You’ve trained, you’ve worked, and you’ve built real clinical experience. Now you’re thinking about practising in a new country, and if you’re like many of the nurses we meet, you feel excited and overwhelmed in the same breath. That’s normal. This guide is here to make the road ahead a little clearer.
We want to be honest with you from the start. We teach and support internationally educated nurses every week, but the registration journey itself isn’t one we’ve personally travelled. So we built this guide in two layers. Every rule or requirement links directly to the organization that sets it, so you can check it yourself (and you should, because these rules change). The lived experience comes from four internationally educated nurses in our circle who now practise in Ontario and generously agreed to share what they wish they’d known.
We start with Ontario, where we’re based, then point out what’s different in other provinces and in the United States.
Who this is for. An internationally educated nurse (IEN) is a nurse who completed their nursing education outside the country where they now want to register. That includes registered nurses and practical nurses. In Ontario, practical nurses are called Registered Practical Nurses (RPNs). In most other provinces and in the US, the title is Licensed Practical Nurse (LPN), and some US states use Licensed Vocational Nurse (LVN). Ontario’s regulator expects your education to match the category you’re applying for: a baccalaureate for RN applicants and a diploma for RPN applicants.
In this guide
- Start with the regulator
- Know the typical stages
- Know where you’re headed: practice, not just registration
- Check your eligibility before you spend money
- Gather your documents early
- Plan for language proficiency
- Prepare for your exams
- Budget for the full cost
- Treat registration and immigration as two separate processes
- Protect yourself from scams
- Build a realistic timeline
- You’re not starting from zero
1. Start with the regulator
There’s no single nursing licence that works everywhere. In Canada, nursing is regulated province by province. In the US, each state has its own board of nursing. Your first job is to find the regulator for the place you want to work, and read its pages for internationally educated applicants before you spend a dollar anywhere else.
In Ontario, the College of Nurses of Ontario (CNO) registers both RNs and RPNs. Its requirements cover nursing education, evidence of recent practice, a registration exam, a jurisprudence exam, English or French proficiency, authorization to work, and declarations about past offences, health and conduct. CNO has also added a Transition to Practice requirement (more on that in section 3).
Elsewhere in Canada, the Canadian Nurses Association keeps a list of every provincial and territorial regulator. Some provinces have separate regulators for RNs and LPNs, so make sure you’re reading the right one.
In the US, each state board sets its own rules for internationally educated applicants. The National Council of State Boards of Nursing (NCSBN) publishes a resource manual that explains how boards approach this.
Forums, group chats and social media are wonderful for encouragement and leads. But Ontario alone changed several requirements in 2025 and 2026, so treat the regulator’s website as the final word and check it again before each big step.
“The ability to start my application with the regulator while I was still back home, before migrating to Canada.” That’s what A.T. wishes she’d known. Her advice: “Start your application before moving to Canada, it will speed things up.”
A.T., Acute Care RN and Clinical Instructor
2. Know the typical stages
The order varies by destination, but most pathways move through the same broad stages: a credential assessment, an application to the regulator, the requirements that regulator sets (language, exams, recent practice), and finally registration. Your immigration and work authorization run alongside all of it.
Ontario. Most IENs start with the National Nursing Assessment Service (NNAS). CNO’s own FAQ notes that you need your NNAS application and ID numbers to complete your online application with CNO. From there, CNO assesses you against each requirement and tells you what’s outstanding.
Other provinces. NNAS is the first step for many regulators, including those in Manitoba and New Brunswick, but not all of them follow the same route. Manitoba’s RN college, for example, lets some degree-educated applicants apply directly, and British Columbia uses a separate assessment partner for parts of its process. Check your regulator’s page rather than assuming another IEN’s route is yours.
United States. Boards generally require a credentials evaluation from an approved agency before you can sit the NCLEX. You apply to the board in the state where you want to be licensed, and that board confirms your eligibility for the exam.
