Maryland Licensing Guides for Immigrant Nurses

How The Profession Is Organized In Maryland

Regulation Of The Nursing Profession

Nursing in Maryland is regulated by the Maryland Board of Nursing. The Board manages two types of nursing licenses that are different in terms of increasing degrees of education, examination and experience:

Registered Nurse (RN); and

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 Maryland license will be your first U.S. nursing license. You will become an RN through Licensure by Exam. 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 Maryland.

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 Maryland

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 Maryland has an urgent need for registered nurses – based on projections from 2018, the Maryland Department of Labor estimated that Maryland will need more than 13,000 additional registered nurses by the year 2028 to meet rising demand. Nationally, employment of registered nurses is project to grow 9 percent from 2020 to 2030, about as fast as the average for all occupations.

The Bureau of Labor Statistics predicts that from 2020 to 2030, the fastest growing jobs for RNs will be employment in medical and surgical hospitals, physician’s offices, home health care, and outpatient care facilities. The median annual earnings for nurses in the following sectors are:  government ($84,490), hospitals ($76,840), ambulatory healthcare facilities ($72,340), and nursing care facilities ($68,450).

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.

Eligibility For Licensing As An Rn In Maryland

OVERVIEW

International Educated Nurses (IENs) need to meet several requirements to receive Licensure by Exam as a RN in Maryland.  See Licensure Process for International Educated Nurses.

Steps to licensing are as follows:

File A Maryland Board Of Nursing Application For Licensure By Exam

Maryland Board of Nursing Applications for Licensure by Exam can be found online at the Maryland Board of Nursing website or can be requested by email at mdbon.nbexam@maryland.gov. You will be required to pay a $100 non-refundable application fee when you submit your completed application.

Note that when you submit your Maryland Board of Nursing Application for Licensure by Exam you should quickly thereafter complete steps B-E below. Any application that is not completed within one year will be destroyed and you will be required to apply again

Complete A Criminal History Record Check

All new RN applicants must pass both a State and Federal criminal history record check. Your fingerprints will be used to check if you have a criminal record. The Maryland Application for Licensure by Exam will include fingerprint cards that are preprinted with a return address. Your fingerprints must be taken at a State Police barracks, a Maryland Criminal Justice Information System office, or another certified site. Certain locations that are equipped for electronic fingerprinting will return results in one week. Sites offering manual fingerprinting will return results in about 3 to 4 weeks. Any flagged criminal history record checks will be reviewed by the Maryland Board of Nursing and additional information may be requested.

Once fingerprinting is completed, keep the purple printed postcard that is attached to the fingerprint card as this will serve as evidence that fingerprinting has been completed for purposes of sitting for your NCLEX exam (see below).

Complete A Credentials Evaluation Service Application

The Maryland Board of Nursing requires you to obtain a Credentials Evaluation Service Professional Report (CES Professional Report) through an organization called CGFNS International. This report will analyze your foreign credentials and provide an assessment of their comparability to U.S. standards. This includes standards for coursework and clinical experience in:

Medical Nursing

Surgical Nursing

Obstetric Nursing

Pediatric Nursing

Gerontologic Nursing

Psychiatric Nursing

If the Board finds some of your coursework to be incomplete, you may have to take courses before you can 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.

The cost of a CES Professional Report is $365.00, though additional fees may apply. You will request licensure validation and/or your academic records directly from your original licensing agency or school and have them sent to CGFNS. The Maryland Board of Nursing will not accept these documents directly; all transcripts and licensure validations should be sent directly to CGFNS:

CGFNS/Attn:CES

3600 Market Street

Suite 400

Philadelphia, PA 19104, USA

Once CGFNS has completed your CES Professional Report, they will send the completed report to the Exam Department at the Board of Nursing. Be sure to indicate the Maryland Board of Nursing as the “Report Recipient” when submitting your CES Professional Report request and direct CGFNS to send the completed CES Professional Report to the Board at the following address:

Exam Department

Maryland Board of Nursing

4140 Patterson Ave

Baltimore, MD 21215, USA

Demonstrate Competency In Oral English

You must demonstrate your competency in oral English by either:

  1. graduating from an onsite 3-year or longer nursing program in the United Kingdom, Australia, Canada (except Quebec), Guyana, New Zealand, or Ireland, or
  2. passing an English language fluency exam (Test of English as a Foreign Language, Internet-Based Test (TOEFL iBT) or International English Language Testing System (IELTS)).

