Six Steps to Working as a Nurse in the USA. The NCLEX Is the Third, and the Longest Wait Is for Your School's Records

Published 31 October 2026 · Luke, co-founder of NCLEX BANK · 11 min read

How do you become a nurse in the USA when your nursing education is from the Philippines, India or Nigeria? There are six steps, each run by a different body, and no office watches the whole line for you. The NCLEX-RN is the third. It is the step everyone has heard of, but it is not where most of the time goes: the evaluators decide in days, while your school's records take an average of 14 weeks just to reach them. For a New York licence, the public fees up to the visa add up to about $1,658, and the NCLEX registration is $200 of that. This article walks the six steps in order: who decides, what it costs, how long it waits, what to ask for at home this week, and what has changed in 2026, including a rule that now stops most Nigerian nurses at the last step.

1. Six steps, six different bodies

In order, with the body that decides each step in brackets:

1. Choose a state (that state's board of nursing)
   Licences are issued by states, and the state you pick sets the rules for everything after it
2. Have your education checked (the board, usually through TruMerit or another evaluator it names)
   Does your nursing education match what the board requires of a registered nurse?
3. Pass the NCLEX-RN (written by NCSBN, delivered by Pearson VUE, with eligibility granted by the board)
4. Receive your licence (the board)
   You may work from the day your licence number is issued
5. Get a health care worker certificate, usually VisaScreen (TruMerit, authorised by USCIS)
   Education, licences, English and the NCLEX, certified together for immigration
6. Get the visa (a US employer, USCIS and the State Department)

None of these bodies tells the next one that you have finished. You send the documents, you count the deadlines, and you notice when something stalls.

There is no national "equivalency" either. The US Department of Education says it does not evaluate foreign qualifications or degrees. For a licensed profession, the authority is the licensing board of the state where you will work, and the evaluations it asks for are done by private, non-governmental services for a fee.

2. Step 1: choose a state before you open a textbook

You cannot register for the NCLEX without a board behind you, because the board, not Pearson, declares you eligible. So the first decision is the state. "Best state for nurses" lists rank pay; for a nurse educated abroad, the useful questions are about paperwork:

• Does it need a US Social Security number? You cannot get one before you live in the US. In NCSBN's 2024 survey, 27 boards (47%) listed an SSN as a requirement for a first RN licence. Some boards let you test without one and hold the licence until you have it
• Who evaluates your education, and how? Some boards name a few evaluators and a specific report; one does the review itself
• Does the licence itself need an English test? This is separate from the visa step, which always does for you (section 6)

Five boards that many nurses educated abroad look at, as their own pages read on 31 October 2026:

• New York: no SSN needed. NYSED must receive your education either straight from your school (Form 2F) or through TruMerit's Credentials Verification Service for New York State ($425). The service is optional, but NYSED says applying without it is often more difficult and slower. Your foreign licence is verified the same way, or on Form 3F. No English test for the licence. Fee $143. NYSED's rule asks for a general nursing course of at least two academic years, certified by your licensing authority. You may register for the NCLEX only after NYSED writes to say your education is approved. You also need two NYSED-approved courses, in child abuse reporting and infection control, unless exempted
• Texas: a course-by-course evaluation from TruMerit, ERES, Josef Silny or The Evaluation Company, dated within one year. Theory and clinical education in adult (medical and surgical), maternal/infant, children's and psychiatric/mental health nursing. An English test if your programme was taught in another language. You must apply within four years of graduating or of last working as a nurse. Fee $75, including the state's jurisprudence exam. The board publishes fingerprint instructions for applicants without an SSN
• Florida: you can apply and sit the NCLEX without an SSN, but the licence is not issued until you have one. A full evaluation from an approved agency, and minimum theory and clinical hours in medical, surgical, obstetric, paediatric and psychiatric nursing. Fee $110
• California: an SSN or ITIN is mandatory, or the application is not processed. The board evaluates your education itself, in five areas including geriatrics, and any gap must be made up with an approved course before you are eligible. Fee for international graduates: $750
• Washington: no SSN needed. Evaluators include TruMerit, ERES, IEE, Josef Silny and The Evaluation Company. The English test for the licence is waived if your school attests that theory and clinical were taught in English. Fee $138

None of this decides where you sit the exam, and none of it is fixed: Texas and Florida both changed their English-test rules or forms this year. Pick the state, then read that board's page for nurses educated outside the US, line by line. Pay is a separate question, and it shrinks a lot once tax comes out; see US nurse salary.

