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California Nurse Professional Licensing Guide — Updated, 2021

 

TABLE OF CONTENTS

1. How the Profession is Organized in California
Regulation of the Nursing Profession
Registered Nurses (RNs) and Educational Background
The Job Market for Nursing in California
The Job Search

2. Eligibility for Licensing as an RN in California
I. Compile Transcripts, Translations, and Fingerprints
II. Apply for RN Licensure by Examination and an Interim License Application
III. Pass the National Council Licensure Examination (NCLEX)

3. Tests
NCLEX-RN

4. Time and Costs
Two Hypothetical Scenarios for MD Licensing

5. Other Careers and Credentials
Lower-Level Opportunities
Higher-Level Opportunities

6. Beyond Licensing
Joining a Professional Association
Licensing Mobility (Reciprocity)

7. Important Links

8. Tips

 

1. HOW THE PROFESSION IS ORGANIZED IN CALIFORNIA

REGULATION OF THE NURSING PROFESSION

Nursing in California is regulated by the California Board of Registered Nursing. The Board manages two types of nursing licenses related to increasing degrees of education, examination and experience:

  1. Registered Professional Nurse (RN); and
  2. Advanced Practice Nurse (APN)

The guide assumes that you hold the equivalent of a U.S. Bachelor of Science in Nursing,
so the most appropriate license type for you is a Registered Nurse. It also assumes that your
California license will be your first U.S. nursing license. You will become an RN through
Licensure by Examination. The National Council of State Boards of Nursing (NCSBN)
administers the National Council Licensure Examination (NCLEX-RN), which is required for
licensing as an RN in California.

REGISTERED NURSES (RNS) AND EDUCATIONAL BACKGROUND

In the U.S., the term RN includes professionals with a variety of education levels but with certain skill sets in common. Most people become RNs after participating in one of two types of degree programs:

  • Associates Degree of Nursing or ADN (2 years of study, typically in a community college)
  • Bachelor of Science in Nursing or BSN (a 4-year university degree)

Usually, a higher level of education corresponds to greater responsibility, specialization, and advancement opportunities in the workplace. Many RNs later go on to receive masters or doctoral degrees in nursing and pursue careers as APNs or in healthcare management, consulting, research, or education roles.

THE JOB MARKET FOR NURSING IN CALIFORNIA

Nursing is a growing field in the U.S., due to factors such as the aging U.S. population,
nurse attrition (choosing to leave the job), and the increasing complexity of nursing practice. The
state of California has an urgent need for registered nurses – a 2007 report estimated almost
60,000 full time employees were needed in the system – even after large investments by the state
in nurse education since 2005.
The Bureau of Labor Statistics predicts that from 2010 to 2020, the fastest growing jobs
for RNs will be employment in physician’s offices, home health care, and outpatient care
facilities. The highest average earnings are paid to nurses working in private industry ($66,650),
physician offices ($62,880), hospitals ($62,690), home health care ($60,690), and nursing care
facilities ($58,180).

THE JOB SEARCH

Qualified RNs are in high demand and employers will compete for their skills. Bilingual
and bicultural nurses can be even more attractive to employers who serve diverse communities.
Because of this demand, even part-time employment can include attractive benefits such as
health insurance, childcare, and tuition fees for continued education.

 

2. ELIGIBILITY FOR LICENSING

OVERVIEW See CA Nursing Board Application

Internationally Educated Nurses (IENs) need to meet several requirements to receive Licensure by Examination as a RN in California.

Steps to licensing are as follows:

I. COMPILE TRANSCRIPTS, TRANSLATIONS, AND FINGERPRINTS

TRANSCRIPTS

The California Board of Registered Nursing directly evaluates your foreign transcript and
nursing license. Their application for RN Licensure by Examination (see Important Links
section) includes forms you must use to get your transcripts sent directly from your foreign
university to the Board of Registered Nursing for evaluation.

You should start your process by sending these forms out early. Getting your foreign
documentation can be complicated and can slow down your application, especially if your
nursing school has never had a graduate apply for a California license.

You cannot send your transcripts directly to the board, even if they are official copies – your school must send them directly to the Board address provided in the request forms.