Karine wishes she’d had “clear pathways.” The most confusing part for her was “how to navigate the system, between the national assessment service and the provincial regulator.” Her advice: “Have in mind different pathways, and always have a plan A/B/C.”
Karine G., RN, Clinical Educator and Nursing Instructor
3. Know where you’re headed: practice, not just registration
Registration opens the door. What happens after you walk through it deserves your attention from day one, not after you pass your exams.
Ontario’s regulator recognizes this formally. CNO’s Transition to Practice requirement exists to make sure RN and RPN applicants are familiar with the competencies specific to practising in Canada. According to CNO, most applicants meet it through Canadian education or current registration elsewhere in Canada; others meet it by completing a CNO-approved Transition to Practice course.
This is the part of the journey we know best, because it’s where we spend our days with nurses. Your clinical knowledge travels with you. What often takes adjusting is the context around it: how documentation is expected to look, when and how to escalate a change in a patient’s condition, what sits inside your scope of practice here, how patients and families expect to be included in decisions, and how the interprofessional team works together. None of that is a judgement on your previous experience. It’s simply a new system with its own habits.
A few things that help:
- When you’re comparing employers, ask what orientation, preceptorship or IEN support they offer
- Read your regulator’s practice standards early; in Ontario, they’re also what the jurisprudence exam covers
- Get comfortable with electronic health records, structured handover, and reporting changes in a patient’s condition
- Connect with IEN communities, mentors and professional associations
- Give yourself time to settle, professionally and personally
Feeling unsettled at first is normal, and it says nothing about how good a nurse you are.
4. Check your eligibility before you spend money
Before paying for tests, courses or evaluations, look honestly at three things.
Your education and your category. Your program has to match the type of nurse you’re applying to be. In Ontario, that means a baccalaureate for RN applicants and a diploma for RPN applicants. If your training doesn’t line up neatly with either category, find out early how your regulator will assess it. Keep your course outlines and syllabi; they matter.
Your recent practice. CNO requires evidence that you’ve practised as a nurse within the past three years, and it updated these rules in 2026, including how it treats volunteer experience. Read the current page carefully, especially if you’ve had time away from nursing while relocating or caring for family.
Your options if something is missing. In Ontario, the Supervised Practice Experience Partnership (SPEP) matches eligible applicants with employers for supervised practice, to help meet the evidence of practice and, in some cases, language proficiency requirements. CNO decides who is eligible. Ontario Health reports that more than 5,500 IENs have completed SPEP and become licensed since it launched in 2022. Some participating hospitals, such as The Ottawa Hospital, describe their placements as paid positions.
If your regulator offers a self-assessment tool or a detailed checklist, use it before you commit money.
“Understanding which pathway applied to my situation and what the regulator actually required. I invested significant time and money in distance learning courses before realizing another pathway would have met the same requirements faster. Verifying my nursing practice history also meant repeated, frustrating back-and-forth between institutions back home and the regulator.”
Mark G., Acute Care RN, IEN Advocate, Educator and Mentor
5. Gather your documents early
As Mark’s experience shows, paperwork can take far longer than you expect. Many documents have to come from schools, employers or councils back home, and you can’t control how fast they respond. Start requesting them as soon as you know your destination, and keep copies of everything you send.
| Category | What you may be asked for | Our tip |
|---|---|---|
| Academic records | Diploma or degree, official transcripts, course outlines showing theory and clinical hours | Make sure your name matches across every document. A maiden or married name difference usually needs certified proof. |
| Professional standing | Current or past licence, proof of good standing, employment history, references | Ask your home regulator and past employers early how they send verifications, and how long it takes. |
| Language results | Your language test scores | CNO requires results to be sent directly from the test organization, so list your regulator as a recipient when you book. |
| Identity and legal | Passport, police checks, certified translations | In Ontario, CNO may accept the police check you gave immigration if you’ve stayed in Canada since your status was granted. |
Your regulator’s own checklist is the final word on what’s required and in what format. Check formatting rules before you order anything, so you don’t pay twice.
