaptive, 85 to 150 questions, up to five hours — at a Pearson VUE centre, including centres outside the US. Fees run around USD $200 plus an international scheduling fee, with state board fees of roughly USD $75–$400 on top.
3. 3
   English test IELTS, TOEFL or OET, depending on what your state and TruMerit accept. Time this carefully — see the warning below.
4. 4
   VisaScreen A federal requirement under section 343 of IIRIRA, issued by TruMerit. It bundles your education, licence and English evidence into one certificate, and no healthcare immigrant visa is approved without it. Budget around USD $540.
5. 5
   Employer sponsorship and the I-140 Registered nursing is a Schedule A occupation, which removes the labour certification stage most employment visas require. Your employer files the I-140 petition; the date it is filed becomes your priority date.
6. 6
   Wait for your priority date, then consular processing Your date has to become current in the monthly Visa Bulletin before an interview can be scheduled. Then medicals, the interview, and travel.

Retrogression: the part that decides your timeline

The US issues a fixed number of employment-based immigrant visas each year, with per-country caps. When demand exceeds supply, cut-off dates move backwards — retrogression — and applications queue.

Through 2026, EB-3 final action dates for most countries sat in the middle to latter part of 2023, while India sat more than a decade back, in 2013. That difference is not a technicality: it is the difference between a two-year plan and one measured in decades. Check the current Visa Bulletin for your country of chargeability before you spend anything.

The English test timing trap

TruMerit requires valid, unexpired English results for VisaScreen, and test results expire — typically two years. Nurses who sit their English test first, then spend a year on the NCLEX and another waiting for a priority date, often find the result has expired and have to retake it.

Unless your state requires English evidence up front, the usual advice is to sit the NCLEX first and the English test afterwards, so the validity window covers the immigration wait rather than the exam phase.

What it costs

Roughly USD $1,200–$1,800 in fees before travel: credentials evaluation, NCLEX and international scheduling, state board fees, an English test and VisaScreen. Preparation courses are extra. Employers frequently cover or reimburse some of this in exchange for a contract commitment — read the terms on that commitment carefully, including what happens if you leave early.

Other routes, and who they suit

• TN status — Canadian and Mexican citizens can work in the US as registered nurses without joining the green card queue at all. If you hold either citizenship, this changes everything.
• H-1B — rarely available for general registered nursing, because the role usually does not meet the speciality occupation test. It is more relevant to some advanced practice and allied health roles.
• Compact licensure — once licensed in a Nurse Licensure Compact state, you can practise in other compact states without a new licence, which matters for travel nursing and for moving later.

Is it worth it?

If you want the highest pay and permanent residence for your family, and you can start now and wait, the US is the strongest offer in international nursing. If you need to be working abroad within a year, it is the wrong destination — the UK can have you on a ward in nine to fourteen months, and Australia in twelve to eighteen. Several nurses do both: start the US petition, then work elsewhere while the date moves.

Frequently asked questions