TRANSLATIONS

If your documents are in a language other than English, you will must arrange for an official translation. You have a few options to consider:

  1. If your country has English as one of its official languages, you can ask your university to provide an English version of your transcripts – but the school must also provide the original language version.
  2. You can have a professional translator – who cannot be personally related to you –
    provide a certified translation. The translator will need to fill out and sign a special form. The
    Board recommends you look for a translator who is a member of the American Translators
    Association, a certified court interpreter or translator, or staff of a foreign consulate.

FINGERPRINTS

Your fingerprints are used by both the Department of Justice and the Federal Bureau of Investigation to check if you have a criminal record.

You should take care of your fingerprinting early because analysis times vary, and this is
another way that your licensing can be slowed down. Another reason to start early is that a
complete fingerprint analysis is now required before you can receive an Interim License – an attractive option as you relicense that will be explained in the next step about your licensing
application.

For fingerprinting, you can use either a Live Scan digital print service or a “hard card” –
two sets of fingerprints on paper cards. You are strongly advised to use Live Scan because
processing times are much faster. However, you cannot use Live Scan if you cannot go
personally to one of the many California Live Scan sites.

  • Live Scan – requires you to go to one of many centers available in California for
    fingerprinting; costs vary ($20-50). Make sure you save your Live Scan receipt! It is required as a part of your credentialing application.
  • Paper fingerprint cards – this is the option you will use if you cannot travel to a
    California Live Scan site; you will need to email the Commission to request the cards and will
    need to pay them an extra service fee (cost as of April 2021: $49).

Links to both options are in the Important Links section.

II. APPLY FOR RN LICENSURE BY EXAMINATION AND AN INTERIM LICENSE APPLICATION

Your application should include:

  • 2-page Licensure by Examination application
  • Completed Live Scan or Applicant Fingerprint Card
  • 2″ x 2″ passport-type photograph
  • Official copy of your foreign nursing license and any specialization certificates
    you may have earned (in midwifery or in psychiatric nursing, for example). If you
    do not have a license, you must explain why in writing.
  • Certified translations of any documents

You will need to show scores for the Test of English as a Foreign Language (TOEFL)
only if you are also applying for an Interim License and you attended a non-English speaking
nursing school (see Special considerations for more information).

Current fees. 

By now you should also have sent your “Request for Transcript” form and the “Breakdown of Educational Program for International Nursing Programs” form to your nursing school, and had translations of your transcript, license, and any other supporting documents made if they are not in English.

Your application will be complete once your foreign nursing school provides your transcripts.

RESULTS OF YOUR APPLICATION EVALUATION

The Board of Registered Nursing will evaluate your education and licensing to see if it is comparable to its minimum standards for a California Registered Nurse program. This includes standards for coursework and clinical experience in:

  • Anatomy and Physiology
  • Microbiology
  • Medical Nursing
  • Surgical Nursing
  • Obstetric Nursing
  • Pediatric Nursing
  • Psychiatric Nursing

If the Board finds some of your coursework to be incomplete, you may have to take courses before you can be given an Interim License or qualify to take the NCLEX. This is especially common if your country has different standards in nursing practice – for examples, male nurses not trained in obstetrical nursing, or nurse midwives not receiving training in other areas of nursing.

Once your application is complete, if your education and experience meets California RN standards, the Board will:

  • Send you an NCLEX Candidate Bulletin with instructions on how to register for your licensing exam
  • Give you an Interim License valid for up to six months, or until you get your first NCLEX results

If you pass your NCLEX, the Board will process your RN license. If you do not pass, your Interim License will immediately stop being valid, and you will not be able to work in a nursing position until you receive a passing score on the exam.

