Yes, you can work as a registered nurse in the United States with your UK training. The path involves passing the NCLEX-RN exam, completing credential evaluations, and securing proper visa sponsorship. This comprehensive guide walks you through every step of the process, costs involved, and real challenges you’ll face along the way.
With nursing shortages across America creating unprecedented opportunities, British nurses are finding themselves in high demand. The journey from NMC registration to US RN licensure isn’t straightforward, but it’s absolutely achievable with proper preparation and understanding of the requirements.
NCLEX Eligibility for UK-Trained Nurses
Your NMC registration provides a solid foundation, but several additional requirements must be met before you can sit for the NCLEX-RN examination.
Core Eligibility Requirements
Educational Standards: Your UK nursing degree must be equivalent to US standards – most BSc nursing degrees from UK universities meet this requirement. The National Council of State Boards of Nursing (NCSBN) recognises UK programmes through individual state board evaluations.
Current NMC Registration: You’ll need active, unrestricted registration with the Nursing & Midwifery Council. Any restrictions or sanctions on your UK licence will impact your US application.
Credential Evaluation: Most US states require verification through CGFNS International (Commission on Graduates of Foreign Nursing Schools). This isn’t optional – it’s your gateway to proving your qualifications meet American standards.
English Proficiency: Despite being native speakers, some states still require IELTS or TOEFL scores. Check your target state’s specific requirements, as policies vary significantly.
State-Specific Variations
Different states have unique requirements:
- California requires comprehensive CGFNS review with minimum IELTS 7.0
- Texas offers streamlined processes for international nurses
- New York demands fingerprinting through MorphoTrust
- Florida accepts CGFNS credentials without additional exams
Step-by-Step NCLEX Application Process from the UK
Phase 1: Choose Your Target State
Research job markets, licensing requirements, and living costs. Each state’s Board of Nursing (BON) has different policies for international applicants.
Phase 2: Initiate CGFNS Process
Apply for CGFNS Credentials Evaluation Service (CES Professional Report). This involves:
- Completing online applications
- Arranging official transcript transfers from your nursing school
- Requesting NMC license verification
- Paying processing fees (approximately $485 USD)
Phase 3: Submit State Board Application
File your licensure by examination application with your chosen state’s BON. Include all required documents and fees (ranging from $50-$300+ depending on state).
Phase 4: Receive Authorization to Test (ATT)
Once approved, Pearson VUE will send your ATT – this document allows you to schedule your NCLEX exam and has an expiration date.
Phase 5: Schedule and Take the Exam
Book your test at a UK-based Pearson VUE centre. Current locations include London, Manchester, Birmingham, Edinburgh, and Glasgow.
CGFNS Certification: Your Gateway to US Practice
The CGFNS process can feel overwhelming, but understanding what’s required makes it manageable.
Required Documents for UK Nurses
| Document Type | Source | Processing Time |
|---|---|---|
| Secondary school transcripts | Your A-level/equivalent institution | 2-4 weeks |
| Nursing programme transcripts | University nursing department | 3-6 weeks |
| NMC licence verification | Nursing & Midwifery Council | 4-8 weeks |
| English proficiency scores | IELTS/TOEFL testing centre | 2-3 weeks |
VisaScreen® Requirements
For immigration purposes, you’ll also need VisaScreen certification, which requires:
- Completed CGFNS CES report
- NCLEX-RN pass confirmation
- English proficiency test results
- Additional fees (approximately $540 USD)
Complete Cost Breakdown for UK Nurses
Understanding the financial investment helps you plan effectively:
Direct Testing Costs
- NCLEX-RN exam fee: $200 USD
- International testing surcharge: $150 USD
- CGFNS CES Professional Report: $485 USD
- VisaScreen certification: $540 USD
- State board application: $50-$300 USD
Additional Expenses
- English proficiency tests: £195-£225 (IELTS)
- Review courses: £50-£500+ (UWorld, Kaplan, Archer)
- Travel within UK: Variable for test centre access
- Document courier fees: £20-£50
Total estimated investment: £1,000-£3,000+
UK Test Centres and Logistics
Pearson VUE operates multiple centres across Britain, making the exam accessible without international travel.
Current UK Locations (2025)
- London: High Holborn, Docklands, Southwark
- Manchester: City centre location
- Birmingham: Central business district
- Edinburgh: Scottish capital facility
- Glasgow: West of Scotland centre
- Leeds: Yorkshire location
- Belfast: Northern Ireland facility
Booking Your Exam
Schedule online through Pearson VUE once you receive your ATT. Popular slots fill quickly, so book early. Bring valid passport identification matching your ATT exactly.
