Making a Smooth Transition: International Nurses Guide to Working in the USA

Nurse is a word to describe a person who is strong enough to tolerate anything and soft enough to understand anyone. Nursing offers a blend of compassion and expertise that shapes the lives of many with their healing hands and thus positively impacts communities. Nursing provides a satisfying journey where empathy meets innovation.

We know how healthcare professionals strived hard during the pandemic. Not only during the pandemic but every day of the nurse's life is a struggle. But the satisfaction they get at the end of the day boosts them to face the next struggling day. "America’s nurses are the beating heart of our medical system. —Barack Obama. American nurses play a vital role in providing the world’s best healthcare facilities to the public. Due to several factors, the US faces a nursing shortage, attracting many international nurses to work there. International nurses should meet certain eligibility criteria to become nurses in the USA.

The basic requirements to work as a nurse in the USA are,

In order to practice in United States foreign-educated should meet English language proficiency in addition to educational requirements. English proficiency is a vital component to ensure effective communication in the healthcare setting and uphold patient safety.

The commonly accepted language proficiency tests include:

Test of English as a Foreign Language (TOEFL): TOEFL assesses reading, listening, speaking, and writing skills in English. It's widely used by educational institutions and professional licensing boards.

Test of English for International Communication (TOEIC): TOEIC focuses on English communication skills in international business and professional contexts. While it's not as commonly used in healthcare, some states might accept it as proof of language proficiency.

International English Language Testing System (IELTS): IELTS assesses English language skills across four language domains: listening, reading, writing, and speaking. It's commonly used for immigration, academic, and professional purposes.

United Kingdom, Australia, New Zealand, Canada (except Quebec), and Ireland: Nurses who completed their education in these English-speaking countries are often exempt from language proficiency testing. Their education already took place in an English-language environment that ensured their proficiency.

For international nurses aspiring to work in the United States, the journey involves navigating a series of requirements as we discussed and the steps to ensure that their education, skills, and qualifications align with the standards set by the US healthcare system. One of the essential components of this process is completing a Foreign-Educated Nurses (FEN) course.

While foreign-educated nurses bring valuable skills and experiences to the US healthcare landscape, it's crucial to ensure that their education and training are in line with the country's healthcare standards. This is where the Foreign-Educated Nurses (FEN) course comes into play. This refresher course is designed to bridge any potential gaps between the nurse's foreign education and the requirements of practicing in the US.

The FEN course typically comprises two key components:

Classroom Hours: The course involves approximately 120 hours of classroom instruction. During this phase, nurses receive updated information on US healthcare practices, regulations, and standards. This theoretical foundation equips them with the knowledge needed to excel in their clinical practice.

Clinical Practice: In addition to the classroom hours, the FEN course also includes 120 hours of hands-on clinical practice. This phase is carried out under the supervision of a licensed Registered Nurse (RN). This practical experience is invaluable as it allows nurses to apply their learning in real-world healthcare settings.

While completing a Foreign-Educated Nurses (FEN) course is a common requirement for foreign-educated nurses, it's important to note that state regulations and requirements can vary. Different states may have specific rules regarding the FEN course, its duration, and the clinical practice component. Aspiring nurses should research the specific requirements of the state in which they intend to practice to ensure compliance.

The NCLEX-RN (National Council Licensure Examination for Registered Nurses) is a significant milestone for aspiring nurses in the United States. This comprehensive exam is designed to assess the knowledge, skills, and abilities necessary for safe and effective entry-level nursing practice. Successfully conquering the NCLEX-RN is a crucial step towards obtaining your nursing license and launching your nursing career.

Before delving into preparation strategies, it's essential to understand the structure and purpose of the NCLEX-RN exam:

Computerized Adaptive Testing: The NCLEX-RN is administered via computerized adaptive testing, which means that the difficulty of the questions adjusts based on your responses. The goal is to determine your competency level with a high degree of accuracy.

Question Types: The exam features a variety of question types, including multiple-choice, select-all-that-apply, and ordered response questions. These diverse formats evaluate your critical thinking and clinical reasoning skills.

Client Needs Categories: The NCLEX-RN exam is organized into four main client needs categories: Safe and Effective Care Environment, Health Promotion and Maintenance, Psychosocial Integrity, and Physiological Integrity. Each category encompasses specific content areas.