3. Step 2: the evaluation, and the 14-week wait

Whatever the state, a board has to see your education from the source. TruMerit (the name CGFNS took in 2024) is the evaluator most boards name. Its general report, the CES Professional Report, costs $485; New York's own verification service is $425; Texas asks for a full course-by-course report. What all of them have in common is who sends the paper:

• Your school sends your transcripts directly, with TruMerit's form. Copies you send yourself are not accepted. If the school has closed, a body that holds its records, such as a ministry, can send them
• The body that licensed you sends a licence validation directly, on TruMerit's form. The signature must be dated within the last three years; TruMerit notes that some boards want one from the last nine months. VisaScreen later checks every licence you have ever held, so list them all
• Your secondary-school record: TruMerit asks for the exam-board certificate in India, most of Africa and the Caribbean, and the school diploma in Southeast Asia. For VisaScreen this is waived if you finished secondary school more than ten years ago
• Everything in English. A transcript in another language should be translated by the school; if it cannot, TruMerit translates for $85 a page

In the Philippines the licence step is a published PRC service: Stateboard Verification/Validation of License/Registration (CGFNS-TruMerit). You book it on the PRC's online system, present your ID at a regional office, and PRC staff fill in and upload the validation to TruMerit's portal themselves. The fee is ₱75, plus ₱30 documentary stamp tax if required. In India and Nigeria, TruMerit does not publish which body it expects; it is the body that registered you, and the personalised forms in your TruMerit account say what to send where.

Now the clock. TruMerit's own figures: 70% of CES reports are issued within 7 business days, and 80% of New York verification reports within 7 business days. The asterisk is the point. Those times start once every document has arrived, and the average wait for documents from schools and regulators is 14 weeks. TruMerit adds that delays at those institutions can stretch it considerably. A school that has never filled in TruMerit's form, a registrar who is on leave, a regulator that wants a fee paid in person: each adds weeks that no amount of study can recover. This is the step to start first.

4. Step 3: the NCLEX-RN, $350 at a centre outside the US

With your application at the board, you register with Pearson VUE, which runs the exam for NCSBN. Two charges apply to a nurse sitting it outside the US:

• Registration: $200. For registrations made from 1 February 2027 it rises to $350. The fee follows the date you register, not the date you test
• International scheduling fee: $150, plus local VAT where it applies. For a US licence, every centre outside the US and its territories counts as international

Neither is refunded for any reason, and paying does not make you eligible. The board declares you eligible, and only then does Pearson email your Authorization to Test (ATT). A registration stays open for 365 days waiting for that decision; if it runs out, the money is gone. The ATT itself lasts about 90 days on average, set by the board, with no extension for any reason.

The centre has nothing to do with the state: a nurse applying to New York can test in Manila. NCSBN's international list for October 2026 has:

• Philippines: Makati (Trident Tower, Gil Puyat Avenue) and Alabang, Muntinlupa
• India: 15 cities. Ahmedabad, Amritsar, Bangalore, Chandigarh, Chennai, Gurugram, Hyderabad, Jalandhar, Ludhiana, Mohali, Mumbai, New Delhi, Noida, Pune and Surat. There is none in Kerala; the nearest are Chennai and Bangalore
• Nigeria and Ghana: none. In Africa the list has only Nairobi and Johannesburg (Sandton). London, Istanbul or a centre in the US are other options

The exam runs 85 to 150 items in up to five hours, and the number of items you get says nothing about the result; NCLEX-RN explained covers how it is built and scored. First attempts in 2025, for a US licence, by country of education:

• Philippines: 22,793 candidates, 45.8% passed
• India: 4,866 candidates, 33.3%
• Kenya: 4,096 candidates, 58.2%
• Ghana: 2,236 candidates, 54.7%
• Nigeria: 1,983 candidates, 54.4%
• All nurses educated outside the US: 52,827 candidates, 47.3%. US graduates: 86.7%

More than half of nurses educated abroad did not pass on the first attempt, and those educated abroad who were retaking it passed at 30.5%. The detail is in NCLEX pass rates. This is the one step of the six that paperwork cannot carry you through.

