10 Top Nurse Requirements in USA:NCLEX, Licensure&Certification

Searching for nurse requirements in USA? We have provided all the information you need. If you have dreams of working as a nurse in the U.S., this article will give you clues about how a career in nursing will be over there. Keep reading to find out more.

The United States of America is a country that consists of 50 States. It is the third-largest country both by land and total area. It is also the third most populous country, with more than 331 million people. The country has over four million registered nurses. 

Nurses have always been the glue that holds the healthcare journey of a patient together. They can be found in every community both large and small. The nursing profession is a highly specialized and dedicated one that allows room for compassion. 

It is constantly evolving to address the health needs of society. The evolution is to ensure the most accurate diagnoses and education of the public about critical health issues. 

The profession has a vast range of specialties and complex skills, these make each nurse possess specific strengths, passions, and expertise. The profession can vary greatly in several ways, including responsibilities. Read on to find out the nurse requirements in USA.

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Types Of Nurses In The USA

All nurses have to go through top-notch programs with extensive education and study. This is because they have to work directly with patients, families, and communities using the core values of the nursing process.

The nursing process is a scientific method that is designed to deliver the very best in patient care. The process contains five simple steps: 

  • Assessment – Patients are assessed on an in-depth physiological, economic, social, and lifestyle basis. 
  • Diagnosis – Both physical symptoms and the behavior of the patient are considered carefully before a nurse forms a diagnosis. 
  • Outcomes/Planning – The nurse uses his/her expertise to set realistic goals for the patient’s recovery, which are closely monitored. 
  • Implementation – A care plan is implemented, then the nurse consistently cares for the patient whilst documenting the progress. 
  • Evaluation – The nurse then analyzes the effectiveness of the care plan and studies the response of the patient, to achieve the best outcome. 

The types of nurses in the U.S. can be divided into three categories by their specific responsibilities:

1. Registered Nurses (RN):

RNs are the backbone of the health care sector in the United States. They provide critical health care to the public wherever and whenever it is needed. 

Key Responsibilities: 

  • RNs perform physical exams and health histories before they make critical decisions. 
  • They provide health promotion, counseling, and education when needed. 
  • They administer medications and other personalized interventions to patients. 
  • They also coordinate care, in collaboration with a wide array of healthcare professionals.

2. Advanced Practice Registered Nurses (APRNs):

In addition to the initial nursing education and licensing that is required for all nurses, APRNs also have to hold at least a Master’s degree. 

Key Responsibilities: 

  • APRNs provide invaluable primary and preventative health care to the public. 
  • They treat and diagnose illnesses and also manage chronic diseases. 
  • They advise the public on health issues. 
  • They engage in continuous education to remain at the forefront of any technological, methodological, or other developments in the nursing field.

APRNs Practice Specialists:

The roles they play are:

  • Nurse Practitioners prescribe medication, and diagnose and treat minor illnesses and injuries. 
  • Certified Nurse-Midwives provide gynecological and low-risk obstetrical care.
  • Clinical Nurse Specialists handle a wide range of physical and mental health problems. 
  • Certified Registered Nurse Anesthetists administer more than 65 percent of all anesthetics.

3. Licensed Practical Nurses (LPNs):

LPNs are also known as Licensed Vocational Nurses (LVNs). They provide basic and routine care by ensuring the well-being of their patients throughout their health care journey.

They support the core health care team and work under the supervision of an RN, APRN, or MD. 

Key Responsibilities:

  • LPNs check the vital signs and look for signs that health is deteriorating or improving in patients. 
  • They perform basic nursing functions such as changing bandages and wound dressings. 
  • They ensure patients are comfortable, well-fed, and hydrated. 
  • Also, they may administer medications in some settings. 

How To Become A Nurse in the USA

In the U.S., qualified nurses are needed not just for bedside care, but also for leadership roles, education, and advocacy. As the number of patients grows and the population ages, the need for nurses is also expected to increase.

The first step to becoming a nurse in the United States is getting a solid education from an accredited nursing program. You will need either a nursing diploma, an associate’s degree, or a bachelor’s degree in nursing. 

Nursing programs include classroom instruction and clinical experience. Clinical training allows you to gain hands-on knowledge, ask questions in real-life scenarios, and connect with nurses.

Remember that before you choose a program in nursing, you have to find out if the nursing school will fit into your busy life. If your program is on campus and you will not have the time to attend, there are many bachelor’s and master’s degrees in nursing that can be earned online.

