How to Hire Foreign Nurses in Washington (2026)

The Nursing Shortage in Washington State

Healthcare facilities across Washington State face persistent shortages of registered nurses. From major hospital networks in the Seattle-Tacoma-Bellevue metropolitan area to regional medical centers in Spokane, the Tri-Cities, and agricultural hubs in the Yakima Valley, open positions often sit vacant for months. To cover shifts, many employers rely heavily on temporary travel nurses, paying rates between $100 and $160 per hour. While travel nurses offer short-term coverage, the financial drag is unsustainable for long-term operational budgets.

Hiring foreign-educated nurses provides a permanent staffing solution, but it requires a commitment to legal processing and credentialing. Washington is one of the higher-paying states for nursing, with permanent staff nurse hourly wages typically ranging from $45 to $65 per hour depending on region and experience. Sponsoring a foreign registered nurse allows healthcare providers to secure long-term team members at local prevailing wage rates, eliminating the markup of staffing agencies. However, the process involves federal immigration steps and state licensing rules that must be understood before extending job offers.

State Licensure and Credential Recognition

Immigration permits a worker to enter the United States, but state licensure permits them to practice. In Washington, nurse licensing is governed by the Washington State Board of Nursing (WABON). Foreign-educated nurses must complete specific state requirements before they can legally practice as registered nurses in a facility.

• Education Evaluation: The candidate must have their international nursing education evaluated by an approved credentialing agency, such as the Commission on Graduates of Foreign Nursing Schools (CGFNS) Credentials Evaluation Service (CES). This evaluation verifies that their education is equivalent to a US bachelor's or associate degree in nursing.
• English Language Proficiency: Candidates from non-English speaking countries must pass an approved English proficiency exam, such as the IELTS Academic or TOEFL iBT, unless their nursing education was completed in a country exempted by WABON rules.
• NCLEX-RN Exam: Candidates must pass the National Council Licensure Examination for Registered Nurses (NCLEX-RN). Many foreign nurses take the NCLEX at international testing centers before seeking US employment.
• VisaScreen Certificate: Federal law requires foreign healthcare workers to obtain a VisaScreen certificate issued by CGFNS or an equivalent approved body before an immigrant visa or TN status can be granted. This certificate confirms their credentials, English proficiency, and eligibility to work in healthcare.

Legal Visa Routes: EB-3 Schedule A and TN Visas

Immigration law is federal and consistent across all states, but how it applies to nursing has one major advantage: registered nurses are designated by the US Department of Labor under Schedule A. This designation recognizes a nationwide shortage of nurses and waives the requirement for an individual Labor Certification (PERM). Employers do not need to conduct local recruitment advertising before sponsoring a nurse for a permanent residency visa.

Employers hiring foreign nurses generally use two primary immigration pathways:

• EB-3 Immigrant Visa (Schedule A): This is the standard green card route for foreign registered nurses. Because individual PERM labor certification is bypassed, the employer files Form I-140 (Immigrant Petition for Alien Workers) directly with USCIS along with an uncertified Form ETA 9089 and proof of internal job posting. Once approved and an immigrant visa number is available, the nurse completes consular processing in their home country to enter the US as a lawful permanent resident.
• TN Visa (USMCA): Available exclusively to citizens of Canada and Mexico. Registered nursing is an eligible profession under the United States-Mexico-Canada Agreement. Canadian nurses can present their job offer, WABON license or authorization, and VisaScreen certificate directly at a US port of entry for immediate entry. Mexican nurses apply through a US embassy or consulate. TN status is temporary (valid up to three years, renewable), but provides a much faster onboarding route for eligible candidates.

Always confirm current federal filing requirements, fee structures, and visa bulletin availability directly with the Department of Labor, USCIS, or a qualified immigration attorney before starting the sponsorship process.

Timelines: From Decision to the Start Date

Hiring foreign nurses is a strategic initiative rather than a quick fix for next week's schedule. Facilities must plan their pipeline based on realistic federal processing times.

• TN Visa (Canadian Citizens): 1 to 3 months. Once state licensure and VisaScreen credentials are verified, onboarding can happen rapidly.
• TN Visa (Mexican Citizens): 2 to 4 months, accounting for consulate interview scheduling.
• EB-3 Schedule A Green Card: 12 to 24 months. Processing times depend on USCIS petition review speeds and visa availability governed by the US Department of State Visa Bulletin. Periodically, visa retrogression occurs when demand exceeds annual visa caps, extending wait times for applicants from certain countries.

Wage Obligations and Mandatory Employer Costs

Federal law dictates that sponsored foreign workers must be paid at least the prevailing wage for their occupation and geographic area, or the actual wage paid by the employer to similarly employed workers, whichever is higher. The National Prevailing Wage Center sets these rates based on local labor market data. In Washington, nurse wages are high relative to national averages. For example, prevailing base wages for registered nurses in the Seattle area routinely exceed $50 per hour, while rates in Eastern Washington typically range from $42 to $52 per hour.

Crucially, federal regulations mandate that employers bear all legal and filing costs associated with the employment process. A legitimate employer never asks a worker to pay for their own recruitment, job placement, or petition processing. Foreign candidates who are asked to pay placement fees, recruitment charges, or mandatory back-pay fees are being defrauded. Employers who utilize third-party agencies that charge candidates fee deductions face severe civil liability, legal penalties, and potential disqualification from federal immigration programs.

What This Costs You, Roughly

Sponsoring a foreign nurse involves predictable administrative, legal, and onboarding expenses. Below is a realistic summary of estimated employer cost lines per candidate:

• USCIS Filing Fees: $1,500 to $3,500 (covers Form I-140 filing fees and optional USCIS premium processing where applicable).
• Immigration Legal Fees: $3,500 to $7,500 per candidate for case preparation and filing.
• Credentialing and VisaScreen Support: $500 to $1,500 if the employer assists with application and translation fees.
• Consular Processing and Immigrant Visa Fees: $400 to $800 per applicant.
• Relocation and Initial Housing Assistance: $3,000 to $8,000 (customary allowance offered by employers to help nurses relocate to Washington State).

Finding Candidates on the Workmerica Registry

Workmerica is not a recruitment agency, takes no per-hire fee, and does not place workers. Workmerica is an open online registry where foreign workers create profiles detailing their qualifications and stating where in the United States they want to work.

Employers in Washington State can log into the Workmerica registry to search directly for registered nurses who have expressed a specific interest in moving to Washington. You can review candidate qualifications, confirm whether they have already passed the NCLEX-RN or hold CGFNS evaluations, and contact candidates directly to initiate your standard interview process.

The Workmerica registry is young and still growing. You will not find tens of thousands of candidates overnight, but you will find motivated healthcare professionals seeking direct employment with US organizations willing to sponsor their visas. By managing recruitment in-house, Washington employers can build a stable pipeline of permanent nursing staff while avoiding agency markups and maintaining full legal control of the hiring process.