5. Step 4: the licence number is the day you can work

Your board sends the official result within about six weeks of the exam. A pass is not a licence. The board issues a licence number once every one of its conditions is met: the evaluation, the forms, the fee and anything else it asked for. You can practise from the day that licence takes effect. No board we checked publishes how many days that takes, because it depends on what was still missing.

Keeping it costs little. In New York the licence itself is valid for life; what you renew is the registration, every three years, for $73, and you may not practise while it has lapsed. Texas renews every two years, for $68. If you will spend a few years between the exam and the move, a New York licence waits for you without being taken again.

6. Step 5: VisaScreen checks it all again, plus English

A licence does not get you a visa. Federal rules (8 CFR 212.15) require nurses and several other health professions to present a health care worker certificate at the visa stage. For nurses this has usually meant TruMerit's VisaScreen, which costs $740. Since 27 March 2026, USCIS has also authorised a second organisation, The Evaluation Company, to issue it for RNs, LPNs and LVNs. VisaScreen checks four things: your education, every licence you have held, your English, and a pass on the NCLEX-RN (or TruMerit's own qualifying exam).

The part that surprises nurses from the Philippines, India and Nigeria is English. VisaScreen excuses you from the test only when your nursing education took place in the UK, Ireland, Australia, New Zealand, Canada (outside Quebec) or the US, taught in English, textbooks included. Studying in English in Manila, Kochi or Lagos does not count, even where a state board waived the test for the licence, as Washington can. Since 12 May 2026 the accepted tests are IELTS Academic, TOEFL iBT, OET, PTE Academic, Cambridge and MET; TOEIC is gone. For an RN the lines include IELTS 6.5 with Speaking 7, and OET with Speaking 360. The full table, and which test suits whom, is in English test scores for nurses.

The certificate must be used within five years to enter the US or to change or extend status, and renewal costs $475. English scores are generally valid for two years. Take the test too early and it may expire before you apply, so count back from the month you will file VisaScreen. TruMerit says 90% of VisaScreen certificates are issued within 3.5 business days once the documents are in, and much of the evidence is the same file as step 2.

7. Step 6: the visa needs an employer, then a queue

The first five steps you can push on your own. The sixth you cannot: only a US employer can file the petition (Form I-140) that starts a nurse's green card. Registered nurses are on the Labor Department's Schedule A, which spares the employer the usual job-advert test, and one way to qualify is a pass on the NCLEX-RN on the day the petition is filed. That day becomes your priority date, your place in the queue. A pass that comes three months later puts you three months further back.

The queue is the Visa Bulletin. Most nurses are in the third employment category (EB-3). The November 2026 bulletin's final action dates for EB-3:

• Philippines: 15 August 2023 (unchanged)
• India: 22 January 2014, up three weeks. Petitions from early 2014 are only now being finalised
• Nigeria, Ghana, Kenya and every country not listed separately: 15 June 2024, a month ahead of October, after a retrogression the month before

A date means a petition filed before it can be finalised now. The bulletin moves both ways, so no one can promise you a month. How to read it, the interview and who pays which fee are in the green card article. Staffing agencies and contracts are in US nurse recruitment.

8. The bill: about $1,658

Here are the public fees for a nurse who tests outside the US and licenses in New York, using TruMerit's New York service, at the exchange rates of 31 October 2026:

• Education and licence verification for New York (TruMerit): $425
• NCLEX-RN registration: $200 ($350 for registrations from 1 February 2027)
• International scheduling fee: $150, plus local VAT
• New York licence and first registration: $143
• VisaScreen: $740

Total: $1,658, or about ₱105,600, ₹1.58 lakh or ₦2.23 million. Register for the NCLEX on or after 1 February 2027 and it becomes $1,808. The exam registration is 12% of the bill. A budget built around "the NCLEX fee" misses most of it. In a state that wants the general CES report, the evaluation line is $485 instead.

