The Global NCLEX Licensure Landscape: A Comprehensive Guide for Nursing Professionals

1.2 Differentiating the NCLEX-RN and NCLEX-PN

The NCSBN develops and administers two distinct versions of the NCLEX, each tailored to a specific scope of nursing practice.1 The choice of which exam to take is determined by the candidate's educational background and the type of license they are seeking.

The NCLEX-RN is designed for candidates seeking licensure as a Registered Nurse (RN). To be eligible for this examination, a candidate must have graduated from an accredited RN program, which typically culminates in an Associate Degree in Nursing (ADN) or a Bachelor of Science in Nursing (BSN).2 The content of the NCLEX-RN is geared towards a broader scope of practice that includes comprehensive patient assessment, the development and management of care plans, and a higher degree of independent clinical decision-making. The questions are framed from a care management perspective, testing the candidate's ability to assess complex patient situations and delegate tasks appropriately.

The NCLEX-PN is intended for candidates seeking licensure as a Licensed Practical Nurse (LPN) or, as they are known in California and Texas, a Licensed Vocational Nurse (LVN). Eligibility for the NCLEX-PN requires graduation from an accredited LPN/LVN program.2 The exam's content reflects the more focused scope of practice of an LPN/LVN, who typically works under the supervision of an RN or physician. The questions concentrate on the collection of patient data (as opposed to the RN's comprehensive assessment), care coordination, and the execution of established care plans and vocational nursing skills.3 While both exams cover similar general topic areas, the NCLEX-PN approaches them from the perspective of a nurse contributing to a care plan, whereas the NCLEX-RN approaches them from the perspective of a nurse managing and directing that care.3

1.3 Deconstructing the Next Generation NCLEX (NGN): Clinical Judgment, Content Areas, and Question Types

On April 1, 2023, the NCSBN implemented the most significant update to the examination in its history: the Next Generation NCLEX (NGN).2 This revision was the culmination of years of research into the demands of modern nursing practice and was specifically designed to more effectively measure a candidate's clinical judgment and decision-making abilities.6

The NGN is structured around the NCSBN Clinical Judgment Model (CJM), a framework that outlines the cognitive processes nurses use to make safe and effective decisions. The CJM consists of several interacting layers that guide the assessment of a candidate's ability to "think like a nurse".2 The core of the model involves a six-step process: recognizing cues (identifying relevant patient data), analyzing cues (interpreting the data), prioritizing hypotheses (forming explanations for the cues), generating solutions (defining desired outcomes and actions), taking actions (implementing the solutions), and evaluating outcomes (comparing observed outcomes against expected ones).2 This model represents a strategic shift away from testing rote memorization of isolated facts towards assessing the integrated, applied process of clinical reasoning in complex, often ambiguous, patient scenarios. This evolution directly reflects a regulatory understanding that contemporary healthcare requires nurses who can manage patients with multiple comorbidities and rapidly changing conditions, a skill that demands sophisticated synthesis of information rather than simple knowledge recall.

The content of the NCLEX-RN remains organized into four major "Client Needs" categories, which are further divided into subcategories with specific percentage distributions of questions on the exam.1 This structure ensures that every candidate is tested across the full breadth of entry-level nursing practice. The categories and their approximate weightings are:

• Safe and Effective Care Environment

• Management of Care: 17–23%

• Safety and Infection Control: 9–15%

• Health Promotion and Maintenance: 6–12%

• Psychosocial Integrity: 6–12%

• Physiological Integrity

• Basic Care and Comfort: 6–12%

• Pharmacological and Parenteral Therapies: 12–18%

• Reduction of Risk Potential: 9–15%

• Physiological Adaptation: 11–17%

The most visible change with the NGN was the introduction of innovative and complex question types designed to measure clinical judgment more effectively. A critical feature of these new items is the use of polytomous (partial credit) scoring, a significant departure from the previous dichotomous (all-or-nothing) model.2 This new scoring acknowledges that a clinical decision is often multi-faceted and that a candidate can demonstrate partial competence even if they do not select all correct options. This provides a more nuanced and realistic assessment of their ability. The new question formats are often presented within unfolding case studies that provide a rich clinical context and include 1:

• Extended Multiple Response: "Select all that apply" questions where the number of correct options can vary.

• Extended Drag and Drop: Requires candidates to move items into a designated area to answer a question, such as prioritizing nursing interventions.

• Cloze (Drop-Down): Candidates select an option from a drop-down menu embedded within a sentence, table, or chart.

• Enhanced Hot Spot: Requires highlighting relevant words or phrases within a portion of a client's medical record.

• Matrix/Grid: Presents multiple options in a grid format, requiring the candidate to make a judgment for each option.

Bowtie: A central question type that requires the candidate to analyze a clinical situation and link the most likely condition to the appropriate actions to take and the parameters to monitor. This format directly assesses multiple steps of the CJM in a single item.

1.4 The Mechanics of the Exam: Computerized Adaptive Testing (CAT) and Scoring Protocols

The NCLEX is administered using a sophisticated methodology known as Computerized Adaptive Testing (CAT).1 This technology tailors the examination to each individual candidate's ability level in real-time. The process works as follows: every candidate begins with a question of medium difficulty. If the candidate answers correctly, the algorithm selects a slightly more difficult question. If the candidate answers incorrectly, the next question will be slightly easier. This process continues throughout the exam, with the computer continuously re-estimating the candidate's ability based on their pattern of responses.1 The primary advantage of CAT is its efficiency; it can determine a candidate's true ability level with a high degree of precision using fewer questions than a traditional fixed-length test.6

The exam ends when one of three conditions is met, governed by a set of strict stopping rules 3:

1. The 95% Confidence Interval Rule: This is the most common reason for the exam to end. The computer stops administering questions when it is 95% certain that the candidate's ability is either clearly above or clearly below the passing standard. The passing standard is a specific point on an ability scale that represents the minimum competence required for safe entry-level practice, and it is re-evaluated by the NCSBN every three years.6

2. Maximum-Length Exam Rule: If a candidate's ability level is very close to the passing standard, the computer may not be able to achieve 95% certainty. In this case, the candidate will continue to receive questions until the maximum number is reached (currently 150 items for the NGN, which includes 135 scored items and 15 unscored pretest items).10 At this point, the computer disregards the confidence interval and makes a final pass/fail decision based solely on whether the candidate's final ability estimate is above or below the passing standard.

3. Run-Out-of-Time (ROOT) Rule: The maximum time allotted for the exam is five hours.2 If a candidate runs out of time before reaching the maximum number of questions, and the computer has not yet achieved 95% certainty, a special rule is applied. If the candidate has answered the minimum number of required questions (85 for the NGN), the computer will evaluate the last 60 scored questions. If the candidate's ability was consistently above the passing standard for all 60 of those questions, they will pass. If their ability dropped below the passing standard even once in the last 60 questions, they will fail. If they have not answered the minimum number of questions, they will automatically fail.

The number of questions a candidate receives can range from a minimum of 85 to a maximum of 150.10 It is a common misconception that receiving more questions is an indicator of failing; it simply means the candidate's performance is close to the passing standard, and the algorithm requires more data to make a statistically confident decision.

Section 2: The U.S. Licensure Pathway: A Federation of Regulatory Requirements

Navigating the path to nursing licensure in the United States presents a unique set of challenges, particularly for Internationally Educated Nurses (IENs). Unlike countries with a single, national regulatory body, the U.S. operates as a federation of individual state and territorial jurisdictions, each with the sovereign authority to set its own standards for nursing practice. This creates a complex and often fragmented regulatory landscape that requires careful strategic planning. This section will dissect the architecture of the U.S. system, outline the distinct pathways for domestic and international graduates, and provide a granular comparative analysis of key states, highlighting the critical variations that can determine the success, cost, and timeline of an IEN's journey to licensure.

2.1 The Regulatory Architecture: NCSBN, State Boards of Nursing, and the Nurse Licensure Compact (NLC)

The U.S. system is defined by a dual-authority structure. At the national level, the National Council of State Boards of Nursing (NCSBN) serves as the central organization that develops, owns, and administers the standardized NCLEX examination.5 This ensures that every candidate for nursing licensure, regardless of their location, is assessed against the same benchmark of minimum competence.

