HOW THE PROFESSION IS ORGANIZED IN MASSACHUSETTS
Regulation of the Nursing Profession
Nursing in Massachusetts is regulated by the Massachusetts Board of Registration in Nursing (“Board”). The Board manages three types of nursing licenses related to increasing degrees of education, examination and experience: Licensed Practical Nurse (LPN); Registered Professional Nurse (RN); and Advanced Practice Nurse (APN) The guide assumes that you have a high school education or GED plus a degree or diploma from a professional nursing program, so the most appropriate license type for you is a RN. It also assumes that your Massachusetts 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 Massachusetts.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); or
- Bachelor of Science in Nursing or BSN (a 4-year university degree).
The Job Market for Nursing in Massachusetts
Nursing is a growing field in the U.S. due to factors including such as the aging U.S. population, nurse attrition (choosing to leave the job), and the increasing complexity of nursing practice. The U.S. Bureau of Labor Statistics estimates that employment of registered nurses is expected to grow 6% from 2021 to 2031. Most nurses practice in hospital settings, but also in physicians’ offices, home healthcare, and outpatient care centers. In 2021, the median pay for registered nurses was approximately $77,600 annually.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 MASSACHUSETTS
Overview
Internationally Educated Nurses (IENs) need to meet several requirements to receive Licensure by Examination as a RN in Massachusetts.
Obtain certification of your graduation from a Board-approved nursing education program
Complete and submit the required certification form.
You must complete and submit the “Certification of Graduation from a Board-Approved Nursing Education Program Located Outside of the United States and the Territories of American Samoa, Guam, Northern Mariana Islands, and U.S. Virgin Islands” found here. This form, along with a $50 processing fee, must be submitted to Professional Credential Services, Inc. (PCS), the Board’s credentials review service.
If you do not have a U.S. Social Security number, fill out and submit an affidavit.
If you do not have a U.S. Social Security Number, you must complete the Board’s Affidavit in Support of Application for Massachusetts Nurse Licensure by Examination located here (see page 4).
Attach supporting documentation
All IENs must complete a Certification of Graduation from a Board-Approved Commission on Graduates of Foreign Nursing Schools (CGFNS) evaluation. CGFNS evaluates your foreign transcript and nursing license.
Massachusetts accepts three methods of verification offered by CGFNS: the (i) Credentials Evaluation Service (CES) Professional Report, (ii) Certification Program Verification Letter, and the (iii) VisaScreen Verification Letter. The CES Professional Report provides a detailed analysis of the credentials earned at multiple levels of nursing education outside the United States, and includes a statement of comparability of a healthcare worker’s education when assessed against US standards. The CGFNS Certification Program includes three parts: (i) a credentials evaluation of secondary education, nursing education and nursing licensure, (ii) the CGFNS Qualifying Exam and (iii) demonstration of passing one of the accepted English language proficiency examinations. Finally, the CGFNS VisaScreen Visa Credentials Assessment is a screening service accepted by the United States Department of Homeland Security and satisfies the U.S. federal screening requirements for healthcare professionals seeking occupational visas.
Once you have completed one of the aforementioned CGFNS evaluations, you must submit the evaluation to PCS. You should start the process of credentials evaluation as early as possible. 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 Massachusetts license.
Acquire translations
In order for CGFNS to evaluate your foreign transcript and nursing license, all documents must be in English. 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:
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.
You can have a professional translator provide a certified translation. The translator will need to fill out and sign a special form. You can 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. CGFNS can also translate documents for an additional fee.
Pass a Board-approved English Language Proficiency Exam
If an applicant’s nursing education was not in English, the Board requires foreign-educated nurses to sit for one of several board-designated Tests of English Proficiency. Test results must be submitted to PCS. The following tests comply with Massachusetts regulations:
Test of English as a Foreign Language (TOEFL)
CGFNS Qualifying Examination Certificate
Pearson Test of English Academic (PTE Academic)
International English Language Testing System (IELTS)
Canadian English Language Benchmark Assessment for Nurses (CELBAN)
Apply for RN Licensure By Examination
Once PCS has certified that you are a graduate of a Board-approved nursing education program, it will mail you a Letter of Eligibility. At that time, you will be able to begin the Application for Initial Licensure as a Nurse by Examination.
RN Licensure by Examination
Your application for RN Licensure by Examination should include:
- Licensure by Examination online application;
- Certification of compliance with good moral character licensure requirements;
- A 2” by 2” passport-style, color photo taken within the last year;
- Official transcript sent directly from the nursing education program to PCS; and
- Payment of the application fee ($230 as of January 2023) by credit card ($80 for repeat applicants within one year of initial application). This must be paid for your application to be reviewed by the Board. Fees are nonrefundable.
Special Considerations
Apply early: you should expect your application to take several months, not including any time spent by your university preparing and sending documents to CGFNS.
