From English Exam to RN- Your Path to US Licensure

Good morning, good afternoon, good evening wherever in the world you may be watching from, welcome to AMN Healthcare Live Show: Onwards and Upwards!

This is the show where we discuss everything a global healthcare professional needs to know about living and working in the United States. I’m your host, Danielle Freedman, and I’m so happy to be with you all today. 

If you're new and just joining us, a warm welcome to you! We are AMN Healthcare International offering direct hire and staffing opportunities across the United States. We’ll be talking more about those opportunities later in the show.

Thank you for being here! Please let us know in the comments where you're watching from I always love seeing where our global viewers are tuning in.

As I reflect on hosting this show over the past two to three years, I’d like to take a moment to introduce myself for those who may not know me. I’m also an immigrant originally from South Africa so if we have any South African nurses joining us today, a special shout-out to you! We’re so glad you’re here.

Today, we’re going to talk about a topic that’s often underestimated but incredibly important in your journey to the U.S.: The English exams.

Why English Exams Matter for Nurses Moving to the U.S. 

Whether it’s the IELTS or the TOEFL, these tests are critical steps in your process, and it’s important not to delay preparing for and taking them. We have an exciting agenda today, so let’s take a look at what’s coming up: 

• We’ll be getting an update from TruMerit if you’re not familiar with them yet, don’t worry we’ll be telling you all about who they are and how they support international healthcare professionals. 
• We’ll dive into the importance of the IELTS and TOEFL exams.
• We’ll also discuss NCLEX and U.S. readiness.
• Dee will join us to talk about dream jobs in the USA.
• And we’ll wrap up with Clinical Corner featuring Holly. 

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There’s so much to cover today! 

I see we already have some viewers checking in: 

• Hello to Hazel from Zimbabwe!
• Arlene from Jamaica, welcome!
• Gabriel from Ghana — great to have you!
• Cuckoo Connie from Zambia, and
• Jace from the UK — hello to you all! 

We're so happy to have such a diverse and global audience with us today. 
If today’s show inspires you and you’d like to apply for opportunities in the U.S., our recruiters are standing by and ready to assist. You can apply at amnhealthcare.com/international we’ll also be dropping that link in the chat.

Throughout the show, feel free to drop your questions and comments I’ll be keeping an eye on the chat and sharing your messages with our guests.

And now, without further ado, let’s bring out our special guests for today! 
Good morning, everyone! How’s everyone doing today? Lots of smiling faces — I love to see it!  

Danielle Freedman:

So happy to have all of you on today. We're going to go around and do some brief introductions. We have a wonderful expert panel with a lot of varied experience, so I'm very excited to hear what you all have to say. Let's start to my left—let's start with Michele.

Michele Kilkenny:

Hello, everyone, and thank you to each guest for being here. I'm Michele Kilkenny, the Senior Director of Immigration and Licensure at AMN International. I've been working here for 36 years. I'm also an immigrant—I came from Ireland in 1989. Many of you may not have even been born then!

My first job was with O’Grady Peyton International, just one week after I arrived in the U.S., and we became part of the AMN family in 2001. So yes, I've been doing this a long time, and I consider it a privilege to work primarily with nurses—though I also work with other healthcare professionals. And I still love what I do, which I think says a lot.

Over the years, we've navigated many types of visas, retrogression, recessions, and travel bans. It’s been nearly four decades, and one thing I always tell people is that everything is cyclical. There’s always a way through. So I’m happy to be here this morning.

Danielle Freedman:

Well, it sounds like you've seen a thing or two, Michele! I’m really excited to hear your advice and insight today. Thank you for being with us. Let's go with Lynda next.

Lynda Belmehdi:

Hey, good morning everyone. I’m Lynda Belmehdi, Visa Screen Manager at CGFNS International. I've been with CGFNS since June 2017—so about eight years now.

I started as an International Credential Evaluator, then became a Program Learning Specialist, and now I serve as the Visa Screen Manager. I'm also an immigrant—from North Africa.

Danielle Freedman:

Oh, very nice, Lynda. Where in North Africa are you from? Nigeria?

Lynda:

Yes!

Danielle Freedman:

Very cool. So we’ve got lots of immigrants here today! Actually, we're all immigrants—which means we each bring a unique perspective to the table, representing different parts of the globe. That’s pretty amazing. Okay, let’s go to Polly next.

Polly:

Good morning, everyone. My name is Polly. I’m a nurse working in Kenya, and I’ve been working there for the past 15 years. Now, I’ve finally decided to make a change and move to the U.S. I’m currently in the process of my U.S. RN journey—AMN filed for an H-1B visa on my behalf, and I’m very excited about it.

