Are you a nurse who would like to practice your profession in the U.S.?
Are you a nurse intending to come to the United States and obtain a “green card”?
If “Yes” is your answer to the above questions, then this chapter is “essential reading” for you! In a document developed by the American Association of Colleges of Nursing (June 2010), it was reported that the shortfall in the number of nurses needed (in the U.S.) is expected to grow to 260,000 by the year 2025. This means that there is likely to be plenty of opportunity for foreign nationals trained in the field of nursing to find employment in the U.S.. Below, you will find the step-by-step procedure to make this a reality for you! (First, you’ll be provided with a general overview of the steps, and then a more detailed analysis of those steps, which require extra attention.
Step 1: Screening test; you need to be screened regarding English Proficiency, register and train for IELTS4, and then take the Exam;
Step 2: Sign up for a U.S. recruiting company: see Appendix 6 for a list of job search engines in the U.S.;
Step 3: Register and train for CGFNS5, then take the Exam;
Step 4: Get NCLEX6 training; 155
Step 5: Go through the Visa Screening process;
Step 6: File for your green card;
Step 7: Wait for green card approval;
Step 8: Get placed for a job;
Step 9: Go to the Embassy/Consulate for an interview;
Step 10: Come to the U.S.;
Step 11: Take the NCLEX/ RN Exam;
Step 12: START WORKING AS A NURSE IN THE U.S.!
It will be valuable to have a clear picture (and a deeper understanding) of some these steps, so please read the following carefully to ensure your pathway forward is as smooth as possible.
If you are a nurse in a foreign country and intend to immigrate into the U.S., it is necessary for you to pass the Test of English as a Foreign Language examination (Step #1 above), which is conducted by the International English Language Testing System (IELTS). It is highly recommended that you visit their website and review what is required to pass this exam.
As Step #2 above conveys, it is essential that you begin your search for a nursing position in the U.S. well in advance of your application for your visa. It will be good to review the list of job search engines provided in the back of this book in Appendix 6, as they are potentially valuable resources to assist you in securing a nursing job.
Regarding Step #3 above, it is the law that you must obtain a full and unrestricted license to practice as a nurse in the particular state in the U.S. where you will be working as a nurse (for example, if you intend to work in California, you would need to obtain a California nursing license). As an alternative, you can provide certification that you have passed the examination, which is administered by the Commission on Graduates of Foreign Nursing Schools (CGFNS) or evidence that you have passed the NCLEX-RN licensing exam, but you are unable to obtain a license because you do not have a Social Security Number.
Most of the States in the U.S. require that a foreign nurse should pass the CGFNS exam before taking the state licensing exam, commonly referred to as the NCLEX exam. These states are as follows:
Alabama, Alaska, Arkansas, Colorado, Connecticut, District of Columbia, Florida, Georgia, Hawaii, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nebraska, New Hampshire, New Jersey, North Carolina, North Dakota, Oklahoma, Pennsylvania, Rhode Island, South Carolina, South Dakota, Texas, Vermont, Virginia, Washington, West Virginia, and Wyoming.
WHAT IS THE CGFNS?
The CGFNS is a certification program for Registered Nurses (RN’s) educated outside the U.S., who want to work in their profession in the U.S.
The program has 3 parts to it:
- Your background will be reviewed. You need to show you graduated with a Nursing degree and that you’re registered and licensed as a nurse;
- You have to demonstrate that you’ve completed classes and have practical experience in:
- Adult Medical/Surgical Nursing;
- Maternal/Infant Nursing (Obstetrics);
- Care of Children (Pediatrics);
- Psychiatric/Mental Health.
- You will be tested on your nursing knowledge (the CGFNS Exam).
PASSING THE CGFNS EXAM
The certificate that is issued by the CGFNS demonstrates that the Registered Nurse has complied with the following:
- A credentials evaluation giving evidence that the RN’s education is the equivalent of an RN diploma or nursing degree from the U.S.;
- Proof that the Registered Nurse has passed the English language proficiency exam; and,
- Evidence that the applicant has managed to pass the CGFNS exam.
