Written by Meladee M. Stankus, RN MS

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 states.

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 links section.)

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 employers.

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 or years.