However, the ultimate power to grant, deny, or revoke a license to practice nursing rests exclusively with the individual Board of Nursing (BON) in each of the 50 states, the District of Columbia, and the four U.S. territories.1 While all BONs use the NCLEX as their licensure exam, each board independently establishes its own set of eligibility requirements that a candidate must meet

before they are permitted to take the test.12 These requirements can vary significantly and may include specific educational standards, background checks, and, for IENs, proof of credential equivalency and English language proficiency.

To address the challenges of this state-based system and enhance nurse mobility, the Nurse Licensure Compact (NLC) was established. The NLC is a multistate agreement that allows a registered nurse or LPN/LVN to hold one multistate license in their primary state of residence (PSOR) and practice in all other states that are part of the compact.14 As of 2025, 43 jurisdictions are members of the NLC, creating a large, unified area for nursing practice.14 This is particularly beneficial for travel nurses and those living near state borders. It is crucial to note, however, that several large and high-demand states, including California and New York, are not currently members of the NLC. A nurse wishing to practice in these states must obtain a separate, single-state license directly from that state's BON, regardless of whether they hold a multistate license from a compact state.15

Facilitating the verification of licenses across this complex system is Nursys, the only national nurse licensure and disciplinary database. Managed by the NCSBN, Nursys is the repository of data submitted by individual BONs and is used by boards, employers, and the public to verify the licensure and disciplinary status of nurses across the country.

2.2 The Pathway for U.S.-Educated Nurses: From Graduation to Licensure

For nurses educated within the United States, the pathway to licensure is relatively linear and standardized. The process generally involves the following steps:

1. Graduate from an Approved Program: The candidate must graduate from a nursing program that is both approved by its state's BON and accredited by one of the two national nursing accreditation bodies: the Accreditation Commission for Education in Nursing (ACEN) or the Commission on Collegiate Nursing Education (CCNE).2

2. Apply to a Board of Nursing: The graduate submits an application for licensure by examination to the BON in the state where they intend to practice. This application typically includes proof of graduation, background check information, and the required fee.

3. Register with Pearson VUE: Concurrently, the candidate registers for the NCLEX examination with Pearson VUE, the third-party administrator of the test, and pays the exam fee.12

4. Receive Authorization to Test (ATT): Once the BON has reviewed the application and confirmed that all eligibility requirements have been met, it declares the candidate eligible. This information is transmitted to Pearson VUE, which then issues an Authorization to Test (ATT) to the candidate via email.13 The ATT is valid for a specific period (typically around 90 days) during which the candidate must schedule and take the exam.

5. Schedule and Take the NCLEX: With the ATT, the candidate can schedule their exam appointment at a Pearson VUE testing center.

Receive License: After the candidate passes the NCLEX, the results are transmitted to the BON. The BON then completes the process and issues the official nursing license.

2.3 The Comprehensive Pathway for Internationally Educated Nurses (IENs)

For IENs, the journey to licensure is significantly more complex, lengthy, and expensive. It involves a multi-stage preliminary process that must be successfully completed before they can even reach the point of applying to a BON for NCLEX eligibility. These steps are often non-sequential and require meticulous coordination with multiple agencies.

2.3.1 Credential Evaluation: The Role of CGFNS and Other Approved Agencies

The first and most critical hurdle for an IEN is to have their foreign educational and professional credentials evaluated to ensure they are equivalent to the standards of a U.S.-accredited nursing program.12 This is not a process that BONs typically undertake themselves; instead, they delegate this function to specialized third-party agencies.

The most widely recognized and accepted of these agencies is TruMerit™ — formerly known as CGFNS International aka the Commission on Graduates of Foreign Nursing Schools. Most state BONs mandate a report from CGFNS as a prerequisite for licensure.12 The most commonly required report is the

Credentials Evaluation Service (CES) Professional Report. This is a detailed, course-by-course analysis that compares the IEN's nursing curriculum—including theoretical coursework and clinical hours—to U.S. standards. It also verifies the validity of the IEN's foreign nursing license.13 While CGFNS is the dominant provider, some states also accept reports from other agencies, such as the Educational Records Evaluation Service (ERES) or Josef Silny & Associates, Inc..13 The credential evaluation process can be lengthy, often taking several weeks to months, depending on how quickly the IEN's foreign school and licensing authority transmit the required documents directly to the evaluation agency.13

2.3.2 Demonstrating English Language Proficiency

Unless an IEN completed their nursing education in a country where English is the native language and the medium of instruction (such as the United Kingdom, Australia, New Zealand, or Canada excluding Quebec), they will almost certainly be required to demonstrate proficiency in English.13 This is typically accomplished by achieving a minimum score on a standardized English language test. The most commonly accepted exams are the

Test of English as a Foreign Language Internet-Based Test (TOEFL iBT), the International English Language Testing System (IELTS) Academic module, and the Pearson Test of English (PTE) Academic. The specific score requirements vary by state BON and can be quite rigorous.

2.3.3 The VisaScreen® Certificate and Immigration Interface

It is essential to distinguish between the requirements for licensure and the requirements for immigration. While they are separate processes, for most IENs, they are inextricably linked. To obtain an occupational visa (such as the EB-3 immigrant visa for skilled workers) to work as a nurse in the U.S., an IEN must obtain a VisaScreen® Certificate, which is issued exclusively by CGFNS.13

The VisaScreen® Certificate is a requirement of the U.S. Department of Homeland Security and confirms that the IEN has met a set of standards. It verifies that:

• The IEN's education is comparable to that of a U.S.-educated nurse.

• The IEN holds a valid, unrestricted license in their country of origin.

• The IEN has demonstrated the required level of English language proficiency.

• The IEN has passed either the NCLEX-RN or the CGFNS Qualifying Exam®.13

Many IENs pursue the VisaScreen® Certificate concurrently with their licensure application, as it is a mandatory step for securing employment and legal authorization to work in the United States.

2.4 State-Level Comparative Analysis: A Deep Dive into Key Jurisdictions

The true complexity of the U.S. system is revealed in the variations among the state BONs. An IEN's choice of which state to apply to first is a critical strategic decision that can significantly impact their timeline, costs, and overall success. The analysis below examines four high-interest states, highlighting their divergent requirements.

2.4.1 New York: The "Gateway" State

• Governing Body: The New York State Education Department (NYSED), Office of the Professions, oversees nursing licensure.21

• SSN/ITIN Policy: New York's most significant feature for IENs is that it does not require a Social Security Number (SSN) or Individual Taxpayer Identification Number (ITIN) for an applicant to be deemed eligible to take the NCLEX.13 This policy makes New York the most common and logical starting point for nurses who are applying from outside the United States and do not yet have legal status to obtain an SSN.

• Credential Evaluation: NYSED has an exclusive arrangement with CGFNS. The Credentials Verification Service (CVS) for New York is optional. Applicants have the option to proceed directly with the Eligibility Application through the New York State Board of Nursing. This means that all required documents, such as school credentials and license verifications, can be requested directly from the school and licensing authority, and submitted straight to the Board of Nursing for evaluation. Choosing this route may help reduce both the processing time and the cost involved in obtaining eligibility.

• English Proficiency: CGFNS states that English proficiency exam scores are not required to be submitted to CGFNS as part of the New York verification service.15 NYSED makes the final determination on whether an applicant must provide proof of English proficiency.

• State-Specific Mandates: All applicants for a New York RN license must complete two state-approved training courses: one in Infection Control and another in Child Abuse Identification and Reporting.21

• Fees: The combined application and initial three-year registration fee is $143. The required CGFNS service has a fee of $425.

The lack of an SSN requirement has created a well-trodden strategic pathway for IENs. They apply to New York first, using it as a "gateway" to sit for and pass the NCLEX. A passing NCLEX result makes them a much more attractive candidate to U.S. employers, who can then sponsor them for an employment-based visa. Upon arriving in the U.S. with a visa, the nurse can obtain an SSN and then apply for licensure by endorsement in their actual target state of employment. This multi-step process adds time and expense but effectively circumvents the "chicken-and-egg" dilemma posed by states that require an SSN upfront.

2.4.2 Texas: The Compact State with Strict Scrutiny

• Governing Body: The Texas Board of Nursing (BON).