Upon completion of your nursing education, you will need to take an exam to demonstrate your knowledge and nursing skills. As a nurse in the United States, you need to be licensed to practice, and exams are the prerequisite to licensing. 

You can get more information on how to become a nurse here

Also, you can check out this article on some of the top accelerated nursing programs in The U.S. here.

Nurses’ Salaries In the USA 

You are likely to wonder about the income rate of nurses in the U.S. if you want to become a nurse there. The amount you would be paid as a nurse depends on some factors: the state you are in, where you work, the degree you hold and the industry you work in, your experience, and others.

According to the U.S. Bureau of Labor Statistics (BLS), as of 2021, registered nurses earn a median annual salary of $77,600. This is just an average across all the specialties in nursing. Some nurses earn over $195,000 annually.

Highest Paid Nurse In USA

According to BLS, the highest-paid nurse in the U.S. is Nurse Anesthetist. They earn an average of  $189,000 per year. 

Also, the top-paying state for Registered Nurses in the United States, according to the BLS occupational employment and wages in California. RNs in California are paid an average of $120,560 per year.

Click here to get more information on this.

Nurses Needed in the USA

The nursing profession has been in demand for years. In 2019, it was ranked as the third-most in-demand job of any profession in the United States, and the trend is not slowing down. As the population continues to increase and age, the demand for nurses also continues to grow. 

The need for healthcare workers is growing steadily in the U.S. According to the U.S. Bureau of Labor Statistics (BLS), employment in healthcare occupations will grow 16% from 2020 to 2030, much faster than the average for all occupations.

Registered nurses (RNs) are among those healthcare workers that will be needed to take care of the aging population. The BLS projects that the employment of registered nurses will grow 9% from 2020 to 2030, about as fast as the average for all occupations.

To better understand the shortage of nurses in the U.S., here is available data with a comparison of state populations to show the deficit on a state-by-state basis. Click here to take a look.

Requirements for Nurses In the USA

There are many reasons nurses would want to work in the healthcare sector in the U.S.

But to do that, some requirements are meant to be met by nurses before they can work in the United States. These requirements include:

Educational Requirements:

These differ by the type of nurse you want to become. It in turn affects the type of nursing program you are supposed to attend. There are four types of nursing programs:

  • Licensed Practical Nurses And Licensed Vocational Nurses Training Programs.
  • Associate’s Degree in Nursing Programs.
  • Bachelor of Science in Nursing Degree Programs.
  • Master of Science In Nursing Degree Programs.

Licensure Examination for Nurses:

All nurses have to earn state licensure after they graduate from an educational program.

Part of earning licensure is taking the National Council Licensure Examination which exists in two forms: one for registered nurses (NCLEX-RN) and one for practical nurses (NCLEX-PN). Both exams require candidates to pay a fee, and exams can be taken via computer. 


This is a way for nurses to show their ability to care for certain groups of people, such as children, the elderly, or patients with mental illness.

According to the BLS, although these credentials are earned voluntarily, some employers may insist that the nurses they hire have additional certifications.

There are professional organizations that offer a wide array of certifications in diverse specialty areas. You can search for them.

Advanced Practice Nurse Certification:

After earning degrees and obtaining RN licensing, nurse practitioners and other advanced practice nurses may need to undergo an additional process of certification, determined by the state in which they work. Certification allows an advanced practice nurse to perform specific care, depending on the state’s regulations. 

NCLEX Exam Requirements for Foreign Nurses

This is a compulsory examination that you must take to be licensed as a Nurse in the United States. The exam is given by the National Council of State Boards of Nursing (NCSBN), a nonprofit organization involved with regulating nurses in the U.S.

Your performance in this examination determines if you will be able to continue your nursing career or not. So it is a big deal. The exam is quite difficult, but it is not impossible.

You can choose to study on your own and get ready for the exam or use the review courses created by a lot of companies to help you. If you would prefer to review courses, here are some available options:

1. Review book:

This option is for self-motivated individuals. They can simply buy an NCLEX review book and work on their own. The book will contain a lot of practice questions as well as test-taking tips.

2. Online Classes:

Online classes are very flexible. All you have to do is sign up and take a course online. Usually, there will be an online instructor who will guide you in completing the course.

3. Offline classes:

These classes are like your normal nursing classes. Here you sign up and physically attend the course. There are also instructors in those classes that will help guide you through the NCLEX preparation.

Foreign Nurses In the USA

For foreign nurses who want to work as an RN in a hospital in the U.S., here are the right steps you would need to take.