Danielle Freedman:

Thank you, Polly! I’m looking forward to hearing more about your journey and what led you to choose AMN. Now let’s go to Monique.

Monique:

Hi, good morning—or good afternoon, depending on where you are. I’m Monique, a registered nurse from the Philippines since 2011. I’ve been working internationally for about 13 years now. I’ve worked in Saudi Arabia, in Africa, and I’m currently working in Germany. I'm really looking forward to continuing my journey in the U.S.

Danielle Freedman:

Wow, you’ve truly worked all over the world! I’m excited to hear more about that experience. Monique, let’s go back to you for a second—then we’ll have Polly share a bit more as well. Can you tell us why you decided to come to the U.S. and why you chose AMN?

Monique:

Sure. For a lot of Filipino nurses, the U.S. is really our dream destination. We studied under an American curriculum and nursing standards, so working in the U.S. feels like a natural step for many of us.

As for why I chose AMN—I’ll be honest—I applied to several agencies. But AMN was by far the most responsive and efficient. I received a response from them within just one week.

At first, they offered me a non-direct hire position, but I was specifically looking for a direct hire role. Even though I had to wait a bit longer, it didn’t take too much time before I was offered exactly what I was looking for. That responsiveness and commitment really stood out to me.

Danielle Freedman:

Wow. Well, that's very exciting—to have moved around and finally reach the goal you’ve been aiming for. That American dream is real, and we’re thrilled that you’re coming with us. I’m also excited to hear more about your English journey. 

Polly, let’s go to you. Why did you decide to come to the U.S.? It sounds like you’ve been working as a nurse for many years in Kenya. I’m sure you’ve built a life there. What helped you make this decision—and why with AMN?

Polly:

So the reason I started this journey to the U.S. is because there are better opportunities in the U.S. compared to my home country—sorry to say. I was looking to move into nurse management and possibly do some research. I tried pursuing those opportunities in Kenya, but it was nearly impossible. So, I decided to start this journey.

I came across AMN online and connected with a lady named Sarah Aristo—and I have to say, she’s amazing! I kept following up with her, asking for opportunities, and she kept sending them to me. Eventually, I got an H-1B visa. I’m so grateful to AMN.

It’s been a really fast journey for me. I just passed my NCLEX in November 2024, and now my petition has already been filed. I’m also fortunate I don’t have to go through retrogression. I’m really happy about that. Thank you so much, Sarah!

Danielle Freedman:

Oh yes—Sarah is amazing! She’s one of our recruiters on the direct hire side, and like all our recruiters, she’s really on top of things. They’re great at matching nurses with the right positions. I'm glad both of you had such positive experiences.

So now let’s shift gears a bit. Can you both share a little more about your English exam journey? That’s what we’re here to talk about today.

Common English Exam Challenges and How to Overcome Them

Danielle Freedman:

Monique, let’s start with you. Can you share what your English journey has looked like and where you are now?

Monique:

Yes. I already have my test report—I passed the English exam with the required score to complete my U.S. application. Sorry if I sound distracted, I’m hearing a bit of background noise.

I took the test three times. The first was a paper-based test, which I took with my partner. I scored higher than him overall, but unfortunately, I didn't reach the required score for the Speaking section. I needed a 7, but I got a 6.5. That was frustrating, of course, but I tried to stay positive since my overall band score was 8. I thought it was just a small hiccup and believed I could do better. 
I quickly booked another test and this time, I scored an 8 in Speaking—more than I needed. But I didn’t realize that the home-based computer test wasn't accepted by CGFNS or TruMerit. That was really frustrating. I had the score, but it wasn’t valid.

So, I decided to try again. This time I took the computer-based test at a test center since those results come back quickly, and I needed to speed up the process. Thankfully, it all worked out.

Danielle Freedman:

Wow—that really was a journey! A tough learning experience too. I’m sure you have a lot of great tips after going through all of that. And congratulations on passing!

I talk to nurses every week, and many tell me that the English exam feels even more intimidating than the NCLEX—so kudos to you for sticking with it and getting it done. We’ll come back to your advice in just a moment. 

Preparation Tips to Pass IELTS or TOEFL

Polly, let’s turn to you. Can you tell us a bit about your English exam journey

Polly:

Sure. When I first connected with AMN, I hadn’t taken any English exams yet. After I signed my contract, I had around three months to prepare for the IELTS. I didn’t want to rush it, so I took my time.

I used a program called 9.0 Niners, which was really helpful. They had great modules that helped me study all the areas I needed. I was determined to pass on my first try because I didn’t want to go back and forth.

