Yes, you will need to complete the Visa Screen process thru CGFNS. Yes, you will need to complete the English requirements now, same as you would for a green card. My suggestion, go for the green card. Very few hospitals are sponsoring now with H1-B visa. Please PM me if any of you have any further questions, and I can give you better answers more detailed to what your needs are. These new rules are in effect now. If you did not start the process ofr an H1B visa by September you have to complete the full requirements. Also, if you don't, and managed to get to the US on an H1B, and have to leave the country for some reason after July, 2005, you will not be allowed back in without the Visa Screen. My suggestion, take the CGFNS, as well as NCLEX, and your English exams, then you will be set. If you skip CGFNS, and decide to move to another state before you have worked in the US for two years, you will be required to complete CGFNS exam to get a license in most other states now.