Visa Pathways for Post-NCLEX Employment
Passing the NCLEX opens doors, but you’ll need proper immigration status to work legally in America.
EB-3 Visa (Most Common Route)
This employment-based immigrant visa leads to permanent residency:
- Requires employer sponsorship
- PERM labour certification process
- Processing time: 12-24 months
- Leads to Green Card status
H-1B Visa (Specialty Occupation)
Less common for entry-level RNs but possible for specialised roles:
- Annual cap with lottery system
- Requires bachelor’s degree minimum
- Temporary status (3+3 years maximum)
- Higher competition than EB-3
TN Visa Limitation
Important: TN visas are NOT available to UK citizens – this option is restricted to Canadian and Mexican nationals under USMCA.
Hospital Sponsorship Opportunities
American healthcare facilities actively recruit international nurses due to ongoing shortages.
Major Sponsors
- Health Carousel International: End-to-end support including CGFNS assistance
- O’Grady Peyton International: Specialises in UK/Irish nurse placement
- Midland Memorial Hospital: Recently used H-1B with EB-3 transition
- HCA Healthcare: Multi-state hospital network
- Kaiser Permanente: California-based integrated health system
What Sponsors Typically Provide
- Visa petition filing and legal fees
- CGFNS and NCLEX preparation support
- Relocation assistance and temporary housing
- Professional onboarding programmes
- Competitive salary packages
NCLEX Pass Rates: What the Data Shows
Understanding success rates helps set realistic expectations.
2025 Statistics
- US-educated first-time takers: 88.37% (down from 94.15% in 2024)
- International first-time takers: 46.55% (down from 58.77% in 2024)
- International repeat takers: 30.15%
The significant drop in 2025 reflects the full implementation of Next Generation NCLEX (NGN), which emphasises clinical judgement over rote memorisation.
UK Nurse Performance
While specific UK data isn’t separately tracked, anecdotal evidence suggests British nurses perform above average among international candidates due to strong educational foundations.
Recent Changes: Next Generation NCLEX Impact
The NGN format, fully implemented since April 2023, has transformed the examination experience.
Key Changes
- Clinical Judgement Focus: Questions assess decision-making rather than knowledge recall
- New Item Types: Case studies, drag-and-drop, highlight questions
- Partial Credit Scoring: Some questions award points for partially correct answers
- Adaptive Testing: Question difficulty adjusts based on performance
Impact on UK Nurses
The emphasis on critical thinking aligns well with UK nursing education, but the format requires specific preparation. Traditional multiple-choice strategies won’t suffice.
Best NCLEX Preparation Strategies for UK Nurses
Success requires targeted preparation addressing format differences and US practice standards.
Recommended Study Approach
Phase 1: Content Review (4-6 weeks)
- Focus on US healthcare terminology
- Study American medication names (generic vs brand)
- Understand delegation and prioritisation principles
Phase 2: Question Practice (6-8 weeks)
- Master NGN item types through targeted practice
- Develop clinical judgement skills using case studies
- Practice test-taking strategies specific to NCLEX format
Phase 3: Final Preparation (2-3 weeks)
- Take full-length adaptive practice exams
- Review weak areas identified through practice
- Maintain confidence and test-taking stamina
Top-Rated Review Resources
- UWorld: Comprehensive question bank with detailed rationales
- Archer Review: Affordable NGN-focused preparation
- Kaplan: Decision Tree strategy for question analysis
- Hurst Review: Content mastery with “why” explanations
Common Challenges UK Nurses Face
Understanding potential obstacles helps you prepare effectively.
Terminology Differences
- Paracetamol vs acetaminophen
- Adrenaline vs epinephrine
- Different measurement units
- Varying medication dosages
Practice Philosophy Gaps
- Greater emphasis on individual vs team-based care
- Different legal frameworks and liability concepts
- Varying scope of practice expectations
- Documentation requirements and standards
Process-Related Hurdles
- CGFNS document verification delays
- State board communication gaps
- Visa processing backlogs
- Cost accumulation pressure
Exam Format Comparison: NCLEX vs NMC
Understanding the differences helps you adjust your preparation strategy.
| Feature | NCLEX-RN | UK NMC Test of Competence |
|---|---|---|
| Format | Computer Adaptive Test (CAT) | CBT + OSCE components |
| Question Types | Multiple formats including NGN | Standard multiple choice |
| Focus | Clinical judgement & prioritisation | Knowledge recall & safety |
| Passing Standard | Variable difficulty-based | Fixed 60% threshold |
| Length | 75-150 questions (up to 5 hours) | 115 questions (2.5 hours) |
| Partial Credit | Available for some items | Not applicable |
US vs UK Nursing Practice Expectations
Prepare for significant practice environment differences.