Be truthful in your application: There are serious consequences for false or incomplete information in the application.
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.
Pass the National Counsel Licensure Examination (NCLEX)
You should register with Pearson Vue to write the NCLEX at the same time you submit your MA Application for Initial Nurse Licensure by Examination to PCS. You must then wait until you have an approved application to schedule an appointment to write the NCLEX and to be admitted to the testing center on the day of your examination.
The NCLEX costs $200 (as of October 2022). Your NCLEX scores should be available to the Board within one month after testing. You will be issued your RN license as soon as it can be processed.
TESTS
Other than the Board-approved English Proficiency Test for applicants whose nursing programs were not taught in English, the NCLEX-RN is the only examination required in the Massachusetts Licensure by Examination process.National Council Licensure Examination for Registered Nurses (NCLEX-RN)
Test Questions and Scoring
The NCLEX-RN is a five hour computer-based examination. It uses “Computerized Adaptive Testing” (CAT), which means that the test adjusts its difficulty level, content, and number of questions based on your answers. Each time you answer an item (question), the computer re-estimates your ability based on your prior answers until it is 95% certain that your abilities are either above or below the passing standard. More information regarding CAT is available on the NCSBN website. The computer will decide whether you have passed the exam using one of three methods: the 95% confidence rule, the maximum-length exam rule, and the run-out-of-time (R.O.O.T.) rule. More information regarding each of those methods is available on the NCSBN website. The exam is mostly comprised of multiple choice questions, but other question types are also included. You are not allowed to skip any questions, and you should avoid making random guesses as this can quickly lower your score. The minimum number of items that will be shown during the exam is 85, while the maximum number of items is 150. Of those questions, 15 questions will be “pretest items,” that are being evaluated and will not contribute to your score. You will not know which of the questions are “pretest items,” so you should do your best to answer each question.Test Content
The content of the NCLEX-RN concentrates on the patient as the focus of care. The 2023 NCLEX-RN Test Plan, which is effective between April 1, 2023 through March 31, 2026, tests the following content areas: Safe and Effective Care Environment Management of Care (15-21%) Safety and Infection Control (10-16%) Health Promotion and Maintenance (6-12%) Psychosocial Integrity (6-12%) Physiological Integrity Basic Care and Comfort (6-12%) Pharmacological Therapies (13-19%) Reduction of Risk Potential (9-15%) Physiological Adaptation (11-17%)Scheduling and Testing Site Procedures
Pearson Vue administers the NCLEX-RN in testing centers across the U.S. and internationally. You can register information with Pearson and pay for the test, 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 as test centers may fill up quickly. On the day of the test, you must bring the ATT and a government-issued photo identification. 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 five hours to complete the test, including time scheduled for the computer tutorial and optional breaks. More information regarding scheduling and testing site procedures are available in the Candidate Bulletin published by NCSBN.Retaking the NCLEX-RN
If you fail your exam, you will receive 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.Preparing 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 sooner. NCSBN has also published NCLEX-RN practice exams that you may use in your preparation.TIME AND COSTS
Evaluating your foreign degree and achieving licensing as a Registered Professional Nurse in Massachusetts depends on many factors, including:- 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 performance on the National Council Licensure Examination (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 RN. 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.
Certified Nurse Aide (CNA)
CNAs are also commonly referred to as nurses’ aides or orderlies. CNAs have 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 CGFNS. Most CNAs in Massachusetts achieve certification by completing a Massachusetts-approved nursing home nurse aid training program and passing the Massachusetts Nurse Aid Competency Evaluation. CNA training programs are short courses that last only 1 or 2 months and are offered through many community colleges or larger healthcare facilities in Massachusetts. It is also possible to request a Nurse Aide Training Waiver which allows applicants to bypass the training program and proceed directly to the Competency Evaluation which consists of a clinical skills exam and a written exam. You must pass both the CNA exam 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.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 Massachusetts, 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 RN license in Massachusetts you may find you want to continue your professional development. Once you hold a valid, unencumbered RN license, 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 RNs. APNs in most states are allowed a more independent nursing practice, which includes diagnosis and treatment of patients and the ability to prescribe medications. 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) An 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 Massachusetts 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 Massachusetts Nurses Association is the largest nursing association in the state. The American Nurses Association is the largest national nursing association. Additionally, there is a large variety of professional associations for nurses that cater to specific disciplines, job type, ethnicity, gender, or religion of RNs.Licensing Mobility (Reciprocity)
Massachusetts is not a member of the Nurse Licensure Compact (NLC), which allows qualifying nurses living in compact states to practice in all other compact states with a single multistate license. However, legislation to join the NLC is pending in the Massachusetts legislature. There are 39 NLC jurisdictions in the U.S. as of January 2023.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 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 subscription service 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 Board.
