How to Work as a Nurse in the US

In the United States, the nursing industry is facing a crisis. There was already a shortage of qualified nurses; however, given the recent mandates that that hospitals, doctors offices, nursing homes, rehabilitation centers, and various other settings have imposed on health care professionals in 2021, the shortage of qualified nursing professionals has grown exponentially, as many experienced nurses who were already working or who were about to enter the field have either left their positions or have been fired from their jobs. As a result of these two factors, health care settings throughout the United States are desperately seeking various types of nurses to fill the many open positions. As such, if you’re a nursing professional in another country, whether you are having a difficult time finding a job in your home country, you are interested in an adventure, or you would like to relocate to America either temporarily or permanently, now would be a great time to consider applying for employment in the United States. 

In order for a foreign nurse to pursue a career in the United States, there are several steps that you will need to take in order to fulfill your goal. If you’re a certified nurse from another country and you’d like to seek employment in the US, keep on reading for some helpful tips and information. 

An Overview of the Nursing Industry in the United States

Before we jump in and explain how foreign nurses can seek employment in the United States, it’s important to have an understanding of the field of nursing in the country. 

As in every other country, in the United States, nurses play a vital role in a patient’s health and well-being. Nurses are dedicated to their patients; not only do nurses provide for the medical needs of their patients, but they also serve as a liaison between doctors and families, and act as patient advocates, as they protect the rights of the men, women, and children that they care for. 

Nursing is a highly varied field, and as such, in the United States, these professionals wear many hats and have numerous responsibilities. According to the American Nurses Association (ANA), the responsibilities of a nurse in the United States can include anything from making treatment decisions to providing emotional support. Much like other countries, the characteristics that unify American nurses include skill, drive, and dedication. 

Types of Nurses in the United States

There are several types of nurses in the United States, which can be divided into three key categories: 

  • Registered nurse. Registered nurses (RNs) are the backbone of American health care. They provide the crucial health care the public requires, wherever that care may be needed. The responsibilities of a registered nurse vary, and the following are just some examples of those responsibilities: 
    • Conduct physical exams and collect health histories of patients 
    • Make crucial health-related decisions for patients
    • Administer personalized interventions, including medications, hot and cold packs, compression, etc. 
    • Collaborate with several health care professionals to coordinate patient care
  • Advanced practice registered nurse. In addition to meeting the licensing requirements that all RNs must meet, advanced practice registered nurses (APRNs) also hold Master’s degrees. Their responsibilities are varied, but providing primary and preventative care to the public is the overall function of an APRN. The following are some of the duties of an APRN: 
    • Diagnose and treat minor illnesses and injuries
    • Prescribe medications and other treatments
    • Assist with the treatment of various physical and mental health issues
    • Administer anesthetics 
  • Licensed practical nurses. Licensed practical nurses (LPNs), also referred to as licensed vocational nurses (LVNs), are tasked with providing the support that core health care teams require. They are supervised by RNs, APRNs, or MDs, and offer the fundamental and routine care that patients require throughout their entire health care journey. 
    • Check vital signs and assess the overall condition of their patients
    • Perform basic nursing duties, such as dressing wounds and changing bandages
    • Ensure the comfort and well-being of patients
    • In some settings, LPNs can administer some medications 

All three types of nurses can work in a variety of settings. Examples of some of the settings that they may work in include: 

  • Hospitals 
  • Physicians’ offices
  • Nursing homes 
  • Assisted living facilities 
  • Home healthcare services
  • Schools 
  • Clinics

Career Outlook 

As mentioned, there is a shortage of nurses in the United States so the outlook for this field is good. According to the Bureau of Labor Statistics, the projected growth between the years 2020 and 2030 is 9 percent, which, when compared to all other fields, is faster than the national average. It is also projected that there will be about 194,500 job openings for nurses in the United States each year between the years 2020 and 2030, and many of the openings are expected to be the result of the need to replace currently employed nurses who have either left the field for other occupations or who have exited the workforce completely by retiring. 

The average annual pay for nurses in the United States varies and depends on several factors, including the type of nursing position, a nurse’s credentials, including their education and previous experience. To illustrate the wages that can be earned in this field, in May of 2020, the median annual wage for registered nurses was $75,330.  

Official Requirements for a Non-US Citizen to Become a Nurse in the United States

Given the positive outlook of the nursing industry in the United States, including the projected growth and the potential income, and the current shortage that the industry is experiencing, it’s easy to see why many foreign nurses are interested in pursuing their careers in the country. If you’re a foreign educated nurse and you’re interested in obtaining employment in the US, it’s important to note that there are basic requirements that you must meet in order to seek a position in the country. The following is an overview of these requirements, including the US federal immigration law requirements, as well as the basic education and/or professional requirements that you will be required to meet. 

