The United States healthcare system is navigating a protracted workforce crisis, characterized by a widening gap between the supply of domestic nursing professionals and the escalating demand driven by an aging demographic and expanded healthcare access. As we move through 2026, the reliance on Internationally Educated Nurses (IENs) has transitioned from a supplementary staffing strategy to a structural necessity for American healthcare resilience. For foreign-trained Registered Nurses (RNs) and Licensed Practical/Vocational Nurses (LPN/VNs), the United States represents the apex of professional opportunity, offering competitive remuneration, advanced clinical specialization, and career mobility.
However, the path to entry is guarded by a complex, fragmented regulatory apparatus comprising over 50 distinct jurisdictions, each with sovereign authority over licensure requirements. Unlike the centralized healthcare systems common in the UK, Canada, or Australia, the US system is federalized. The authority to license nurses rests exclusively with the individual states, not the federal government. This results in a patchwork of requirements where a nurse qualified in New York is not automatically qualified in California.
One of the most significant developments in US nursing regulation over the past two decades is the Nurse Licensure Compact (NLC). The NLC fundamentally alters the landscape of nursing mobility, but its implications for international nurses are often misunderstood. This comprehensive guide explores what the NLC is, how it works, and whether international nurses should strategically target Compact states for their initial US licensure.
Understanding the Nurse Licensure Compact (NLC)
The Nurse Licensure Compact (NLC) is an interstate agreement that permits registered nurses (RNs) and licensed practical/vocational nurses (LPN/VNs) to practice in all member states with one multistate license. Under the compact, a nurse’s license issued by their home state (state of primary residence) is recognized by every other compact state, allowing seamless practice across state lines.
If a nurse wants to practice (in person or via telehealth) in another compact state, they do not need to apply for a separate license or pay additional fees for that state. This flexibility benefits nurses who travel, work telehealth or remote positions, or live near state borders. It also benefits employers and patients by improving access to nursing care, especially in underserved areas.
Importantly, the NLC applies only to RNs and LPN/LVNs. It does not automatically cover Advanced Practice Registered Nurses (APRNs) like nurse practitioners; the APRN Compact is a separate agreement. Every state still retains the authority to regulate nursing practice within its borders, meaning nurses must adhere to each state’s nursing laws and rules when practicing there (for example, scope of practice or specific regulations) even if they are practicing on a multistate license.
The NLC increases mobility while maintaining public protection: all compact nurses must meet a set of uniform requirements (including background checks), and states share disciplinary and investigatory information to ensure patient safety.
The Evolution of the NLC
The concept of mutual recognition for nurse licensure has been developing for over two decades. The original Nurse Licensure Compact was launched in 2000, when a handful of pioneer states (Maryland, Texas, Utah, and Wisconsin) enacted the compact into law. In the early 2000s, up to 25 states joined that first version of the NLC.
However, not all states were eager to join initially. There were concerns from some nurses and associations about differences in licensing standards and the absence of certain safeguards, such as universal background checks. To address these concerns, the National Council of State Boards of Nursing (NCSBN) developed the enhanced Nurse Licensure Compact (eNLC), which was implemented in 2018. The eNLC introduced Uniform Licensure Requirements (ULRs), which mandated state and federal fingerprint-based criminal background checks for all applicants.
Today, the NLC has become widely adopted. As of 2026, 43 U.S. jurisdictions (including states and territories) have enacted the compact. In practical terms, this means the vast majority of states are either already compact members or in the process of implementing the NLC.
Current NLC Member States (2026)
The NLC has seen significant expansion in recent years. As of 2026, the 43 jurisdictions that have enacted the NLC include:
| State | State | State | State |
|---|---|---|---|
| Alabama | Indiana | Nebraska | South Carolina |
| Arizona | Iowa | New Hampshire | South Dakota |
| Arkansas | Kansas | New Jersey | Tennessee |
| Colorado | Kentucky | New Mexico | Texas |
| Delaware | Louisiana | North Carolina | Utah |
| Florida | Maine | North Dakota | Vermont |
| Georgia | Maryland | Ohio | Virginia |
| Guam | Mississippi | Oklahoma | Washington |
| Idaho | Missouri | Pennsylvania | West Virginia |
| Montana | Rhode Island | Wisconsin | Wyoming |
| Virgin Islands |
Note: Some states may have enacted the legislation but are still in the process of full implementation. Always verify the current status with the specific state’s Board of Nursing.
