How to Become a US Registered Nurse: The Complete Independent Guide (2026)
Last updated: June 2026 · Source data: NCSBN 2024, CGFNS fee schedule 2026, DOS Visa Bulletin June 2026
Summary
Internationally educated nurses must complete six steps to work as a Registered Nurse in the US: (1) CGFNS credential evaluation, (2) state board application, (3) NCLEX-RN exam, (4) VisaScreen certificate, (5) employer job offer and visa petition, and (6) immigrant or nonimmigrant visa. Total out-of-pocket cost: approximately $2,435–$3,935 before agency fees. Total timeline for Filipino nurses: 20–48 months. For Indian nurses: 10–13 years under EB-3.
The 6-Step Pathway
Master Timeline
For Filipino nurses applying today under EB-3. India timeline shown separately — see India guide.
| Phase | What Happens | Minimum | Typical | Slow |
|---|---|---|---|---|
| CGFNS CES | Document collection + evaluation | 10 weeks | 16 weeks | 6 months |
| State Board | Application processing | 15 days (TX) | 2 months | 8 months (NY) |
| NCLEX prep + exam | Study + sit + results | 6 weeks | 3 months | 4 months |
| VisaScreen | Post-NCLEX certificate | 4 weeks | 6 weeks | 8 weeks |
| I-140 + job offer | Employer files petition | 4 weeks | 8 weeks | 3 months |
| EB-3 wait (Philippines) | Priority date to current | 12 months | 24 months | 36+ months |
| Consular processing | Interview + visa issuance | 6 weeks | 10 weeks | 3 months |
| Total (Philippines) | ~20 months | ~32 months | 48+ months |
India EB-3 total: ~10 years minimum, ~12 years typical, 13+ years slow. Indian nurses should evaluate H-1B as the primary pathway.
Total Cost Breakdown
What you pay before any agency involvement. Agency fees are additional and not publicly disclosed by most recruiters — see our agency comparison.
| Fee | Amount | Notes |
|---|---|---|
| CGFNS CES Professional Report | $485 | Standard processing 10–12 weeks |
| CGFNS CES Expedited add-on | +$425 | Reduces to ~4 weeks |
| CGFNS Certification Program | $495 | Required by some states — not all |
| VisaScreen Certificate | $740 | Required for EB-3 immigrant visa |
| VisaScreen Priority Processing | +$650 | Priority processing option |
| State board application fee | $80–$300 | Varies by state (TX: $186; CA: $300) |
| NCLEX registration | $200 | NCSBN fee — same for all candidates |
| NCLEX international surcharge | $150 | If testing outside US |
| NCLEX prep course | $199–$499 | Kaplan, UWorld — strongly recommended |
| IELTS/TOEFL | $215–$310 | If required by state board (verify exemption) |
| Total (no expedite) | ~$2,435–2,635 | Before agency costs |
| Total (with expedite) | ~$3,510–3,935 | Before agency costs |
Source: CGFNS/TruMerit fee schedule 2026, NCSBN fee schedule 2026, state board websites. Fees subject to change — verify before submitting applications.
CGFNS Credential Evaluation
Before you can apply to a US state board, your nursing education must be evaluated by a credential evaluation service. This confirms your degree and clinical hours meet US standards. For most states, CGFNS (now operating as TruMerit) is the required provider.
What recruiters don't tell you
CGFNS processing has historically backed up to 9 months during high-demand periods (documented in AllNurses community threads, 2024). The stated 10–12 week standard timeline is an estimate. If your job offer depends on fast processing, budget for the $425 expedite fee.
State Board of Nursing Application
You apply for NCLEX eligibility through a state Board of Nursing, not through NCSBN directly. Most internationally educated nurses apply in Texas first — it processes applications in as little as 15 days and allows you to endorse your license to another state after passing.
| State | Processing Time | Fee | Notes |
|---|---|---|---|
| Texas | ~15 days | $186 | Most popular for speed; endorsement allowed after NCLEX pass |
| Florida | 4–8 weeks | $145 | |
| Georgia | 4–8 weeks | $80 | Lower cost entry point |
| Illinois | 6–12 weeks | $150 | |
| California | 3–6 months | $300 | High demand; significant backlog |
| New York | 3–8 months | $143 | Slow processing; avoid if speed matters |
NCLEX-RN Exam
The NCLEX-RN is the national licensing exam administered by NCSBN. Since April 2023, it uses the Next Generation NCLEX (NGN) format — a significant change that affects how you should study. Internationally educated nurses pass at much lower rates than US-educated nurses.
