|NCLEX for Foreign Nurses – A guide.
Written by Meladee M. Stankus, RN MS
Note: As of August 1, 2002 the Arizona Board of Nursing will accept
applications from foreign educated nurses who have not completed the CGFNS
exam. These nurses will only need the TOEFL or similar English exam, if
their nursing education in their country was not in English. In addition,
the nurse must have the nursing program transcripts evaluated for
equivalency to US nursing educational standards and a validation of
unrestricted licensure in their country or origin.
This will facilitate the licensure into Arizona for those foreign
nurses who would prefer to take the NCLEX. And not take
The National Council License Exam (NCLEX) is a test that each nurse
must pass in order to obtain a license to practice nursing in the state
where they will work. In the United States, licensing is under the
authority of each individual state, not the federal government. Nurses
cannot apply directly to the NCLEX, but must apply through one of the
State requirements for foreign educated nurses.
Each state has unique laws and regulations for Registered Nurses.
Differences are apparent between states in requirements for foreign
educated nurses. For example, California and Nevada have very different
requirements . California does not require that a foreign educated nurse
have passed the CGFNS exam in order to apply for licensure. California
does require that the nurse undergo a credential review by specialists
within their agency. This means that foreign nurses must have their
transcripts from their nursing school sent directly to the California
Board of Nursing as well as documents verifying their license from the
licensing authority in their country. Unfortunately, California will not
accept the Visa Screen by the CGFNS or any other credential evaluation.
They will review a copy of a credential certificate from another source,
but California still must complete their own review of the transcript.
Since the immigration law specifically requires the Visa Screen, foreign
nurses applying for licensure in California, must be credentialed
twice, and have the forms and transcripts sent to both California
and the CGFNS. CGFNS will not accept the California Board of Nursing
Credential Review. Neither California or the CGFNS will recognize their
respective credential review, leaving the foreign nurse with two sets of
fees, the potential for delays when documents are not received, etc. The
most common cause for delays in the completion of the credentialing by
both agencies is not receiving the required documents from the licensing
agency and also from the nursing school in a timely manner. Note: As of
this July 2002, California is now requiring the foreign educated nurse
applicant to provide a valid social security number. California will only
issue a temporary license without the social security number.
Unfortunately, the INS will not accept a temporary license to file the
I-140 and/or adjustment of status. As long as this situation exists, I
would not recommend foreign educated nurses apply in California for
purposes of filing the I-140 unless they are also a CGFNS test passer. If
they are a CGFNS test passer with a pass on TOEFL, the I-140 petition can
be filed. Then if a concurrent adjustment of status and EAD is filed, the
nurse can apply for the social security card after the EAD is received in
about 90 days. Then....with the social security card, the nurse can obtain
the full license. However, with the temp license and the social security
card, the nurse can begin to work.
Application forms from various agencies can be difficult to complete.
Some of the applications forms are written in language that native
speakers, find confusing, let alone someone who has English as a second
language. In addition, when the foreign educated nurse, who is residing
abroad tries to phone these licensing agencies, they often get busy
signals as well as long waits. This can be expensive and frustrating.
Carl Schusterman, the leading US Immigration Law firm, handling
healthcare workers, has provided links to various states web sites to
assist with solving state problems. Not all states have web sites and
those that do have web sites, may not have
a specific area for instructions to foreign educated nurses.
See our Nurse
Taking the NCLEX in Guam or
Some Philippine nurses who have passed the CGFNS exam as well as those
who have not taken the CGFNS exam, will seek to take the NCLEX in either
Gaum or Saipan or will obtain a US Tourist Visa and travel to the US to
sit for the NCLEX exam. Saipan does not currently require a US tourist
visa for Philippine nurses traveling to take NCLEX and staying only 3
days. However, the test site can only handle 6 nurses taking NCLEX per
day. Guam does require a US tourist visa. However, with the actual paper
approving the nurse to take the NCLEX in Guam, the US Embassy has in the
past, been approving nurses for tourist visa to travel to Gaum for NCLEX.
Guam can handle 12 or more NCLEX test takers each day. The NCLEX
organization is in a one year long process of changing from the Chauncy
company that run the test sites. This might mean improvements in test site
capacity. It also may result in other international test sites being
opened in such cities as Manila. As of
August 16, 2002, new test sites and phone numbers for Guam and
Saipan. Please read this article, written by Meladee M. Stankus,
President of Nurse Immigration USA. Click
Here For More. as well as the NCS
Pearson VUE web site.
