There are two major tests every international nurse must pass in order to make it to the USA:
- NCLEX-RN exam
- IELTS English language exam (nurses from English-speaking countries are exempt from this test)
The order in which these should be cleared is debatable as is which examination is more difficult. So, let’s not focus on issues so subjective. Let’s tackle this process head on.
After watching the video below and reading this article, international nurses will be able to make smart choices regarding how to qualify to sit for the NCLEX exam.
#1: Apply for a nursing license with a U.S. State Board of Nursing.
A U.S. State Board of Nursing must grant you permission to take the NCLEX exam and will do so only after you meet its requirements. Furthermore, each state has differing requirements. With so many U.S. states, how does one decide which state is best to apply through, and does it really matter?
Yes, this can be a daunting process, and yes, it does matter which state.
Our Recommendation on Choosing a State Board of Nursing to Apply Through (And Those to Avoid)
Some states require more exhaustive educational and English language certifications (even if your nursing program was taught in English) before they allow an international nurse to take the NCLEX exam. Even though you will be required to pass the IELTS English language examination in the future to secure a U.S. visa, we are not focused on that now. (Remember, the point of this article is not to get you a U.S. visa – but a ticket to take the NCLEX). And unless you are unclear why taking and passing the NCLEX is so important here’s why:
There are tens of thousands of international nurses wanting to come to the USA. Having passed the NCLEX is a bit like when Charlie got the golden ticket in Willy Wonka and the Chocolate Factory (obscure U.S. movie reference).
The point here is that once you pass the NCLEX exam, companies and hospitals that recruit international nurses for opportunities in the USA take you seriously. Once you pass NCLEX you’re at the front of the line and these companies will INVEST to help you make it to the USA.
One more thing to point out: some states, such as California, will not issue an actual nursing license until a U.S. Social Security Card has been issued. Other states with this same guideline include Arizona, Maryland, New Jersey, and Vermont. We recommend not filing through these states as it just complicates things. The issue here is that no U.S. Social Security Card is issued until a visa has been issued. This situation can be remedied but is a hassle nonetheless – and one that is better off avoided. If your goal is to work in one of the previously mentioned states, your nursing license can be endorsed to that state at a later date. In fact, it is not uncommon for a U.S. nurse to hold three, five, or even 10+ licenses for different states.
Simply put, AVOID FILING THROUGH STATES THAT WON’T ISSUE A LICENSE WITHOUT A SOCIAL SECURITY CARD.
Step #1 Completed: You’ve selected a state Board of Nursing to apply through.
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#2: Evaluation of your Nursing Qualifications
When you apply for a nursing license through your state selected from Step No. 1, you will also need to submit proof that backs up your credentials as a nurse. This includes, but is not limited to, the results of a credential evaluation service.
The most popular credential evaluation service is offered by the Commission on Graduates of Foreign Nursing Schools (CGFNS International).
But wait, there are other companies that offer credential evaluations, companies that may be cheaper and still accepted by State Boards. These include:
- International Education Research Foundation (IERF) ($350 per report, see states that accept IERF) States that accept IERF include: Arizona, Arkansas, California, Florida, Michigan, Missouri, Montana, New Mexico, North Dakota, Oregon, Texas, Vermont, and Washington
- Educational Records Evaluation Services (ERES) ($375 basic fee)
Before you go the way of IERF or ERES, you should first check to see if your state Board accepts these alternative companies. And as much as we like to see competition, we still can’t help but advise nurses to use CGFNS because of its nearly universal acceptance and brand recognition.
So, let us assume you use CGFNS.
Which CGFNS evaluation service should you choose? CGFNS offers five distinct services for international nurses. Here is a brief description of each one:
Certification Program (CP): The Certification Program includes the CGFNS Qualifying Exam® for first-level, general nurses; a credentials evaluation of secondary and nursing education and registration; demonstration of passing one of the accepted English language proficiency exams. When successfully completed, applicants receive the CGFNS Certification Program Certificate, whereby, an official verification can be sent to the respective state Board requiring this assessment as a prerequisite for authorization to sit for the NCLEX® exam. The CGFNS Certification Program Certificate is valid for life.