So I gave myself enough time to study, took many mock tests, especially for speaking, and when I finally took the exam, I passed on my first try with a 7.5. That was enough for me to move forward in the process.

Danielle Freedman:

That’s fantastic! I’m sure it was a huge relief when you got that score. Thank you for sharing, Polly, and congratulations. We’ll hear more from both of you about your tips and advice shortly.

But first, I want to pause and address a question I’ve been seeing: Who is TruMerit? There have been some changes in U.S. licensing agencies, so Lynda, can you give us a bit of background? I think many of us may already know TruMerit—but under a different name.

Lynda Belmehdi:

Thank you, Danielle. Yes, TruMerit is the new name for CGFNS International. CGFNS has been around since 1977—almost 50 years! Originally, we focused on credential evaluation and the Visa Screen service for nurses and other health professionals.

Recently, however, our scope has expanded. We now offer certification and support for a broader range of healthcare professionals, globally. So we rebranded to reflect this broader mission.

The name TruMerit emphasizes our role in validating qualifications and achievements of healthcare workers worldwide. It signifies a new era—focusing on empowering healthcare professionals with the tools, knowledge, and inspiration to achieve excellence.

So yes, CGFNS is now TruMerit, and this name better reflects the global impact and diverse healthcare support we’re now focused on.

Danielle Freedman:

Thank you for explaining that, Lynda! I didn’t even realize CGFNS had been around for that long. That’s amazing. So it sounds like the organization was originally more focused on nurses, and now, as TruMerit, it’s expanding to serve a broader range of healthcare professionals globally. Is that right?

Lynda Belmehdi:

Yes, that’s exactly right.

Danielle Freedman:

Very interesting—thank you so much for being with us today. We’re looking forward to hearing more of your insights as we go through today’s discussion about the Visa Screen process and how to get to the U.S.

Now, let’s go back to the topic of English exams and talk about the basics. These exams are crucial—sometimes even required depending on where you're coming from—as part of your journey to the United States. 

Understanding IELTS and TOEFL

Michele, can you give us some background? What are the IELTS and TOEFL exams, and what skills do they test?

Michele Kilkenny:

Sure. English is very important for all of our international clinicians. Only six countries are considered English-speaking and are exempt from taking the English test: Ireland, the UK, Australia, New Zealand, Canada, and the U.S.—if you were educated there.

That’s key: it’s about where you were educated. So for example, if you're from the Philippines but were educated in the U.S., you’re exempt.

You need to pass an English exam to obtain your Visa Screen certificate or Healthcare Worker Certificate. This is required at the time of your U.S. embassy interview—whether you're coming on a TN visa as a Canadian, on an H-1B, or on an immigrant visa. You’ll need to show that certificate.

English is also often required for licensure, but that depends on the state. Each state board has its own rules about whether English testing is needed and which tests they accept.

The English exams—like IELTS or TOEFL—test four main areas: 

• Speaking
• Listening
• Reading
• Writing 

These skills are important not only for passing the test and getting your certificate or license but also for helping you thrive in the U.S. You’ll need to be comfortable having conversations with colleagues, patients, and in clinical settings.

So yes, English proficiency is very important—not just as a requirement, but as a foundation for success once you arrive.

Danielle Freedman:

Thank you, Michele. We're going to dive into a lot of what you said as we move through the show. That was some great insight into what the English exam is and why it matters—not just for passing your test and getting your Visa Screen, but also for once you’re in the U.S. and working. It’s such an important skill to develop.

I was just looking at the chat while we were talking, and I see we’ve got lots of people joining us. I want to say hello to Matella joining us from South Africa—hello! We’ve also got Fressie joining us from Kenya—Polly, another fellow countrymate! Nesting is also with us from South Africa. And I saw a question from Kesha asking whether we recruit nurses from Sri Lanka.

The answer is yes! You can apply on our website. We’ll drop the link in the chat—amnhealthcare.com/international—and one of our recruiters will help you with your application, whether it’s for direct hire or staffing. We have many opportunities across both sides of AMN.

Let’s keep going. Monique, I want to come back to you. You took the exam three times—which takes a lot of persistence and discipline. What advice would you give to international nurses who didn’t pass the first time and are feeling discouraged or unsure whether to keep trying?

Monique:

Well, of course, it’s completely normal to feel frustrated and discouraged. Honestly, you might even feel—sorry to use the word—stupid. But that feeling does not define you. It’s just an exam designed to test how well you can communicate in English. That’s all it is—a way to measure how effectively you can use the language.