SPECIAL CONSIDERATIONS

  • Request an Interim License: You can pay an extra $100 for an Interim License when you
    apply for Licensure by Examination. The Interim License is a credential that lets you work as a
    nurse under supervision in the time period between having the Board confirm that your
    application is complete, and the time you actually pass the NCLEX licensing exam. The interim license is valid for up to 6 months.
  • Apply early: you should expect your application to take several months, not including
    any time spent by your university preparing and sending documents to the Board.
  • Be truthful in your application: There are serious consequences for false or incomplete
    information in the application. If you write on your application that you have no criminal record, but your fingerprint check shows even a minor offense, it can make you ineligible for a license. If this applies to you, you will need to provide specific information about your record and steps you have taken.
  • Be sure your names match on all of your documents: If they do not match even in small ways (for example, your driver’s license shows your middle name, but your application shows the initial only), this can complicate your licensing process. You should take steps early to identify any differences and see if they need to be fixed.

III. PASS THE NATIONAL COUNCIL LICENSURE EXAMINATION (NCLEX)

The Board recommends that you do not register for your National Council Licensure
Examination (NCLEX-RN) until the Board sends you a notice that your Licensure by
Examination application is approved. This notification is called the Authorization to Test (ATT).
At that time, the Board will also send you information about the NCLEX and how to find a
testing administration site. You must have your ATT to schedule an appointment and to be
admitted to the testing center on the day of your examination.

The NCLEX costs $200 (as of April 2021). Your NCLEX scores should be available to
the California Board of Registered Nursing within one month after testing. You will be issued
your RN license as soon as it can be processed.

 

3. TESTS

The National Council Licensure Examination for Registered Nurses (NCLEX-RN) is the
only examination required in the California Licensure by Examination process.

NCLEX-RN TEST TECHNOLOGY

The NCLEX-RN is computer-based test, called a variable length adaptive test. This means that the test will adjust its difficulty level, content, and number of questions based on your answers.

The test will continue until all content areas are covered in the required proportions, and the system is 95% certain that your abilities are either above or below the passing standard due to its analysis of your answers. As a result, you may be asked to answer anywhere from 75 to 265 items. Test takers with either very high or very low abilities tend to have the tests with the fewest questions.

The exam is mostly multiple-choice but other question types are also included. You will be given a short tutorial that will expose you to the different question types. You are not allowed to skip any questions, but you should avoid making random guesses, as this can quickly lower your score.

You cannot bring reference materials or other testing aids to the exam. An on-screen calculator is provided for some problems.

NCLEX CONTENT AREAS

The content of the NCLEX-RN concentrates on the patient as the focus of care. The NCLEX-RN exam (2013 edition) is divided into four categories of Client Needs, some of which have subcategories. The percentages show the approximate percent of questions each test taker will receive in the category:

  • Safe and Effective Care Environment
    • Management of Care (17-23%)
    • Safety and Infection Control (9-15%)
  • Health Promotion and Maintenance (-12%)
  • Psychosocial Integrity (6-12%)
  • Physiological Integrity
    • Basic Care and Comfort (-12%)
    • Pharmacological Therapies (12-18%)
    • Reduction of Risk Potential (9-15%)
    • Physiological Adaptation (11-17%)

SCHEDULING AND TESTING SITE PROCEDURES OF THE NATIONAL COUNCIL LICENSURE EXAMINATION FOR REGISTERED NURSES (NCLEX-RN)

Computerized Adaptive Testing (CAT) administers the NCLEX-RN in testing centers
across the U.S. and internationally. You can register information with Pearson and pay for the
test ($200), but you cannot schedule the NCLEX-RN exam until your application for Licensure
by Examination has been processed and you have received an Authorization to Test (ATT)
notice. The ATT includes detailed instructions for choosing a testing center and scheduling a
date to take the NCLEX-RN. The ATT is valid for only 90 days, so you should not delay in
scheduling an exam session.

On the day of the test, you must bring the ATT and a government-issued photo
identification. You will be fingerprinted and photographed before your test and will be
fingerprinted when you re-enter the testing area after breaks. You should arrive at least a half
hour early; you will not be allowed to take the test if you arrive more than a half hour late for
your appointment. You will have up to six hours to complete the test, including time scheduled
for the computer tutorial and optional breaks.

FAILING THE NCLEX-RN

If you fail your exam, the California Board of Registered Nursing will send you a Candidate Performance Report which shows the areas that need improvement. You can use the report to learn what areas to study before you retake the exam. You may take the NCLEX-RN again after waiting 45 days. If your score is far from passing you should consider additional test preparation or taking refresher courses.

