Internationally educated nurses in 2026: visas, fees and the backlog

If you trained as a nurse outside the United States and want to work here, you are dealing with two separate systems that run on different clocks. One is a state nursing license, which you earn by passing the NCLEX-RN and satisfying a state board. The other is an immigration route, which for most nurses means an employer-sponsored green card and a place in a queue that moves month by month.

This guide is for internationally educated nurses weighing a move, and for the public hospitals and health departments thinking of recruiting them. It sets out the steps in the order they actually happen, the fees USCIS publishes, where the green-card backlog stood in the October 2026 Visa Bulletin, and the 2025–26 policy changes that are still being fought in court. Rules changed repeatedly in 2025 and 2026, so treat every date here as a snapshot as of early October 2026, and confirm your own case with an immigration attorney before you resign a job or book a flight.

Which visa do nurses actually use?

For registered nurses, the main route is an immigrant visa in the employment-based third preference category, known as EB-3, sponsored by a US employer. It leads straight to permanent residence — a green card — rather than to a temporary work permit that has to be renewed.

Nurses have an advantage most other workers do not. Registered nurses and physical therapists are listed on Schedule A, Group I, a Department of Labor list of occupations for which the government has already decided there are not enough US workers. That lets an employer skip the recruitment-based labor certification process known as PERM, which in other occupations is a long, separate stage before the green-card petition can even be filed. To use Schedule A, the regulation says a nurse must have one of three things: a certificate from the Commission on Graduates of Foreign Nursing Schools (CGFNS), a permanent, full and unrestricted license to practice professional nursing in the state of intended employment, or a passing result on the NCLEX-RN.

Two other routes are worth knowing about. Canadian and Mexican citizens can work as registered nurses in TN status, covered below. And a nurse who is already in the United States in another lawful status may be able to adjust status here rather than go through a consulate abroad. Which route fits you depends on your citizenship, your country of birth, where you are now and what your employer is willing to sponsor.

Step by step: the EB-3 route in the order it happens

The sequence below is the common path for a nurse who is outside the United States. Individual cases vary and some steps overlap, but the order matters, because several steps cannot start until the one before them is finished.

• Get your credentials verified and pass an approved English test. Nurses entering the United States need a health care worker certificate under federal regulations, and the usual one is VisaScreen, issued by TruMerit, the organization formerly called CGFNS. It checks that your education is comparable to a US graduate’s, verifies every nursing license you have ever held, and requires a passing English proficiency exam. TruMerit says it does not accept the at-home versions of those exams.
• Pass the NCLEX-RN. VisaScreen accepts either the NCLEX-RN or TruMerit’s own Nurse Qualifying Exam, but you will need the NCLEX for a US license anyway. It is offered abroad at test centers in Australia, Brazil, France, Hong Kong, India, Israel, Japan, Jordan, Kenya, Malaysia, Mexico, Pakistan, the Philippines, South Africa, Spain, Taiwan, Türkiye and the United Kingdom, as well as in Puerto Rico.
• Apply for a state license where you can. Each state board sets its own rules for internationally educated applicants. A full license in the state where you will work also satisfies one of the three Schedule A conditions.
• Secure a job offer from an employer willing to sponsor you. Hospitals recruit directly, and specialist international recruitment agencies also place nurses. Read the whole contract before you sign, including any clause requiring you to repay costs if you leave early.
• Your employer files Form I-140 with USCIS under Schedule A. For a Schedule A petition, the regulations set your priority date — your place in the queue — as the date the complete, signed petition with the correct fee is properly filed with USCIS.
• Wait for your priority date to become current in the monthly Visa Bulletin for your country of chargeability, which is generally your country of birth rather than your citizenship.
• Complete the final stage. From abroad, that means consular processing through the National Visa Center and an interview at a US embassy or consulate. If you are already in the United States in a qualifying status, it may mean filing Form I-485 to adjust status.
• Present your VisaScreen certificate when your visa is issued or when you are admitted. The regulation requires the certificate to be used for admission within five years of the date it was issued, so time it with your likely visa date in mind.

What the government fees are, and who usually pays

USCIS publishes its fees in Form G-1055. The figures below come from the edition dated 1 October 2026. Fees change, so check the current edition on the USCIS site before anyone pays anything.

• Form I-140, the employer’s immigrant petition: $715 on paper or $665 online, plus an Asylum Program Fee of $600 for a regular employer, $300 for a small employer and nothing for a nonprofit.
• Form I-485, adjustment of status for an applicant over 14 who is already in the United States: $1,440 on paper or $1,390 online.
• USCIS Immigrant Fee, paid by people who immigrate through a consulate as lawful permanent residents: $235.
• State Department immigrant visa application fees are separate, and are listed on the department’s travel.state.gov site.

