For an internationally educated nurse planning to work in the United States, the immigration process can quickly become confusing.
There is NCLEX. There is state nursing licensure. There is credential evaluation. There is an English examination. Then there is VisaScreen or Visa4Nurses. And after all of that, there is still the actual immigration process.
One of the most common questions we hear is:
What is the difference between VisaScreen and Visa4Nurses, and which one should a nurse use?
The answer is more straightforward than it first appears.
VisaScreen is the service offered by TruMerit, formerly known as CGFNS International. Visa4Nurses is the service offered by Josef Silny & Associates.
For nurses, both are used to obtain the federal health care worker certification required for certain U.S. immigration pathways.
The important difference is not that one is a legitimate immigration certificate and the other is not. Josef Silny was formally approved by U.S. Citizenship and Immigration Services in 2021 as an organization authorized to issue health care worker certificates and certified statements for people seeking to enter the United States to work as nurses.
The more useful question is therefore which service is more convenient, less expensive, faster, and better suited to the nurse’s particular circumstances.
And on those questions, there are some meaningful differences.
First, VisaScreen and Visa4Nurses are not visas
The names can be misleading.
VisaScreen does not give a nurse a visa.
Visa4Nurses does not give a nurse a visa either.
Both are services used to obtain the Health Care Worker Certification required under U.S. immigration law for certain foreign health care professionals.
That certification is one part of the immigration process.
A nurse may still need to pass NCLEX, obtain a state nursing license, have an employer sponsor the immigration case, qualify under the applicable employment based immigration category, and wait for an immigrant visa to become available.
This distinction is particularly important for nurses pursuing EB 3 immigration.
Obtaining VisaScreen or Visa4Nurses does not mean that the nurse has a green card or that an immigrant visa is immediately available.
The process is better understood as a series of separate steps:
Foreign nursing education → NCLEX → U.S. nursing licensure → Health Care Worker Certification → immigration petition and visa process → U.S. immigration status
Not every nurse will follow exactly the same sequence, but the important point is that these are separate requirements.
The federal regulations governing health care worker certification are found in 8 CFR §212.15.
What is VisaScreen?
VisaScreen is TruMerit’s branded Visa Credentials Assessment.
TruMerit evaluates the nurse’s education, professional licenses and English language proficiency and verifies that a registered nurse has passed NCLEX RN or the applicable qualifying examination.
When the requirements are satisfied, TruMerit issues the International Commission on Healthcare Professions certificate, which satisfies the federal health care worker screening requirement.
VisaScreen has been around for many years and is probably the name most international nurses have heard.
That history matters.
CGFNS, now operating as TruMerit, has been involved in international health professional credentialing for decades, and VisaScreen has become deeply established within the international nurse recruitment and immigration industry.
TruMerit also has a broad scope beyond nursing. It is authorized to provide health care worker certification services for the federal government’s covered health professions.
For a registered nurse, however, the relevant part of the service is the nursing certification.
What is Visa4Nurses?
Visa4Nurses is Josef Silny & Associates’ certification service for internationally educated nurses.
Josef Silny is a long established U.S. credential evaluation organization, but its role in federal health care worker certification is newer than CGFNS’s.
That does not mean Visa4Nurses is an unofficial version of VisaScreen.
USCIS approved Josef Silny & Associates on July 22, 2021 as an additional credentialing organization authorized to issue health care worker certificates and certified statements for people seeking to enter the United States primarily to work as registered nurses, licensed practical nurses or licensed vocational nurses. USCIS subsequently referenced that approval in a later Federal Register notice.
This is an important distinction.
VisaScreen is the name of TruMerit’s product. Visa4Nurses is the name of Josef Silny’s product. The federal requirement is the underlying health care worker certification.
That is why immigration professionals sometimes describe the two as serving essentially the same immigration function.
For example, immigration attorney Chris Musillo, speaking through Connetics USA, has described the two certificates as having no substantive difference from the immigration perspective.
So which one is cheaper?
This is one area where there is a clear difference based on the currently published prices.
TruMerit currently lists the initial VisaScreen application at $740.
Josef Silny currently lists the standard Visa4Nurses certification at $600 for nurses for whom Josef Silny did not previously complete a nursing board evaluation.