PRACTICING FOR THE NCLEX-RN

There are many different resources that can help you prepare for the content and the computer-based testing technology. Consider investing in test preparation as it may save you money by not having to pay to retake the test and by entering the job market faster. Please refer to Important Links for test preparation options.

 

4. TIME AND COSTS

Evaluating your foreign degree and achieving licensing as a Registered Professional Nurse in California depends on many factors. A few of these include

  • The completeness of your educational and professional records (the more documentation, the better)
  • The efficiency of your home country’s system in compiling and transmitting your university records and verification of licensing
  • Your fingerprint evaluation and criminal background check
  • Your performance on the National Council Licensure Examination (NCLEX)
  • Your free time and how much money you have to spend

 

5. OTHER CAREERS AND CREDENTIALS

TRANSITIONAL OPPORTUNITIES

You may want to consider if taking a lower-level job in healthcare in the short-term can help you meet longer-term goals of licensing as a registered nurse.

Preparing for the National Council Licensure Examination (NCLEX) can take time. Working in healthcare in a different way and with fewer responsibilities may offer you some advantages, such as:

  • employers paying for tuition and fees associated with the NCLEX and licensing
  • more energy to focus on studying
  • a chance to adapt to the U.S. healthcare system and workplace culture in a lower-pressure environment

You should be honest with your employer about your long-term plans and be sure that they have benefits such as tuition reimbursement or schedule flexibility that will support your goals.

CERTIFIED NURSING ASSISTANT, CNA

CNAs are also commonly referred to as nurses’ aides or orderlies. CNAs have very
limited responsibilities and work under nurse supervision. As a foreign trained nurse, you can
become a CNA fairly easily once you have completed your degree evaluation through either
ERES or CGFNS. You do not need to take a U.S. CNA course if you can provide the following
materials to register for the written competency exam:

  • A copy of your diploma translated into English
  • A copy of your official transcripts in English, including the number of hours of training you received for each course
  • Social Security card
  • Proof of employment authorization

The exam is basic, but CNA test preparation materials are available to practice. If you fail
the email 3 times, you must take a CNA training course in order to be able to register for the
exam again. CNA training programs are short courses that last only 1 or 2 months. They are
offered through many community colleges or larger healthcare facilities in California.

Additionally, you must pass a test and a criminal background check before working as a
CNA. Working as a CNA in the healthcare field will provide you with an opportunity to build a
professional network, gain U.S. experience that is highly relevant to your profession, and
possibly receive tuition reimbursement for relicensing purposes. CNAs typically earn
approximately $16 per hour. The profession is regulated by the California Board of Vocational
Nursing.

HEALTHCARE INTERPRETER

If you are bilingual and a strong communicator, you may want to research opportunities
for work in hospitals as an interpreter. This type of role is not regulated in California, so
standards for employment as well as pay and benefits may be very different depending on the
employer. You are more likely to have benefits such as tuition reimbursement if you find work
as a direct employee of a healthcare facility, instead of working for a company that provides
interpretation services to hospitals. You may want to begin your research by directly contacting
human resource departments at hospitals.

HIGHER-LEVEL OPPORTUNITIES

After you receive your Registered Nurse license in California you may find you want to continue your professional development. If you have the equivalent of a Bachelor of Science in Nursing, you can qualify to train as an Advanced Practice Nurse (APN).

ADVANCED PRACTICE NURSE (APN)

The advanced practice nurse is the highest licensure in nursing practice and involves
graduate school education, examination, and licensing processes beyond the level required of
Registered Nurses. APNs in most states are allowed a more independent nursing practice, which
includes diagnosis and treatment of patients and the ability to prescribe medications. In
California, APNs must have a joint agreement with a California licensed physician on record, but
direct physician supervision is not required in order to practice. APNs can choose from
specialties in one of 4 recognized practice areas:

  • Certified Registered Nurse Anesthetist (CRNA)
  • Clinical Nurse Specialist (CNS)
  • Certified Nurse Midwife (CNM)
  • Nurse Practitioner (CNP)

A RN who wants to become an APN will find a variety of opportunities for education, including accelerated degree programs or courses designed for working professionals (e.g. weekend and evening courses).