• SSN/ITIN Policy: The Texas BON requires all applications to be submitted through their online portal, regardless of whether the applicant has a U.S. Social Security Number (SSN) or Individual Taxpayer Identification Number (ITIN).27 

• Approved Credential Evaluation Service (CES) Providers: CGFNS,  ERE,  Josef Silny & Associates, Inc, SpanTran: The Evaluation Company. As of August 15, 2021, IERF (International Education Research Foundation, inc.) stopped accepting new applications.

• English Proficiency: Proof of English proficiency is required if the applicant's nursing education program was not conducted in English. The BON has specific minimum score requirements for the TOEFL, IELTS, PTE, MET, and OET exams.29

• State-Specific Mandates: A significant requirement for all applicants is the successful completion of the Texas Nursing Jurisprudence Examination (NJE), which tests knowledge of the state's Nursing Practice Act and Board Rules. Furthermore, the Texas BON maintains a list of
  "Non Approved International School(s)." Graduates from programs on this list are permanently ineligible for a Texas nursing license, making it critical for IENs to verify their school's status before applying.

• Fees: The application fee for licensure by examination is $75, while the fee for licensure by endorsement is $150.

2.4.3 California: The Concurrency Challenge

• Governing Body: The California Board of Registered Nursing (BRN).

• SSN/ITIN Policy: The BRN requires all applicants to have either a valid U.S. SSN or an ITIN to be issued a license. This presents a major obstacle for IENs applying from abroad who are not eligible for either number.

• Credential Evaluation: The California BRN conducts its own in-house evaluation of foreign nursing credentials. Applicants must arrange for their nursing school to send official transcripts and a completed "Breakdown of Educational Program for International Nursing Programs" form directly to the BRN.38 While not a formal requirement, many applicants use CGFNS to facilitate the collection and forwarding of these documents from their home institutions.37

• The Concurrency Requirement: This is California's most notorious and unique educational requirement. The California Code of Regulations (CCR 1426) mandates that for each of the five core content areas (Medical-Surgical, Obstetrics, Pediatrics, Geriatrics, and Psychiatric-Mental Health), the theoretical instruction and the corresponding clinical practice must have occurred concurrently, meaning within the same academic term or instructional period. Many international nursing programs, particularly those in the Philippines—a primary source of nurses for the U.S.—are structured differently, with blocks of theoretical coursework followed by separate, consolidated blocks of clinical practice. This structural difference means that even highly qualified and experienced IENs are often found to have educational "deficiencies" by the BRN. To remedy these deficiencies, they are required to complete specified coursework at a BRN-approved nursing program in California before they can be made eligible for the NCLEX.37

• Fees: The application fee for international graduates is a substantial $750.36

The concurrency rule functions as a significant barrier to entry. It is not necessarily a reflection of superior educational outcomes but rather a rigid structural mandate that disproportionately impacts graduates from many foreign nursing education systems. This policy effectively limits the pool of eligible IENs and funnels those with "deficiencies" into California-based educational institutions for remedial coursework, raising questions about whether its primary purpose is public safety or a form of educational and economic protectionism.

2.4.4 Washington: The Structured Multistate Option

• Governing Body: Washington State Board of Nursing (WABON)

• SSN/ITIN Policy: Washington is a member of the NLC. To be issued a multistate license (MSL) with practice privileges in other compact states, an applicant must have a valid U.S. SSN.40 However, an IEN without an SSN can still apply for and be issued a
  single-state license, which is valid for practice only within Washington. They must submit a "No Social Security Number" form as part of their application.40

• Credential Evaluation: For licensure by examination, WABON requires a transcript evaluation from one of its approved providers: CGFNS (CES Professional Report), ERES, Josef Silny, or International Education Evaluations, LLC (IEE).40

• English Proficiency: An English proficiency exam is required unless the IEN's nursing education was completed in a specified list of English-speaking countries or if the applicant can provide evidence of at least 1,000 hours of active nursing practice in another U.S. state. WABON accepts TOEFL, IELTS, OET, MET, and the Canadian English Language Benchmark Assessment for Nurses (CELBAN) with specific minimum scores.40

• Concurrency Policy: Washington Administrative Code (WAC) 246-840-045 indicates that an IEN's education program must meet the requirements for nursing education approved in Washington. It explicitly states that deficiencies in theory and clinical practice in the core nursing areas may need to be remedied in a board-approved program.43 This suggests that the board reviews for educational equivalency, including the relationship between theory and practice, though it is not as rigidly defined as California's concurrency rule.

• Fees: The initial RN/PN license fee is $141.45.34

The following table provides a succinct, at-a-glance comparison of these key state requirements, designed to serve as a strategic decision-making tool for IENs.

Table 1: Comparative Analysis of U.S. State Requirements for IENs

Section 3: The Canadian Licensure Pathway: The National Nursing Assessment Service (NNAS) Gateway

The Canadian approach to licensing Internationally Educated Nurses (IENs) presents a stark contrast to the fragmented system in the United States. Canada has implemented a centralized, national gateway for the initial assessment of IEN credentials, providing a more standardized, albeit still rigorous, pathway to licensure. This section will provide a detailed examination of the Canadian framework, focusing on the pivotal role of the National Nursing Assessment Service (NNAS) and the subsequent steps required to achieve eligibility to write the NCLEX and practice as a nurse in a Canadian province.

3.1 Understanding the NNAS Framework for IENs

Established as a partnership among Canadian nursing regulatory bodies, NNAS functions as a single, national point of entry for credential assessment. This centralized model is a fundamental departure from the U.S. system, where IENs must navigate the disparate requirements of over 50 different regulatory bodies and a variety of credentialing agencies.

The primary role of NNAS is to collect, verify, and evaluate an IEN's documents against Canadian nursing standards.44 This comprehensive review covers the applicant's nursing education, licensure history in their home country, and professional work experience. The process culminates in the creation of an

The NNAS Advisory Report is a standardized document that provides a comparative analysis of an Internationally Educated Nurse’s (IEN) qualifications. It is not a license to practice, but an essential assessment tool that applicants use when applying to their chosen provincial or territorial nursing regulatory body. Some boards, such as British Columbia, no longer require NNAS due to changes in their licensing system, while others, such as Ontario, now accept WES and ICAS instead. The provincial regulator uses the NNAS Advisory Report as the basis for its own assessment to determine an applicant’s eligibility for licensure and to take the NCLEX-RN.

Canada recognizes three distinct regulated nursing professions: the Registered Nurse (RN), the Licensed Practical Nurse (LPN) (referred to as a Registered Practical Nurse or RPN in Ontario), and the Registered Psychiatric Nurse (RPN), a specialized role regulated only in the western provinces of British Columbia, Alberta, Saskatchewan, and Manitoba.48

This centralized NNAS system reflects a distinct regulatory philosophy. By creating a mandatory, uniform entry point, Canadian regulators have standardized the most document-intensive and time-consuming phase of the IEN assessment process. This ensures consistency in how foreign credentials are initially evaluated, creates a single, national repository of IEN data, and allows the provincial bodies to concentrate their resources on assessing final competency and knowledge of local practice standards, such as jurisprudence. While the process remains complex, it is more systematic and predictable than the state-by-state approach in the U.S., and it affords Canadian regulators greater collective control over the pipeline of IENs entering the country.