It’s also a test of patience. Preparing takes a lot of time, dedication, and mental focus. My advice is not to dwell on negative emotions if you don’t pass the first time. It doesn’t mean you’re not capable of doing it—you are. You just need to reflect: Why didn’t it go well? Maybe you didn’t practice enough. Maybe you weren’t fully prepared. You’ll be the best judge of that.

In my case, I honestly thought I did well. During the speaking exam, the examiner was smiling and conversing with me—it felt natural, like a real conversation. But I still didn’t get the score I needed. It was disappointing, but I didn’t give up.

When you’re taking the test, try to think of it as a conversation, not an interrogation. That can help calm your nerves. And most importantly—believe in yourself. You can do it. Just keep going and don’t give up, like I didn’t.

Danielle Freedman:

Thank you, Monique—those are such wise and encouraging words. I’m sure it’s inspiring for many nurses to hear that. You didn’t get the result you wanted right away, but you kept going—and that’s what matters. Like you said, it’s just an exam. It doesn’t define you. It’s just something to check off so you can move forward toward your goal. And once you pass, you never look back—you move on with your journey.

Polly, let me ask you: what advice would you give to nurses who are still figuring out how to pursue their American dream? Do you think it’s a good idea to take the English exam while they’re job-hunting or interviewing?

Polly:

Yes, I think it’s really important to take your time to study and prepare. The more you practice, the better you become. That’s what I did, and I passed on my first try.

I would tell anyone planning to take the IELTS: don’t rush. Give yourself enough time to study and really understand the material. There are a lot of mock exams online—especially on 9.0 Niners—that are very helpful. Those practice tests really prepare you, and they help reduce anxiety. If you do enough mock exams, the real test will feel familiar—it’ll feel manageable.

Also, during the speaking test, try to manage your time wisely. Don’t spend too long on one question. Keep your answers balanced. Time can go by very quickly, and if you lose track, you might not finish your answers properly. 
When it comes to the listening section, you need to be extremely focused. They only play the recording once, so if you miss something, that’s it. You won’t get another chance to hear it again. If you get stuck thinking about a question you didn’t answer well, it can distract you from the rest of the test. So stay focused and move forward.

My biggest tip: do as many mock tests as you can. It makes a big difference.

Danielle Freedman:

That’s great advice, Polly—thank you. So slow and steady wins the race: take your time, study well, and only take the exam when you’re ready.

For everyone watching, if you’re worried about retrogression or delays—this is something you can control. Use your time wisely. Take the English exam. Take the NCLEX. Be proactive.

When you get that job offer, you want to be ready. You don’t want to wait or delay your consulate interview because you haven’t passed your English exam yet. Even Monique, who was prepared, had to retake it simply because she took the wrong version. Things happen—so get ahead of it, and control what you can. 

Visa Screen Requirements: IELTS, TOEFL Scores, and Application Timing

Lynda, I’m going to turn to you now. What are the required scores for the IELTS and TOEFL to qualify for a Visa Screen?

Lynda Belmehdi:

Sure. For IELTS, the required overall score is 6.5, and the Speaking score must be at least 7.0.

For TOEFL, you need a total score of 81, with at least 24 in Speaking. The combined total for Listening, Reading, and Writing must be at least 57.

These are the requirements for obtaining a Visa Screen certificate through TruMerit.

Danielle Freedman:

Great—thank you, Lynda. That’s helpful information for anyone wondering what scores they need.

I also saw a question in the chat from Judea asking if there’s an age limit to apply. First of all—congratulations on passing your NCLEX! That’s a huge step. And to answer your question: no, there is no age limit. We’d love for you to apply and see if there’s a great match for you in the U.S. While you’re job-hunting, go ahead and start studying for your English exam. Like Polly said—it’s a marathon, not a sprint. Give yourself time to prepare. 

Which English Exam Is Right for Nurses?

Michele, I want to turn back to you. We've been talking about IELTS and TOEFL, but we know there are other exams out there—OET, PTE, etc. Why do we specifically recommend IELTS and TOEFL to our nurses?

Michele Kilkenny:

That’s a great question. We recommend IELTS and TOEFL because of the states where we have job opportunities. Some states don’t accept alternative tests like PTE or OET. For example, Tennessee doesn’t accept PTE—so if a nurse has only taken that exam, they can’t get licensed in that state. That would mean retaking the English exam.

We think long-term. We want to ensure our nurses have everything they need not only to get their Visa Screen but also to qualify for licensure in the states where we’re hiring. While OET is growing in acceptance, it’s still not accepted in a few major states where we have a lot of jobs.

PTE is another option, but we’re cautious about it. The passing score for Speaking is only 50 for the Visa Screen, but if you want to get licensed in a state like South Carolina, they require a 66 in Speaking—which many applicants don’t achieve on the PTE.