That means the standard Visa4Nurses application is currently $140 less expensive.
In percentage terms, Visa4Nurses’ $600 base fee is approximately 19% lower than TruMerit’s $740 VisaScreen fee.
There is another $500 Visa4Nurses price listed for applicants in circumstances where Josef Silny previously completed a board of nursing evaluation.
That can make the difference even larger.
However, this is where applicants need to be careful.
The cheapest initial fee does not necessarily mean the cheapest overall process.
If a nurse already has documents with one organization, changing providers may create additional administrative work. A nurse should also consider whether the same organization can be used for the nurse’s state licensing requirements.
In other words, $140 in savings is useful, but it should not be the only factor.
Which one is faster?
This is more interesting because the answer depends on what we mean by “faster.”
Josef Silny currently states that its standard Visa4Nurses certification is normally prepared within 10 working days after it has received all required fees, information, documentation and verifications.
It also offers a two working day rush service for an additional $300 and a five working day rush service for an additional $200.
That means the published prices work out approximately as follows:
| Service | Published base price | Published processing time |
|---|---|---|
| Visa4Nurses standard | $600 | 10 working days |
| Visa4Nurses 5 day rush | $800 | 5 working days |
| Visa4Nurses 2 day rush | $900 | 2 working days |
| VisaScreen standard | $740 | 90% within 3.5 business days once documents are complete |
| VisaScreen expedited | $1,390 total | Review within 10 business days once documents are complete |
Josef Silny’s figures come from its current Visa4Nurses application materials, while TruMerit’s figures come from its current fee schedule and processing page.
On the standard processing stage, TruMerit currently appears faster.
TruMerit says that 90% of VisaScreen certificates are issued within 3.5 business days once all primary source documentation has been received and validated, and 50% are issued the same day.
That is substantially faster than Josef Silny’s published standard 10 working day period.
But there is an important catch.
The clock does not really start until the documents are there.
TruMerit says the average time for it to receive all necessary primary source documents is approximately 14 weeks.
That means a nurse should not read “3.5 business days” and assume the entire VisaScreen process takes three or four days.
The actual process can be considerably longer because universities, licensing authorities and other institutions have to send and verify documents.
TruMerit itself says that waiting for primary source documents is the greatest source of delay and that processing times can vary considerably by country.
This is probably the single most important practical point for nurses.
The credentialing company’s review time is often not the same thing as the total time required to obtain the certificate.
What about expedited processing?
This is where the comparison gets particularly interesting.
Josef Silny’s published rush options are:
Two working days: $300 additional fee
Five working days: $200 additional fee
That means the total would be approximately:
$900 for the two day option
or
$800 for the five day option.
TruMerit’s VisaScreen expedited review costs $650 in addition to the $740 application fee, bringing the total to approximately $1,390.
TruMerit says the expedited service guarantees that the active VisaScreen order will be reviewed within 10 business days after all required documents have been received, entered and imaged.
Importantly, it does not guarantee that the certificate will be issued within 10 days. If additional information is required, the review stops until the requested information is provided.
So if a nurse has a completely documented file and needs an expedited service, Visa4Nurses is considerably less expensive based on the currently published prices.
There is also an important difference in the way the two organizations describe their expedited services.
Josef Silny advertises a two working day rush certification for an additional $300.
TruMerit advertises a 10 business day expedited review.
That makes the services difficult to compare on a simple “who is faster” basis because they are describing somewhat different processes.
The safest conclusion is:
TruMerit currently advertises the faster standard review once a complete file is ready, while Josef Silny offers a very competitive rush option at a much lower additional cost.
There is another reason nurses choose Josef Silny
Cost is not the only reason.
Josef Silny operates a more focused service for nurses seeking this particular certification.
Its Visa4Nurses materials state that the service is conducted by mail and that applicants are responsible for having their educational institutions and licensing authorities provide the necessary verification.
This can be attractive to applicants who prefer a more traditional credential evaluation process.
TruMerit, on the other hand, has invested heavily in its online platform and digital verification systems.
TruMerit says its digital certificate can be accessed electronically and verified by government authorities through its secure platform.
It has also introduced additional digital identity verification procedures during 2026.
