HOW THE PROFESSION IS ORGANIZED IN WASHINGTON, D.C.
REGULATION OF THE NURSING PROFESSION
Nursing in Washington, D.C. is regulated by the Board of Nursing, a division within the D.C. Department of Health, Health Regulation and Licensing Administration. The Board manages different types of nursing licenses related to varying degrees of education, examination and experience, including:
- Registered Nurse (RN); and
- Advanced Practice Registered Nurse (APRN).
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 an RN. It also assumes that your D.C. license will be your first U.S. nursing license.
You will become an RN through Licensure by Examination. The National Council of State Boards Nursing (NCSBN) administers the National Council Licensure Examination (NCLEX-RN), which is required for licensing as an RN in D.C.
REGISTERED NURSES 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 APRNs or in healthcare management, consulting, research, or education roles.
THE JOB MARKET FOR NURSING IN WASHINGTON D.C.
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 COVID-19 pandemic has only emphasized the nursing shortage by placing an unprecedented burden on the U.S. healthcare system. In February 2021, an RN was the fifth-most in-demand job in the United States according to LinkedIn.
The Bureau of Labor Statistics predicts that the employment of RNs is predicted to grow 9% from 2020 to 2030, on par with the average growth rate for all professions. Approximately 194,500 openings for registered nurses are projected each year, on average, over the decade—many of these openings reflect the need to replace existing RNs who will retire or transfer to different occupations. In May 2020, the average annual wage estimate for RNs in Washington, D.C. was $90,050. Nationally in 2020, the industries with the highest levels of employment of RNs were hospitals (30.9%), outpatient care centers (15.66%), home health care services (11.35%), nursing care facilities (9.34%), and physician offices (7.42%). The average annual wage estimates for RNs in these five industry sectors were: $81,680 (hospitals); $89,300 (outpatient care centers); $75,870 (home health care services); $72,090 (nursing care facilities); and $71,660 (physician offices).
THE JOB SEARCH
Qualified RNs are in high demand and employers will compete for their skills. Bilingual and multicultural 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 AS AN RN IN WASHINGTON D.C.
Internationally Educated Nurses (IENs) must meet several requirements to receive Licensure by Examination as a RN in D.C.
Steps to licensing are as follows:
I. COMPILE CREDENTIALING DOCUMENTS AND COMPLETE CRIMINAL BACKGROUND CHECK
The D.C. Board of Nursing requires IENs to request a “Credentials Evaluation Service Professional Report”, which provides an analysis of the credentials earned outside the U.S. and assesses comparability against U.S. standards, through the Commission on Graduates of Foreign Nursing Schools (CGFNS). You must submit the following documents for evaluation:
- Secondary School Information: A secondary school diploma or an external exam certificate showing the highest level of secondary education received. Secondary school (high school) is a school between elementary (primary) school and university. All documents must be in English. Secondary diplomas can be translated by an applicant or someone chosen by an applicant.
- Licenses/Registrations/Diplomas: CGFNS verifies the validity of all licenses, registrations, and diplomas obtained by an applicant in non-U.S. jurisdictions for the Evaluation Report. Note CGFNS and State Boards of Nursing require license validations to be current (the signature of the validating authority must be dated within the last three years).
- Professional Education Information: A complete academic record or transcript from each educational institution attended for the nursing profession. These documents must be in English and must be translated by an official registered translator. CGFNS can translate documents for an additional fee.
CRIMINAL BACKGROUND CHECK
If you are not living in the U.S., you must obtain a national criminal background check from your home country. It is sometimes called a national police check. Include the original report with your application for licensure.
II. APPLY TO D.C. BOARD OF NURSING FOR LICENSURE BY EXAMINATION
You may apply online for Licensure by Examination by visiting this website and following the instructions: https://doh.force.com/dchealthrenewals/s/licenseapplications
If you do not have a Social Security Number (SSN), you must follow the non-SSN specific applicant instructions when applying online.
- Non-SSN applicants must submit a Notarized Affidavit along with the application.
- The applicant must provide the Board with a SSN within 90 days.
- Applicants will not be able to renew their license until they have provided a valid SSN to the Board.
