Recruiting Internationally Educated Nurses: A Practical Overview for U.S. Healthcare Employers
Many U.S. hospitals, clinics and long-term care providers look abroad to help fill nursing roles. Internationally educated nurses bring valuable skills and experience, but bringing them to the United States is a long, multi-step process involving education reviews, licensing exams, immigration filings and careful onboarding. This overview from Ecruiter Corp explains the main steps so employers can plan realistically.
Is international recruitment right for your organization?
International recruitment works best as part of a longer-term workforce plan, not as a quick fix. Typical timelines run from many months to several years, depending on licensing, visa availability and processing times. Before starting, consider:
- How many nurses you will need over the next few years, and in which units.
- Whether you can provide orientation, mentoring and support with housing and settling in.
- Your budget for legal fees, credential reviews and relocation support.
- Whether your leadership and staff are prepared to welcome and integrate international colleagues.
Step 1: Credentials evaluation
An internationally educated nurse's education and license must be evaluated to confirm that they are comparable to U.S. standards. State boards of nursing set their own requirements and often require a credentials report from an approved evaluation service. CGFNS International is one of the best-known organizations in this field. Some states also require proof of English proficiency.
Step 2: The NCLEX and state licensure
Registered nurses in the United States must pass the NCLEX-RN examination, administered by the National Council of State Boards of Nursing (NCSBN), and hold a license in the state where they will practice. The exam is offered at Pearson VUE test centers in the United States and in several other countries. In Florida, licensure is handled by the Florida Board of Nursing. If the nurse will work in a different state from the one where they first license, plan for endorsement or a multistate license where the Nurse Licensure Compact applies.
Step 3: VisaScreen and immigration
Federal law requires many foreign-educated healthcare workers, including registered nurses, to obtain a healthcare worker certificate before receiving a U.S. visa or green card for that occupation. The VisaScreen certificate issued by CGFNS's International Commission on Healthcare Professions is the most common example. It reviews education, licensure and English proficiency.
Most internationally recruited registered nurses come to the United States as permanent residents through the employment-based third preference category (EB-3). Registered nurses are listed on the Department of Labor's Schedule A, which means employers can generally skip the standard labor market recruitment test, though they must still meet notice and wage requirements and file the petition properly. Visa availability depends on the State Department's monthly Visa Bulletin, and waits can be long for some countries. Temporary visas are available in limited circumstances, but they are often not a fit for standard staff nurse roles. An experienced immigration attorney should guide the employer through these choices.
Step 4: Offer, onboarding and transition
Once a nurse arrives, thoughtful onboarding makes a large difference to retention and patient safety:
- Clinical orientation covering U.S. documentation, electronic health records, medication systems and scope of practice.
- Mentoring by an experienced colleague for the first months.
- Cultural and communication support, including workplace norms and patient communication.
- Practical help with housing, transportation, banking and family settlement.
- Standard credentialing: primary-source license verification, background screening and health requirements, just as for any other hire. Our guide to healthcare credentialing and background checks in Florida covers these steps.
Ethical recruitment
International recruitment carries ethical responsibilities to the nurses and to their home countries. The World Health Organization's Global Code of Practice on the International Recruitment of Health Personnel encourages fair treatment and attention to countries facing severe health workforce shortages. In the United States, many employers and agencies follow the Health Care Code for Ethical International Recruitment and Employment Practices. Good practice includes:
- Not charging recruitment fees to nurses.
- Providing clear, written contract terms in advance, including pay, schedule, location and any repayment obligations.
- Avoiding excessive breach-of-contract penalties.
- Paying wages and benefits equal to comparable U.S. nurses.
- Being transparent about timelines and uncertainties.
Working with a recruitment partner
A recruitment partner can source candidates, track credentials and exams, coordinate with immigration counsel and support onboarding. When choosing one, ask:
- Which countries do you recruit from, and how do you assess clinical skills and English proficiency?
- Who pays which costs, and do candidates pay any fees?
- Which ethical recruitment code do you follow?
- How do you support nurses after arrival?
- What happens if a placement does not work out?
Common questions
How long does international nurse recruitment take?
It varies widely. Credentials evaluation, the NCLEX, the VisaScreen certificate and immigration processing can each take months, and visa availability for some countries adds further waiting. Employers should plan in years, not weeks, and keep candidates informed.
Can internationally educated nurses work as nursing assistants while they wait?
Not usually from abroad. Work authorization in the United States depends on immigration status, so employers should get immigration counsel's advice before offering any interim role.
Planning ahead
Because international recruitment takes time, most employers combine it with domestic hiring. Our earlier article on healthcare hiring in 2026 covers ways to fill roles faster at home while longer-term pipelines develop.
Ecruiter Corp provides healthcare talent acquisition, technology placement, global workforce solutions and industry-specific recruitment. Ecruiter Corp is part of Kingdom Holding Group. Planning international or domestic healthcare hiring? Contact our team.
This article is general information, not legal or immigration advice. Immigration and licensing rules change frequently and vary by state and country; consult a qualified immigration attorney and the relevant board of nursing before making decisions.