Healthcare organizations in the U.S. are experiencing a shortage in the nursing workforce. Since nurses are essential to the delivery of health care, it is not surprising that foreign-educated nurses are coming to the U.S. to fill gaps in nursing services. Those who want to become a nurse in the U.S. must be willing to invest time and patience in the intensive process.

Basic Information

There are two major processes you have to undergo: the licensing process and the education qualification process.

1. For licensing, each state has different requirements for you to obtain a license to work. It is thus essential to determine in what state you will be working so that you satisfy all requirements for licensure. The primary licensing requirement is for you to successfully complete the Nursing Comprehensive Licensure Examinations for Registered Nurses (NCLEX-RN).
2. For education qualification licensing, you will have to undergo a certification process administered by the Commission on Graduates of Foreign Nursing Schools (CGFNS). Essentially, CGFNS is designed to assess your likelihood of passing the NCLEX-RN licensure examination and becoming licensed as a registered nurse in the U.S.

This involves: the Certification Program; VisaScreen; and the Credentials Evaluation Service. The Certification Program and the Credentials Evaluation are required by the State Boards of Nursing, while the Immigration and Naturalization Service (INS) needs the VisaScreen certificates.

Certification Program (CP)

The CP consists of three parts: review of credentials; a Qualifying Exam on nursing knowledge, and the TOEFL.

• Credentials Review: This step examines your foundation in theory and practice in five fields of nursing: medicine, surgery, obstetrics, pediatrics, and psychiatry, to see if these are comparable to U.S. standards.
• Language Tests: The Test of English as a Foreign Language (TOEFL) measures your English language proficiency. TOEFL and the CGFNS Qualifying Exam should be taken within 2 years of each other to remain valid. The tests include Test of Written English and Test of Spoken English.
• CGFNS Qualifying Exam: To be eligible for the exam, you must possess a valid nurse’s license from your country and comply with specified hours of instruction and clinical practice in the five fields of nursing practice mentioned above.

Only 11 states allow you to take NCLEX-RN without completing the CGFNS Qualifying Exam first. For the 39 other states and the District of Columbia, you must pass CGFNS before taking NCLEX-RN.

The CGFNS Qualifying Exam is given only 3 times a year in over 40 locations worldwide. The CGFNS Website publishes this information.
Fees for the CP (includes the CGFNS Qualifying Exam fee) are $418 for first application; $308 for re-application. There are smaller fees for other transactions.

VisaScreen Certificate

The International Commission on Healthcare Professions (ICHP), a unit of CGFNS, administers VisaScreen. This certificate is a requirement for processing of your occupational/residency visa. The requirements for processing the VisaScreen Certificate are:

• Completed application form
• Validation of past and present licenses, to come from licensing authorities. Forms are supplied in the packet, but you handle sending them to the licensing authorities in your country after filling out the forms.
• Successful completion of the TOEFL
• Successful completion of CGFNS Qualifying Exam or NCLEX-RN examination
• Copy of high school diploma or equivalent
• Payment of application fee. The initial certification process requires $448 and there are other fees for renewals, replacements, and other transactions.

Credentials Evaluation Service (CES)

Conducted by CGFNS, this evaluation process is more exhaustive than the credential review performed in the CP. The CES examines the content of your entire nursing education and professional program to confirm its comparability with the U.S. program of study. The CES report goes to the State Board of Nursing, employers or other entities that may require it.

Different recipients may require different credentials. Check to make sure you submit exactly what is required. Note that academic records and license validations will be sent by issuing bodies.

Get the CES application (or download it) from CGFNS. Complete the form and send it to CGFNS, along with all required documents and full payment on fees (only in US dollars). Send all documents only by regular postal mail.

Request your school and licensing authorities to send to CGFNS your academic transcripts and license validations.

The CES fee for a full education report is $378 (for study purposes); for the healthcare profession and science report, the fee is $328 (for work purposes). There are other smaller fees, but the most relevant is the CGFNS Language Report for Boards of Nursing, equal to $75 each.

The education qualification process may take about one year to complete. If you can hurdle this process successfully, you may find a rewarding career that gives access to more advanced technology, better working conditions, and higher pay in the United States.