The United States is facing a critical nursing shortage, and this has opened the door for foreign-trained nurses to find meaningful career opportunities. If you're an international nurse dreaming of working in the U.S. but haven't yet passed the NCLEX (National Council Licensure Examination), you're not alone—and you're not without options.
Through the support of trusted recruitment agencies and specialized visa sponsorship programs, many foreign nurses are successfully building careers in America. This guide explores how you can enter the U.S. healthcare workforce, even without NCLEX, and grow your career in a country where your skills are in high demand.
The U.S. Nursing Job Landscape
The healthcare system in the U.S. has been under immense pressure due to an aging population and the long-lasting effects of the global pandemic. As a result, the demand for skilled nurses is growing rapidly—especially in long-term care facilities, rural hospitals, and states with aging demographics.
Several roles are available even if you haven’t passed the NCLEX:
- Certified Nursing Assistants (CNA)
- Nursing Aides
- Patient Care Assistants
- Home Health Aides
These roles often serve as stepping stones, allowing foreign nurses to gain experience, earn an income, and prepare for the NCLEX while residing in the U.S.
Can You Work in the U.S. Without NCLEX?
Yes, it’s possible.
While the NCLEX is required for licensed registered nurse (RN) positions, there are alternative pathways to begin working in the healthcare system without it. Many U.S. employers are open to hiring international nurses in support roles that don’t require a license. These jobs can help you:
- Integrate into the U.S. healthcare system.
- Gain on-the-job experience in a clinical environment.
- Secure a path to sponsorship for permanent residence.
Roles That May Not Require NCLEX:
- Nursing Assistants: Work under the supervision of an RN, helping patients with daily needs.
- Personal Care Assistants: Often work in private homes or assisted living facilities.
- Medical Support Workers: Handle non-clinical or basic clinical tasks in hospitals or clinics.
Visa Sponsorship Pathways for Foreign Nurses
Navigating the U.S. immigration system can be complex, but several visa categories can support your career transition:
EB-3 Visa (Employment-Based Immigration Visa)
- Ideal for skilled workers including nurses.
- Includes a path to a green card.
- Most commonly used by U.S. recruitment agencies hiring foreign nurses.
H-1B Visa (Temporary Work Visa)
- Limited applicability for nurses unless working in specialized roles.
- Requires a bachelor's degree and employer sponsorship.
TN Visa (Canada and Mexico Only)
- Available for Canadian and Mexican citizens under NAFTA/USMCA.
- Fast-tracked processing and low application barriers.
J-1 Visa (Exchange Visitor Visa)
- Short-term placement for training and education.
- Typically used for cultural exchange programs, not long-term employment.
Recruitment agencies often provide legal support to handle visa processing, credential evaluation, and job placement—greatly simplifying the process for you.
Top Nursing Recruitment Agencies in the USA
Choosing the right recruitment agency is critical to a successful journey. The best agencies not only help you find jobs but also guide you through the licensing, immigration, and relocation processes.
Here are some highly regarded agencies:
1. O'Grady Peyton International
- Decades of experience placing foreign-trained nurses.
- Offers full-service support including NCLEX preparation.
- Known for high placement rates and transparency.
2. Avant Healthcare Professionals
- Specializes in direct hire placements.
- Provides licensing support and cultural transition programs.
- Offers competitive compensation packages.
3. MedPro International
- Offers EB-3 sponsorship and full onboarding support.
- Helps nurses get credentialed and licensed while working in interim roles.
4. Westways Staffing Services
- Provides per diem and long-term contracts.
- Has opportunities in multiple states for nursing assistants.
5. Alda Professional Placement Services
- Focuses on healthcare workers from the Philippines, India, and Africa.
- Offers visa sponsorship and guidance on passing NCLEX while employed.
These agencies often offer educational stipends, accommodation support, and assistance with credential evaluations—making them valuable partners in your U.S. nursing journey.
How to Choose the Right Recruitment Agency
Not all agencies are created equal. Some prioritize profit over your professional growth, while others genuinely invest in your success.