6. Plan for language proficiency
If your nursing education wasn’t in English or French, expect to show proficiency, and check whether your regulator needs it from you regardless. Each regulator decides which tests it accepts and sets minimum scores, usually for each skill, so a strong overall score isn’t always enough on its own.
Ontario. CNO accepts CELBAN (a Canadian test built for nurses), IELTS General and Academic, and other approved tests once it has set benchmarks for them. Results must be sent to CNO directly by the test organization. SPEP can also be a route to meeting this requirement for some eligible applicants.
Elsewhere in Canada, the accepted list can be narrower. Alberta’s RN regulator, for example, currently accepts only CELBAN and IELTS Academic, and British Columbia lists CELBAN, IELTS Academic and OET. A test that works in one province may not work in another, so confirm before you book.
United States. Boards set their own English requirements. Minnesota’s board, for example, lists its own minimum IELTS Academic scores, and the US visa screening process separately verifies English proficiency.
Passing the test is one piece. Clinical English has its own vocabulary, abbreviations, documentation style and rhythm, even for fluent speakers. Start a personal glossary while you study, and practise writing concise notes, giving handover, and explaining things to patients in plain language. In our experience, this is where confidence grows fastest once you start practising it out loud. If you’d like a structured place to start, our online course, Clinical Communication & Documentation Decoded, was built around exactly these skills.
7. Prepare for your exams
Which exam you write depends on where you’re going and which category you’re applying for.
Ontario. RN applicants write the NCLEX-RN, now in its Next Generation (NGN) format. RPN applicants write the REx-PN, which is also the exam for LPNs in British Columbia. Everyone applying to CNO also completes a separate jurisprudence exam on Ontario’s nursing laws, regulations and practice standards. It’s written online, and you’ll get access once you’ve submitted your application and fees.
Here’s some genuinely good news. CNO confirms that you can write the NCLEX-RN at Pearson test centres in other countries (an extra fee applies outside Canada and the US), and the same is true for the REx-PN. CNO also states there’s no limit on how many times you can write the NCLEX-RN until you pass.
The one thing Anisha wishes she’d known: “That you can take the licensing exam from your home country.”
Mark put it this way: “That I would need to take the licensing exam, I would have taken it before coming to Canada if I’d known, which would have removed a lot of anxiety while also trying to provide for my family.”
Anisha D., RN, registered through Ontario’s SPEP program · Mark G., Acute Care RN, IEN Advocate, Educator and Mentor
Other provinces. Practical nurse exams vary across Canada, so confirm with your regulator which one applies to you before you buy any prep materials.
United States. RNs write the NCLEX-RN and LPNs or LVNs write the NCLEX-PN, once your state board confirms you’re eligible.
How to study (this part is our lane). These exams test how you apply knowledge, not how much you’ve memorized. The NCLEX’s current format puts clinical judgment at the centre. Practise thinking through prioritization, assessment, patient safety, infection prevention, medications, communication and ethics in realistic scenarios. Use the official test plan as your map, do practice questions under timed conditions, and study with other IENs when you can; explaining your reasoning out loud is one of the fastest ways to find the gaps.
8. Budget for the full cost
The total is usually more than the application fee alone. Build a realistic budget that includes:
- Credential assessment and regulator application fees (CNO’s application fee is non-refundable)
- Document requests, couriers and certified translations
- Language tests and possible retakes
- Registration exam fees, plus any international test centre fee if you write abroad
- Exam preparation, and any courses your regulator asks you to complete
- Visa and immigration costs
- Travel, accommodation and time off work for in-person steps
We haven’t listed amounts on purpose. Fees change, and each regulator and exam body publishes its own current fees, so take your numbers from their sites.
If an employer or program offers to cover some of these costs, that can make a real difference. Get the offer in writing and understand what comes with it, such as a required length of service, before you sign.
Asked about the most challenging part, Anisha’s answer was short:
“The cost.” So was her advice: “Don’t delay.”
