Nursing Jobs in the USA for Foreign Nurses: NCLEX, EB-3 Green Card and $97,550 Median Pay

Registered nurses in the United States earned a median of $97,550 a year in May 2025, according to the Bureau of Labor Statistics. In California the median was around $140,000. For a nurse earning a few hundred dollars a month in Manila, Lagos, Nairobi or Kerala, those numbers explain why US recruitment agencies never run short of applicants.

The route is real, and thousands of foreign nurses take it every year. But it is slow. Most internationally educated nurses enter the US on an EB-3 green card, which means a wait of two to four years after the hospital signs your paperwork, on top of the time it takes to pass the NCLEX and get licensed.

This guide walks through each step, the real costs, current waiting times, and the contract traps to avoid.

In this guide

1. US Nursing Jobs for Foreign Nurses at a Glance
2. Who Can Work as a Nurse in the USA
3. Step-by-Step: From Home Country Nurse to US RN
4. US Nurse Pay by State and Setting
5. Costs for Foreign Nurses
6. Hospital or Staffing Agency?
7. Waiting Times in 2026
8. Other Visa Routes for Nurses
9. Documents Checklist
10. Life After Arrival
11. Common Mistakes
12. Frequently Asked Questions
13. Before You Apply

US Nursing Jobs for Foreign Nurses at a Glance

Who Can Work as a Nurse in the USA

To work as a registered nurse you need a licence from the state board of nursing where you will work. Each state sets its own rules, but they all require:

• Completion of a nursing education program that is comparable to a US registered nurse program, including clinical hours in medical-surgical, maternal, paediatric and psychiatric nursing
• A passing result on the NCLEX-RN exam
• A clean criminal background check

Nurses trained as midwives only, or whose program skipped key clinical areas, may need extra coursework before a board will approve them. Licensed practical nurses (LPNs) can also immigrate, but under the slower EB-3 "skilled worker" route without the shortcut described below.

Step-by-Step: From Home Country Nurse to US RN

1. Credential evaluation. Most boards ask for a course-by-course review of your nursing education from an approved evaluator. TruMerit (formerly CGFNS) is the most common.
2. Apply to a state board for NCLEX approval. The board checks your education and authorises you to test. Some boards accept applicants without a US Social Security number; others do not, so choose carefully.
3. Register and sit the NCLEX-RN. You can test at Pearson VUE centres in several countries, including the Philippines, India and the UAE. The exam uses the Next Generation format with case studies.
4. English test. Take an approved test such as IELTS Academic, TOEFL iBT, PTE Academic or OET, unless your nursing education was in English in an exempt country. At-home versions are not accepted.
5. Find a US employer. Hospitals, health systems and staffing agencies recruit abroad. The employer offers a permanent full-time job.
6. Employer files Form I-140. Nurses are on "Schedule A," a list of shortage occupations, so the employer skips the PERM recruitment process and files directly with USCIS. Our EB-3 sponsorship guide explains the rest of the green card process.
7. Wait for a visa number under the monthly Visa Bulletin.
8. VisaScreen certificate. This federal healthcare worker certificate confirms your education, licence and English. It is required before your visa interview.
9. Immigrant visa interview at the US embassy, then travel. You arrive as a permanent resident.

US Nurse Pay by State and Setting

By state

High pay states also have high costs. Rent in San Francisco or Honolulu can absorb half of a new nurse's take-home pay. Texas, Florida and the Midwest pay less but stretch further. Weigh pay against rent before you accept a job in a particular state.

By work setting

Most foreign nurses start in hospitals or nursing homes, often on night shifts. Shift differentials for nights and weekends can add several dollars an hour.

Costs for Foreign Nurses

Many recruiters cover some of these costs. In return, they usually ask you to sign a work commitment of two or three years.

Hospital or Staffing Agency?

Foreign nurses usually join through one of two doors.

Direct hire by a hospital or health system. You sign with the employer you will actually work for. Pay and benefits match local staff, and you know your unit and city in advance. Fewer hospitals recruit abroad directly, and they tend to want NCLEX passed and experience in acute care.