What to Look For:
- Transparency about fees and contracts
- Legal support for visa applications
- Credential evaluation and NCLEX prep resources
- Housing and relocation assistance
- Positive reviews from other international nurses
Red Flags to Avoid:
- Upfront payments or vague fee structures
- Lack of a written contract or offer letter
- No support with legal or immigration processes
Always research thoroughly, and don’t hesitate to reach out to current or former clients of the agency to understand their experiences.
States Actively Recruiting International Nurses: Focus on WI, USA
Some states are more welcoming than others when it comes to international healthcare professionals. Wisconsin (WI) is one such state.
Why Wisconsin?
- Significant demand for nurses in both urban hospitals and rural clinics.
- A growing aging population that needs long-term care.
- State-level programs supporting visa sponsorship for international healthcare workers.
- Local agencies and healthcare providers offer relocation bonuses and NCLEX sponsorship.
Cities like Milwaukee, Madison, and Green Bay are seeing strong growth in healthcare hiring, including for roles that don’t require immediate NCLEX clearance.
Here is Part 2 of the blog post:
Preparing for Success – Steps to Start Your Journey
Landing a nursing job in the U.S. without NCLEX is entirely possible—but it requires preparation, persistence, and the right guidance. Below are the essential steps every international nurse should take to maximize their chances of success.
1. Build a U.S.-Style Resume
Your resume should align with American healthcare hiring standards. Focus on:
- Clear, chronological job history
- Specific duties and accomplishments in each role
- Educational background and certifications
- Any international or volunteer experience
2. Get Your Credentials Evaluated
Before most agencies or employers will consider you, your academic and licensing credentials need verification. These services help assess your foreign education:
- CGFNS (Commission on Graduates of Foreign Nursing Schools) – Most commonly used
- Josef Silny & Associates
- Educational Credential Evaluators (ECE)
These evaluations ensure your qualifications meet U.S. standards and help determine your eligibility for visa sponsorship.
3. Demonstrate English Proficiency
Depending on the visa category and state requirements, you’ll likely need to pass:
- IELTS (Academic) or
- TOEFL iBT
Aim for scores above 6.5 (IELTS) or 83 (TOEFL) to improve your visa application and agency placement chances.
4. Prepare for Interviews
Many agencies and employers conduct interviews online. Here’s how to make a strong impression:
- Dress professionally, even on video calls
- Practice common interview questions
- Be honest about your licensing status and your plans to take the NCLEX
- Show enthusiasm and a willingness to adapt to the U.S. healthcare system
Common Challenges and How to Overcome Them
Licensing Delays
Solution: Start credential evaluations and applications early. Use agency resources to speed up the process.
Housing and Relocation
Solution: Work with agencies that provide relocation support. Some agencies offer temporary housing for your first few months.
Cultural Adjustment
Solution: Join support groups and online communities of international nurses. Many agencies also offer cultural training sessions to help you adjust to American workplace norms.
Financial Stress
Solution: Choose agencies that sponsor your visa and do not charge high upfront fees. Budget wisely and explore local financial assistance programs.
Checklist to Begin Your U.S. Nursing Journey Without NCLEX
✅ Research and choose a reputable recruitment agency
✅ Prepare a professional, U.S.-formatted resume
✅ Get your nursing credentials evaluated by CGFNS
✅ Take and pass an English language test (IELTS/TOEFL)
✅ Gather your education and work experience documents
✅ Apply for interim roles such as CNA or Patient Care Assistant
✅ Secure visa sponsorship through your agency
✅ Start working while preparing for the NCLEX
✅ Take the NCLEX in the U.S. or your home country (when ready)
✅ Transition to a full RN role and work toward permanent residency
Conclusion
If you’re an international nurse without NCLEX, your dream of working in the U.S. is still within reach. With the ongoing demand for skilled healthcare workers and the support of ethical recruitment agencies, you can start your career in the U.S. today—even in support roles—while working toward full licensure.
States like Wisconsin and others are actively welcoming nurses through sponsored programs and training pathways. Whether you’re just beginning your journey or already have clinical experience abroad, the U.S. healthcare system has a place for you.
Don’t wait until you pass the NCLEX to start building your career in America. Let a trusted recruitment agency help you take the first step now.