3.2 A Step-by-Step Guide to the NNAS Application Process

The NNAS application is a meticulous, multi-step process that places a high degree of responsibility on the applicant to coordinate the submission of documents from various third-party institutions. The key stages are as follows 48:

1. Create an Online Account: The journey begins on the NNAS website, where the applicant creates a secure online account, provides basic personal information, and agrees to the terms and conditions.44

2. Complete the Application and Pay Fees: The applicant completes a detailed online application form, providing information about their identity, nursing education, all past and present nursing licenses, and nursing employment history. Upon completion, the main application fee must be paid.48

3. Coordinate Submission of Required Documents: This is the most critical and often the most time-consuming stage. The applicant must ensure that all required documents are sent directly to NNAS from the issuing institutions. NNAS will not accept these documents if they are submitted by the applicant. The required documents include:

• Proof of Identity: The applicant must submit notarized, certified true copies of at least two forms of identification (e.g., passport, birth certificate). These are the only documents the applicant submits directly.45

• Nursing Education Forms and Transcripts: The applicant downloads specific forms from the NNAS portal and sends them to their nursing school(s). The school must complete the forms and send them directly to NNAS along with official transcripts and, for the Regular Service, detailed course descriptions or a curriculum syllabus.44

• Nursing Registration/Licensure Forms: The applicant sends forms to every nursing regulatory body outside of Canada where they have ever held a license. The authority must complete the form and send it directly to NNAS, verifying the applicant's licensure status and history.48

• Nursing Practice/Employment Forms: For the Regular Service, the applicant sends forms to all nursing employers from the past five years. The employer must complete the form, verifying the applicant's role and hours of practice, and send it directly to NNAS.48

4. Receive the NNAS Advisory Report: NNAS verifies the authenticity of all received documents. Once the file is complete, NNAS performs its evaluation and issues the final Advisory Report. The applicant is notified via email and can download the report from their online portal.44

5. Apply to a Provincial Regulatory Body: With the completed Advisory Report, the IEN can then formally apply to the nursing regulatory body in the province where they wish to practice. This is done directly from the NNAS portal, which transmits the report and file to the chosen regulator.47 The provincial body then undertakes its own review and determines the final steps required for licensure eligibility.

3.3 Strategic Decision-Making: Expedited vs. Regular Service Pathways

NNAS offers two distinct service pathways, and the choice between them is a key strategic decision for an IEN. The creation of these two tiers is not merely a procedural variation but a policy instrument designed to attract different segments of the global nursing workforce.

• Expedited Service:

• Eligibility: This pathway is specifically for IENs who have not only completed their nursing education outside Canada but have also been licensed as a nurse in another country.48

• Process: The Expedited Service is significantly faster and requires less documentation. It relies on a country-level assessment of nursing education rather than an in-depth review of an individual's specific curriculum. Applicants must arrange for a separate Course-by-Course educational credential assessment from an organization approved by Immigration, Refugees and Citizenship Canada (IRCC), such as World Education Services (WES).48

• Timeline and Cost: The NNAS Advisory Report is issued within five business days after all required documents have been received and verified. The main application fee is $750 CAD.48

• Strategic Purpose: The new Expedited Service offers Internationally Educated Nurses (IENs) a quick, easy, and secure way to start licensing in Canada as an RN or LPN. It works through a simplified application in partnership with participating nursing regulators.

• Regular Service: 

• The NNAS standard service is available for IENs interested in becoming licensed as a Registered Psychiatric Nurse (RPN) or for IENs interested in applying to Nursing Regulatory Bodies that are not participating in the Expedited Service.

• Timeline and Cost: The Advisory Report is issued within 12 weeks after all documents are received and verified. The main application fee is $650 USD.48

3.4 From NNAS Advisory Report to Provincial NCLEX Eligibility

Receiving the NNAS Advisory Report is a major milestone, but it is not the end of the process. The provincial regulatory body uses the report to conduct its own assessment. Based on the NNAS evaluation, the regulator may decide that the Internationally Educated Nurse (IEN) fulfills the credential requirements, along with any additional criteria such as the jurisprudence exam (if applicable).

Alternatively, the regulator may identify gaps in the applicant's education or competency. In such cases, they may require the IEN to complete additional steps before becoming eligible for the NCLEX. These additional requirements can include 8:

• A Jurisprudence Examination: A test on the laws, regulations, and standards of nursing practice specific to that province.

• Further Education: Requiring the applicant to complete specific nursing courses at a Canadian institution to address identified educational gaps.

• A Competency Assessment: Such as an Objective Structured Clinical Examination (OSCE) or a period of supervised practice to assess clinical skills.

Only after all requirements set by the provincial regulatory body have been met will the applicant be granted final eligibility. The regulator will then notify Pearson VUE, which will issue the Authorization to Test (ATT), allowing the IEN to schedule their NCLEX-RN examination.51

Section 4: The Australian Licensure Pathway: The Outcomes-Based Assessment (OBA) Framework

Australia's pathway to licensure for Internationally Educated Nurses (IENs) is one of the most rigorous in the world, combining the cognitive assessment of the NCLEX with a mandatory, in-person clinical skills examination. This dual-assessment model, known as the Outcomes-Based Assessment (OBA), reflects a strong regulatory emphasis on ensuring that IENs can demonstrate both theoretical knowledge and practical competence within the specific context of the Australian healthcare system. This section provides a detailed analysis of Australia's regulatory structure and a step-by-step guide to navigating the complex OBA pathway.

4.1 The Roles of AHPRA and the NMBA in IEN Regulation

The regulation of nursing in Australia is managed through a partnership between two key national bodies 52:

1. The Nursing and Midwifery Board of Australia (NMBA): The NMBA is the primary regulatory authority responsible for setting the national standards, codes, and guidelines that govern the practice of nurses and midwives in Australia.52 Its core mission is to protect the public.

2. The Australian Health Practitioner Regulation Agency (AHPRA): AHPRA is the national agency that works in partnership with the 15 National Boards (including the NMBA) to implement the National Registration and Accreditation Scheme.52 AHPRA manages the practical aspects of the registration process, including receiving and assessing applications, collecting fees, and maintaining the national online register of health practitioners.53

Together, AHPRA and the NMBA oversee a single, unified national system for health practitioner regulation, ensuring that standards are applied consistently across all Australian states and territories.56

4.2 Navigating the OBA Pathway: From Online Self-Check to Full Registration

Introduced in March 2020, the Outcomes-Based Assessment (OBA) is the standard pathway for IENs whose qualifications are assessed as being relevant to, but not substantially equivalent to, an Australian-approved nursing qualification.55 The OBA replaced the previous system of mandatory "bridging programs" and is designed to be a more direct assessment of an IEN's ability to meet Australian nursing standards. The pathway is a sequential, multi-stage process 57:

• Step 1: The Self-Check: The journey begins with a free, online Self-Check tool on the AHPRA website.54 The IEN enters information about their qualifications, and the tool provides an initial assessment, assigning the applicant to one of two streams: Stream A (IQNMs who hold a qualification considered to be substantially equivalent, or based on similar competencies, to an approved qualification.) or Stream B (IQNMs who hold a qualification that is relevant to the profession, but is not substantially equivalent, nor based on similar competencies to an approved qualification.).

• Step 2: Portfolio and Orientation Part 1: Applicants directed to the Stream B (OBA) pathway must pay a non-refundable IQNM assessment fee of $410.00 AUD.57 They then submit a detailed portfolio of documents for verification, including proof of identity, qualification transcripts, and evidence of registration history. Concurrently, they must complete
  Orientation Part 1, a mandatory online learning module that provides an introduction to the Australian healthcare context.52

• Step 3: OBA Stage 1 - Cognitive Assessment (NCLEX-RN): After the portfolio is successfully processed, the candidate must register for, take, and pass the NCLEX-RN. This is the first formal assessment stage of the OBA.57

• Step 4: OBA Stage 2 - Behavioural Assessment (OSCE): Only after receiving a passing result on the NCLEX-RN can the candidate proceed to the second stage: the Objective Structured Clinical Examination (OSCE). This is a practical, in-person examination.57

• Step 5: Application for Registration: Upon successfully passing both the NCLEX-RN and the OSCE, the IEN is finally eligible to submit their formal application for registration as a nurse in Australia.62

4.3 Stage 1: The NCLEX-RN Cognitive Assessment

In a significant move toward global standardization, the NMBA officially adopted the NCLEX-RN as the cognitive assessment component of the OBA pathway.57 This decision aligns Australia's standard for theoretical nursing knowledge with that of the United States and Canada.

The process for an OBA candidate to take the NCLEX-RN is as follows:

• After AHPRA confirms the candidate's eligibility to proceed with the OBA, the candidate registers for the NCLEX-RN directly with Pearson VUE.

• The registration fee for the Authorization to Test (ATT) is USD 200, and the exam fee is USD 150. The ATT and the exam scheduling are subject to applicable taxes.  Please note that scheduling fees and tax rates may vary depending on the country where the chosen testing site is located.