Credentials Evaluation Service (CES) Professional Report meets the specific requirements of individual State Boards of Nursing. The CES professional report provides a detailed analysis of the credentials earned at multiple levels of nursing education received outside the United States according to requirements specific to a state. The report includes a statement of comparability of an applicant’s education when measured against U.S. standards.
Credentials Evaluation Service (CES) Academic Report is designed to meet the needs of applicants pursuing further education in U.S. institutions of higher learning. The CES Academic Report provides a detailed analysis of the nursing education received outside the United States. The report is advisory in nature and does not make specific placement recommendations.
VisaScreen®: Visa Credentials Assessment (VS) certification is a comprehensive screening program for health care professionals who are not U.S. citizens and are seeking an occupational visa to work in the United States. The VisaScreen®: Visa Credentials Assessment Service requires specific health care professionals complete a screening program before they can receive either a permanent or temporary occupational visa, including Trade NAFTA status:
- An assessment of an applicant’s education to ensure that it is comparable to that of a U.S. graduate in the same profession
- A verification that all professional health care licenses that an applicant ever held are valid and without restrictions
- An English language proficiency examination
- For registered nurses only, a verification that the nurse has passed either the CGFNS Qualifying Exam®, NCLEX-RN® or for select years and Providences its predecessor, the State Board Test Pool Examination (SBTPE).
NOTE: You will need a full VisaScreen to get a U.S. visa, but not now to sit for the NCLEX exam. (Remember, the point of this article is not to get you a U.S. visa – but a ticket to take the NCLEX)
Credential Verification Service for New York State (CVS) verifies the authenticity of international education and licensure credentials for the state of New York. The service is for those healthcare professionals educated outside the United States who wish to practice in New York. As specified by the state, CGFNS International completes a verification of foreign education and credentials. New York State Education Department then completes the actual evaluation of the verified credentials.
The table below shows certification required by state:
|State Board of Nursing||CGFNS services required or accepted for Registered Nurses (RNs)||Secondary School Evaluation Required for CES Report||Website|
|Alabama||CP and CES||Yes||Link|
|Alaska||CES or CP||No||Link|
|America Samoa||No CGFNS requirement||N/A|
|Arizona||CES, VS or CP||No||Link|
|Arkansas||CES and English, CP or VS||Yes||Link|
|California – RN||CES may be accepted||N/A||Link|
|Colorado||CES and English||No||Link|
|Connecticut||CP and CES||No||Link|
|Delaware||CP and CES||Yes||Link|
|Georgia – RN||CES or CP||Yes||Link|
|Guam||CP, CES may be accepted||Yes||Link|
|Hawaii||CES or CP||No||Link|
|Idaho||CES or CP||No||Link|
|Illinois||CES, VS or CP||Yes||Link|
|Iowa||CES and English or CP||No||Link|
|Louisiana – RN||CP||No||Link|
|Maine||CES or CP||Yes||Link|
|Massachusetts||CES, CP or VS||No||Link|
|Michigan||CES and English or CP||No||Link|
|Minnesota||CES or CP||No||Link|
|Mississippi||CP or CES||No||Link|
|Missouri||CES or CP||No||Link|
|New Hampshire||CP or CES||No||Link|
|New Jersey||CES and English or CP||Yes||Link|
|North Carolina||CES or VS||No||Link|
|North Dakota||CP, CES may be accepted||No||Link|
|North Marianas Islands||No CGFNS requirement, CES may be accepted||Yes||Link|
|Oklahoma||CES, VS or CP and transcripts||LPN only||Link|
|Oregon||CES, CP or VS||No||Link|
|Pennsylvania||CP and transcripts||LPN only||Link|
|Puerto Rico||No CGFNS requirement||N/A|
|Utah||CP and CES||No||Link|
|Vermont||CES, CP may also be required||Yes||Link|
|Virgina||CES and English, or CP||Yes||Link|
|Washington||CES or CP||No||Link|
|Washing DC (District of Columbia||CP, CES may be accepted||LPN only||Link|
|West Virginia – RN||CP||Yes||Link|
A cursory review of the above table shows that Credentials Evaluation Service (CES) Academic Report is among the most commonly accepted. The CES is also one of the least arduous to obtain as it is much less comprehensive than the Visa Screen and does not require a review of secondary education or demonstration of English language proficiency.