Beyond government fees, budget for VisaScreen, the English test, the NCLEX, state board fees, credential translations and legal fees. TruMerit, Pearson VUE and the state boards publish their own fee schedules, which differ by profession and by state, so they are not quoted here. The single most useful question to put to a prospective employer is which of these costs it will cover, in writing, and what happens to that money if you leave before your contract ends.

Where the green-card backlog stands in the October 2026 Visa Bulletin

The Visa Bulletin, published monthly by the State Department, sets cutoff dates for each category and country in two charts. The Final Action Dates chart decides when a green card can actually be approved or a visa issued: your priority date must be earlier than the cutoff. The Dates for Filing chart is earlier in the process and decides when you may submit your paperwork. For October 2026, the first month of the government’s 2027 fiscal year, USCIS said that applicants adjusting status inside the United States in every employment-based category must use the Dates for Filing chart, which lets more people file now even though approval still waits on the Final Action Dates.

These were the EB-3 final action dates in the October 2026 bulletin:

• Rest of world (all chargeability areas not listed separately): 15 May 2024
• Mexico: 15 May 2024
• Philippines: 15 August 2023
• China (mainland born): 8 January 2022
• India: 1 January 2014

The same bulletin’s Dates for Filing chart showed EB-3 at 1 August 2024 for the rest of the world and Mexico, 1 January 2024 for the Philippines, 1 April 2024 for China and 15 January 2015 for India. Compared with September, the rest-of-world final action date moved backward by three and a half months, from 1 September 2024 to 15 May 2024, and the rest-of-world filing date, which had been current, moved back to 1 August 2024. The Philippines final action date advanced by two weeks.

To see what that means in practice, suppose two nurses had I-140 petitions filed on the same day in March 2024. One was born in the United Kingdom and falls under the rest-of-world column; her priority date is earlier than the 15 May 2024 final action date, so her case can proceed to approval. The other was born in the Philippines, where the final action date is 15 August 2023, so she is still waiting. Even if she is already in the United States in a qualifying status, she cannot file to adjust status yet, because her priority date is later than the Philippines filing date of 1 January 2024. Same kind of job, same filing date, a different place in line because of where each was born.

The 2025–26 policy changes, and where each one stands

Three changes since mid-2025 affect internationally educated nurses, some directly and some at the margins. Two have been changed by courts, and all three can change again, which is why the dates matter.

The $100,000 H-1B payment. Proclamation 10973, signed on 19 September 2025 and effective on 21 September 2025, required a $100,000 payment with new H-1B petitions. On 8 June 2026 the U.S. District Court for the District of Massachusetts vacated the agency guidance implementing it, in State of California v. Mullin, and on 24 July 2026 the First Circuit denied the government’s request to pause that ruling during the appeal. USCIS says it is complying with the court order, but that DHS still plans to collect the payment if the order is later lifted. A federal court in Washington, D.C., upheld the proclamation in December 2025 in a separate case, Chamber of Commerce v. DHS, which is on appeal, the American Immigration Lawyers Association reported. The proclamation was due to lapse on 21 September 2026, but on 18 September 2026 the President signed Proclamation 11069, which extends it for another 12 months, to 21 September 2027, with no exception for health care workers beyond the existing national-interest exception. Then, on 30 September 2026, a federal court in the Northern District of California blocked USCIS, Customs and Border Protection and the State Department from implementing the payment until they complete notice-and-comment rulemaking, in Global Nurse Force v. Trump, according to the law firm Ogletree Deakins. So as of early October 2026 the requirement was extended on paper but blocked by two separate court orders, and the government can appeal both. For nurses, this mainly matters for advanced practice roles that can use the H-1B.

Entry restrictions by nationality. A June 2025 proclamation, expanded by another signed on 16 December 2025 and effective on 1 January 2026, fully or partially suspends entry for nationals of a list of countries. For partially restricted countries — Nigeria is one — the suspension covers immigrants, which includes employment-based green cards, as well as visitor, student and exchange visas. The exceptions include people who already held a valid visa on the effective date, lawful permanent residents, and case-by-case national-interest exceptions.