Therefore, there is a genuine difference in the overall user experience.
Josef Silny can be attractive to someone primarily concerned with price and a straightforward nursing specific certification.
TruMerit can be attractive to someone who values a larger established credentialing infrastructure and a highly digitalized process.
Neither statement means that one organization will necessarily be easier for every nurse.
The state nursing license can change the decision
This may actually be more important than the price difference.
A nurse should not choose a credentialing organization only by asking which one can issue the health care worker certificate.
The nurse should also ask:
Where am I going to obtain my U.S. nursing license?
State boards have their own requirements for internationally educated nurses.
Some states accept documentation from both TruMerit and Josef Silny. Others may have more specific requirements.
This means a nurse who intends to use the same credentialing organization for both licensing and immigration may find it more convenient to stay with that organization.
Connetics USA specifically discusses this issue and notes that Josef Silny is not accepted by every state in the same way as CGFNS for licensing purposes.
That is why there is no universal answer that Visa4Nurses is “better” or VisaScreen is “better.”
The correct answer depends partly on the state where the nurse plans to practice.
Visa4Nurses can be particularly attractive when the nurse already has a suitable licensing pathway
Imagine a nurse who already has a U.S. nursing license through a state that accepts Josef Silny for the relevant credentialing purpose.
That nurse may have little reason to pay the additional $140 for VisaScreen simply because CGFNS is the more familiar name.
On the other hand, imagine a nurse planning a licensing pathway where CGFNS documentation is already required.
In that situation, using TruMerit may make more sense even if the initial fee is higher.
This is why international nurse recruitment companies should avoid giving every nurse the exact same instruction.
The best process is to identify:
- The nurse’s country of education
- The nurse’s nursing degree
- NCLEX status
- U.S. state of licensure
- Current nursing license status
- English test and test date
- Immigration pathway
- Existing credential evaluation history
- Whether documents have already been sent to CGFNS or Josef Silny
That information can determine which option is more efficient.
The English requirement deserves special attention in 2026
This is an area where older online information can be misleading.
HRSA published a new list of approved English competency tests and scores effective May 12, 2026.
For registered nurses and other bachelor’s level health care workers, the current federal standards include:
IELTS: 6.5 overall and 7.0 speaking
OET: 360 speaking, 340 reading, 350 writing and 320 listening
PTE: 55 overall, 76 speaking and 62 in reading, writing and listening
MET: 58 overall and 59 speaking
Cambridge: 169 overall and 194 speaking
The applicable requirements depend in part on when the English examination was taken.
This creates an important publishing issue for anyone writing about Visa4Nurses.
Josef Silny’s Visa4Nurses PDF dated September 16, 2025 still displays the previous federal scores, including the previous PTE, OET and Cambridge requirements.
That document should therefore not be used by itself as the authority for the current 2026 federal English scores.
HRSA’s May 12, 2026 publication is the more recent federal source.
TruMerit has already updated its VisaScreen information to reflect the May 12, 2026 changes.
For a nurse applying today, the safest approach is to verify the current requirement with the credentialing organization and the applicable federal requirements rather than relying on an older PDF circulating online.
Another important point: English requirements can depend on the nurse’s education
Not every nurse necessarily needs to take an English examination.
For example, TruMerit explains that applicants can qualify for an English language exemption where their entry level professional education was completed in the United Kingdom, Australia, Canada except Quebec, New Zealand, Ireland or the United States and English was the language of instruction.
This is particularly relevant to Canadian nurses.
A Canadian educated nurse whose professional nursing education was completed in an eligible English language program may therefore have a very different process from a nurse who completed nursing school in another country and later obtained Canadian registration.
The important point is that the relevant issue is not simply the nurse’s nationality.
The location and language of the professional education matter.
TruMerit specifically states that its Canadian exemption does not include Quebec.
VisaScreen has one other advantage: familiarity
There is a practical advantage to VisaScreen that is difficult to quantify.
It has been part of the international nurse immigration ecosystem for a very long time.
Hospitals, recruitment companies, immigration lawyers and nurses are familiar with the name.
That does not make it legally superior to Visa4Nurses.
It simply means that VisaScreen has a larger historical footprint.
