The advanced society of the US, diverse population, varied geography and high standard of living makes it a considered destination for many citizens of other countries with fewer advantages. This is also true of nurses from many regions of the world. Nurses in the US have many opportunities to further their careers and education. They also have better salaries and therefore a higher standard of living. But most importantly, nurses command more respect within American society than many nurses do in other countries.
The current and impending nursing shortage is not the first one in the history of US health care. Attempts to alleviate nursing shortages has included unsuccessful measures such as states bringing forth legislation that would have allowed foreign educated nurses to practice in medical centers without taking the state licensing exam. Health care organizations’ need for nurses also created the health care recruiting industry that started operations in foreign countries that could supply nurses, such as the Philippines and India. The companies in this industry wanted to capitalize on the health care system’s need for more nurses and the desire of foreign educated nurses to migrate to a location with more opportunity. Inevitably, legal and ethical abuse arose.
The decades of the 1960s and 70s were a time of a national nursing shortage. Yet most foreign educated nurses recruited by medical centers and agencies were unable to pass the state board test pool exam the precursor to the NCLEX. Those that failed and remained in the US worked in health care but as aides or technicians for example. Employers sometimes expected these foreign educated nurses to do nursing duties but these workers were not paid or protected as nurses. Therefore this constituted illegal activity in the health care field.
In 1977 the American Nurses’ Association and the National League for Nursing co-funded an organization called Commission of Graduate Foreign Nurses Services (CGFNS). The US department of state was also involved. They wanted to create a service to assist and assess foreign educated nurses who wanted to migrate to the US to work. In 1996 the Illegal Immigration and Reform and Immigration Response Act mandated that most entering health care professionals except doctors would need to be screened. CGFNS was appointed to carry out the screening. For a foreign educated nurse to be granted an occupational visa he or she must obtain a VisaScreen certificate from CGFNS. There are several steps required for an applicant to get the VisaScreen. Entering nurses need a review of their professional education and licensure, especially with regard that nursing education is at post secondary level, English proficiency testing, and successfully passing either the CGFNS qualifying exam or the NCLEX RN exam. The certificate is valid for 5 years. If a health care professional has not been granted permanent status by then, the certificate can be renewed by initiating the process at least 6 months before expiration. If the renewal applicant has continual employment that meet certain time restrictions the English proficiency part of the VisaScreen is waived.
The other services of interest for potential nurse applicants are the Certification Program and the Credential Evaluation Service. The Certification Program applies to first level general nurses. In order for these nurses to qualify for the CGFNS exam they must have courses in the areas of adult health, maternal and infant nursing, pediatric care, and psychiatric nursing. They must also hold a valid license from their own country. It will also include the English proficiency exam. The CGFNS also offers the Credential Evaluation Service for other levels of nursing and are for individuals who want to become licensed in the US or for academic admission to further education. The professional report satisfies the requirements of individual state boards and contains a statement of academic comparability of the applicant’s education. The academic report assists those nurses who want to pursue higher education in the US.
The CGFNS is a neutral non profit organization authorized to evaluate credentials pertaining to education registration and licensure of nurses and serves to protect both nurse and public. It is a source of information for international nurse education and licensing. It conducts and publishes studies relevant to foreign educated nurses. It also has created programs for nurses in specific countries in South Asia through the International Standards for Professional Nurses.
CGFNS offers the qualifying exam globally in countries throughout the world. The knowledge exam gives prospects an idea whether they can pass the NCLEX RN which is now offered in a few locations outside the US. The CGFNS qualifying exam has 2 purposes: Before a nurse leaves her home country she would have a good idea if she would qualify, and employers would know if licensure was possible before obtaining a visa.
However, each state controls nursing practice through the State Board of Nursing. Each state grants licenses so a foreign educated nurse needs to investigate in advance the state’s regulation where they would like to work, to ensure that he or she can practice in the location of their choice.
Interested stakeholders in the US have also created the Alliance for Ethical International Recruitment Practices. The Alliance is made up of 5 stakeholders; unions, professional organizations, recruiting agencies, licensing bodies and employers. To date they have created a voluntary code of ethics, and a pilot program of subscribers. It has been endorsed by the International Council of Nursing. It will examine and deal with challenges faced by foreign educated health professionals, the relinquishing countries, employers and country of destination. For example, when health professionals including nurses migrate how does that affect the health care system they leave behind? Often the countries that offer publicly funded nursing education lose their nurses to more developed countries. Can health care systems in these countries progress if they keep losing their skilled professionals? Yet circular migration can also benefit if nurses send back new found skills or monetary benefits, or return to their home country with more skills and knowledge. In a future article discussion will center around the effects of globalization on the nursing profession.
- Sources:
http://www.cgfns.org/sections/programs/country/country.shtml
http://www.fairinternationalrecruitment.org/
http://www.intlnursemigration.org/
The Official Guide for Foreign-Educated Nurses: What you need to know about nursing and health care in the United States. B. Nichols, C. Davis 2009
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