To qualify, the foreign-born nurse has to possess a diploma in nursing and an unrestricted and unencumbered nursing license from the nurse's home country (if the nurse was educated outside the United States). In addition, to be eligible for immigrant sponsorship by a U.S. healthcare institution, nurses from foreign countries must meet one of two licensing/certification requirements: possession of license in the state of intended employment in the U.S. or successful completion of the Commission on Graduates of Foreign Nursing Schools (CGFNS) certification program.

In general, state nursing boards generally require passage of the National Council Licensure Examination (NCLEX-RN) exam, a frequently scheduled examination offered exclusively in the United States (and U.S. territories such as Guam). Licensure requirements differ from state to state, and it is important to contact the state licensing authority for guidelines. Contact information for the state Boards of Nursing is available at the website of the National Council of State Boards of Nursing (www.ncsbn.org). If the only bar to obtaining the final license is a social security number requirement, the immigration petition can usually still move forward.

In the alternative to directly pursing state licensure, the nurse can complete the CGFNS certification program. The CGFNS certification program consists of three parts: a review of foreign nursing credentials; the CGFNS qualifying exam (offered in all 50 states and worldwide); and an English language proficiency component. CGFNS accepts qualifying results from three standard English language proficiency examinations, known as TOEFL, TOEIC and IELTS. These exams are respectively administered by the Educational Testing Service (ETS), The Chauncey Group, and a consortium of the Cambridge ESOL Examinations, the British Council and IDP Education Australia. The Michigan English Language Assessment Battery (MELAB) exam is no longer offered for the purpose of CGFNS certification. Native-English speaking applicants who received their nursing education in Australia, Canada (except Quebec), Ireland, New Zealand or the United Kingdom may be exempt from the English language proficiency requirement. Full details of the CGFNS certification program can be found on their website.

The processing of the nurse immigrant visa application takes place in one of two ways, either Adjustment of Status or Consular Post Processing. For those candidates already lawfully present in the United States in an appropriate nonimmigrant visa status, an Adjustment of Status application for the nurse and family members may be filed simultaneously with the immigrant petition. The nurse may be authorized to accept employment with the healthcare institution immediately upon approval of the employment authorization component of the Adjustment of Status track, generally 3-4 months after filing (assuming state licensure issues are resolved). In order to be eligible for the Adjustment of Status track, the individual must have been lawfully admitted to the United States in a nonimmigrant classification that does not require nonimmigrant intent. Furthermore, the I-140 immigrant petition must have been filed before the expiration of the period of authorized U.S. stay, and the individual must not have been employed without authorization

If the nurse is resident outside the United States, or is otherwise ineligible for Adjustment of Status, then the immigrant petition will designate Consular Post Processing (CPP) at a U.S. consulate abroad. Upon approval of the immigrant petition, the Bureau of Citizenship and Immigration Services (USCIS) will generally notify the U.S. State Department's National Visa Center, who will then contact the nurse candidate by mail, providing instructions on how to apply for an immigrant visa at a U.S. Consulate. After submitting the immigrant visa application to the U.S. Consulate, the nurse awaits the immigrant visa interview at the U.S. Consulate.

After the immigration petition is filed, but before obtaining permanent residency approval (under either track), the nurse must obtain a VisaScreen Certificate. The VisaScreen Certificate is a based on criteria very similar to the CGFNS Certificate described above, and is composed of three parts: a credentials review; successful completion of either the CGFNS qualifying exam or NCLEX-RN examination; and English proficiency examination passage. Exemptions from the English language proficiency requirement are also available under the same criteria outlined above. The VisaScreen Certificate program is administered by the International Commission on Healthcare Professions (ICHP), a division of the Commission on Graduates of Foreign Nursing Schools (CGFNS).