Josef Silny has been gaining recognition in the nurse immigration market since receiving its federal authorization in 2021.
The existence of two providers is actually useful for applicants because it introduces competition in an area where nurses previously had far fewer options.
What does this mean for EB 3 nurses?
For a nurse pursuing an EB 3 case, the most important thing to understand is that obtaining the certificate does not eliminate the rest of the immigration process.
Professional nurses have a special position under Schedule A, Group I, which allows employers to use a streamlined labor certification process rather than the standard PERM labor certification procedure applicable to most employment based positions.
But Schedule A is not VisaScreen.
VisaScreen is not EB 3.
And neither is NCLEX.
They address different parts of the overall process.
The nurse can therefore have:
NCLEX passed
U.S. nursing license
VisaScreen or Visa4Nurses certificate
EB 3 employer sponsorship
and still have to wait for visa availability depending on the nurse’s country of chargeability and the applicable Visa Bulletin.
This is particularly important during periods of EB 3 retrogression.
So which should a nurse choose?
There are several practical conclusions that can be drawn from the current information.
If price is the priority
Visa4Nurses currently has the lower published base price.
At $600 versus $740, the difference is $140.
For a nurse who does not need another credentialing service from TruMerit, that is meaningful.
If standard processing speed is the priority
TruMerit currently publishes the more aggressive standard processing time.
It states that 90% of VisaScreen certificates are issued within 3.5 business days once all primary source documentation has been received and validated.
Josef Silny publishes a standard 10 working day processing time.
However, neither number should be interpreted as the total time from application to certificate because obtaining and verifying documents can take much longer.
If expedited processing is the priority
The comparison becomes more complicated.
Josef Silny offers a two working day rush service for $300 above the base fee.
TruMerit’s expedited service costs $650 and provides expedited review within 10 business days after the file is complete.
Therefore, Josef Silny currently appears considerably cheaper for applicants who want to pay for an expedited service, based on the published prices.
If the nurse wants to minimize duplication
Look at where the nurse is getting licensed.
If the state board already requires or accepts documentation from one organization, using the same organization for the immigration certification may simplify the overall process.
If the nurse values an established digital infrastructure
TruMerit currently has the more developed online and digital verification environment.
That may matter to nurses and recruiters who are managing large numbers of candidates.
The bottom line
The debate over VisaScreen versus Visa4Nurses is sometimes presented as though one is the “real” certificate and the other is an alternative.
That is not the most accurate way to look at it.
For nurses, both services operate within the federal health care worker certification framework, and Josef Silny has formal USCIS authorization to issue the relevant certification for nurses.
The more useful comparison is practical.
Visa4Nurses currently has the lower published price.
VisaScreen currently advertises the faster standard review once a complete file is received.
Visa4Nurses offers comparatively inexpensive rush processing.
VisaScreen has the longer institutional history and a highly established presence in international nurse immigration.
The state where the nurse intends to become licensed can be more important than the price difference.
And perhaps most importantly, the biggest delay is often not the credentialing organization’s review time at all. It is getting complete, acceptable documents from universities, licensing authorities and other primary sources.
For that reason, a nurse who is preparing for U.S. immigration should not wait until the last moment to begin the credentialing process.
The best choice is the one that fits the nurse’s entire pathway, not simply the organization with the lower application fee.
For nurses, recruiters and employers, understanding that distinction can save both time and money and can prevent one of the most common misunderstandings in international nurse immigration: confusing a credentialing certificate with the immigration process itself.
U.S. Citizenship and Immigration Services (USCIS).Approval of Josef Silny & Associates as a Credentialing Organization for Health Care Workers. Federal Register, July 29, 2021.
Federal Register – Josef Silny approvalJosef Silny & Associates.Visa4Nurses: Application for Certificate for Foreign Health Care Workers.
Josef Silny & Associates – Visa4NursesTruMerit (formerly CGFNS International).VisaScreen: Visa Credentials Assessment.
TruMerit – VisaScreenTruMerit.Application Processing Times and Fees.
TruMerit – Processing TimesHealth Resources and Services Administration (HRSA).English Language Proficiency Testing Requirements for Foreign Health Care Workers, effective May 12, 2026.
HRSA – English Language Requirements