Remember that the state board for the NCLEX need not necessarily match your work destination. Your work placement often depends on the institution that selects you. Regardless of the U.S. license obtained, applying for an endorsement of the license is essential. When selecting a state for the NCLEX, consider board requirements, such as IELTS or TOEFL results, clinical experience, and the need for a Social Security Number (SSN).

When pursuing a nursing career in the United States as a foreign-educated nurse, navigating the complex landscape of credential evaluation is crucial. The Commission on Graduates of Foreign Nursing Schools (CGFNS) is a significant player in this process, tasked with ensuring that applicants meet the necessary requirements and are well-prepared to take the NCLEX-RN exam. Let's delve into the role of CGFNS and the different types of credentialing reports it offers.

Established in 1977 as a response to the growing immigration of foreign-born and educated registered nurses, CGFNS was developed in collaboration with the U.S. Department of State and Labor. The primary objectives of CGFNS are twofold: to ensure the delivery of safe patient care in the U.S. and to prevent the exploitation of graduates from foreign nursing schools who are employed in the country.

CGFNS undertakes a thorough assessment of nursing school transcripts and educational history from your home country. While it's one of the most well-known and popular organizations for credential evaluation, it's worth noting that the process can be expensive and the specific requirements vary from state to state.

CGFNS offers three main types of credentialing reports to accommodate different needs:

1. Credentials Evaluation Service Professional Report

This report provides the essential information required by the State Boards of Nursing. It's a less complex and more cost-effective option compared to the Certificate Program or VisaScreen. However, only a limited number of states accept this report.

Requirements for this report include:

2. CGFNS Certification Program

This evaluation is similar to the Credentials Evaluation Service Professional Report but requires applicants to take the CGFNS Qualifying Exam. This exam further assesses your nursing knowledge and competence.

3. Visa Credentials Assessment (VisaScreen)

Visa Screen is a comprehensive evaluation report that includes both a credentials review and an assessment of your English language proficiency. This report is particularly essential for nurses seeking a U.S. visa.

Credential evaluation through CGFNS plays a vital role in the journey of foreign-educated nurses.

For nursing practice in the USA, professional licensure from the state of employment is a must. Each state has its own nursing board regulations. Passing a state-specific licensure exam is often required. First-level general nurses from outside the U.S. might choose the CGFNS Certification Program before taking the licensure exam.

Securing an RN Immigrant Visa is streamlined with employer or agency assistance. The Commission on Graduates of Foreign Nursing Schools (CGFNS) receives a visa screen certificate from authorities.

Completing the complex steps leads to the visa interview and health checkup stages. Following successful completion, the Citizenship and Immigration Service (USCIS) forwards your file to the National Visa Center (NVC) for further processing. After a successful visa interview, the embassy issues the visa. A health checkup is required before visa issuance.

The visa processing timeline can vary from days to weeks, with occasional delays or denials.

Embarking on a nursing career in the USA as an international nurse is an intricate journey, encompassing exams, licensing, and interviews. By meticulously following these steps, you'll inch closer to your goal of contributing to healthcare in the United States.

Preparing for the NCLEX-RN exam requires a combination of effective study techniques, time management, and self-assessment. Here are some strategies to help you conquer the exam:

Create a structured study plan that outlines your study goals, topics to cover, and a realistic timeline leading up to the exam date. Allocate time for each client’s needs category and make sure to include review and practice sessions.

Thoroughly review the content areas within each client needs category. Understand key concepts, medical terminology, and nursing interventions. Use reputable study resources, textbooks, and review books to reinforce your understanding.

Engage in consistent practice by answering a wide range of practice questions. These questions will help you get accustomed to the format of the exam and enhance your critical thinking skills. Many study guides and online resources offer practice questions.

Set up a study environment that mimics the actual testing conditions. This helps you become comfortable with the testing format and reduces anxiety on exam day.

Consider enrolling in an NCLEX-RN review course. These courses provide comprehensive content review, practice questions, and valuable insights from experienced educators.

After completing practice tests, thoroughly review your answers, especially the ones you got wrong. Understand the reasoning behind the correct answers and learn from your mistakes.

During the exam, time management is crucial. Answer questions efficiently without spending too much time on any single question. If you're unsure about an answer, mark it and move on, then come back to it later if time allows.

Maintain a positive mindset and manage test anxiety. Engage in relaxation techniques, deep breathing, and positive self-talk to stay calm during the exam.

Ensure you're well-rested and well-nourished leading up to the exam day. A healthy body and mind contribute to improved concentration and performance.