Before taking the National Council Licensure Examination (NCLEX), foreign nurses wishing to work in the United States must first pass a qualifying examination administered by the Commission on Graduates of Foreign Nursing Schools (CGFNS). CGFNS is a nonprofit organization that performs credential evaluations and verifications for internationally trained health care professionals. Candidates who pass their CGFNS qualifying examination and language proficiency test are eligible to take the NCLEX examination. CGFNS applicants must meet sufficient classroom and clinical training requirements.

CGFNS Examination

Candidates approved to take the CGFNS examination must submit their transcripts, demonstrating their coursework completion in adult health, maternal and infant nursing, nursing care of children and psychiatric and mental health nursing. Candidates who meet these requirements are eligible to take the CGFNS test. The CGFNS test satisfies the requirement for obtaining an occupational visa to work in the United States. The examination evaluates a candidate’s knowledge and understanding of nursing according to U.S. instructional standards. The examination is delivered in a multiple choice format.

English-Language Proficiency

International nursing candidates seeking employment opportunities in the U.S. must demonstrate their English-language proficiency by taking an oral and written test. The test is a jointly approved examination, administered by the U.S. Department of Education and the U.S. Department of Health and Human Services. International nurses who come from countries where English is the local dialect and where nursing textbooks are written in English are exempt from taking the English Language Proficiency Examination.


Candidates who pass the CGFNS and meet their English-language proficiency requirement can take the NCLEX. The NCLEX is administered at test centers throughout the U.S. and internationally. The examination covers four areas: safe effective care environment, health promotion and maintenance, psychosocial integrity and physiological integrity. The NCLEX is delivered in multiple choice format. Nursing candidates must answer a minimum of 75 questions. Foreign nurse examinees must submit their applications along with a fee of $200.


International nurses who pass their NCLEX examination are eligible to become permanent residents of the U.S. After taking the NCLEX examination, international nurses seeking employment visas will be contacted by tour immigration specialists, who will guide applicants through the green card application process and required fees. The U.S. immigration law requires foreign health care professionals other than physicians to complete a screening program as proof that they meet the U.S. government’s eligibility standards for foreign healthcare professionals. The National State Boards of Nursing supports the entry of international nurses who seek employment in the U.S.