Several other states, including major hubs like New York, Illinois, and Alaska, have pending legislation to join the NLC in 2026. However, notable exceptions like California remain outside the compact, requiring nurses to obtain a single-state license to practice there.
Uniform Licensure Requirements (ULRs)
To qualify for a multistate license under the NLC, an applicant must meet the Uniform Licensure Requirements (ULRs). These requirements ensure a baseline standard of competence and safety across all participating states. The ULRs include:
- Primary State of Residence: The applicant must meet the requirements for licensure in their home state (state of residency).
- Education: The applicant must have graduated from a board-approved education program, or an international education program approved by the authorized accrediting body in the applicable country and verified by an independent credentials review agency.
- English Proficiency: The applicant must have passed an English proficiency examination if they graduated from an international education program not taught in English, or if English is not their native language.
- Examination: The applicant must have passed the NCLEX-RN or NCLEX-PN Examination (or predecessor exam).
- Active License: The applicant must be eligible for or hold an active, unencumbered license (i.e., without active discipline).
- Background Checks: The applicant must submit to state and federal fingerprint-based criminal background checks.
- Criminal History: The applicant must not have been convicted or found guilty, or entered into an agreed disposition, of a felony offense under applicable state or federal criminal law. Misdemeanor convictions related to the practice of nursing are determined on a case-by-case basis.
- Alternative Programs: The applicant must not currently be a participant in an alternative program and is required to self-disclose current participation.
- Social Security Number: The applicant must have a valid United States Social Security Number (SSN).
The NLC Paradox for International Nurses
At first glance, the NLC appears to be the ultimate prize for an Internationally Educated Nurse (IEN). The ability to hold one license and practice in 43 states offers unparalleled career flexibility, especially for those interested in travel nursing or telehealth. However, a critical regulatory nuance makes the NLC a complex proposition for international nurses applying from abroad.
The Primary State of Residence (PSOR) Requirement
The cornerstone of the NLC is the concept of the Primary State of Residence (PSOR). To be eligible for a multistate license, a nurse must legally reside in an NLC state. “Residence” is legally defined by documents such as tax returns, voter registration, or a driver’s license from that state.
An IEN applying from outside the United States does not have a US residence. Therefore, even if an international nurse applies for licensure in a Compact state (e.g., Texas or Florida), they will initially receive a Single-State License valid only in that specific state.
The Social Security Number (SSN) Bottleneck
Furthermore, the Uniform Licensure Requirements (ULRs) explicitly mandate that an applicant must have a valid United States Social Security Number (SSN) to obtain a multistate license. The US Social Security Administration issues SSNs only to individuals with work authorization (e.g., a visa or green card).
This creates a regulatory paradox for many IENs: they need a nursing license to secure a job offer and a visa, but they need a visa (and the resulting SSN) to get a multistate license.
Because of these two factors—lack of US residency and lack of an SSN—international nurses applying from abroad cannot obtain a multistate NLC license directly. They can only obtain a single-state license, even in a Compact state.
Should International Nurses Target Compact States?
Given that IENs cannot immediately obtain a multistate license, should they still target Compact states for their initial US licensure? The answer depends on the nurse’s immediate goals, their immigration timeline, and their ability to meet specific state requirements.
The Case for Targeting Compact States
While an IEN will initially receive a single-state license in a Compact state, there is a significant strategic advantage for the future.
Once the international nurse successfully immigrates to the US, establishes residency in that Compact state (obtains a driver’s license, signs a lease, etc.), and receives their SSN, they can apply to upgrade their single-state license to a multistate license.
This conversion process is generally straightforward and unlocks the massive labor market of the 43 NLC jurisdictions. For nurses who plan to settle in a Compact state and eventually want the flexibility to travel or work across borders, starting in a Compact state is a sound long-term strategy.
Pros of Targeting Compact States:
- Future Mobility: Easy conversion to a multistate license once residency and SSN are established.
- Travel Nursing Opportunities: Once the multistate license is acquired, the nurse can easily take lucrative travel assignments across the country.
- Telehealth: Opens doors to remote nursing roles that serve patients in multiple states.
The Case for Targeting Non-Compact States (The “Gateway” Strategy)
For many IENs, the immediate priority is simply getting a US nursing license as quickly and smoothly as possible to begin the immigration process. In this scenario, targeting specific non-Compact states—most notably New York—is often the most strategic move.