The CGFNS exam is becoming less attractive to US
Applying for the CGFNS exam, waiting two months for the exam and
obtaining the results two to three months after the exam, can take a nurse
up to 6 months or even one year to complete. Test results take so long to
be mailed to the nurse, that the deadline for the next exam will have
passed. This means that a failure to achieve a score of 400, and the nurse
must apply for the next exam. Then that nurse will have a another one year
wait for the results of that exam. CGFNS exam results are not
published/mailed to the nurse until after the expiration date for
application the next exam. In addition, the CGFNS exam is expensive
and it is only given three times per year. Last year, in Manila ,
Philippines, several thousand Philippine nurses completed the CGFNS exam.
CGFNS does not publish the pass /fail rate for various countries. Current
CGFNS application test fees are $295.00 However, one can estimate that
Philippine nurses are projected by this writer to be providing at least
$3,000,000 annually in revenue to the CGFNS for exams. Additional fees
of $325.00 are paid for Visa Screen to the ICHP, a division of the CGFNS.
If only 2000 Visa Screen application are sent from the Philippines
annually, a very conservative estimate, that would represent $625,000 of
additional revenue provided by Philippine nurses to the CGFNS.
Although, the CGFNS exam certificate will allow for the filing of the
I-140,with an US employee sponsor, some US employees will require that the
nurse pass the NCLEX prior to departing and arriving in the US to start
employment. At one point in the past, the CGFNS web site asserted that the
foreign educated nurses who obtained a passing score on the CGFNS exam,
was predicted have an 85% probability of passing NCLEX. However, US
employers are learning this is questionable. In fact, the published
statistics from the NCLEX indicated that all foreign educated nurses pass
NCLEX at a rate of about 40%. The CGFNS is a "paper and pencil"
examination. The CGFNS exam may have a multiple choice question on a
subject. The NCLEX is a test taken on a computer and claims to evaluate
the test takers ability in critical thinking on the various subjects. The
nurse test taker must be able to identify the implications of signs and
symptoms and what action is required of the nurse. The NCLEX requires
knowledge of the US nursing role as well as the role of personnel such as
LPN’s. This will be a challenge to a foreign educated nurse who has
not worked in US hospital.
The NCLEX is a Computer Adaptive Test. The NCLEX is unique test of
experience which uses advanced computer programming. This allows the test
to increase levels of difficulty for the individual test, depending upon
correct and incorrect responses to various questions. For example, if an
exam question on cardiac pharmacology is missed, the test can select other
questions in that subject for that individual test taker. With this
approach, each set of questions will vary amongst different test takers.
In addition, the test program is scoring and evaluating after each
question. A test taker who gives incorrect responses to a certain number
of questions, will find the computer shuts down with a message that the
test is over. Conversely, the test taker who has answered sufficient
number of questions correctly ….will have the same experience. In both
cases, the test taker is not told of the reason the test is "complete" and
only finds out when official test results are available. This can result
in a few sleepless nights for all individuals. Some will get the good news
that they passed, others will get bad news.
Hospitals are discovering that the nurses who take NCLEX after passing
the CGFNS ,may not pass NCLEX. Once the nurse has not passed the NCLEX,
the nurse must wait 90 days before retaking and about $200.00 in
additional fees must be paid . US hospital employers are quickly
learning to require a thorough and specialized NCLEX review course prior
to the NCLEX examination. Some are actually requiring the foreign nurse
hire who has passed the CGFNS exam, to obtain NCLEX in Guam or Saipan
prior to arrival in US, This is seen of late in advertising by foreign
nurse recruitment agencies literature and web sites, that seek to provide
foreign nurses to US employers. I believe that when NCLEX is given
internationally, that very few nurses will seek to take the CGFNS exam.
There is an increasing trend for US employers to pay the fees for all
test and requirements for foreign nurse hires. This is due to the
competition for qualified nurses. If the employer has to choose between
the CGFNS exam or the NCLEX, employers will choose NCLEX. Obviously, the
employer will then have a known "RN" product. Those nurses who are
currently arriving with the green card, and have only the CGFNS exam and
must take NCLEX in US, are facing delays until they can assume RN work.
This foreign educated nurse may only work in a limited capacity because of
these delays. If the nurse passes NCLEX the first time, this delay may
only be months. If the first exam is not passed, that delay may be months
Licensure by Endorsement.
Those nurses who apply to take the NCLEX exam through a state like
Arizona that does not have a requirement of having passed the CGFNS exam,
may intend to apply for endorsement into another state that does
require the CGFNS. Thereby, the foreign educated nurse who has not passed
the CGFNS exam, first applies to a state like Arizona. Then, after
obtaining the Arizona license, seeks endorsement into this other state.
Not all states provide for endorsement and the applicant must research
each state and the exact requirements for