Nursing in the USA: Visa, Career, and Green Card in 2026

Nursing remains one of the most structurally understaffed professions in the United States, and the window of opportunity for foreign-trained professionals stays open in 2026. Hospitals, clinics, academic institutions, and home care networks are grappling with mass retirements, expanding geriatric care demand, and a domestic training pipeline that cannot keep pace. For Brazilian nurses and other Portuguese-speaking professionals, the landscape combines three rare elements: real demand, competitive salaries, and well-established legal pathways for employment-based immigration.

BLS Projected Demand

The Bureau of Labor Statistics maintains two distinct projections for the 2023–2033 decade that must be read separately. For Registered Nurses (RNs), projected growth is approximately 6%, with around 194,500 annual job openings generated by a combination of new positions and the replacement of professionals who retire or change careers. The advanced practice category — which includes Nurse Anesthetists, Nurse Midwives, and Nurse Practitioners — projects aggregate growth of nearly 40% over the same period, with approximately 31,900 annual openings, ranking among the fastest-growing occupations in the American labor market.

The distinction matters. RN is the entry point for most foreign nurses, while advanced practice roles require a clinical master’s degree and additional licensure. Both tracks offer real opportunities, but with distinct academic, salary, and immigration requirements.

Careers in American Nursing

The American system segments nursing into well-defined levels. Understanding each one is the first step toward mapping your career path.

Registered Nurse (RN): the foundation of direct patient care. Requires an accredited degree (associate or bachelor’s), passing the NCLEX-RN exam, and a license issued by the Board of Nursing in the state where the professional will practice.

Nurse Practitioner (NP): an advanced practice professional with a master’s degree (MSN) or doctorate (DNP). Diagnoses, treats, and prescribes medications with varying levels of autonomy depending on state law.

Licensed Practical Nurse (LPN) or Licensed Vocational Nurse (LVN): provides care under supervision in basic nursing settings. A shorter training path, but with a limited scope of practice.

Certified Registered Nurse Anesthetist (CRNA): anesthesia specialist, typically among the highest-earning nurses in the US.

Certified Nurse Midwife (CNM): focused on women’s health, pregnancy, childbirth, and postpartum care.

Foreign Credential Evaluation

Before practicing, a foreign nursing degree must be evaluated by a recognized agency — the CGFNS (Commission on Graduates of Foreign Nursing Schools) issues the CES report required by most states. In parallel, the professional must demonstrate English proficiency via TOEFL, IELTS, or OET, pass the NCLEX-RN, and apply for state licensure. Each state operates its own Board of Nursing, with specific eligibility rules, fees, and timelines. States such as California, Florida, and New York typically require additional documentation and have longer processing queues.

Green Card for Qualified Nurses

The most established pathway for nurses is the EB-3 Skilled Worker category, a preference-based employment immigrant visa. A U.S. employer sponsors the professional, obtains labor certification (PERM) from the Department of Labor, and files the I-140 petition with USCIS. Nursing is listed on the DOL’s Schedule A — a roster of occupations with recognized shortages — which allows bypassing the PERM step and expedites I-140 filing, a significant advantage over most EB-3 categories.

For professionals with an exceptional profile — publications, clinical leadership, academic contributions, public health research — the EB-2 NIW (National Interest Waiver) opens an alternative route that requires neither a job offer nor a sponsor. The applicant petitions on their own behalf by demonstrating that their work has substantial merit, is well-positioned to advance, and benefits the United States sufficiently to justify waiving the PERM requirement. NPs with publications in critical areas such as mental health, oncology, and primary care in underserved communities are finding increasing success with the NIW.

Green Card holders negotiate directly with employers, change hospitals without jeopardizing their immigration status, and have full access to benefits, federal programs, and graduate school funding.

States with the Highest Demand

The geography of American nursing concentrates opportunities in five major markets.

California

The state with the highest RN salaries in the country, with a median close to USD 137,000 according to BLS data from May 2024, with potential earnings exceeding USD 200,000 in areas such as anesthesia and ICU at academic hospitals in the Bay Area. Centers such as Stanford Health Care, UCLA Medical Center, and Cedars-Sinai operate at the forefront of medical technology. The cost of living is high, particularly in San Francisco, Los Angeles, and San Diego, and state licensure is considered among the most rigorous in the country.

Texas

A combination of above-average salaries and a lower cost of living, especially in Houston, Dallas, and Austin. The Texas Medical Center in Houston is the largest medical complex in the world. Population growth sustains continuous demand, and the Texas Board of Nursing has reciprocity with several states through the Nurse Licensure Compact (NLC).

Florida

The rapidly aging population creates constant pressure for geriatric nursing, home care, and clinical nursing in retirement communities. Miami, Orlando, and Tampa are home to large hospital networks. Florida also participates in the NLC.

New York

A dense market for high-complexity specialties — ICU, oncology, neonatal, transplants — at institutions such as NewYork-Presbyterian, Mount Sinai, and NYU Langone. Competitive salaries partially offset the cost of living in Manhattan. New York is not part of the NLC, requiring independent state licensure.

Pennsylvania

Strong presence of academic hospitals such as UPMC in Pittsburgh and Penn Medicine in Philadelphia. Its strategic location between New York City and Washington, D.C. facilitates conference attendance and regional mobility. Above-average salaries and a moderate cost of living.

In-Demand Specialties

The profiles with the highest absorption in 2026 include geriatric care, mental health and psychiatry, oncology nursing, intensive care (adult and neonatal ICU), perioperative nursing, and telehealth. The shortage of bilingual nurses — particularly Spanish- and Portuguese-speaking — is treated as a competitive differentiator in markets such as Florida, Texas, and California, where the Hispanic and Brazilian populations are growing steadily.

How to Prepare Before Immigrating

Professionals who begin preparation 12 to 24 months in advance are more likely to complete the transition smoothly. Before departure, it is strategic to complete the CGFNS process, take the NCLEX-RN in Brazil or at a nearby testing center, achieve competitive English scores, and build an American-style résumé with publications, certifications (BLS, ACLS, PALS, CCRN depending on specialty), and membership in organizations such as the American Nurses Association. Mentorship from professionals already working in the US accelerates adaptation to evidence-based protocols, Joint Commission standards, and American clinical culture.

The path requires an investment of time and resources, but the return in professional stability, quality of life, and immigration security keeps nursing among the most attractive professions for global mobility through 2026–2030.

Victoria Harper

Editor-in-Chief

Meet the author

Leading journalism and editorial content at Visto n’ Visa, Victoria helps make immigration topics clear, trustworthy, and easy to understand. Her focus is on delivering useful, human, and relevant content for people exploring new paths abroad.