What is retrogression and what does it mean for nurses planning to work in the USA?

The US has the largest number of nurses globally, and half of all the English-speaking nurses in the world work in the US.  

But faced with a national shortage that continues to grow, the US has been welcoming nurses from around the world to keep its healthcare system ticking.  

Higher salaries, good working conditions, and the ability to bring family have made it a top destination for international nurses looking for a new chapter.   

We explore what’s behind the nursing shortage and why more and more nurses are choosing to call the US home.  

Why is there a nursing shortage in the US?  

The combination of an aging population and increased healthcare needs after Covid means that there aren’t enough nurses in the US to meet patient demand.  

Many experienced nurses are also retiring, with almost a quarter of Registered Nurses (RNs) having stepped down or planning to retire in the next five years, according to a 2022 national survey.  

There’s a shortage of nursing educators too; nursing schools had to turn away almost 66,0000 applicants in 2023 because they didn’t have enough teaching staff.  

The result is that hospitals and healthcare facilities are actively recruiting international nurses to fill critical gaps, offering a stable and secure career path for nurses willing to relocate to the US. 

How many nursing job openings are there in the US

There are almost 4.7 million registered nurses in the US.

That number is projected to grow by almost 10%, according to the US Bureau of Labor Statistics, who predict that there will be almost 200,000 vacancies for Registered Nurses each year between 2020 and 2030.  

Where do international nurses come from?  

The number of nurses relocating to the US has tripled since 1994, and around 8% of current Registered Nurses were educated outside of the US.   

The Philippines (29%) and Jamaica (29%) are the top countries Registered Nurses have relocated from, followed by India (19%).  

Quickly part of the team, almost 90% of international nurses say they feel accepted by patients and nursing colleagues.  

Why do nurses choose the US? 

For many international nurses, moving to the US means better professional and personal resources and different ways to specialize, train and focus their careers.  

Higher salaries 

The US is known for offering some of the highest rates of pay for nurses globally.  

On average, Registered Nurses earn just under $95,000 a year (c.$45 an hour), with the top 10% of nurses earning over $132,000 annually.  

The states with the highest mean annual salaries for nurses are California ($137,690) and New York ($106,620).   

Many US healthcare facilities also offer sign-on bonuses and retention bonuses. 

Better benefits 

The financial benefits of nursing in the US go beyond the salary. US employers provide comprehensive compensation packages that include healthcare coverage for nurses and their families, pensions, paid sick leave and vacation days.   

Over a quarter of employers also provide childcare, with 10% providing their nursing staff with help repaying student loans. 

Ability to bring family 

There’s a myth that moving to the US means leaving your family behind. But with nurses in such high demand, spouses and children under 21 are allowed to accompany nurses to the US — even on a H-1B Registered Nurse temporary visa.  

Those dependents on a H-4 visa are able to apply to work in the US, with the opportunity for the whole family to become US citizens if you progress to the employment-based EB-3 permanent residency visa, or “Green Card” as it’s better known. 

Flexibility with the nurse licensure compact 

Another advantage of working as a nurse in the US is the flexibility of the Nurse Licensure Compact (NLC).  

From large urban hospitals in Dallas to rural clinics in North Dakota, this multistate license allows nurses to practice in any of the 42 jurisdictions, finding the setting that best suits their expertise, family, and lifestyle.  

Opportunities to specialize 

Whether it’s pediatric care, oncology, critical care, or advanced practice nursing, the US healthcare system provides many opportunities for nurses to specialize.  

Hospitals and healthcare institutions in the US often have training programs to help nurses achieve their specialization goals and gain hands-on experience with the most advanced medical technology and procedures.  

Being able to specialize in the areas that are of special interest not only boosts job satisfaction, but it also unlocks opportunities for higher pay and stepping up the career ladder. 

Career advancement and leadership roles 

For those interested in a leadership role, there are many different options within US nursing, such as Nurse Managers, Directors of Nursing, or Chief Nursing Officers.  

These positions not only come with higher salaries but also provide the opportunity to influence healthcare policies, mentor the next generation of nursing professionals, and improve patient care on a broader scale.  

Professional and personal opportunities

Relocating to the US offers nurses a whole host of professional and personal opportunities.  

In high demand, international nurses are valued by healthcare employers, with high wages, great benefits, and opportunities to take their nursing career in the direction that interests them most.  

Thinking of making the move? Take that first step with PTE Academic — the faster, fairer, simpler way to evidence your English skills.   

PTE Academic covers all four skills in just a single two-hour test, so test takers don’t need to worry about taking a separate speaking test with a human examiner. PTE Academic is a computer-based test and so test takers are judged purely on their English skills. Not their accent, their age, their outfit or their appearance.  

Accepted by the major US nursing bodies, find out more about how PTE can help you start your new chapter in the US.

We have all been there; it’s normal to be full of nerves before a test, with uncertainty of what to expect, and doubts about how you’re going to perform. 

However, whilst nerves and anticipation are an unavoidable part of the testing experience, there are ways to reduce this when preparing for your PTE test, so you can grow in confidence before test day and achieve your desired score.

At PTE, we are all about doing it worry-free!  

And to do it worry-free, you need to know what’s coming up and familiarise yourself with the PTE test.

Here are 4 ways you can start your PTE preparation and get the practice in, so you are confident for when test day comes. 

1. Familiarize yourself with the test and what’s expected:

A great way to prepare is to know all about what you can expect on test day. We have lots of resources available on our Preparation page. We'd recommend that you explore this section of our site and gather any top tips that you can from our range of free resources, also known as our A-Z of PTE. This includes a run-through of each question type as well as a video of what to expect on test day, which you can also watch below on this page!

Are you booking PTE for the first time? Do you know which of our PTE tests is right for you? No worries, we will guide you through the booking process.