So yes, some tests may technically qualify for Visa Screen, but they won’t always work for licensure. That’s why we strongly prefer IELTS and TOEFL—they’re widely accepted and allow more flexibility across states.

You can find a full list of accepted exams on the TruMerit website, including MET, Cambridge, and others—but for AMN, we recommend IELTS and TOEFL because they provide the most reliable pathway for both the Visa Screen and state licensure.

Danielle Freedman:

That makes sense. So, while we accept other exams, IELTS and TOEFL give you the most options. They’re the least restrictive, especially when it comes to licensure and visa processing.

Polly, I saw you asked about OET in the chat—if you’ve already passed, go ahead and apply! Our recruiters will match you with states that accept OET and help find the best fit. Again, that link is amnhealthcare.com/international. 

Starting the Process Before Passing English Exams

Monique, one more question for you. What impact did not passing the English exam have on your process? Did it delay things or stop your application? Can you tell us more about that?

Monique:

Well, actually, at first I thought I needed to have a passing English test before starting the process. But along the way, one of the AMN staff members informed me that I could begin my visa application even without having passed the English exam. So I started uploading all my documents and meeting the other necessary requirements. I left the English test for later.

That approach made things a little faster for me because I had already completed all the paperwork. So, when it came time to focus on the English exam, it was the only thing left. I found that much easier because I could dedicate all my attention to preparing for the test.

So, I would advise other nurses who are planning to apply for a visa to do the same—start uploading your documents and fulfilling the other requirements. Then you can focus fully on the English test, which, let’s be honest, is one of the more challenging parts of the process. It requires preparation, time, and focus. And, as I learned the hard way, it's important to be informed about which versions of the English test are accepted by CGFNS or TruMerit. If you're not aware of that, you may lose valuable time—like I did—when I had to retake the exam because the version I originally took wasn't accepted for visa purposes.

Danielle Freedman:

Okay, thank you, Monique. That all makes a lot of sense. I just want to clarify something you said: you submitted your application and documents first, and then you focused on studying for your English exam, right?

Monique:

Yes, exactly. I submitted all the required documents first, and while I was preparing for the IELTS, everything else was already done. That way, when it was time to take the exam, I could fully concentrate on it, without worrying about any other paperwork.

Danielle Freedman:

That makes perfect sense. You did your homework first and made sure everything else was in place so that when you passed the exam, you were ready to move forward without delay.

Michele, let’s talk about that a little more. There seems to be a perception among many nurses that they have a lot of time—especially if they’re affected by retrogression. While that may be true, I’m seeing a lot of people delay studying for their English exams, and then run into unexpected issues—either they don't pass, or there's a technicality, or something else causes a delay. What advice do you have for nurses who are in the interview stage or waiting in line but haven’t passed their IELTS yet?

Michele Kilkenny:

That’s such a good point. I think sometimes people underestimate how important the English exam is. They think they can put it off—but as you said, passing the English exam doesn’t always happen on the first try.

Here’s what I always emphasize: once you pass your English exam, your scores are valid for two years. As long as you complete your Visa Screen within those two years, the Visa Screen certificate itself is valid for five more years. So really, the sooner you pass your English test, the better. You’re giving yourself more time and flexibility for the rest of your process.

And I want to echo something Polly said earlier—use the resources you're given. We work with 9.0 Niners, and I truly believe they offer some of the best support out there for IELTS and TOEFL prep. But it only works if you actually use it. We see it all the time—people who don’t pass often haven’t completed much of the course. We can track that. If someone only completes 5% of the course, it shows. The people who go through the full course, do the mock tests, and really commit—they’re the ones who pass.

It’s not just about language skills—it’s about learning how to take the test. That’s a key difference. Just like we have to learn how to take multiple-choice tests for the NCLEX, you have to learn the structure and expectations of English exams. 9.0 Niners shows you exactly how to approach questions, manage your time, and understand what the examiners are looking for.

So again—my advice is this: take the English exam as soon as your I-140 is filed. Don’t wait. Control what you can control, and don’t leave this for the last minute. English is proving to be more of a hurdle than NCLEX in many cases, and delays in passing English can set people back more than they expect.

Also, just a quick clarification—earlier we mentioned the IELTS requirements as needing 6.5 in reading, writing, and listening. But for the Visa Screen, only your Speaking score (7.0) and Overall score (6.5) matter. Some states may require a minimum in each section for licensure, but for the Visa Screen, it's just those two scores that matter.

Danielle Freedman:

Thank you, Michele—that’s such helpful clarification. That’s exactly why you’re the expert! It’s all about knowing the details, and it sounds like that early planning and using the right resources makes a big difference.