International staffing agencies. These recruit in large numbers, often cover exam and visa costs, and place you with client hospitals. The trade-off is less control: you may be assigned to a facility or state you did not choose, the agency usually takes a margin from your pay, and contracts often run two to three years with penalties for leaving early.

Neither route is wrong. Ask both types the same questions: hourly rate, guaranteed hours, shift pattern, location, who pays which costs, and what happens if you leave.

Waiting Times in 2026

Because demand from nurses and other EB-3 workers exceeds supply, there is a queue. From the October 2026 Visa Bulletin, EB-3 Final Action Dates were:

If your priority date is before the cut-off, you can be issued a visa. Dates change monthly. Check the State Department Visa Bulletin.

Country restrictions

Under a presidential proclamation in force since January 1, 2026, immigrant visas are suspended for nationals of about 39 countries, including Nigeria, Zimbabwe, Zambia, Tanzania and Senegal. Nigerian nurses, one of the largest groups in the pipeline, are directly affected. An approved I-140 keeps your place in line, but a visa cannot be issued while the suspension applies unless an exception is granted. Check the State Department's notice for the current list.

Other Visa Routes for Nurses

• H-1B: rarely works for staff nurses, because most RN jobs do not require a bachelor's degree. It can work for nurse managers, nurse educators and some specialist roles, but it still goes through the lottery.
• TN: Canadian and Mexican nurses can work under USMCA on a TN visa, renewable without a cap.
• EB-2: nurses with a master's degree, or a bachelor's plus five years of progressive experience, in an advanced role may qualify for EB-2, which sometimes moves faster.

Documents Checklist

• Passport
• Nursing diploma or degree and full transcripts
• Home country nursing licence and verification letters
• Proof of clinical hours by specialty
• NCLEX result and US state licence
• English test result
• Employment letters from hospitals you have worked at
• Birth and marriage certificates, police certificates
• VisaScreen certificate and medical exam (visa stage)

Life After Arrival

You arrive with a green card, so you can live and work anywhere, and your spouse can work from day one. Most hospitals run an orientation of several weeks to several months. Expect to be paired with an experienced nurse before you take a full patient load.

Adjusting to US charting systems, patient ratios and the legal culture around documentation takes time. Many foreign nurses say the first six months are the hardest. After five years as a permanent resident you can apply for citizenship.

Common Mistakes

• Paying an agency to "process" a job offer. Legitimate hospitals do not sell jobs. Read our guide to visa and job scams.
• Choosing a state board at random. Some boards take much longer or need a Social Security number. Research first.
• Letting documents expire. NCLEX authorisations, English test results and police certificates all have time limits.
• Signing a contract without understanding penalties. Breach fees are the most common complaint from foreign nurses.

Frequently Asked Questions

How long does it take a foreign nurse to work in the USA?

Plan on roughly three to five years in total. NCLEX preparation and licensing can take six months to a year, and the EB-3 visa queue currently adds two to three years for most countries after the employer files.

Can I take the NCLEX outside the USA?

Yes. Pearson VUE offers the NCLEX at international centres in several countries, including the Philippines and India. You pay a $150 international scheduling fee on top of the registration fee.

Do US hospitals sponsor foreign nurses?

Yes. Many hospitals and staffing agencies sponsor nurses for EB-3 green cards. Because nursing is a Schedule A shortage occupation, employers can skip the labour market test and file directly.

What English score do nurses need?

TruMerit sets minimum scores for IELTS Academic, TOEFL iBT, PTE Academic and OET. The table was updated in May 2026, so check its VisaScreen page for the current registered nurse scores before booking a test.

Can my family come with me?

Yes. On an EB-3 green card your spouse and unmarried children under 21 come as permanent residents too, and your spouse can work.

Is nursing in the USA better than in Canada or the UK?

US pay is usually higher, but the wait is longer. Canada and the UK can be faster for some nurses. Compare our guides to nurse jobs in Canada and the UK Health and Care Worker visa.

Before You Apply

• Request your transcripts and licence verification now. Schools and councils can take months.
• Pick a state board whose rules suit you and start your NCLEX application.
• Book an English test at a test centre, not at home.
• Ask any recruiter for the full contract and all penalty clauses in writing before you commit.