• A crucial exemption exists for IENs who have already passed the NCLEX-RN for licensure in the U.S. or Canada. If the exam was passed within the last 10 years, the candidate may not need to retake it. They must, however, arrange for their results to be officially transferred from the relevant U.S. BON or Canadian provincial regulator to AHPRA.60

4.4 Stage 2: The Objective Structured Clinical Examination (OSCE)

The OSCE is the defining feature of the Australian pathway and represents the highest level of regulatory scrutiny among the three NCLEX-using countries. It is a practical, behavioral assessment designed to evaluate an IEN's ability to apply their clinical knowledge and skills in simulated, real-world patient scenarios according to Australian standards of practice.57

• Purpose: The OSCE assesses competencies that cannot be measured by a multiple-choice exam, such as clinical skills, communication, patient safety, and culturally competent care within the Australian context.55

• Logistics: The OSCE is a high-stakes, in-person examination managed by AHPRA. It is delivered exclusively at the Adelaide Health Simulation center in Adelaide, South Australia, or a facility in Melbourne.57 This means that nearly all IENs must travel to Australia to complete this stage of the assessment, adding significant travel and accommodation costs to the process.

• Cost: The fee for the OSCE is exceptionally high, at $4,000 AUD per attempt.57 This fee is non-refundable and covers AHPRA's costs for administering the complex, resource-intensive examination.

The inclusion of the mandatory, expensive, and logistically challenging OSCE serves as the ultimate gatekeeper to Australian nursing practice. It underscores a clear policy decision by the NMBA and AHPRA that cognitive knowledge, as tested by the NCLEX, is a necessary but insufficient condition for licensure. The regulators demand that practical, behavioral competence must be physically observed and assessed against Australian standards before an IEN is deemed safe to practice. This places a paramount emphasis on demonstrable clinical safety, even at the cost of creating a significant financial and logistical barrier for applicants.

4.5 General Registration for Internationally Qualified Registered Nurses Pathways

The new Registration Standard for Internationally Qualified Registered Nurses (IQRN), taking effect in April 2025, introduces two pathways for registration in Australia while retaining the existing IQNM assessment:

Pathway 1 – For nurses who obtained their qualification in an NMBA-approved jurisdiction and already hold general registration under that regulatory framework.

Pathway 2 – For nurses with qualifications outside NMBA-approved jurisdictions (from 1 January 2017 onwards) and who must successfully complete a regulatory examination from an NMBA-approved jurisdiction.

Section 5: Financial and Logistical Analysis: A Global Cost and Timeline Assessment

The decision for an Internationally Educated Nurse (IEN) to pursue licensure abroad is a significant life event, involving not only professional ambition but also substantial financial and time commitments. A clear understanding of the costs and timelines associated with each country's pathway is therefore critical for effective planning. This section provides a comprehensive financial and logistical analysis, breaking down the total estimated costs and timelines for the U.S., Canadian, and Australian licensure journeys. It aims to move beyond the headline cost of the NCLEX exam fee to present a realistic picture of the overall investment required.

5.1 Comprehensive Cost Breakdown for IEN Licensure Pathways

The total cost of obtaining a nursing license as an IEN is a multi-layered expense, with the NCLEX exam fee itself constituting only a fraction of the total. The following breakdown itemizes the typical, mandatory fees associated with each country's pathway. These figures are estimates and can vary based on the specific state or province, the chosen service providers, and fluctuations in currency exchange rates. They do not include costs for optional review courses, travel, accommodation, or visa processing.

• United States Pathway (Example: New York as "Gateway" State):

• Credential Evaluation (CGFNS): The "Credential Verification Service for New York State®" has a fee of $425 USD.24 For other states requiring the standard CES Professional Report, the fee is
  $485 USD.24

• English Proficiency Test (IELTS/TOEFL): Fees in the Philippines, a major source country, range from approximately PHP 10,000 to PHP 14,000, which is roughly $170 - $240 USD.71

• BON Application Fee (New York): The combined application and initial three-year registration fee is $143 USD.23 This is relatively low compared to other states like California, where the fee for international graduates is $750.36

• NCLEX Registration (Pearson VUE): The standard registration fee is $200 USD.34

• International Scheduling Fee: For candidates taking the exam outside the U.S. (e.g., in Manila), an additional, non-refundable fee of $150 USD is required.65 Note: Scheduling fees and taxes may vary depending on the country where the selected testing site is situated, unless the applicant will take the NCLEX in the US for NCLEX US.

• Fingerprinting/Background Check: Costs typically range from $30 - $75 USD.76

• Canadian Pathway (Example: Expedited Service):

• NNAS Main Application Fee: The fee for the Expedited Service is $750 CAD.50 The Regular Service fee is $650 USD.

• Third-Party Credential Assessment (WES, etc.): Required for the Expedited Service, this typically costs around $200 - $250 CAD.

• Document Courier and Notarization Fees: These can vary significantly but applicants should budget several hundred dollars. Some estimates suggest these ancillary costs can reach up to $500 CAD.44

• Provincial Regulatory Body Application Fee: This varies by province but is an additional cost after the NNAS process is complete.

• NCLEX Registration (Pearson VUE): The fee for Canadian candidates is $360 CAD (excluding local taxes).34

• International Scheduling Fee: an additional $150 CAD is required.65 Note: Scheduling fees and taxes may vary depending on the country where the selected testing site is situated.

• Australian Pathway (OBA Stream B):

• AHPRA IQNM Assessment Fee: The initial, non-refundable fee to begin the process is $410 AUD.57

• English Proficiency Test (IELTS/OET): Costs are comparable to other countries, roughly $400 AUD.

• NCLEX Registration (Pearson VUE): The registration fee is $200 USD.64

• International Scheduling Fee: An additional $150 USD is required if testing outside Australia.57  Note: The ATT and scheduling fees are subject to taxes, which may vary depending on the country where the chosen testing center is located.

• Objective Structured Clinical Exam (OSCE): This is the single largest cost, at a mandatory $4,000 AUD per attempt.57

• AHPRA Application & Final Registration Fee: May vary depending on the pathway you fall under.

The following table aggregates these mandatory fees to provide a clear, comparative financial overview.

Table 2: Estimated Total Cost for IEN Licensure Pathways (Excluding Travel and Prep Courses)

Note: The ATT and scheduling fees are subject to taxes, which may vary depending on the country where the chosen testing center is located. All figures are estimates in local currency where applicable and are subject to change. USD/CAD/AUD conversions are approximate. 

This comparison starkly illustrates the financial realities facing IENs. The U.S. pathway, particularly through a state like New York, is the most affordable in terms of direct regulatory fees. The Canadian pathway is more than double the cost, largely due to the high NNAS and NCLEX registration fees. The Australian pathway is by far the most expensive, with the $4,000 AUD OSCE fee making it a formidable financial undertaking, more than five times the cost of the U.S. route.

5.2 Estimated Timelines: A Comparative Journey from Application to Authorization to Test (ATT)

The timeline for an IEN to become eligible to take the NCLEX is often long and unpredictable, with document processing being the most common source of delay.

• United States: The total time from initiating a credential evaluation with CGFNS to receiving an ATT from a BON varies widely but is generally estimated to be between 6 and 18 months.13 Key variables include the efficiency of the IEN's home institutions in sending documents and the processing backlog at the specific state BON.

• Canada: The NNAS process itself has a defined timeline after all documents are received: 12 weeks for the Regular Service and 5 days for the Expedited Service.48 However, the time required to collect all third-party documents can take many months. Following the NNAS report, the provincial regulator's review adds more time. The total journey to receiving an ATT can realistically take
  6 to 12 months or longer.

• Australia: The AHPRA OBA pathway is also a lengthy, sequential process. Estimates suggest it can take 9 to 12 months from the initial Self-Check to completing both the NCLEX and OSCE, assuming first-time passes and reasonable exam availability.60

A common element across all three countries is the validity period of the key authorizations. An NCLEX registration with Pearson VUE remains open for 365 days, awaiting the candidate to be made eligible by their chosen regulatory body. Once the regulatory body grants eligibility and the ATT is issued, it is typically valid for a 90-day window in which the exam must be scheduled and taken.21 First-time candidates are generally offered an appointment within 30 days, while repeat candidates must wait a minimum of 45 days between attempts.83

5.3 Global Testing Infrastructure: A Directory of Pearson VUE International Test Centers

The global administration of the NCLEX by Pearson VUE is a critical piece of logistical infrastructure that makes international licensure feasible. IENs are no longer required to travel to the U.S. to take the exam. Pearson Professional Centers (PPCs) are available in numerous countries around the world. As of 2024-2025, key international testing locations include 7:

• Asia-Pacific: Sydney, Australia; Hong Kong; Bangalore, Chennai, Hyderabad, Mumbai, and New Delhi, India; Osaka, Tokyo, and Shinjuku, Japan; Seoul, South Korea; Manila, Philippines; Taipei, Taiwan.