Remember the goal here is to GET THE GOLDEN TICKET to get agencies to take you seriously.
Our recommendation for the CGFNS service to use is therefore the Credentials Evaluation Service (CES) Academic Report.
Step #2 Completed: Credential Evaluation Service Selected.
#3: Final Steps to Complete Your State Nursing License Application
The remaining steps to be granted an authorization to test (ATT) for the NCLEX are rather straightforward and include items such as:
- Submitting the complete State Board of nursing application
- Paying all fees associated with the application
- Completing a criminal history report
- Providing verification of foreign nursing licenses
Additionally, some states require proof of a minimum length of and/or recency of nursing work experience.
The State Boards of Nursing provide pretty detailed instructions on these steps and if you follow them there really aren’t any decisions that need to be made, so we’ll not delve into those items in detail.
#4: Waiting for Your Authorization to Test
Once the above steps have been completed, the State Board of Nursing for your chosen state will review your application. This can take a few weeks to a few months. During this time you must be preparing diligently for the actual NCLEX examination.
Why study now? Because once the State Board declares that you are eligible to take the NCLEX, you will receive an Authorization to Test (ATT).
A few points critical on your ATT Notification:
- You will receive ATT notification via the email you provided when registering
- Each ATT is valid for a period of time specified by the BON/RB (the average length of an ATT is 90 days).
- Once the BON/RB has declared you eligible to test and you receive your ATT, you must test within the validity dates on the ATT.
- These ATT validity dates cannot be extended for any reason.
So the fact that the ATT has an expiration date is why you must be diligently preparing to take the NCLEX throughout this process. Your nursing knowledge will soon be tested as you sit for the formal NCLEX examination . . . but more on that in another article.
#5: Selecting an NCLEX Test Center
You can’t actually schedule your NCLEX exam at a test center until you receive your ATT. But prior, to receiving your ATT you should have a plan on when and where you will be sitting for the exam.
NCLEX test centers are only located in the USA, England, Hong Kong, India, Japan, Mexico, Philippines, Puerto Rico and Taiwan. Included in the U.S. test centers are American Samoa, Guam, Northern Mariana Islands and the U.S. Virgin Islands. So you may have to plan for and budget a trip to a testing location outside your country of residence.
DON’T WAIT TO SCHEDULE. Once you receive your ATT, don’t wait to schedule an exam appointment as it may limit the selection of dates from which you can choose to schedule. Additionally, some test center locations may fill up and be unavailable.
If you are a first-time test taker you will be offered an appointment within 30 days of the request to schedule an appointment. Repeat candidates will be offered an appointment within 45 days. If you wish, you may decline the appointment offered and schedule later than the 30 or 45 days. If your first choice date or time is unavailable, you will be offered an alternative as close to your first choice as possible.
Tips on Managing Expenses
Aside from the steps outlined above, there are a few financial matters to consider. Here are some tips on planning and managing the costs involved:
- Plan not only for the costs of license applications and test registration, but for any test prep services you may need, travel and accommodations to NCLEX test location and international mailings of documents
- If you are working with an agency, even if you are not yet contracted with them, ask what costs they will be able to either reimburse, defray, or pay for upfront.
Remember, sitting for the NCLEX is an investment in your AND YOUR FAMILY’S success. The U.S. market needs and welcomes international nurses – even if the current immigration situation is slowed down due to retrogression.
We hope this article clarifies a few of the steps in the process to becoming a U.S. nurse. Get started toward passing the NCLEX exam today by applying for a CGFNS credential review and visiting the website for the U.S. State Board of nursing through which you choose to apply to get specific requirements.