We’re hearing a clear message: don’t delay your English exam. Do it as early as you can. It's one of the few things you can control in this process—and it can save you a lot of time and stress.

We have a few questions in the chat. One is from Randi, asking: How long after filing the I-140 should someone apply for the Visa Screen?

Michele Kilkenny:

Great question. For us at AMN, we monitor English score validity and use that to determine the best timing. Especially in times of retrogression, there could be a two- or even three-year delay before you're eligible for a visa. So, we want to make sure your English test is still valid when it's time to apply for your Visa Screen.

We don’t apply for the Visa Screen too early if the English will expire before you can use it. But if you’ve passed English and we can see a clear path ahead, we move forward. Again, it’s all about planning and timing.

Danielle Freedman:

There you go, Randi—that’s why it’s so important to work with a team that understands these processes. You want to make sure your scores and certificates don’t expire at the wrong time. These little details matter a lot. 
I also see a question from Antoinette: What visas are you offering—EB-3 or H-1B?

Well, the answer is: both. We offer opportunities under both EB-3 and H-1B, depending on what’s available at the time you apply and what role you’re matched to. So feel free to apply on our website—amnhealthcare.com/international—and one of our recruiters will help determine the best fit for you.

Now, I want to shift gears slightly and talk about the licensing process more broadly. We’ve talked about the Visa Screen and English tests—both are critical parts of licensing. But Lynda, can you tell us a bit more about the overall role that TruMerit plays in licensing? 

How Nurses Can Avoid Delays in the Documentation Process

Danielle Freedman:

And also, what’s one common mistake that often causes delays for nurses trying to get their Visa Screen?

Lynda:

Great question. First, let me explain TruMerit's role. We offer two main services—Credential Evaluation Service (CES) and Visa Screen. Most applicants begin with a Professional Report through CES to obtain their nursing license in a U.S. state.

We evaluate the education of internationally educated nurses against U.S. Registered Nurse standards—this is our role in the licensing process. Once a nurse has completed their CES report, they can then apply for their Visa Screen certificate. Because we already have their documentation on file from CES, we won’t ask for it again. The only additional documents we typically require are proof of English Language Proficiency (ELP) and NCLEX pass results—especially because some states require ELP for licensure, and others do not. 
Now, regarding common mistakes—we see a few, but the biggest one is exactly what Monique mentioned earlier. She smartly submitted all her documents first, and then focused on taking the ELP. That gave her time to prepare without delaying her application.

Unfortunately, many applicants take their English language exam years before they apply for Visa Screen, assuming we can still use those results. But ELP scores are only valid for two years. If your exam is older than that, we cannot accept it, and you’ll need to retake it—this can significantly delay your application.

Another common issue is when a nurse’s school has closed, and they apply without knowing where their academic records are stored. My advice: Before applying for Visa Screen, reach out to your school (if it’s still operational) and inform them that you will be applying through TruMerit, and that you’ll need them to send us your documents. If the school is closed, you need to inquire where their records are archived—often this is a government education body or another university.

Also, contact your licensing authority and let them know to expect a license verification request from us. This proactive step will help ensure we receive your documentation promptly.

Remember, the Visa Screen application remains open for 12 months, but our goal is to issue the certificate as soon as possible once we have all required documents. These small steps can prevent unnecessary delays.

Navigating State Licensure and NCLEX Requirements for Foreign Nurses 

Danielle Freedman:

Thank you, Lynda—very helpful information for our nurses considering applying for a Visa Screen with TruMerit.

Michelle, we’re almost out of time, but I know many nurses are curious about the licensing process overall. Could you walk us through the basic steps from taking the NCLEX to getting licensed?

Michele Kilkenny:

Absolutely. Here’s a simplified overview:

1. Choose the Right State Board of Nursing:

First, choose where you want to apply for your NCLEX license. This is important because not all boards will issue a license without a Social Security Number (SSN). Many nurses used to apply through California years ago, but California doesn't issue a license without an SSN—so many are left with just a pass letter, not an actual license. This complicates endorsement later.

2. Start with the CES Report:

Most boards require a credential evaluation before you can sit for NCLEX. I recommend starting this process early. TruMerit has made this much faster by obtaining documents electronically, but it still takes time. Also, be aware of application expiration timelines. Some boards only keep applications active for 6–12 months, so it might make sense to wait to apply to the board until your CES is nearly complete. 

3. Prepare for the NCLEX Exam:

Study thoroughly—use your prep resources, complete mock tests, and learn how the exam is structured. NCLEX is about more than just book knowledge—it tests your critical thinking. Even experienced nurses should not assume they’ll pass without studying. Use materials like Kaplan or NCSBN learning extensions. 