• Europe, Middle East, and Africa: Frankfurt, Germany; Tel Aviv, Israel; Doha, Qatar; Johannesburg, South Africa; Madrid, Spain; Istanbul, Turkey; London, United Kingdom.

• The Americas: Sao Paulo, Brazil; multiple locations throughout Canada; Mexico City, Mexico.

This widespread availability significantly reduces the travel burden for many IENs, though the $150 international scheduling fee still applies. Candidates can schedule their appointments at these international centers online or by phone through Pearson VUE Candidate Services.87

Section 6: Strategic Recommendations and Concluding Analysis

The journey for an Internationally Educated Nurse (IEN) to achieve licensure via the NCLEX in the United States, Canada, or Australia is a formidable undertaking, demanding significant strategic planning, financial investment, and perseverance. The preceding analysis has dissected the complex regulatory frameworks, costs, and timelines associated with each country. This concluding section synthesizes these findings into a series of actionable recommendations designed to help IENs optimize their application strategy, anticipate and overcome common hurdles, and successfully navigate the global licensure landscape.

6.1 Pathway Optimization Strategies for Internationally Educated Nurses

The choice of where and how to begin the licensure process is the most critical decision an IEN will make. A one-size-fits-all approach is ineffective; the optimal strategy depends on the applicant's individual circumstances, including their country of education, financial resources, and ultimate career goals.

• Employ the "Gateway State" Strategy for U.S. Licensure: For IENs residing outside the U.S. who do not possess a Social Security Number (SSN), the most viable strategy is to apply initially to a state that does not require an SSN for NCLEX eligibility. New York is the preeminent "gateway state" for this purpose.13 By first securing eligibility and passing the NCLEX through the New York State Education Department, an IEN obtains a passing exam record—a valuable asset that makes them significantly more attractive to U.S. employers for visa sponsorship. Once a visa is secured and the IEN has relocated to the U.S. and obtained an SSN, they can then apply for licensure by
  endorsement in their desired state of employment, thereby satisfying the SSN requirement they could not initially meet.36 This approach, while adding an extra administrative layer, provides a proven workaround to the SSN barrier.

• Conduct a Proactive "Concurrency" Audit for California: IENs, particularly those educated in the Philippines, who are considering licensure in California must conduct a thorough, proactive audit of their nursing school transcripts against the California Board of Registered Nursing's strict concurrency requirement.37 This rule, which mandates that theory and clinical practice for core nursing subjects occur in the same academic term, is a frequent point of failure for many international curricula.18 Before investing the substantial $750 application fee and months of waiting, applicants should meticulously compare their course structure to the regulation. If a deficiency appears likely, it is strategically wiser to pursue licensure in another state first and gain practice experience before attempting to endorse into California, as some requirements may be waived for experienced nurses.

• Make a Strategic Choice Between Canada's NNAS Pathways: NNAS offers two service pathways for internationally educated nurses, and choosing between them requires a strategic assessment of one’s credentials. The Expedited Service is tailored for IENs who are already licensed in another country and want a faster, simplified route—requiring fewer documents and issuing an Advisory Report in as little as five business days. Applicants only need to secure a Course-by-Course credential assessment from an IRCC-approved agency, making this pathway ideal for experienced nurses competing in the global market. The Regular Service, on the other hand, is more appropriate for recent graduates or applicants to regulatory bodies that do not participate in the expedited pathway and follows the traditional assessment process, which can take up to 12 weeks. Selecting the right pathway can save considerable time and effort when pursuing licensure in Canada.

• Perform a Rigorous Cost-Benefit Analysis for Australia: Australia’s OBA pathway is the most financially and logistically demanding option for IENs, primarily due to the in-person OSCE, which costs around $4,000 AUD and requires international travel. With the new Registration Standard for IQRNs taking effect in April 2025, the cost-benefit calculation now depends heavily on whether an applicant qualifies for Pathway 1 or Pathway 2. Nurses trained and already registered in NMBA-approved jurisdictions (such as the UK, Ireland, USA, Canada [ON/BC], Singapore, or Spain) may be able to bypass the entire OBA and avoid the OSCE altogether. Those educated outside of these approved systems must still complete the full assessment under Pathway 2, including the OSCE. As such, IENs should carefully assess the upfront costs and travel requirements against the potential long-term salary and lifestyle benefits before pursuing registration in Australia.69

6.2 Proactive Approaches to Overcoming Common Application Hurdles

Across all jurisdictions, several common challenges consistently delay or derail IEN applications. Proactive management of these issues is key to a successful outcome.

• Prioritize Meticulous Document Management: The single greatest cause of delays in the licensure process is incomplete or incorrectly submitted documentation.13 IENs must begin the process of contacting their former nursing schools and home country licensing authorities as early as possible. It is imperative to maintain clear, persistent communication with these institutions to ensure that official documents are sent directly to the correct evaluation agency (CGFNS, NNAS, etc.) in the required format. Applicants should keep digital and physical copies of every document submitted, every application form completed, and every email correspondence to create a comprehensive personal record.13

• Engage in Realistic Financial Planning: The NCLEX registration fee is merely the tip of the iceberg. As detailed in Section 5, the total mandatory costs for licensure can range from over $1,200 USD for the U.S. pathway to over $6,200 AUD for the Australian pathway. Applicants must budget for the total anticipated cost, including credential evaluations, application fees, English exams, background checks, and, for Australia, the OSCE. This figure does not include optional but highly recommended NCLEX preparation courses or the significant costs of travel and accommodation if required.

• Focus NCLEX Preparation on the NGN Framework: Success on the modern NCLEX requires more than content knowledge; it demands proficiency in clinical judgment. Preparation efforts must focus on materials specifically designed for the Next Generation NCLEX (NGN) and its underlying Clinical Judgment Model.2 Candidates should utilize official resources from the NCSBN, such as the NCLEX Practice Exam and detailed test plans, as the foundation of their study.89 Practice with the new NGN question types (e.g., Bowtie, Matrix) is essential to build familiarity and confidence with the exam's format and scoring logic.

6.3 Future Outlook: The NCLEX as an Evolving Global Standard for Nursing Excellence

The trends analyzed in this report point toward the continued consolidation of the NCLEX as the premier global standard for entry-to-practice nursing licensure. The adoption of the NGN by Australia, following the U.S. and Canada, signals a growing international consensus on the importance of assessing clinical judgment. This convergence suggests that more countries seeking to attract international talent and standardize their own regulatory benchmarks may look to adopt or grant equivalency to the NCLEX in the future.

A significant development on the horizon is the NCSBN's exploration of at-home or online proctored NCLEX testing.6 Should this option become a reality, it would represent a paradigm shift in accessibility for IENs. It could eliminate the need for international travel to a Pearson VUE center and remove the associated costs and logistical hurdles, further democratizing access to this critical licensure examination.

In conclusion, the path to licensure through the NCLEX is a complex, jurisdiction-dependent process that requires IENs to act as adept project managers of their own careers. By understanding the distinct regulatory philosophies, anticipating the specific requirements of each pathway, and engaging in careful strategic and financial planning, internationally educated nurses can successfully navigate these challenges and achieve their goal of practicing in a new country, contributing their vital skills to the global healthcare workforce.

---

Appendix: Directory of Key Organizations and Resources

U.S. Boards of Nursing (BONs)

A complete, official directory of all U.S. member Boards of Nursing, including websites and contact information, is maintained by the National Council of State Boards of Nursing (NCSBN) and can be accessed via their website. Applicants should always consult the official BON website for the most current and accurate information.

• NCSBN Contact Page for U.S. Members: https://www.ncsbn.org/membership/us-members/contact-bon.page 5

Key International and National Regulatory and Assessment Bodies

• National Council of State Boards of Nursing (NCSBN): The developer and owner of the NCLEX.

