The National Council of State Boards of Nursing (NCSBN) is an independent, non-profit organization representing the 59 nursing regulatory bodies across all 50 U.S. states, the District of Columbia, and four U.S. territories. NCSBN develops and administers the NCLEX-RN and NCLEX-PN examinations, which are standardized tests required for nurse licensure in virtually all U.S. jurisdictions. Each state board of nursing uses NCSBN's licensing framework to regulate nursing practice and protect public safety.

To register as a nurse in the USA, you must hold a valid nursing license from your home country, have a minimum of 2 years of nursing experience (though you may apply with 12 months of current experience), pass the NCLEX-RN exam, and demonstrate English language proficiency through TOEFL, IELTS, OET, or PTE. You must also obtain a CGFNS Credentials Evaluation Service (CES) Professional Report to verify your nursing qualifications against U.S. standards, pass a criminal background check, and be of good moral character.

CGFNS (Commission on Graduates of Foreign Nursing Schools) is the world's largest credentials evaluation organization for international nurses, serving for over 42 years and helping over 3 million medical professionals from 189 countries. CGFNS's Credentials Evaluation Service (CES) Professional Report validates and authenticates all your licenses, registrations, and diplomas obtained outside the United States and assesses whether your nursing education is comparable to U.S. nursing standards. This verification is mandatory for most U.S. states before you can apply for state licensure.

The VisaScreen®: Visa Credentials Assessment Service is a comprehensive screening program required for international nurses seeking occupational visas (H-1B, TN, or EB-3) to work in the United States. To obtain VisaScreen certification, you must have an active nursing license, minimum 2 years of nursing experience, English language proficiency, and verification of passing either the CGFNS Qualifying Exam or the NCLEX-RN. Successfully completing VisaScreen results in an official ICHP Certificate that fulfills all U.S. federal immigration screening requirements for healthcare workers.

The NCLEX-RN (National Council Licensure Examination for Registered Nurses) is a standardized, computerized exam that assesses your knowledge, skills, and clinical decision-making ability required for safe and effective entry-level nursing practice in the USA. The Next Generation NCLEX (NGN), launched in 2023, uses realistic case scenarios and advanced scoring methods to better evaluate clinical judgment. The exam contains 85-265 questions, and you have up to 6 hours to complete it; passing requires demonstrating competency in areas including patient care, pharmacology, infection control, and critical thinking.

The USA accepts multiple English language tests: TOEFL (iBT score 94-95 minimum with specific component scores), IELTS (overall band 7 with no component below 6.5), OET (Grade B in all components with Writing at 300), and PTE (overall score 65 with no section below 50). English proficiency requirements vary by state; some states require specific tests while others accept multiple options. Most states accept IELTS and TOEFL equally, though OET is specifically designed for healthcare professionals and focuses on medical communication scenarios.

The entire USA nursing registration process typically takes 6-12 months from application to state licensure. Key timelines include CGFNS credential evaluation (varies by state), NCLEX scheduling and completion (1-3 months), state board processing (varies by state from 10-12 weeks in California to 30-60 days in Louisiana), and VisaScreen processing (4-6 weeks). Processing times vary significantly by state; California processes international applications in 10-12 weeks, while other states may take longer.

The national average registered nurse salary in the USA is approximately $94,480 per year ($45.42 hourly rate) in 2025. Entry-level RNs typically earn $60,000-$65,000 annually, while experienced RNs earn $100,000 or more. Salaries vary significantly by state, with Alaska offering the highest average at $109,210 annually, followed by New York ($106,620) and Texas ($90,210). Specialized nursing roles such as Nurse Practitioners earn $100,000-$150,000, while Certified Registered Nurse Anesthetists (CRNAs) earn $130,000-$200,000 annually.

International nurses can work in the USA through several visa pathways: the H-1B specialty occupation visa (for advanced practice nurses and specialized positions), the EB-3 employment-based green card for nurses, and the TN visa for Canadian and Mexican nurses. The H-1B Cap-Exempt program now allows nurses with an Associate Degree in Nursing (ADN) plus 6+ years of clinical experience to be considered BSN-equivalent, expanding eligibility. Certified Advanced Practice Registered Nurses (APRNs), including Certified Registered Nurse Anesthetists and Clinical Nurse Specialists, have priority for H-1B acceptance.

DESMA International provides comprehensive end-to-end services for USA nursing registration including expert guidance through CGFNS credential evaluation and VisaScreen certification, NCLEX-RN exam preparation and coaching, English language test preparation (TOEFL, IELTS, OET, PTE), document assistance and verification from your country's nursing authorities, visa sponsorship guidance and H-1B petition support, and job placement assistance with U.S. healthcare employers. Our experienced team understands the complex multi-step process and provides personalized support tailored to your specific nursing background and career goals throughout your journey to practicing as a Registered Nurse in the United States.