New York State (currently a non-Compact state, though legislation is pending in 2026) has engineered a regulatory framework that effectively decouples professional licensure from immigration status.
Why New York is the Global Gateway:
- No SSN Required for Initial Licensure: New York explicitly processes applications without an SSN. The licensure database assigns a dummy identifier until the nurse eventually immigrates and provides a real SSN. This eliminates the SSN bottleneck that blocks entry in many Compact states.
- No English Exam Required for Licensure: Unlike many boards that mandate an overall IELTS or TOEFL score before issuing an Authorization to Test (ATT), New York relies on the applicant’s ability to pass the NCLEX-RN as the definitive proof of language competence required for safe practice. (Note: An English exam will still be required later for the VisaScreen process for immigration, but it is removed as a barrier to taking the NCLEX).
For an IEN who lacks an SSN and has not yet taken an English proficiency test, New York offers the path of least resistance to obtaining a US RN license and passing the NCLEX.
Once the nurse passes the NCLEX under New York, they can use that license to secure a US employer and begin the visa process. If their employer is located in a different state (including a Compact state), the nurse can apply for licensure by endorsement in that new state once they arrive in the US and obtain their SSN.
Pros of the Gateway Strategy (e.g., New York):
- Accessibility: No SSN required to apply or test.
- Streamlined Testing: No English proficiency exam required prior to the NCLEX.
- Global Recognition: A New York RN license is highly respected and easily endorsed to other states later.
Navigating the Licensure Process as an IEN
Regardless of whether an international nurse targets a Compact state or a Gateway state, the licensure process involves several critical steps:
1. Credential Evaluation
The state Board of Nursing must verify that the applicant’s foreign nursing education is substantially equivalent to a US nursing degree. This is almost exclusively outsourced to private Credential Evaluation Services (CES) such as CGFNS International, ERES, or Josef Silny & Associates.
The rigor of this evaluation varies. Some states require a simple document verification, while others mandate a granular course-by-course analysis of theory and clinical hours. Choosing the right evaluation service depends on the specific requirements of the target state.
2. English Proficiency
While English is the language of US healthcare, states differ on when and how this competency must be proven. Some states mandate passing scores on exams like the TOEFL iBT, IELTS Academic, or OET before eligibility to take the NCLEX is granted. Others, like New York, defer the formal language test until the federal immigration stage (VisaScreen).
3. The NCLEX Examination
Passing the National Council Licensure Examination (NCLEX-RN or NCLEX-PN) is mandatory for all nurses, domestic and international. Once the state Board of Nursing approves the application and credential evaluation, they will issue an Authorization to Test (ATT), allowing the candidate to schedule the exam through Pearson VUE. The NCLEX can be taken at international testing centers in various countries.
4. Immigration and VisaScreen
Obtaining a state nursing license is only half the battle; the other half is immigration. To obtain an occupational visa (such as the EB-3 immigrant visa or H-1B non-immigrant visa), healthcare workers must obtain a VisaScreen certificate from CGFNS. This federal requirement verifies the nurse’s education, licensure, and English proficiency, independent of the state Board of Nursing’s requirements.
Conclusion: A Strategic Decision
The Nurse Licensure Compact (NLC) is a transformative agreement that offers unprecedented mobility for nurses within the United States. However, for Internationally Educated Nurses applying from abroad, the NLC’s Primary State of Residence (PSOR) and Social Security Number (SSN) requirements mean that a multistate license is not immediately attainable.
The decision of whether to target a Compact state should be based on a strategic assessment of the nurse’s current situation:
- Target a Compact State if: You already have a US SSN, you can easily meet the state’s English proficiency requirements prior to the NCLEX, and you have a firm job offer or plan to reside in that specific Compact state upon arrival. This sets you up for an easy transition to a multistate license later.
- Target a Gateway State (like New York) if: You do not have a US SSN, you want to take the NCLEX before tackling the English proficiency exams, and you prioritize getting licensed as quickly as possible to start the immigration process. You can always endorse your license to a Compact state later.
Ultimately, the “best” state for an international nurse is the one that offers the most accessible path to passing the NCLEX and securing a US employer. The NLC is a powerful tool for career mobility, but it is a destination to be reached after the initial hurdles of US licensure and immigration have been cleared. By understanding the nuances of the regulatory landscape, international nurses can make informed decisions that align with their long-term American dream.
