Nurse salaries in 2026 vary considerably by state, specialty, experience and work setting. According to the latest available Bureau of Labor Statistics data, the national median annual wage for registered nurses was US$97,550 in May 2025, while the national mean was US$101,420.
For internationally educated nurses, salary is only one part of the decision. State licensure, credential evaluation, immigration sponsorship, housing costs and membership in the Nurse Licensure Compact can materially change the value of an offer.
The 10 Highest-Paying States for Registered Nurses
The following ranking uses the latest BLS median annual wage data available, collected in May 2025 and released in 2026:
| Rank | State | Median annual RN wage |
|---|---|---|
| 1 | California | US$140,270 |
| 2 | Hawaii | US$136,320 |
| 3 | Oregon | US$129,010 |
| 4 | Washington | US$124,200 |
| 5 | Alaska | US$109,480 |
| 6 | New York | US$109,440 |
| 7 | New Jersey | US$106,500 |
| 8 | Massachusetts | US$104,550 |
| 9 | Nevada | US$103,670 |
| 10 | Connecticut | US$102,740 |
These figures are statewide medians, not guaranteed starting salaries. Compensation can be higher or lower depending on the metropolitan area, union contract, shift differentials, specialty and years of experience.
A higher salary also does not necessarily produce greater purchasing power. Housing and transportation in California, Hawaii, New York and Massachusetts may offset a substantial portion of the wage advantage.
Requirements for Foreign-Trained Nurses
Before practicing as a registered nurse, an internationally educated professional must satisfy the requirements of the relevant state board of nursing. These may include a credential evaluation, English-language examination, background check, NCLEX-RN and additional education when the original program is considered deficient.
The NCLEX-RN and state license are related but separate steps. Passing the examination does not automatically create an unrestricted right to practice in every state.
Foreign health care workers may also need a health care worker certification, commonly completed through VisaScreen. The process reviews education, licensing, English proficiency and the qualifying nursing examination.
As of 2026, the initial VisaScreen application fee published by the credentialing organization is US$740. Additional services, translations and state-board evaluations may increase the total.
Schedule A and the EB-3 Route
Professional nurses are included in Schedule A, Group I, a category for occupations that the Department of Labor has determined have an insufficient number of qualified US workers.
This means an employer sponsoring a qualifying professional nurse does not complete the standard PERM recruitment and certification process used for many other EB-3 occupations. Instead, the employer generally submits the required Schedule A documentation and an uncertified labor certification form directly with Form I-140.
Schedule A does not eliminate employer sponsorship, licensing requirements or Visa Bulletin waiting periods. The nurse must still qualify for the position, and an immigrant visa must be available before permanent residence can be granted.
The timing therefore depends heavily on the nurse’s country of chargeability and the applicable Visa Bulletin category.
H-1B for Nursing Positions
A standard RN position does not automatically qualify for an H-1B visa. The employer must demonstrate that the particular role is a specialty occupation that normally requires at least a bachelor’s degree in a directly related field.
Advanced-practice positions—such as certain nurse practitioner, clinical nurse specialist or nurse anesthetist roles—may present a stronger H-1B case because their licensing and educational requirements are more specialized.
The job title alone is not decisive. USCIS examines the actual duties, employer requirements, state law and normal industry standard.
Nurse Licensure Compact
The Nurse Licensure Compact allows an eligible nurse whose primary state of residence is a participating jurisdiction to hold a multistate license and practice in other compact states.
A single-state license from a compact state does not automatically become a multistate license. The nurse must meet the compact requirements, including maintaining primary residence in an NLC jurisdiction.
California, Hawaii, Oregon, Alaska, New York and Nevada are among the higher-paying states that do not currently participate in the compact. Washington participates, while Massachusetts has enacted the NLC but implementation remains pending.
Licensure status should always be confirmed on the official NLC map and with the destination board before accepting a position.
Salary vs. Cost of Living
A nurse comparing California with Texas should evaluate more than the headline salary. California offers the country’s highest median RN wage, but housing costs and state income tax can be substantial.
Texas does not appear in the ten highest-paying states by raw median wage, but it has no individual state income tax and participates in the Nurse Licensure Compact. For some households, the lower living costs and easier multistate practice may produce a better financial result.
The right comparison should include:
- net salary after federal and state taxes;
- rent or mortgage costs;
- health insurance contributions;
- commuting and vehicle expenses;
- union dues;
- overtime and shift differentials;
- licensing and relocation costs.
Common Mistakes
The first mistake is starting an immigration process before confirming state licensure eligibility. A candidate can satisfy federal immigration requirements and still face a licensing obstacle in the destination state.
The second is assuming that every nursing employer must complete the standard PERM process. Professional nurses may qualify for Schedule A treatment, which follows a different filing procedure.
The third is relying only on statewide salary figures. Offers should be compared using the metropolitan wage, scheduled hours, overtime policy and cost of living.
The fourth is assuming a license transfers automatically. A compact license depends on the nurse’s primary state of residence, while noncompact states require separate endorsement.
The fifth is confusing a pending I-140 with work authorization. An immigrant petition does not independently permit a nurse to begin working in the United States.
Estimated Costs and Timeline
The cost of becoming licensed can include credential evaluation, VisaScreen, English testing, NCLEX-RN, state applications, fingerprints, translations and document delivery.
Timelines vary because universities and licensing authorities must often send records directly. State-board processing can also differ substantially, especially when additional coursework or verification is required.
Visa Bulletin backlogs may add months or years after approval of the employer’s petition. For this reason, no universal EB-3 completion period should be promised.
All values and timelines are estimates and should be confirmed with the credentialing organization, destination board, employer and relevant government agencies.
Checklist for International Nurses
- Select the target state before ordering an evaluation.
- Confirm the board’s credentialing service and education requirements.
- Complete the required English-language examination.
- Apply for and pass the NCLEX-RN.
- Request VisaScreen or the applicable certification.
- Confirm whether the job qualifies for Schedule A.
- Review the current Visa Bulletin.
- Compare net wages and local living costs.
- Verify compact-license eligibility before relocating.
How D4U Supports International Nurses
D4U Immigration is an international planning company, not a law firm, nursing board or credentialing agency. We help professionals organize documents, deadlines and relocation stages, while licensed legal and health care professionals handle advice reserved for their fields.
Our processes are informed by Warren Janssen, former USCIS director. D4U has a success rate of over 91% among our clients who complete the structured planning process. Clients also receive six months of Doctor24 access and our guarantee: your journey completed, or your money back.
Frequently Asked Questions
What is the national median salary for registered nurses?
The latest BLS data reports a national median annual wage of US$97,550 for registered nurses as of May 2025.
Which state pays registered nurses the highest median salary?
California leads the current ranking, with a median annual RN wage of approximately US$140,270.
Do professional nurses need the standard PERM process?
Qualifying professional nurses are included in Schedule A. Their employers generally submit the required labor-certification documentation directly with Form I-140 instead of completing the standard PERM recruitment process.
Does passing the NCLEX-RN allow me to work in every state?
No. Each state board establishes its own licensing requirements, and the nurse must obtain authorization for the state where the patient is located.
Can a registered nurse qualify for an H-1B visa?
Possibly, but not every RN role qualifies. The employer must demonstrate that the specific position meets the specialty-occupation standard.
Talk to the D4U team and start your international journey.