 

6. BEYOND LICENSING

JOINING A PROFESSINAL ASSOCIATION

State and national associations for nurses provide opportunities for professional development and networking. They also help set acceptable working conditions for nurses, and give information and opinions on policy in California and across the U.S. Their websites may offer useful information to nursing candidates about the licensing and examination process, including test preparation. They often provide Continuing Education to members as well.

The California Nurses Association is the largest nursing association in the state.

The American Nurses Association is its national counterpart.

Additionally, there is a large variety of professional associations for nurses that cater to specific disciplines, job type, ethnicity, gender, or religion of registered nurses.

LICENSING MOBILITY (RECIPROCITY)

The state of California does not have any shared agreement to honor the nursing licenses
of other states. It grants licensing to nurses by either examination (the process described in this
topic) or endorsement (where a registered nurse licensed in another state must meet all California
requirements for licensing). Fortunately, since the National Council Licensure Examination
(NCLEX) is accepted by all states, a registered nurse looking to relocate to California will not
have to retake the NCLEX. However, the country is now moving toward increased mobility of
nursing licenses, as the nursing shortage encourages states to attract more qualified professionals. See the National Resources part of the Important Links section to view the states that are
currently participating in mutual licensing reciprocity for licensed practice nurses and registered
nurses; you can learn more about this Nurse Licensure Compact through the National Council of
State Boards of Nursing.

 

7. IMPORTANT LINKS

REGULATION:

The California Board of Registered Nursing issues licenses for Registered Nurses (RN) and Advanced Practice Nurses of several varieties. Their RN License Examination Homepage has an application with instructions for foreign-educated nurses on how to meet California requirements. The packet includes a form for translators and another for your school to use to describe your nursing program.

NATIONAL RESOURCES:

The National Council on State Boards of Nursing (NCSBN) represents member Nursing
Boards for all 50 states. It develops the National Council Licensure Examination (NCLEX). Its
website also shows an up-to-date map of states that have formed a Nurse Licensure Compact.

National Council on State Boards of Nursing (NCSBN) Learning Extension is a portal for e-learning for nursing that includes test preparation for the National Council Licensure Examination for Registered Nurses (NCLEX-RN) for nursing candidates and continuing education for practicing nurses at all levels. The NCSBN’s Review for the NCLEX-RN® Examination v10.0 is a subscription service that includes extensive NCLEX preparation resources, including skills assessment to identify knowledge gaps, plus curriculum, test questions and interactive exercises.

The California Nurses Association is the largest nursing association in the state.

The American Nurses Association is its national counterpart.

 

8. TIPS

PROVIDE COMPLETE DOCUMENTS

Nursing foreign degree evaluation services require that your university and licensing
authority send transcripts directly to them. Invest the time and money early to facilitate this
process. Providing additional documentation about your program of study, such as syllabi or
course descriptions, can make the most of your degree evaluation. Making an effort here can
result in significant savings of time and money by minimizing the gaps in comparing your degree
to its U.S. equivalent.

GET YOUR QUESTIONS ANSWERED

Be your own advocate throughout the licensing process. Seek clarification about questions and concerns directly from official sources. If you feel your degree has been misinterpreted or you do not understand a fine point of the state regulations, organize your question and contact the Board of Registered Nursing or Pearson Vue and ask for assistance.

INVEST IN TEST PREPARATION

If you can afford it, invest some money in test preparation. There are online and inperson formats available, including a moderately priced subscription service by the makers of the
National Council Licensure Examination (NCLEX). Investing money wisely now to make your
licensing process a success will get you into a job that pays well that much faster! You should
feel prepared to take the NCLEX by the time your licensing by examination application is ready
to submit to the California Board of Registered Nursing.

BE FLEXIBLE IN YOUR JOB SEARCH

Build professional networks; consider employment in healthcare at a lower level, such as a CNA, to give you a lower-stress job that allows you to study for licensing and open opportunities to meet employers. If you are overqualified for positions you are applying for, explain how your plans can bring long-term value to the employer.

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