International Nursing Graduates: The 2026 Pathway to a US RN or LPN License

The US is short tens of thousands of nurses, and internationally educated nurses (IENs) remain one of the most reliable ways state boards close the gap. The pathway is well-trodden, but it is also paperwork-heavy, state-specific, and unforgiving of skipped steps. If you trained as an RN or LPN outside the US in 2026 and want to practice here, this is how the pathway actually works, which credential evaluator you should use, and where most files lose six months they did not need to lose.

The Five Pieces of the IEN Pathway

Every state board of nursing requires the same basic deliverables before they will let you sit for the NCLEX-RN or NCLEX-PN. The order varies, but the pieces do not:

A credentials evaluation from an approved agency comparing your foreign nursing program against US RN or LPN/LVN standards.
License verification from your country of education, sent directly to the credential evaluator and/or the state board.
English language proficiency evidence (TOEFL iBT, IELTS Academic, or PTE Academic) unless you are exempt by country of education or English-language nursing program.
NCLEX-RN or NCLEX-PN registration with Pearson VUE and an Authorization to Test (ATT) from your chosen state.
Background check and license application with a specific state board, plus fingerprinting in most states.

CGFNS, TruMerit, and the Naming Confusion

CGFNS International rebranded to TruMerit in 2024. The legacy CGFNS-branded products — the CGFNS Certification Program, the Credentials Evaluation Service (CES) Professional Report, and VisaScreen — still exist under TruMerit and are still the most widely accepted credential evaluations in the US. Approximately two-thirds of state boards either require or accept the CGFNS Certification Program (which bundles a credentials review, a one-day qualifying exam, and an English proficiency exam) as a prerequisite to NCLEX. The CES Professional Report — a credentials-only evaluation without the qualifying exam — is accepted by all 50 state boards of nursing for licensure purposes.

If you only see "CGFNS" on a state board's website, assume they mean TruMerit's CGFNS Certification Program or CES Professional Report. The names are interchangeable in 2026.

Alternative Evaluators: Josef Silny and IEE

TruMerit is dominant, but it is not the only path. Two NACES-member alternatives are widely used and meaningfully cheaper:

Josef Silny & Associates issues nursing credential reports (including the Visa4Nurses product) accepted by roughly 26 state boards of nursing. Acceptance lists shift, so always verify with your target state before paying.
International Education Evaluations (IEE) publishes a focused list of accepting boards: Colorado, DC, Florida, Hawaii, Idaho, Illinois, Kentucky, Montana, North Carolina, North Dakota, Northern Mariana Islands, South Carolina, Utah, Virginia, and Washington. Outside that list, do not assume IEE is accepted.

The savings versus TruMerit are real — often $200-$400 per evaluation — but the trade-off is acceptance risk. If you might license in multiple states, TruMerit's universal acceptance usually wins on a portfolio basis.

State-Specific Quirks That Catch Files

Two states deserve their own warning labels:

New York does not require TruMerit, but its alternative is so cumbersome that virtually every IEN files through TruMerit's Credential Verification Service (CVS) for New York. NYSED accepts the CVS report directly. Trying to license in New York without an evaluator means assembling primary-source documents yourself and routing them through NYSED — possible, but realistically adds 3-6 months.
California does not accept the standard CGFNS Certification Program in lieu of its own course-by-course review. The California Board of Registered Nursing requires official transcripts (including the clinical hours portion) routed through CGFNS/TruMerit and reviewed against California-specific course requirements (obstetrics, pediatrics, medical-surgical, psychiatric, and geriatric clinical hours). Many otherwise-qualified IENs are deemed deficient on a single clinical category and must complete remediation coursework before California will issue an ATT.

Other notable patterns: Florida, Texas, and Illinois are relatively IEN-friendly with broad evaluator acceptance. Oregon and Minnesota have stricter clinical-hour rules similar to California's. Always read the BON's IEN page, not a third-party summary, before you pay for an evaluation.

English Proficiency: Who Tests, Who Is Exempt

Most state boards exempt graduates of nursing programs taught in English in approved countries — typically Australia, Canada (except Quebec), Ireland, New Zealand, the United Kingdom, and (in some states) the Caribbean English-medium programs. Everyone else takes one of:

TOEFL iBT — common minimums of 83-84 total with a 26 in Speaking.
IELTS Academic — common minimum of 6.5 overall with 7.0 in Speaking.
PTE Academic — accepted by a growing number of boards; minimums vary.

Score minimums and accepted tests are board-specific. Always confirm with the target state and TruMerit (if using the Certification Program) before scheduling.

NCLEX-RN and NCLEX-PN for IENs

The NCLEX is the same exam US-educated and internationally educated nurses sit. There is no separate "international NCLEX." You register with Pearson VUE, pay the $200 exam fee, apply to a specific state board, and wait for that board to issue your Authorization to Test. The NCLEX is offered at international Pearson VUE test centers, so you can sit the exam before relocating to the US. First-time pass rates for IENs holding a CGFNS Certificate run in the high 80s to low 90s — markedly higher than IENs who sit without the qualifying-exam preparation.

NLC Eligibility for IENs

The Nurse Licensure Compact (NLC) lets nurses hold one multistate license valid in all 43 NLC jurisdictions. IENs can be eligible — but with a critical catch. The NLC requires you to declare a Primary State of Residence (PSOR) in a compact state, and PSOR is proven by tax returns, a driver's license, or voter registration. An IEN applying from abroad has no US residence yet. Practically, this means most IENs first receive a single-state license from their NCLEX state of application. Once they relocate, establish residence in a compact state, and complete a federal fingerprint-based background check, they can apply to convert to a multistate license. Plan for a single-state license at the start; the multistate upgrade is a step-two filing, not step one.

The Realistic 6-12 Month Timeline

From the day you start the credentials evaluation to the day you hold a US license, most IENs spend 6-12 months. The phases:

Months 1-3: Open the TruMerit (or alternative) file, request license verifications and transcripts from your country, sit the English exam, and — if going through the CGFNS Certification Program — schedule the qualifying exam.
Months 3-6: Evaluation completes; report transmits to your chosen state board. State board reviews and issues the ATT for NCLEX. This is the most variable phase — California and New York routinely run 90-120 days; Florida and Texas are often 30-60.
Months 6-9: Sit the NCLEX-RN or NCLEX-PN. Background check and fingerprinting run in parallel. License issues.
Months 9-12: Visa/SSN/employment steps if you have not already completed VisaScreen. NLC multistate upgrade once US residence is established.

Files that go faster than six months almost always have an English-medium program (no English exam needed), a fully digital primary-source verification from the home country, and a non-California, non-New-York state of first licensure.

What to Do First

Pick the state of first licensure before you pay for anything. The evaluator you should use, the documents you must collect, and whether you need the CGFNS Certification Program or just the CES Professional Report all flow from that single decision. If you do not yet know where you will work, default to TruMerit's CES Professional Report — it is universally accepted and gives you the most flexibility to switch states later. We help IENs sequence the steps, route documents to the right place the first time, and avoid the California clinical-hours trap that quietly costs nurses an extra year.

Sources: TruMerit (formerly CGFNS) — Certification Program; NCSBN — Licensure of Internationally Educated Nurses Resource Manual; NYSED — RN Pathway 5 (Foreign Nursing Graduates); California BRN — Qualifications for Graduates of International Nursing Schools; NCSBN — Licensure Compacts; IEE — Nursing Credential Evaluation.

The IEN pathway is not fast, but it is predictable. Pick the right state first, pick the right evaluator second, and the rest of the timeline is mostly waiting on documents you have already requested.