The 39-point gap is real and persistent. It reflects differences in nursing education curriculum, not nurse competence — Philippine RNs are fully trained clinicians. The gap closes significantly with NGN-specific preparation.
NCLEX fees (2026)
- NCSBN registration fee: $200
- International testing surcharge (if testing outside US): $150
- Total exam fees: $200–$350
VisaScreen Certificate
VisaScreen is a separate CGFNS product required for permanent immigration (EB-3 Schedule A visa) and for some H-1B positions. It verifies your US nursing license is valid and meets federal requirements. Apply after passing NCLEX.
VisaScreen also requires an English proficiency test (IELTS 7.0 overall or TOEFL iBT 83) unless you are exempt. Most Filipino nurses qualify for the exemption through their English-medium nursing education — verify with your specific state board and CGFNS before registering for IELTS.
Visa Pathway
Most internationally educated nurses use the EB-3 Schedule A immigrant visa — a category that exempts nurses from the labor market test because there is a documented US nursing shortage. However, EB-3 wait times vary dramatically by country of birth.
| Visa | For | Wait Time | Employer Required? | Green Card? |
|---|---|---|---|---|
| EB-3 Schedule A | All countries | 2–13+ years (varies by country) | Yes | Yes — permanent |
| H-1B | BSN-required; lottery | 6–12 months (if lottery won) | Yes | No — temporary (3+3 yrs) |
| TN | Canadian/Mexican citizens only | Same day at border | Yes | No — temporary |
June 2026 Retrogression Warning
DOS has warned that EB-3 Final Action Dates may retrogress in coming months. Current dates: Philippines = August 1, 2023; India = December 15, 2013; All Others = June 1, 2024. Check the Visa Bulletin Tracker monthly for updates.
Job Offer & Agency Selection
Most internationally educated nurses work with a recruitment agency to find a US employer and navigate the visa petition process. This is where the process becomes most financially consequential — and least transparent.
What the Type Investigations investigation found (2023)
Investigative journalism documented recruitment agencies charging upfront fees of $8,000 or more, plus breach penalties of up to $30,000 — enforced against nurses who left their first US job. These terms are rarely disclosed before nurses sign contracts.
Frequently Asked Questions
How long does it take for a Filipino nurse to work in the US?
The total process for a Filipino nurse typically takes 20–48 months from starting the CGFNS application to arriving in the US. This includes 4–6 months for credential evaluation and state board processing, 2–4 months for NCLEX prep and exam, 6 weeks for VisaScreen, and 24–36 months of EB-3 priority date wait under current DOS Visa Bulletin dates.
How much does it cost to become a nurse in the USA from the Philippines?
Out-of-pocket costs before agency involvement total approximately $2,435–$3,935, depending on whether you use expedited CGFNS processing, which state you apply in, and which NCLEX prep course you choose. Agency fees (if you use a recruiter) are additional and are not publicly disclosed by most agencies.
What is the NCLEX pass rate for Filipino nurses?
In 2024, 28,112 Filipino nurses took the NCLEX-RN for the first time. 51.7% passed. The US-educated nurse pass rate in the same period was 91.2%. This 39-point gap is persistent but can be significantly reduced with NGN-specific preparation.
Do Filipino nurses need IELTS for the US?
It depends on the state board. Many state boards exempt Filipino nurses from English proficiency testing because the Philippines uses English as the language of nursing instruction. However, VisaScreen has its own English requirement (IELTS 7.0 or TOEFL iBT 83) — verify your specific exemption eligibility with CGFNS before registering for IELTS.
Can I work as a nurse in the US without going through a recruitment agency?
Yes. You can find a US employer independently and have them sponsor your visa without an agency. However, most US hospitals that hire internationally educated nurses work through agencies because the visa petition process is complex. If you work independently, you will still need an employer to file the I-140 petition and potentially the labor certification (unless covered by Schedule A exemption).
Ready to start?
The NCLEX exam is the single biggest hurdle. Philippine nurses pass at 51.7% first-try. The right prep course — built for the NGN format — closes most of that gap.
Compare NCLEX prep courses →