4. Pass the NCLEX & Save the Pass Letter:

When you pass, keep your pass letter safe. You’ll be asked for it again later—sometimes even years after you’ve moved to the U.S. It includes vital information like your test date and board.

5. Get Your License Issued:

If your board issues a license without an SSN, great! If not, you may need to wait until you're in the U.S. to obtain one. Once you have your license, the next step is endorsement to the state where you’ll be working.

6. Plan the Timing for Endorsement Carefully:

Some boards will accept CES reports now and hold them for future use. Others might require the CES report to be recent (within one year). So again—it’s all about timing. You want to have your license ready when you arrive in the U.S. so you can begin your assignment promptly. 

That’s why working with an expert team—like ours—is so important. We guide each clinician through the process, with a personalized action plan to make sure everything happens at the right time.

Danielle Freedman:

Thank you, Michele, for walking us through that. Whether you’re hearing this for the first time, or you’ve been on this journey for years, we know—it can feel overwhelming. Polly and Monique are going through it right now. Linda, Michelle, and I have gone through the immigration process ourselves. It’s exciting—but also stressful and emotional.

Monique, I saw you nodding—we all understand how you feel. And that’s why having a trusted partner with experience is so important.

Here’s what we want all of you to take away from today:

Retrogression may slow the timeline, but you can still take action. 
You can control your own progress by completing your exams early—NCLEX, English, Visa Screen—don’t let those be the reason your dreams are delayed. 
You might be like Polly and have a quick journey—or like Monique, who faced challenges but stayed committed. Either way, you can get to the U.S.—and we want to help get you there.

So take heart, stay focused, and don’t let an exam stand in the way of your dream.

We’ll continue answering your questions in the chat as we move into Dream Jobs with Dee and Clinical Corner with Holly, but I just want to say a huge thank you to our expert panel today—Michele, Lynda, Polly, and Monique. Your wisdom and experiences are truly inspiring, and I know our viewers feel the same way.

Thank you all so much for joining us!

Danielle Freedman:

All right, I see we still have lots of great questions in the chat. Before we jump to Dee, I just want to mention something about immigration and travel bans. If you have specific questions about these topics, be sure to join our monthly Immigration Shows. We host them with expert immigration attorneys who can provide accurate and up-to-date guidance on things like travel bans, visa categories, and more. 

Staffing vs. Direct Hire: Choosing Your Path

Now, let’s bring out Dee to answer your questions about job openings and employer matchings.

Dee:

Hi everyone! Good morning, good afternoon, or good evening—wherever you’re joining from! I was backstage listening to all the amazing information shared today, and while it might feel overwhelming, the great thing about choosing AMN Healthcare International is that you’ll have an expert team to guide you every step of the way.  

Our goal with these shows is to provide the education and support you need—both for the exciting parts of the journey and the more challenging ones, like preparing for your English exam, which is a critical step.

Today, I’m here to talk about one of the more exciting parts of your journey: choosing your job in the U.S.—which you actually do before arriving in the U.S. 
As a reminder, AMN Healthcare International is the only organization that provides both staffing and direct hire opportunities. We'll talk about some highlighted jobs shortly, but first, I want to address a couple of questions I saw coming in while I was backstage. 

Some people asked: 

• "I'm still studying,"
• "I haven’t taken the NCLEX yet,"
• "Can I start the process?" 

Here’s the answer: 

Right now, our clients are looking for current bedside experience, and the NCLEX is a must. English is always required, though you don’t need to take it immediately in most cases. However, for some direct hire positions, like the ones I’m about to share, those who have already passed English will be prioritized for interviews.

This is why we emphasize the importance of getting English done as soon as possible. Also, many of you saw the most recent Visa Bulletin, where Rest of World progressed, but unfortunately, the Philippines did not. So, if you’re someone who wants to get to the U.S. as quickly as possible and secure your priority date, staffing may be your best option.

Apply now at amnhealthcare.com/international — our recruiters are ready to help you choose the best path.

We have many EB-3 opportunities through our staffing division, and the great thing is you’ll have time to choose your perfect location. 

Highlighted Jobs of the Week 

Let’s talk about our highlighted jobs this week. These are direct hire positions—and as you heard from Monique, direct hire was her goal. She waited a little longer but ultimately got the position she wanted.