The 75-country immigrant visa pause. From 21 January 2026, the State Department paused immigrant visa issuance to nationals of 75 countries on public-charge grounds. According to the law firm Jackson Lewis, the U.S. District Court for the Southern District of New York vacated that policy on 21 August 2026 in Catholic Legal Immigration Network v. Rubio, and the department then paused immigrant visa interview appointments to give consular officers updated public-charge training, without saying how long that would last. The State Department has since said that, in line with the court’s order, the January 2026 pause is no longer in effect, as reported by the immigration law firm BAL; the government can still appeal, so confirm interview scheduling with the embassy or consulate handling your case. KFF estimated that foreign-born workers from 69 of the 75 countries made up about 8 percent of US health care workers — roughly 1.2 million people — and noted that the Philippines and India were not on the list.

The court removed a refusal based on nationality, not the ordinary public-charge test. Consular officers still assess each applicant individually against every ground of inadmissibility.

Canadian or Mexican? The TN route

Registered nurse is on the list of professions eligible for TN status under the US–Mexico–Canada Agreement. The regulation’s minimum requirement is a state or provincial license, or a Licenciatura degree. TN admission lasts up to three years at a time and can be extended.

Canadian citizens can generally apply at a port of entry with proof of citizenship, an employer letter and their credentials, while Mexican citizens must first obtain a TN visa at a US embassy or consulate. The health care worker certificate rule applies to nurses entering in TN status too, so VisaScreen still comes first.

TN is a temporary status, not a green card. If you later want to stay permanently, an employer can still sponsor you for EB-3, but the move from temporary to permanent plans raises timing questions worth taking to an attorney before anything is filed.

Which public-sector employers can hire you?

Citizenship rules shut some public-sector doors, and it is better to know that before you plan a career around a particular employer. USAJOBS states that only US citizens and nationals may compete for and be appointed to competitive service jobs. Agencies may hire non-citizens in limited cases when no qualified citizens are available, and annual appropriations law restricts it further.

VA is stricter than many nurses expect. Under title 38, a person may not be appointed to a VA nurse position unless they are a US citizen, except under section 7407(a), which allows certain temporary and part-time appointments without regard to citizenship when VA’s Under Secretary for Health determines that it is not possible to recruit qualified citizens. A nurse on a green card should not count on a permanent VA appointment until naturalized.

State and local government is a different picture, with rules set by each state and employer: county and city hospitals, state psychiatric and developmental facilities, correctional health units and public health departments. Read the eligibility and work-authorization section of each posting rather than assuming either way.

Common mistakes that cost nurses months

• Relying on the Dates for Filing chart when USCIS has said employment cases must use Final Action Dates.
• Assuming your citizenship decides your place in the queue. Chargeability generally follows your country of birth.
• Booking an at-home English test that TruMerit will not accept for VisaScreen.
• Letting a VisaScreen certificate age out. It must be used for admission within five years of issue.
• Paying a recruiter a placement fee for a job you cannot verify. Check the employer independently before you send money or documents.
• Resigning abroad on the strength of a projected date. Cutoffs retrogress.
• Leaving the United States while an adjustment application is pending without advance parole or a protected status.

Can a registered nurse get an H-1B visa?

Rarely. USCIS guidance says most RN positions are not specialty occupations. Certain advanced practice roles, including nurse anesthetist positions, can qualify if the employer shows the job normally requires a relevant bachelor’s degree or higher.

Does the $100,000 H-1B payment apply to nurses?

Only to nurses on new H-1B petitions covered by the proclamation, which leaves out most staff nurses on the EB-3 route. Proclamation 11069 extended the requirement to 21 September 2027, but as of early October 2026 two federal courts, in Massachusetts and in Northern California, had blocked the agencies from implementing the payment. Both rulings can be appealed, so check USCIS for the current position before any petition is filed.

How long is the wait for an EB-3 green card?

It depends on your country of birth and your priority date. In the October 2026 bulletin, rest-of-world nurses with priority dates before 15 May 2024 could proceed to final approval, as could Philippines-born nurses before 15 August 2023 and India-born nurses before 1 January 2014. Nobody can promise how fast those dates will move, and the rest-of-world date moved backward in October.

Do I need a US nursing license before the green card?

Not necessarily for the petition. Schedule A accepts a CGFNS certificate, a full license in the state of intended employment, or an NCLEX-RN pass. You will need a state license before you can actually work as a registered nurse.

Can I work for VA on a green card?

Generally not in a permanent nurse appointment. Title 38 requires citizenship for VA nurse appointments, with a narrow exception for certain temporary and part-time appointments when qualified citizens cannot be recruited.

Last reviewed Sep 13, 2026. First published Oct 12, 2026. Federal hiring rules change — confirm anything you act on against the agency's own announcement or OPM guidance.