The primary goal of the CGFNS is to ensure that the nurse will be able to qualify for the requirements for U.S. licensure once they enter the U.S.. If the applicant has already passed the NCLEX-RN exam, they will not be required to obtain the CGFNS certificate. 157
All Registered Nurses are also required to comply with the licensing requirements of the state of intended employment. All intending foreign Registered Nurses should check with the state of intended employment to determine if there are other special needs.
To work as a nurse in the U.S., however, it is not sufficient to simply have completed your nursing training abroad and passed the CGFNS Exam. As Step #4 above indicates, you must also take and pass the NCLEX, an exam that is described in more detail below.
WHAT IS THE NCLEX?
The NCLEX is an exam for the licensing of nurses in the U.S.. The National Council of State Boards of Nursing, Inc. (NCSBN), which has board members from all over the U.S., administers this.
By administering the NCLEX to all foreign national nursing applicants, the NCSBN makes sure that each nurse from outside the U.S. has the knowledge, skills, and essential abilities to practice nursing safely and efficiently. Passing the NCLEX is REQUIRED for nurses who want to work in the U.S. You will be tested on:
- Safe Effective Care Environment:
- Management of Care;
- Safety and Infection Control.
- Health Promotion and Maintenance;
- Psychosocial Integrity;
- Physiological Integrity:
- Basic Care and Comfort;
- Pharmacological and Parenteral Therapies;
- Reduction of Risk Potential;
- Physiological Adaptation.
It is highly recommended that the applicant reviews the NCLEX online training site and considers going through their training program. Once the NCLEX has been successfully passed, the applicant may legally begin working as a nurse for their hiring hospital, organization, or company. 158
Regarding Step #5 above, every applicant must fulfill the following visa screening requirements:
- You should have a diploma or a degree in Nursing from your home country;
- You should be licensed as a Registered Nurse in your home country;
- You will have to obtain a full and unrestricted license to practice as a nurse in the particular state in the U.S. where you will be working as a nurse (for example, if you intend to work in California, you would need to obtain a California nursing license). As an alternative, you can provide certification that you have passed the examination, which is administered by the Commission on Graduates of Foreign Nursing Schools (CGFNS), or evidence that you have passed the NCLEX-RN licensing exam, but you are unable to obtain a license because you do not have a Social Security Number;
- You should provide a credential evaluation of your education, giving evidence that your education is equivalent to that of an RN from the U.S.;
- Be ready to provide certified translations of documents that are not in English.
Regarding Step #6 mentioned above, the “good news” is that Registered Nurses are listed by the United States Department of Labor as “Shortage Occupations.” Unlike most professionals who have to undergo the rigorous requirements giving evidence that there are not enough American workers to fill a position by the Department of Labor, Registered Nurses do not have to meet this requirement. In other words, since Registered Nurses do not have to undergo the Labor Certification process, they obtain their “green cards” faster than most other categories. The demand for Registered Nurses in the U.S. is very high, and it is quite rare to find a good Registered Nurse jobless in the U.S..
Steps #7 and #8 above are basically waiting for your green card to get approved and getting placement for a nursing job within the state you wish to work.
Before you go to the Consulate’s office for your interview (Step #9 above), be sure to read Appendix 1 in this book, titled “Rules to Follow During the Interview Process.” It will ensure that you have as smooth and successful an interview experience as possible.
The next steps (Steps #10 and #11) will require you to come to the U.S. and take the NCLEX/RN Exam. As discussed earlier, it is suggested that you consider taking the NCLEX online training before taking the exam.
Once you’ve completed the exam and successfully passed it, you are then at Step #12: You’re ready to begin practicing as a nurse at the position you’ve been hired to fill. CONGRATULATIONS! 159
To begin working as a nurse in the United States, a series of specific steps must be taken, primarily aimed at ensuring you are properly trained, qualified, knowledgeable, and practiced in the field of nursing. Some of these steps include testing and examination on essential aspects of nursing and health care. Permanent immigration for nurses falls under the EB3 category of the Visa Bulletin. Currently, the average time for a nurse to qualify for permanent residence may turn out to be a few years.