US Nursing Licensure for International Nurses: State Boards, NCLEX-RN, Credentials, Fees and Discipline (2026 Guide)

Part of our Nursing Councils of the World series. Last checked: October 2026.

The United States has no national nursing licence. Each state and territory has its own board of nursing (BON), and that board decides who can practise there. The boards work together through the National Council of State Boards of Nursing (NCSBN), which owns the licensing exam, the NCLEX. For an internationally educated nurse, that means three systems to deal with: a state board, the NCLEX, and (if you are immigrating) a federal screening certificate.

Who does what

Body	Role
State board of nursing	Reviews your application, decides eligibility for the NCLEX, issues and renews your licence, and disciplines nurses.
NCSBN	Develops the NCLEX-RN and NCLEX-PN, runs Nursys (the national licence database), and administers the Nurse Licensure Compact.
Pearson VUE	Takes NCLEX registration and payment, and delivers the exam at test centres in the US and internationally.
Credentials evaluators	Compare your education with US standards. The best known is TruMerit (formerly CGFNS International); some states also accept others, such as Josef Silny & Associates or ERES.
USCIS / US consulates	Handle immigration. Nurses usually need a VisaScreen certificate from TruMerit for a work visa or green card.

Step by step

1. Choose a state. Requirements vary widely. Some states accept applicants without a US Social Security number, use a particular credentials evaluator, or allow you to test before your evaluation is complete. Many international nurses start with a state that has a straightforward route for foreign-educated applicants. If you already have a US employer, apply to the state where you will work.
2. Get your credentials evaluated by the evaluator your board names. Your school and your home nursing council send transcripts and licence verification directly to the evaluator. Delays usually happen here, so start early.
3. Apply to the board of nursing for licensure by examination, and pay the board fee. Complete fingerprinting and a criminal background check.
4. Register with Pearson VUE for the NCLEX and pay the exam fee. You can do this at the same time as the board application.
5. Receive your Authorization to Test (ATT) once the board confirms you are eligible, then book a test date before it expires (usually within about 90 days).
6. Pass the NCLEX-RN. The board then issues your licence.
7. For immigration: get the VisaScreen certificate, then your employer files your visa or green-card petition.

Fees in 2026

Item	Typical cost
NCLEX registration (Pearson VUE)	$200
International scheduling fee (testing outside the US, Canada or Australia)	+$150, plus local VAT where it applies
State board application	About $75–$400, depending on the state
Fingerprints and background check	About $50–$150
Credentials evaluation	Varies by evaluator and report type. Check the evaluator’s fee schedule.
Jurisprudence exam (some states, such as Texas)	About $25–$50
VisaScreen (for immigration)	See TruMerit’s current fee schedule
NCLEX retake	$200 again, plus any board re-application fee

The NCLEX-RN explained

• Format: the Next Generation NCLEX (NGN), in use since April 2023. It is computerised adaptive testing, so questions get harder or easier depending on your answers.
• Length: between 85 and 150 questions, with a time limit of 5 hours. This includes clinical judgement case studies and new question types such as matrix, highlight, drag-and-drop and bow-tie.
• Scoring: pass or fail against a fixed standard, not against other candidates. Partial credit is given on many NGN items.
• If you fail: you receive a Candidate Performance Report. Most states require you to wait at least 45 days before retesting.
• International test centres: there are Pearson VUE NCLEX centres in several countries, including India, the Philippines, the UK and parts of the Middle East. Check Pearson VUE for the current list before booking travel.

English language and VisaScreen

VisaScreen is required for nurses entering on most US work visas and employment-based green cards. It checks your education, verifies every licence you have held, confirms English proficiency, and requires a pass in the NCLEX-RN or TruMerit’s Nurse Qualifying Exam. TruMerit accepts IELTS Academic, TOEFL iBT, OET, PTE Academic, Cambridge English and MET. At-home versions are not accepted. Updated score requirements apply to tests taken after 12 May 2026. For PTE Academic, for example, you need 55 overall, 63 in speaking and at least 50 in the other sections.

You are exempt from the English test if your nursing education was in English in the UK, Ireland, Australia, New Zealand, Canada (except Quebec) or the US. Nurses trained elsewhere, including Nigeria, Ghana, Kenya, India and the Philippines, normally need a test.

The Nurse Licensure Compact (NLC)

More than 40 US states and territories belong to the Nurse Licensure Compact. A nurse whose primary state of residence is a compact state can hold one multistate licence and practise in all the other compact states. This is ideal for travel nurses. Large states such as California and New York are not members, so a nurse working there needs a separate single-state licence.

Renewal and continuing education

Licences are usually renewed every two years, though some states use other cycles. Each state sets its own continuing education requirement. Some require a set number of contact hours, sometimes on specific topics such as implicit bias, human trafficking, opioids or infection control. Others require none. Check your board’s rules each cycle.

Discipline: how state boards handle complaints

1. Complaint: it can come from an employer, a patient, a colleague or a mandatory report (for example after a termination or a criminal arrest).
2. Investigation: board investigators collect records and interview witnesses. You will be asked to respond in writing.
3. Resolution: many cases are settled by a consent agreement. Others go to a formal hearing before the board or an administrative law judge.
4. Sanctions: a letter of concern, reprimand, fine, mandatory education, probation with conditions, suspension, or revocation. Many boards also offer confidential alternative-to-discipline programmes for nurses with substance use or mental health issues.
5. Public record: board actions are reported to Nursys and the National Practitioner Data Bank. They follow you to every other state, and to other countries.

Tip: professional liability insurance often covers a lawyer for board investigations. Many US nurses buy their own policy for this reason.

Common mistakes

• Choosing a state only because “everyone uses it”, without checking whether it fits where you will actually work, or its SSN and evaluation rules.
• Letting your ATT expire, which means paying $200 again.
• Using a home-council verification that has expired or is incomplete. Request it early.
• Paying agencies that promise a “guaranteed” NCLEX pass or green card.

Sources: UWorld, 2026 NCLEX exam cost breakdown (verified March 2026); TruMerit (formerly CGFNS), VisaScreen requirements; NCSBN (NCLEX and Nurse Licensure Compact). Fees and rules vary by state and change often, so confirm with your board of nursing and with Pearson VUE.