The delivery of nursing and health care services is increasingly global in nature, largely as the result of international trade and migration. For the delivery of care and services to be safe, international regulation must come into play. Ensuring nurse competency depends on evaluation in three fundamental areas: knowledge and skills, clinical judgment, and language competency. Countries use a variety of regulatory methods, and there is no perfect regulatory model. Each presents its own challenges in the areas of screening, supervision, and testing. Regulation is going international with several regions having developed mutual recognition agreements. The implementation of trade agreements such as General Agreement on Trades in Services may pose new challenges for international regulation in nursing, the basic purpose of which must remain protection of the public.