Nurse Practitioners on the Move: The Journey to the United States

Barbara Sheer DNSc, FNP-C, FAANP


Topics in Advanced Practice Nursing eJournal. 2007;7(2) 

In This Article

Steps for Nurses/APNs Moving to the United States

The journey to the United States for an APN takes considerable time, money, and patience. It is a multiple-step process that will take more than a year to complete. Because regulations in the United States vary from state to state, it is wise to first select a state in which to practice. The steps to working in the United States include:

  • Selecting a state for practice;

  • Contacting the state board of nursing;

  • Contacting the Commission on Graduates of Foreign Nursing Schools;

  • Applying for a visa;

  • Taking the National Council Licensure Examination (NCLEX);

  • Applying for state licensure;

  • Obtaining credentialing as an APN; and

  • Applying for a position as an APN.

Licensure requirements for each state can be found at the state boards of nursing Web sites.[3] An understanding of these individual state requirements is essential because all states do not have the same requirements for migrating nurses.

Because nursing education is not standardized on an international level, a transcript evaluation is conducted to determine the equivalency of the migrating nurse's educational background. The Commission on Graduates of Foreign Nursing Schools (CGFNS International) is an internationally recognized authority on credentials evaluation and verification pertaining to the education, registration, and licensure of nurses and healthcare professionals worldwide. Services include a visa screen, certification, qualifying examination, and credentials evaluation service. A prospective nurse applicant should check with the appropriate state board to ascertain which of these services are necessary.

To be eligible to take the CGFNS Qualifying Exam, nurses must have attended a postsecondary school for at least 2 years and pass an English proficiency exam. According to CGFNS, the certification qualifying examination has predictive value for passing the NCLEX. All states require applicant nurses to take and pass the NCLEX-RN, following which they may apply for an RN license in the state where they wish to be employed. State boards of nursing use the same process to license migrating nurses that boards use to license new graduate RNs.

Once licensed in a state, the APN can practice as an RN. The next challenge is obtaining credentials as an APN. The NP requirements also vary from state to state. NPs educated in the United States moving from state to state also face these challenges.

In most states, APN regulations fall under the state boards of nursing, but in a few states, regulations fall under a joint board of nursing and medicine or an advanced practice board. Most states now require both a master's degree and national certification.

The entire process may take several years to complete. The following story, although it took place a decade ago, illustrates the time, persistence, and patience necessary to reach the desired goal. Fortunately, online information and computerized testing have facilitated more timely application procedures, examinations, and results reporting.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.