• Website: https://www.ncsbn.org/ 5

• Pearson VUE: The third-party administrator for the NCLEX examination.

• Website: https://home.pearsonvue.com/nclex 91

• CGFNS International: The leading credential evaluation agency for IENs applying to the U.S.

• Website: https://www.cgfns.org/ 12

• National Nursing Assessment Service (NNAS) - Canada: The mandatory first step for IENs seeking licensure in Canada.

• Website: https://www.nnas.ca/ 48

• Australian Health Practitioner Regulation Agency (AHPRA): Manages the registration process for health practitioners in Australia.

• Website: https://www.ahpra.gov.au/ 53

• Nursing and Midwifery Board of Australia (NMBA): Sets the standards for nursing practice in Australia.

• Website: https://www.nursingmidwiferyboard.gov.au/ 54

Essential Applicant Resources

• NCSBN Candidate Bulletin: A comprehensive guide to the NCLEX examination process. It is considered essential reading for all candidates.89

• NCSBN NCLEX Practice Exam: An official practice exam comprised of previously used NCLEX questions to help candidates familiarize themselves with the exam format.89

• Licensure of Internationally Educated Nurses: A Resource Manual (NCSBN): A detailed guide to the uniform licensure requirements for IENs in the U.S..4

Works cited

1. National Council Licensure Examination - Wikipedia, accessed on July 21, 2025, https://en.wikipedia.org/wiki/National_Council_Licensure_Examination

2. What is the NCLEX? Everything You Need to Know & How to Prepare - Nurse.org, accessed on July 21, 2025, https://nurse.org/resources/what-is-the-nclex/

3. What Is the NCLEX? | Academic and Career Programs - Austin Community College, accessed on July 21, 2025, https://programs.austincc.edu/health-sciences/what-is-the-nclex/

4. Licensure of Internationally Educated Nurses A Resource Manual - NCSBN, accessed on July 21, 2025, https://www.ncsbn.org/public-files/23_IEN_manual.pdf

5. NCSBN: National Council of State Boards of Nursing, accessed on July 21, 2025, https://www.ncsbn.org/

6. About - NCLEX, accessed on July 21, 2025, https://www.nclex.com/About.page

7. NCLEX Exam Centres Around the World | Academically Global, accessed on July 21, 2025, https://academically.com/blogs/nclex-exam-with-exam-centres-around-world/

8. NCLEX Score Accepting Countries and Score for Each Country - Neethus Academy, accessed on July 21, 2025, https://neethusacademy.com/nclex-score-accepting-countries-and-score-for-each-country/

9. What is the NCLEX-RN Exam? - The Princeton Review, accessed on July 21, 2025, https://www.princetonreview.com/professional/nclex-rn-exam-overview

10. How Much Does the NCLEX Exam Cost? (2025) - Tutors, accessed on July 21, 2025, https://tutors.com/costs/nclex-exam-cost

11. Information for Foreign Educated Nurses - U.S. License | ANA, accessed on July 21, 2025, https://www.nursingworld.org/practice-policy/workforce/clinical-practice-material/foreign-educated-nurses/

12. How Foreign Applicants Can Apply for NCLEX-RN Examination ? | Archer Review, accessed on July 21, 2025, https://www.archerreview.com/blog/how-foreign-applicants-can-apply-for-nclex-rn-examination

13. Foreign Nurses: U.S. Licensure Requirements & Process, accessed on July 21, 2025, https://www.registerednursing.org/articles/foreign-nurses-usa-licensure-requirements/

14. Home | NURSECOMPACT, accessed on July 21, 2025, https://www.nursecompact.com/

15. New York Nursing Credentials Evaluation - CGFNS International, Inc., accessed on July 21, 2025, https://www.cgfns.org/licensure/new-york/

16. Become a Nurse in New York – Education, Licensure, Requirements, accessed on July 21, 2025, https://nursinglicensemap.com/states/new-york-nursing-license/

17. California Nursing Credentials Evaluation - CGFNS International, Inc., accessed on July 21, 2025, https://www.cgfns.org/licensure/california/

18. California RN Licensing Guide on Vivian Health, accessed on July 21, 2025, https://www.vivian.com/licensing/nursing/california/

19. QuickConfirm License Verification Terms & Conditions - Nursys®, accessed on July 21, 2025, https://www.nursys.com/LQC/LQCTerms.aspx

20. The Department does not review a foreign credential evaluation report prior to - Illinois.gov, accessed on July 21, 2025, https://nursing.illinois.gov/nursing-licensure/internationally-educated-nurses.html

21. New York Licensing Guides for Immigrant Nurses - Upwardly Global, accessed on July 21, 2025, https://www.upwardlyglobal.org/career-coaching/professional-licensing-guides/new-york/nurse/

22. Guide to New York Nursing Board Licensure, accessed on July 21, 2025, https://www.hctravelnursing.com/blog/new-york-board-of-nursing

23. The New York RN Licensing Guide | White Glove Placement, accessed on July 21, 2025, https://whiteglovecare.com/new-york-rn-licensure-guide/

24. Fee Schedule and Policies - CGFNS International, Inc., accessed on July 21, 2025, https://www.cgfns.org/support/fee-schedule/

25. Endorsement Applications - Texas Board of Nursing, accessed on July 21, 2025, https://www.bon.texas.gov/applications_endorsement.asp.html

26. Welcome to the Texas Board of Nursing Website, accessed on July 21, 2025, https://www.bon.texas.gov/

27. Licensure - Endorsement Information - the Texas Board of Nursing Website, accessed on July 21, 2025, http://52.7.180.77/licensure_endorsement.asp.html

28. rn endorsement application for graduates of international programs - Texas Board of Nursing, accessed on July 21, 2025, https://www.bon.texas.gov/pdfs/education_pdfs/education_programs/RN%20END%20INTL%20INSTRUCTIONS%208.22.pdf

29. Texas Board of Nursing - Examination, accessed on July 21, 2025, https://www.bon.texas.gov/licensure_examination.asp.html

30. Texas Licensing Guide for Immigrant Nurses - Upwardly Global, accessed on July 21, 2025, https://www.upwardlyglobal.org/career-coaching/professional-licensing-guides/texas/nurse/

31. Application Forms - Graduates & NCLEX Examinations - Texas Board of Nursing, accessed on July 21, 2025, https://www.bon.texas.gov/applications_graduates_and_nclex_examinations.asp.html

32. Texas Board of Nursing - Endorsement, accessed on July 21, 2025, https://www.bon.texas.gov/licensure_endorsement.asp.html

33. Initial Licensure and Recognition Forms - Schedule of Fees - Texas Board of Nursing, accessed on July 21, 2025, https://www.bon.texas.gov/forms_fees.asp.html

34. NCLEX and License Costs - Nurse Plus Academy, accessed on July 21, 2025, https://nurse.plus/become-a-nurse/nclex-and-license-costs/

35. California Board of Registered Nursing, accessed on July 21, 2025, https://www.rn.ca.gov/

36. California RN License Process for International Nurses – 2025 Full Guide - Nursing Manthra, accessed on July 21, 2025, https://nursingmanthra.com/california-rn-license-for-international-nurses-2025/

37. CA RN Licensure Qualifications for Graduates of International Nursing Program, accessed on July 21, 2025, https://www.rn.ca.gov/pdfs/education/edp-i-35.pdf

38. Licensure by Endorsement - California Board of Registered Nursing, accessed on July 21, 2025, https://www.rn.ca.gov/applicants/lic-end.shtml

39. Licensure by Examination - California Board of Registered Nursing, accessed on July 21, 2025, https://www.rn.ca.gov/applicants/lic-exam.shtml

40. Educated Outside the United States - Washington State Board of Nursing - | WA.gov, accessed on July 21, 2025, https://nursing.wa.gov/licensing/apply-license/educated-outside-united-states

41. RN/LPN Trained Outside U.S. Licensure Requirements - Washington State Board of Nursing, accessed on July 21, 2025, https://nursing.wa.gov/sites/default/files/2022-06/669423.pdf

42. Washington State Licensing Guides for Immigrant Nurses - Upwardly Global, accessed on July 21, 2025, https://www.upwardlyglobal.org/career-coaching/professional-licensing-guides/washington-state/nurse/