Not included: the English test, New York's two required courses, the PRC or council fees at home, couriers and translation, travel to a test centre (from Nigeria, a flight), study material, and the green card itself. The immigrant visa fee ($345) and the USCIS immigrant fee ($235) are usually yours; the employer's fees are its own. The split, and what an employer may not charge you, is in the green card article.

9. The clock: reviews take days, paper takes months

Line up the waiting times that are published, and a pattern shows:

• Evaluation: 70% of CES reports in 7 business days, after the documents arrive. The documents: 14 weeks on average
• NCLEX registration: open 365 days while the board decides
• ATT: about 90 days on average, no extension
• Official result: within six weeks of the exam
• Licence number: not published
• VisaScreen: 90% in 3.5 business days, again after the documents
• Visa: the Visa Bulletin queue, which no one can promise

Every review is quick. What takes months is paper moving between your school, your regulator, TruMerit and the board. Study cannot speed that up. Starting early can. If you send the requests the week you decide, the 14 weeks run while you study. If you wait until you feel ready for the exam, they are added on top, and in the queue that follows, the date you pass is the date you start counting from.

Summary

1. Six steps: state, evaluation, NCLEX-RN (the third), licence, VisaScreen, visa. Each has its own decision-maker, and no national body grants "equivalency"
2. Choose the state first, on SSN, evaluation and English. New York and Washington need no SSN; Florida lets you test without one; California needs an SSN or ITIN
3. The evaluation is quick; getting documents to it takes 14 weeks on average. Schools and regulators send them directly. In the Philippines, the PRC uploads your licence validation for ₱75
4. Boards check level, length and content, not the word "diploma": US RNs come from diploma, associate and bachelor's programmes
5. NCLEX: $200 + $150 abroad ($350 + $150 for registrations from 1 February 2027). Centres in Makati, Alabang and 15 Indian cities, none in Kerala or Nigeria
6. VisaScreen ($740, five years) needs an English score even when your course in the Philippines, India or Nigeria was taught in English
7. The visa needs an employer and a place in the queue: EB-3 in November 2026, Philippines 15 August 2023, India 22 January 2014, everyone else 15 June 2024. Nigerian nationals' immigrant entry is suspended under Proclamation 10998
8. Public fees for New York: about $1,658, of which the NCLEX registration is 12%

Frequently asked questions

Can a GNM nurse from India become a registered nurse in the USA?

There is no national rule; the state board decides from your evaluation. US states license RNs from diploma, associate and bachelor's programmes, so the word "diploma" is not the issue. Boards check length and content: New York asks for a general nursing course of at least two academic years certified by your licensing authority, and Texas for theory and clinical education in adult medical-surgical, maternal/infant, children's and psychiatric nursing. A gap in one area can stop the application, so read the evaluation before you register for the NCLEX. For the visa, VisaScreen requires first-level, general nursing education and an English score.

How much does it cost to become a nurse in the USA from the Philippines?

For a New York licence, the public fees are about $1,658 (around ₱105,600 on 31 October 2026): TruMerit's New York verification $425, NCLEX registration $200, the international scheduling fee $150, the New York licence $143 and VisaScreen $740. The PRC licence validation for TruMerit adds ₱75 (plus ₱30 documentary stamp tax if required). Not included: the English test, couriers, review material and the green card fees. NCLEX registrations made from 1 February 2027 cost $350 instead of $200.

Can Nigerian nurses still move to the USA as nurses in 2026?

You can still qualify, but the last step is closed for most. Since 1 January 2026, Proclamation 10998 suspends the entry of Nigerian nationals as immigrants, which covers the green card route nurses use, with no exception for health care workers. Exceptions include dual nationals travelling on the passport of a country not on the list and case-by-case national-interest decisions. The state licence and the NCLEX are not affected, though there is no NCLEX centre in Nigeria; the only ones in Africa are in Nairobi and Johannesburg.