Applicants who choose to take the TOEFL iBT are required to pass with a score of at least a 26. Applicants who choose to take the IELTS must pass with a score of at least a 7 on the speaking module and must score at least a 6 on all other modules.

The TOEFL iBT may be taken in person at a testing center or remotely. You can register for the TOEFL iBT online at www.ets.org. You may alternatively register to take the IELTS at www.ielts.org. Note that you must request that the results of your chosen language fluency exam be sent to the Maryland Board of Nursing.

Pass The National Council Licensure Examination (NCLEX)

Once you have submitted your Maryland Application, Criminal History Record Check, TOEFL iBT or IELTS score, and CGFNS CES Professional Report, you should register for the NCLEX exam with Pearson VUE. Once your application materials have been approved by the Maryland Board of Nursing, you will receive an Authorization To Test letter (ATT). This ATT will allow you to schedule your NCLEX exam date. Your ATT will also be required for admission into the testing center on the day of your examination.

The NCLEX costs $200. Your NCLEX scores should be available to the Maryland Board of Registered Nursing within six weeks after testing. You will then be issued your RN license as soon as it can be processed.

NCLEX Test

NCLEX-RN Test Technology

The NCLEX-RN is a 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 145 items.

The exam is mostly multiple-choice but other question formats are also included. A tutorial is provided to help candidates become familiar with the exam and different question types. You must provide an answer for each question, so if you are unsure of the correct answer, consider all response options and chose what you believe is the best answer. Note that you will not be permitted to return to previous questions.

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 2019 NCLEX-RN plan, which is effective between April 1, 2019 and March 31, 2023, tests the following content areas:

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

Scheduling And Testing Site Procedures Of The NCLEX-RN

The NCLEX uses Computerized Adaptive Testing (CAT) to administer 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 Exam has been processed and approved by the Board and you have received an ATT notice. The ATT includes detailed instructions for choosing a testing center and scheduling a date to take the NCLEX-RN. You must test within the validity dates on your ATT, so you should not delay in scheduling an exam session.

On the day of the test, you must bring the ATT and an acceptable form of government-issued photo identification. The first and last names on your photo identification must match exactly with those found on your ATT. You will be required to present a digital signature, take a palm vein scan, and have your photograph taken before your test. You will also be required to provide a palm vein scan when you re-enter the testing area after breaks. You should arrive at least half an 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 five hours to complete the test, including time scheduled for the computer tutorial and optional breaks.

Failing The NCLEX-RN

If you fail your exam, you can schedule to re-take the examination after at least 45 days have elapsed since your original examination date. A reschedule application will be sent with your NCLEX failure results or may be requested from the Maryland Board of Nursing Exam Department by email at mdbon.nbexam@maryland.gov.

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 the Important Links section below for test preparation options. 

Time And Costs

Evaluating your foreign degree and achieving licensing as a Registered Nurse in Maryland 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 criminal background check,
  • Your ability to demonstrate competency in oral English,
  • Your performance on the NCLEX, and
  • Your free time and how much money you have to spend.

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 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, and
  • 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. The first step in becoming a CNA in the state of Maryland is to complete a state-approved training program. 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 Maryland (see list of approved CNA training programs here). Additionally, you must pay a fee and pass 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 Maryland Board of 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 Maryland, 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 Maryland, 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 Maryland, APNs must consult and collaborate with a physician or nurse practitioner for the first 18 months of 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 (NP) 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).

Beyond Licensing

Joining A Professional 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 Maryland 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 Maryland 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 Maryland grants licensing to nurses by either examination (the process described in this topic) or endorsement (where a registered nurse licensed in another state must submit fingerprints and verification of their nursing license and, for foreign educated nurses, a passing oral English test score). You can find more on the Endorsement process on the Maryland Board of Nursing website. Maryland is part of the National Nurse Licensure Compact (NLC), which allows nurses with a multistate license to practice in any of the other states that have adopted the Compact (39, as of March 2022).
National Resources: The National Council of 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. In November 2021, The Princeton Review purchased practice questions developed by NCSBN for use with NCSBN’s Learning Extension courses, which have since been discontinued.  Test preparation for the NCLEX-RN using these questions can be found on The Princeton Review website.  Continuing education for practicing nurses at all levels can still be found on the NCSBN Learning Extension website. Nursing Associations The Maryland Nurses Association is the largest nursing association in the state. The American Nurses Association is its national counterpart.

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 questions and contact the Maryland Board of 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 in-person formats available, including a moderately priced course offered by The Princeton Review containing questions developed by the makers of the 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 Maryland Board of 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 offers 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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