Meet the United States Educational Requirements for Nurses

The first thing that an international nurse must do in order to be qualified for a position in the United States is meet the country’s education requirements, which include: 

  • Graduating from an accredited Registered Nursing program, such as an Associate Degree in Nursing (ADN) or a Bachelor of Science in Nursing (BSN)
  • Receiving a Registered Nurse (RN) license
  • Gain experience as a practicing Registered Nurse for a minimum of two years

It’s important to note that international Licensed practical nurses (LPNs) and licensed vocational nurses (LVNs), as well as patient care assistants, are not able to transfer their licenses to the United States. 

Complete a Foreign-Educated Nurse (FEN) Course

Though all international nurses must meet the US education requirements for nurses, in the majority of American states, foreign nurses must also complete a Foreign-Educated Nurses (FEN) refresher course. The course involves completing 120 classroom hours and 120 clinical practice hours while under the supervision of a licensed Registered Nurse. 

Successfully Pass English Proficiency Tests

In addition to meeting the basic educational requirements for nurses in the United States, some international nurses will also be required to take and successfully pass a English proficiency test, such as the Test of English as a Foreign Language (TOEFL), the Test of English of International Communication (TOEIC), or the International English Language Testing System (IELTS). The requirements for this will vary and depend on your country of origin. If you are required to take an English language proficiency test, the results of the exam will be sent directly to the nursing board of the state where you will be applying for a nursing position. 

Foreign nurses who completed nursing school in Australia, the United Kingdom, Canada (with the exception of Quebec), New Zealand, and Ireland are exempt from having to take an English proficiency test, as English is the language, read, and written in nursing schools in these countries. Therefore, nurses who attended nursing school in one of these countries are proficient in the English language.

Pass the NCLEX-RN Exam

Once you meet the basic education requirements for nurses, as well as the language requirements, the next step to becoming a nurse in the United States is applying for the NCLEX in the state where you intend on obtaining employment. You will need to register for this examination with Pearson Vue. There is a $200 registration fee, and additional foreign fees may also apply. At the time of writing, the NCLEX exams were being administered in Canada, Australia, England, Germany, India, Hong Kong, Mexico, Japan, Puerto Rico, Philippines, and Taiwan. 

Have Your Credentials Evaluated by a Credentialing Organization 

You will also have to have your credentials evaluated by a qualified credentialing organization. One such organization is the Commission on Graduates of Foreign Nursing Schools (CGFNS). 

CGFNS is an organization that State Boards of Nursing employ to ensure that foreign nurses who apply for positions do, in fact, meet the basic requirements for foreign nurses that have been established by the United States, and that applicants are qualified to sit for the NCLEX. 

The United States Department of State and Labor developed the Commission of Graduates of Foreign Nursing Schools in 1977. It was established after an in-depth investigation of the immigration of nurses who were born in and received their education in a foreign country. The purpose of this organization is to ensure that American patients receive safe care, and to help to prevent the exploitation of nurses who have graduated from foreign nursing schools who are employed to practice in the United States.

 The CGFNS will assess all of the transcripts and the educational history from your country of origin. Though the CGFNS is the best-known company that the State Boards of Nursing uses to assess and confirm the requirements of foreign nurses who are applying to practice in the United States, the cost is exorbitant and the credentialing requirements vary from state to state. 

There are three main credentialing reports used in the United States, which include the following: 

  • Credentials Evaluation Service Professional Report. This report isn’t as complex and it’s less expensive than the Certificate Program or VisaScreen. It offers the basic details that the State Board of Nursing requires; however, only a handful of states accept it. With this report, you will need to meet the following requirements: 
    • The English language requirement 
    • Secondary school documents
    • Licensure documents from your home country 
    • Nursing education documents from your home country 
    • A $350 fee
  • CFGNS Certificate Program. This evaluation is the same as the Credentials Evaluation Service Professional Report; however, it requires you to take the CGFNS Qualifying Exam. The following are some key details: 
    • Everything required in a Credentials Evaluation Service Professional Report
    • CGFNS qualifying exam
    • $445 fee
  • VistaScree: Visa Credentials Assessment. This assessment has the same requirements as the CGFNS Certificate Program; however, you will be qualified for a Work Visa after you have completed the NCLEX. You’ll also need to pay a $540 fee. 

While there are other credentialing services, and they may be less expensive and accepted by the State Boards of Nursing, make sure to check with the State Board before you use one to confirm the acceptance. Other options include the International Education Research Foundation and the Educational Records Evaluation Service. 

Obtain Your Nursing Employment Visa

Once you have met all of the above-mentioned requirements, you must then obtain a nursing employment visa. There are several type of work visas for foreign nurses, including: 

  • The TN Visa for Mexican and Canadian nurses
  • H1-B temporary work visa for nurses who have a four-year degree and who fulfill a specialized nursing role
  • A permanent work visa or “green card”, is required by most foreign nurses

Apply for Nursing Positions 

After you’ve satisfied the above-mentioned requirements, you can proceed with applying for a job as a nurse in the United States. Visit job boards, where you will find an array of openings in your field. You can also contact hospitals, physicians’ offices, nursing homes, and other facilities directly.

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