Anisha D., RN, registered through Ontario’s SPEP program
9. Treat registration and immigration as two separate processes
Being eligible to register as a nurse doesn’t give you the right to live and work in a country, and the reverse is also true. The two processes run side by side and sometimes depend on each other, so look into both at the start.
Canada. CNO asks for proof of your citizenship, residency status or authorization to practise before it registers you. On the immigration side, Canada’s Express Entry system has run healthcare-focused draws that include registered nurses and licensed practical nurses.
United States. Nurses seeking an occupational visa generally need a VisaScreen certificate, which checks your licences, education and English proficiency, and for RNs confirms you’ve passed the NCLEX-RN or an accepted equivalent.
Immigration is outside our expertise, and it’s an area where mistakes are costly. Use the official government sites, and if you need advice, work with a licensed immigration lawyer or a regulated consultant.
10. Protect yourself from scams
Many recruiters and employers support IENs well. But when you’re far from home, under pressure and eager to move forward, it’s easier to be targeted by offers that sound too good. Be cautious of:
- Guarantees of registration or a job before you’ve been assessed
- Large upfront fees to “fast-track” a process only the regulator controls
- Pressure to sign a contract you haven’t had time to read, especially one with heavy penalties for leaving early
- Anyone who can’t show clear, verifiable credentials
Two facts worth knowing. First, only the regulator decides on registration, and CNO states plainly that it does not recruit nurses to practise in Ontario. Second, Ontario’s Employment Protection for Foreign Nationals Act prohibits recruiters from charging fees to foreign nationals who are working or looking for work in Ontario through an immigration or temporary foreign worker program. If someone asks you to pay for a job placement, pause and check.
When in doubt, contact the regulator directly, and read every contract carefully before you sign.
11. Build a realistic timeline
We’re not going to give you a number. Every path depends on your education, your country of training, how recently you’ve practised, your destination, and how quickly documents and exams fall into place. What we can tell you is what the nurses in this guide keep coming back to: start earlier than feels necessary, and do what you can before you move.
Work backwards from your goal date. Keep one tracker with every application, document, deadline, fee and reference number, and record each submission as you make it.
Your starting checklist
- Choose your destination and find its regulator
- Read the regulator’s requirements for internationally educated applicants, start to finish
- Think about the practice environment you’re preparing for, not just the exam
- Check your eligibility, including your education category and recent practice
- Request documents and verifications early
- Confirm which language tests your regulator accepts, then book
- Plan your exam and study timeline, including whether you can write from home
- Budget for every cost and ask about employer support
- Look into immigration alongside registration, using official sources
- Verify recruiters and read every contract
- Connect with IENs who’ve been through it
You’re not starting from zero
Learning a new healthcare system doesn’t mean restarting your career. You bring your education, your clinical experience and your perspective with you. Think of this process as building a bridge between what you already know and what you need to practise safely and confidently in your new setting. It takes patience, organization and persistence, and you don’t have to do it alone.
“Don’t give up on your nursing dream, but don’t navigate blindly either. Review the requirements directly from the regulator, track every deadline, and don’t be afraid to ask for clarification. Don’t compare your journey to someone else’s; every IEN’s path is different. Connect with other IENs; there’s real strength in community.”
Mark G., Acute Care RN, IEN Advocate, Educator and Mentor
Your nursing experience matters. The next step is learning how to carry it confidently into your new healthcare system.
Ready to build your confidence for practice?
When you’re preparing to step into a new healthcare environment, hands-on practice helps. Our simulation sessions in Toronto give you a judgement-free space to practise assessment, handover and escalation before you’re on the unit. Book a session, or start online with Clinical Communication & Documentation Decoded.
Where to verify
- Ontario: College of Nurses of Ontario, registration requirements
- Canada: National Nursing Assessment Service · Canadian Nurses Association, list of regulators
- United States: NCSBN resource manual for internationally educated nurses · CGFNS VisaScreen
- Immigration: Government of Canada, Express Entry
Requirements change often. Information in this guide was checked against the linked sources in October 2026; always confirm with the official source before you act.