Scope of Practice
US nurses typically have:
- Greater individual responsibility
- More autonomous decision-making
- Broader medication administration authority
- Different delegation expectations
UK nurses generally experience:
- More team-based approaches
- Clearer hierarchical structures
- Stricter medication protocols
- Different legal frameworks
Documentation Requirements
American healthcare emphasises extensive documentation for legal protection and reimbursement. Electronic health records usage is more prevalent and detailed than many UK settings.
State-Specific Requirements Breakdown
Each state maintains unique policies for international nurses.
High-Demand States
Texas
- Streamlined international nurse processes
- Active recruitment programmes
- Lower cost of living
- No state income tax
Florida
- No additional exams beyond NCLEX
- Large healthcare market
- Growing international nurse community
- Diverse practice opportunities
California
- Strict CGFNS requirements
- Minimum IELTS 7.0 mandate
- High salary potential
- Comprehensive orientation programmes
Emerging Opportunities
States like Arizona, Colorado, and North Carolina are increasingly recruiting international nurses with competitive packages and simplified processes.
Job Market and Sponsorship Landscape
The nursing shortage has created a seller’s market for qualified international candidates.
High-Demand Specialties
- Critical Care: ICU, CCU, ED positions
- Medical-Surgical: General ward nursing
- Perioperative: OR and recovery room roles
- Telemetry: Cardiac monitoring units
- Long-term Care: Growing elderly population needs
Salary Expectations
Entry-level sponsored nurses typically earn $60,000-$80,000 annually, with significant regional variations. California and New York offer higher salaries but increased living costs.
Contract Terms
Most sponsored positions include:
- 2-3 year employment commitments
- Visa fee reimbursement
- Continuing education support
- Career advancement pathways
Upcoming Policy Changes and Trends
Stay informed about developments affecting international nurses.
2025 Legislative Developments
- Bipartisan bills proposing 25,000 additional nursing visas
- Enhanced VisaScreen requirements under consideration
- State-level streamlining initiatives
- Improved credential recognition discussions
Technology Integration
- Digital credential verification systems
- Enhanced online testing capabilities
- Streamlined visa processing platforms
- Improved communication between regulatory bodies
Frequently Asked Questions
Can I take the NCLEX before securing a job offer? Yes, you can take the NCLEX in the UK before having US employment. Many nurses complete this step while job searching to strengthen their applications.
Is CGFNS certification mandatory for all states? Most states require CGFNS evaluation, but specific requirements vary. Always check your target state’s Board of Nursing website for current policies.
What happens if I fail the NCLEX? You can retake the exam after a 45-day waiting period, up to 8 times annually. Many nurses pass on their second attempt with additional preparation.
How long does the entire process take? From starting CGFNS to obtaining US licensure and visa approval typically takes 12-24 months, depending on efficiency and processing backlogs.
Do I need additional clinical experience in the US? Your UK experience is valuable, but most employers provide orientation programmes to familiarise you with American practices and technology.
Can I work in multiple states with one NCLEX pass? Yes, once licensed in one state, you can apply for licensure by endorsement in other states, though each has specific requirements.
Success Stories and Community Support
Connect with other UK nurses who’ve successfully made the transition through online communities:
Active Forums
- Reddit: r/NCLEX, r/nursing, r/BritishExpats
- AllNurses.com: International nursing sections
- Facebook Groups: UK Nurses Going to USA, NCLEX Support for International Nurses
- LinkedIn: Professional networking groups for international healthcare workers
These communities provide real-world insights, study tips, and emotional support throughout your journey.
Taking Your Next Steps
The path from UK nursing to US practice requires commitment, preparation, and patience. Start by researching your target state’s specific requirements and connecting with other nurses who’ve completed the journey.
Remember: thousands of UK nurses work successfully in America. With proper preparation, realistic expectations, and persistence, you can join their ranks and build a rewarding career in the United States.
Ready to begin? Visit your chosen state’s Board of Nursing website and start your CGFNS application today. Your American nursing career awaits.