This week's opportunities are located in St. Louis, Missouri, and we are hiring for the following specialties: 

• CVOR (Cardiovascular Operating Room)
• Emergency Room
• ICU (Intensive Care Unit)
• BMT (Bone Marrow Transplant) 

Requirements: 

• NCLEX Pass
• 2+ years of current bedside experience
• Must be working in an acute care facility of 100+ beds 

Because it’s a competitive market, English passers will be prioritized for interviews. We have interview events scheduled for July 22nd–24th, and we’ll begin filling those slots next week.

If you’re interested and meet these qualifications, apply now at amnhealthcare.com/international.

And if you don’t qualify for these particular roles, don’t worry—we still want to hear from you! We have many staffing opportunities available to help you secure that priority date and begin your journey.

Danielle:

Thanks, Dee! That’s an exciting opportunity—St. Louis is a fantastic city, and it sounds like a great career step.

We do have some questions coming in about other specialties. Are we only hiring for those four areas?

Dee:

Great question. For this specific direct hire event happening in July (22nd–24th), the facility is only interviewing for CVOR, BMT, ICU, and ER.

However, we are always looking for qualified applicants across almost all specialties. So if you’re a Med-Surg nurse, or work in any cardiac unit—we want to hear from you!

Again, AMN Healthcare International is the only company that offers both direct hire and staffing. If your priority is to secure your I-140 filing and get your priority date, we are here to help.

No one can predict the visa bulletin month to month—so secure your spot now. That priority date is yours forever and critical to keeping your journey on track.

Danielle:

Exactly! We can’t control visa retrogression, but we can control when we apply, when we take the NCLEX, and when we pass English. Great advice, Dee. Thank you for joining us today!

Dee:

Thank you, everyone! Have a great day and weekend.

Danielle:

If you were inspired and want to apply for one of the job-of-the-week opportunities, visit amnhealthcare.com/international. And don’t forget to follow us on Facebook and Instagram to stay updated—we’re always posting about new jobs!

Now, let’s bring out Holly for our Clinical Corner. 

Holly – Clinical Corner Segment 

Hi, Danielle! Great to see you—and I’ve loved hearing all the amazing insights today. It’s been such a helpful session.

In today’s Clinical Corner, I want to talk about something nurses often find surprising and exciting when they arrive in the U.S.: the ability to directly impact clinical outcomes.

In the U.S., nurses are the last protective barrier for patients. You have a major role in helping patients recover, preventing complications, and ensuring that they feel they received excellent care.

Here are some key elements that make a difference:

1. Assessment: 

Your head-to-toe assessments are critical. If you notice something different than what was reported during handoff—like abnormal lung sounds or vital signs—you can request further testing. This can lead to early diagnosis of conditions like pneumonia.

📌 Tip: If you don’t own a stethoscope yet, get one and start practicing at home! 

2. Communication:

Nurses in the U.S. do a lot of patient education—on meds, treatments, discharge plans. Building rapport is key. Use direct eye contact, active listening, and therapeutic communication to help patients feel heard and safe. 

3. Emotional Support:

Many nurses are surprised by how much emotional support they provide. Patients are often scared and looking to the nurse for reassurance—especially because family often can’t stay at the bedside. Your calm, compassionate presence matters. 

4. Technology & Skills:

While tech and hands-on skills (e.g., using EMRs, IV pumps, cardiac monitors) are important, your soft skills—like assessment and communication—often matter more.

📌 Tip: Be ready to use EMRs and computers confidently from day one.

These four elements—assessment, communication, care, and technology—are essential. Focus on all of them to be successful when you arrive in the U.S.

Danielle:

Thanks, Holly! As always, fantastic and practical tips. It's great to hear from you and provide our nurses with guidance they can use both now and, in the U.S., 

Upcoming Events 

Let’s look at what’s coming up on our Onwards and Upwards Show: 

 📅 July 17 – Immigration Q&A with attorneys 
 ⏰ Both shows are 7–8 a.m. Pacific Time

So, if you have questions today about immigration or travel bans, make sure to attend that July 17th session—our expert attorneys will be there to help.

Also, don’t forget our AMN Academy—every Monday at 6 a.m. Pacific Time. These are free NCLEX and English prep classes offered through our partners at 9.0 Niner and iPass.

Remember, while some parts of the immigration journey are out of your control, you can control when you take your NCLEX and IELTS.

You’ve heard it today: start early, prepare well, and pass on your first try.

We believe in you—you just have to believe in yourself. You heard from Monique and Polly, who both made it through. 

Their advice? 

1. Start now 

2. Prepare well 

3. Don’t delay your exams 

So, if you’re feeling inspired today, apply at amnhealthcare.com/international. Our recruiters are ready to help. Thank you all for being with us. We hope this session was informative and uplifting.

Until next time—onwards and upwards!

Have a great weekend!