Step 1: Meet the U.S. Education Requirements for Nurses: 

Firstly, as a foreign nurse, you would have to meet basic education requirements, which include: 

  • Graduate from an accredited RN program: Associate Degree in Nursing (ADN) or Bachelor of Science in Nursing (BSN).
  • Get licensed as a Registered Nurse (RN).
  • Have at least two years of practicing as an RN.

Step 2: Complete a Foreign-Educated Nurses (FEN) Course:

Most states would require foreign nurses to complete a Foreign-Educated Nurses (FEN) refresher course.

The course consists of 120 hours in the classroom and 120 hours of clinical practice under the supervision of a licensed Registered Nurse.

Step 3: Pass English Language Proficiency Tests:

Some foreign nurses would have to take and pass the Test of English as a Foreign Language (TOEFL), the Test of English for International Communication (TOEIC), or the International English Language Testing System (IELTS).

This will vary depending on the country of origin and results are sent directly to the state nursing board. 

Step 4: Pass the NCLEX-RN Examination:

It is time to apply for the NCLEX in the state of intended employment. Registration with Pearson Vue is required and costs $200 plus additional foreign fees.

Step 5: Have the CGFNS or Another Credentialing Organization Evaluate Your Credentials:

The Commission on Graduates of Foreign Nursing Schools (CGFNS) is a company that is employed by State Boards of Nursing to ensure that applicants meet the basic requirements and are fit to take the NCLEX.

The company goes through all nursing school transcripts and education history from your home country. 

Step 6: Find a Nursing Recruiting Agency or US-Based Employer:

Now, it is time to obtain an employment visa. There are several options for this but nurses must have sponsorship from a staffing agency.

It is easier for foreign nurses to work with an independent staffing recruiter and agency than directly with a hospital. 

Step 7: Obtain Your Nursing Employment Visa or Work Visa:

There are three types of work visas for nurses in the U.S., they include:

Mexican And Canadian Nurses – TN Visa:

Nurses from these places may work in the United States with a special TN visa if they have an offer of employment, a license to practice in their home country and pass the NCLEX and state licensure requirements. 

H-1B Temporary Work Visa:

Nurses who hold a four-year degree and fulfill a specialized nursing role may qualify for this temporary work visa and then apply for a green card once stateside. The specialized roles can include critical care nurses, emergency room nurses, and/or cardiology nurses. 

Permanent Work Visa:

The majority of foreign-trained nurses will need to obtain a permanent work visa, otherwise known as a green card. This application needs to be completed before traveling to the United States and the visa must be obtained before immigrating legally. 

Step 8: Find a Registered Nursing Job in the US:

Nurses are advised to conduct targeted job searches that are specific to their area of expertise. You can start by checking out the available positions on the nurse.org job board. If there is a particular hospital you’re interested in, you may want to look on their site to see if they have any openings.

You can get more information here.

Nurse Requirements in USA: Recruitment Agencies In the USA to Consider

The demand for nurses is steadily increasing in the U.S. This is also because the majority of the population is aging. Since the outbreak of the pandemic, foreign nurses have had the opportunity to work here temporarily or permanently.

This is where the international nursing recruitment agencies in the USA come in. These international nursing recruitment agencies in the USA hire foreign-trained nurses to mitigate the shortage of nurses in the United States.

There are several international nursing recruitment agencies in the USA. Some of them identify, select and facilitate the process of hiring a nurse for a fee per nurse hired. 

Besides the fees, other charges might be for accommodation, flights, language lessons, and all other expenses of mentoring and inducting nurses. The roles these international nursing recruitment agencies in the USA play cannot be overemphasized.

You can view some of the best recruitment agencies for nurses in the U.S. here.

Requirements to Study Nursing in USA for International Students

The nursing schools in USA welcome applications from those who reside outside of the United States. The specific admission criteria and documentation requirements for international applicants to each degree program is provided below.

Hospitals Sponsoring International Nurses in the USA

Several hospitals sponsor green cards for international nurses in the U.S. There are some basic requirements by some of these hospitals, some of them are:

  • Nurses must have obtained a nursing degree and NCLEX RN license.
  • Nurses should possess basic healthcare skills and patient relationship skills.
  • An IELTS, especially for those coming from non-English speaking countries. 

These sponsorships for international nurses are best done through international recruitment agencies. Remember we talked about them above. The hospitals advertise vacant positions through recruitment agencies that act as a link between the International nurse and the hospital.

Always remember to find out the specifications and requirements for the vacancy to know if you are the right fit for the hospital before you apply. 

You can access a list of hospitals sponsoring international nurses in the U.S. here

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