Graduates of foreign nursing schools in US ORs

AORN Journal,  March, 2005  by Ellen K. Murphy

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The recruitment of foreign nursing school graduates to meet the needs precipitated by the US nursing shortage is not without controversy. Many people feel strongly that the United States should not be "poaching" nurses from other countries that also are experiencing shortages. Others feel this concern is balanced by a belief that nurses should have the freedom to live and work where they wish. Some authors have argued that the global nursing shortage must be addressed via global strategies to increase salaries; improve working conditions; and invest in nursing education to attract, educate, and retain sufficient numbers of nurses in all countries. (1)

Regardless of the need for a more comprehensive global strategy, the fact remains that even facilities that have never done so in the past now are considering recruiting foreign nurses as at least a short-term approach to easing their personnel shortages.

   The rapid growth in employment of
   foreign born nurses accounts for
   nearly one third of the total growth of
   RN employment in the US nurse
   labor market during the past two
   years, which means the trend toward
   an increased reliance on foreign born
   RNs has accelerated. (2 (p529))

Recruiting graduates of foreign nursing schools is time, money, and effort intensive for both the nurse and the recruiting facility. Done legally and ethically, it can be a positive experience for nurses and fill necessary positions in receiving facilities. Done illegally or unethically, it can result in exploitation of foreign nurses, unsafe patient care, and wasted effort for facilities. This article briefly outlines the legal requirements that must precede employment of a foreign nursing school graduate as an RN in the United States.

LICENSURE REQUIREMENTS

Graduates of foreign nursing schools must meet the same licensure requirements as US graduates, including passing the National Council Licensure Examination (NCLEX). What is different are the legal requirements that precede foreign nursing school graduates' ability to take the NCLEX and come to the United States to work.

COMMISSION ON GRADUATES OF FOREIGN NURSING SCHOOLS CERTIFICATION

Most states require graduates of foreign nursing schools to obtain a certificate from the Commission on Graduates of Foreign Nursing Schools (CGFNS) before they are eligible to sit for the NCLEX. The CGFNS certification requires

* authentication of documents,

* demonstrated English proficiency, and

* a passing score on the CGFNS Qualifying Examination. (3)

The CGFNS is an immigration-neutral, not-for-profit organization that was created in 1977. (4) It was founded in response to studies conducted in the late 1960s and early 1970s, including those funded by the then Department of Health, Education, and Welfare and other federal agencies. These studies showed that US immigration officials were having difficulty deciding whether foreign nurses applying for occupational visas met or could meet licensure requirements in the United States. The studies also showed that only about 15% to 20% of foreign-educated nurses were passing the licensing examination on their first attempt. (4) The mission of the CGFNS is to protect the public by ensuring that nurses educated outside the United States are eligible and qualified to meet licensure requirements. Along with this commitment to quality health care for the public, CGFNS also fosters the equitable treatment of nurses. (5)

Authentication of documents. All states require a nurse licensure applicant to have graduated from a formally organized nursing education program. Part of the CGFNS process of authentication of documents is examining transcripts from the foreign nursing school to ensure that the individual's education is comparable to that of a nurse educated in the United States. For example, some countries teach nurses at the secondary school level, which is not equivalent to US postsecondary programs.

Other portions of the authentication process verify that the nurse is who he or she claims to be, is a graduate of the program as claimed, and is licensed without any restrictions in his or her home country. Fraudulent documents are more pervasive in some countries than others. Authentication is a comprehensive verification process.

English proficiency. Graduates of foreign nursing schools also must demonstrate proficiency in English. Unless the candidate is a graduate of a nursing program taught in English in an English-speaking country, this requires obtaining a passing score on a standardized English test such as the Test of English as a Foreign Language (ie, TOEFL), the Test of English for International Communication (ie, TOEIC), or the International English Language Testing System (ie, IELTS). The established passing score requires more than a conversational understanding of English. For example, the nurse who takes the paper-based TOEFL must achieve a score of 540 out of a possible 677 points. (6,7) Many US universities require a 520 for admission to baccalaureate programs and a 550 for admission to graduate school.