43. Draft Rule Language WAC 246-840-015 through 260 - Washington State Board of Nursing, accessed on July 21, 2025, https://nursing.wa.gov/sites/default/files/2025-03/DRAFT%20246-840-015-260%202025-03-19.pdf

44. National Nursing Assessment Service (NNAS) Application Process - Neighbourhood Notary, accessed on July 21, 2025, https://www.neighbourhoodnotary.ca/nnas-application-process.html

45. Internationally Educated Nurses - Canadian Council for Practical Nurse Regulators (CCPNR), accessed on July 21, 2025, https://ccpnr.ca/internationally-educated-nurses/

46. National Nursing Assessment Service: Start your nursing journey in Canada., accessed on July 21, 2025, https://www.nnas.ca/

47. National Nursing Assessment Service - WES, accessed on July 21, 2025, https://www.wes.org/evaluations-and-fees/education/national-nursing-assessment-service/

48. Fees - National Nursing Assessment Service, accessed on July 21, 2025, https://www.nnas.ca/fees/

49. NCLEX Canada Requirements for International Nurses: A Guide - FBNPC, accessed on July 21, 2025, https://fbnpc.com/blog/nclex-canada-requirements-for-international-nurses/

50. AHPRA Registration - Profco - Nursing and Doctor Jobs in Australia, Middle East, Saudi Arabia and the UK, accessed on July 21, 2025, https://www.profco.com/index.php?page_id=432

51. Australian Health Practitioner Regulation Agency - Home, accessed on July 21, 2025, https://www.ahpra.gov.au/

52. Nursing and Midwifery Board of Australia - Home, accessed on July 21, 2025, https://www.nursingmidwiferyboard.gov.au/

53. Outcome Based Assessment | OBA Preparation - Nurse Assist International, accessed on July 21, 2025, https://nurseassistinternational.com/pages/oba

54. Australian Health Practitioner Regulation Agency - Wikipedia, accessed on July 21, 2025, https://en.wikipedia.org/wiki/Australian_Health_Practitioner_Regulation_Agency

55. Fact sheet: Transition to a new assessment model for internationally qualified nurses and midwives, accessed on July 21, 2025, https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/faq/transition-to-a-new-assessment-model-for-internationally-qualified-nurses-and-midwives.aspx

56. OBA for International Nurse and Midwife | Expert Education Australia, accessed on July 21, 2025, https://experteducation.com/australia/services/oba-for-international-nurse/

57. Before you apply - Nursing and Midwifery Board of Australia, accessed on July 21, 2025, https://www.nursingmidwiferyboard.gov.au/Accreditation/IQNM/Before-you-apply.aspx

58. Outcome Based Assessment Pathway for International Nurse | NETA, accessed on July 21, 2025, https://nursingeta.com/outcome-based-assessment

59. A step-by-step guide for overseas qualified nurses to be a Registered Nurse in Australia, accessed on July 21, 2025, https://www.sbs.com.au/language/filipino/en/podcast-episode/a-step-by-step-guide-for-overseas-qualified-nurses-to-be-a-registered-nurse-in-australia/mkd420ygv

60. Nursing and Midwifery Board of Australia - Examination, accessed on July 21, 2025, https://www.nursingmidwiferyboard.gov.au/Accreditation/IQNM/Examination.aspx

61. Information for registered nurses - Nursing and Midwifery Board of Australia, accessed on July 21, 2025, https://www.nursingmidwiferyboard.gov.au/accreditation/iqnm/examination/registered-nurses.aspx

62. Fees & Payment - NCLEX, accessed on July 21, 2025, https://www.nclex.com/fees-payment.page

63. Navigating the Nursing Registration Landscape in Australia: The Outcome Based Assessment Pathway, accessed on July 21, 2025, https://nurseassistinternational.com/blogs/news/navigating-the-nursing-registration-landscape-in-australia-the-outcome-based-assessment-pathway

64. OSCE and Australian Nursing Registration, accessed on July 21, 2025, https://nurseassistinternational.com/blogs/news/osce-and-australian-nursing-registration

65. OSCE-FAQS - Nurse Assist International, accessed on July 21, 2025, https://nurseassistinternational.com/pages/osce-faqs

66. Understanding the New AHPRA Pathways: A Game Changer for Australian Healthcare Employers - Career Grids, accessed on July 21, 2025, https://careergrids.com/understanding-the-new-ahpra-pathways-a-game-changer-for-australian-healthcare-employers/

67. How to Perfectly Use the New Pathway for Nurses to Australia - Career Grids, accessed on July 21, 2025, https://careergrids.com/how-to-perfectly-use-the-new-pathway-for-nurses-to-australia/

68. IELTS Test Dates | EPro Training Centre Baguio, accessed on July 21, 2025, https://www.eprobaguio.com/ielts-test-dates

69. Country Information - Philippines - IELTS Online Tests, accessed on July 21, 2025, https://ieltsonlinetests.com/country-information-philippines

70. IELTS test registration procedure in the Philippines, accessed on July 21, 2025, https://ielts.idp.com/philippines/about/article-ielts-test-registration-procedure

71. IELTS Exam Overview - Types, Fees, and Steps to Book - AECC Global PHILIPPINES, accessed on July 21, 2025, https://www.aeccglobal.com.ph/english-proficiency-tests/ielts/exam-overview

72. How to Register for the 2025 NCLEX® Exam - UWorld Nursing, accessed on July 21, 2025, https://nursing.uworld.com/nclex/exam-registration/

73. How Much Does the NCLEX Cost in 2025? Fees, Extras, and Budget Tips - 1Nurse, accessed on July 21, 2025, https://www.1nurse.com/blog/story/2025/07/02/how-much-does-it-cost-take-nclex/

74. NNAS Application Guide: Expedited vs. Regular Service Explained (2025 Update), accessed on July 21, 2025, https://nursingmanthra.com/nnas-application-fees-expedited-vs-regular-guide/

75. Total cost to become a nurse in Canada | RN and LPN - YouTube, accessed on July 21, 2025, https://www.youtube.com/watch?v=lg76c1K-VuE

76. NCLEX Exam Fees Explained - Smart'n | The GPT for nurses, accessed on July 21, 2025, https://www.smartn.ca/blog/nclex-fees

77. NCLEX-NGN-FAQ - Nurse Assist International, accessed on July 21, 2025, https://nurseassistinternational.com/pages/nclex-ngn-faq

78. AHPRA Registration for Nurses in UK & Ireland: Complete Guide - HRstride.COM, accessed on July 21, 2025, https://hrstride.com/ahpra-registration/

79. How To Become A Registered International Nurse To Work In Australia Through AusPath., accessed on July 21, 2025, https://www.auspath.agency/how-to-become-a-registered-international-nurse-to-work-in-australia-through-auspath/

80. Exploring Nurse Registration Pathways in Australia | The Philippine Times, accessed on July 21, 2025, https://philtimes.com.au/exploring-nurse-registration-pathways-in-australia/

81. NCLEX exam for living and working permit in USA, Canada, and Australia, accessed on July 21, 2025, https://nclexclasses.com/nclex-exam-for-living-and-working-permit-in-usa-canada-and-australia/

82. Registration - NCLEX, accessed on July 21, 2025, https://www.nclex.com/registration.page

83. Scheduling | NCLEX, accessed on July 21, 2025, https://www.nclex.com/scheduling.page

84. NCLEX International Test Centers - WorldWide HealthStaff Solutions, accessed on July 21, 2025, https://healthstaff.org/nclex-international-test-centers/

85. How to Apply for the NCLEX-RN for Internationally Educated Nurses, accessed on July 21, 2025, https://www.crns.ca/license_membership/becoming-a-nurse-in-sask/rn-rnnp-exam/nclex-application/nclex-ien/

86. Contact a U.S. Member - NCSBN, accessed on July 21, 2025, https://www.ncsbn.org/membership/us-members/contact-bon.page

87. Customer service information for NCLEX Examinations – NCSBN testing with Pearson VUE, accessed on July 21, 2025, https://www.pearsonvue.com/us/en/nclex/contact.html

88. U.S. Nursing Licensure for Internationally Educated Nurses - NCSBN, accessed on July 21, 2025, https://www.ncsbn.org/nursing-regulation/licensure/internationally-educated-nurses.page