If you are a first-time registrant, you must register in the new licensure system through D.C. Health: https://doh.force.com/dchealthrenewals/s/portal-page (step-by-step directions for registration can be found here).
Your application should include:
- A completed online application form (the entire process should take between 30-60 minutes to complete).
- One (1) 2” x 2” passport-type photograph.
- One (1) photocopy of a current government-issued photo ID.
- You must agree to the criminal background check question when completing the online application.
- Any required supporting documents, such as documents required for screening questions, pertaining to continuing education or for other names used. Please keep a photocopy of all documents for your records.
- If your nursing education was not provided in English, you must take one of two English language literacy tests: the Test of English as a Foreign Language Internet-Based Test (TOEFL iBT) or the International English Language Testing System (IELTS) and submit the results with the application.
- TOEFL iBT – Required Scores: 84 (Overall) and 23 (Speaking)
- IELTS – Required Scores: 6.5 (Overall Band) and 7.0 (Spoken Band)
RESULTS OF YOUR APPLICATION EVALUATION
Once your application is complete, the D.C. Board of Nursing will send you an NCLEX Candidate Bulletin with instructions on how to register for your licensing exam, the NCLEX-RN. If you pass the NCLEX-RN and your criminal background check is clean, the Board will process your RN license.
Apply early: you should expect your application to take several months, not including any time spent preparing and sending documents to CGFNS.
Be truthful in your application. There are serious consequences for false or misleading information in the application.
Be sure your names match on all 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-RN)
After your Licensure by Examination application is complete, the Board recommends registering and paying for the National Council Licensure Examination (NCLEX-RN).
If your education and experience meets the D.C. RN standards, the Board will grant you eligibility to take the NCLEX-RN in the Pearson VUE system. Pearson VUE will then send your Authorization to Test (ATT) via the email address you used to register for the NCLEX-RN. At that time, you will also receive information about the NCLEX-RN and how to find a testing administration site. You must have your ATT to schedule an appointment. If you do not receive an ATT email, contact the Board to ensure all necessary materials have been submitted and received, or to find out why the Board has not granted eligibility to your registration.
The NCLEX-RN costs $200 (as of November 2021). Your NCLEX-RN scores should be available to the D.C. Board of Nursing and then sent to you within six weeks after taking the exam. If you pass the exam and your criminal background check, you will be issued your RN license as soon as it can be processed.
The NCLEX-RN is the only examination required in the D.C. Licensure by Examination process.
NCLEX-RN TEST TECHNOLOGY
The NCLEX-RN is computer-based, variable-length, adaptive test. This means that the test will adjust its difficulty level, content, and number of questions based on your answers.
In general, 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. A few of these items are pretest items that are not scored.
The exam is mostly multiple-choice but other question types are also included. A short tutorial is available that explains how to answer 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-RN CONTENT AREAS
The content of the NCLEX-RN concentrates on the patient as the focus of care. The NCLEX-RN exam (2019 edition) is divided into four categories of Client Needs (underlined below), 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 6-12%
Psychosocial Integrity 6-12%
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 to administer the NCLEX-RN in testing centers across the U.S. and internationally. You can register information with Pearson VUE and pay for the test ($200), but you cannot schedule the NCLEX-RN exam until the D.C. Board of Nursing has processed your application for Licensure by Examination and you have received an Authorization to Test ATT. 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 a government-issued photo ID that matches exactly the first and last names you provided when you registered. The following biometric data will also be taken at the testing site: signature, photograph, and palm vein scan. 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 a short introductory screen and two pre-programmed optional breaks.
FAILING THE NCLEX-RN
If you fail the NCLEX-RN, the D.C. Board of 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 concentrate on studying before you retake the exam. You may retake the NCLEX-RN 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 below for test preparation options.
TIME AND COSTS
Evaluating your foreign degree and achieving licensing as an RN in D.C. depends on many factors. A few of these include:
- The completeness of your educational and professional records
- The efficiency of your home country’s system in compiling and transmitting your university records and verification of licensing to CGFNS
- Your criminal background check
- Your performance on the NCLEX-RN
- Your free time and how much money you have to spend
OTHER CAREERS AND CREDENTIALS
You may want to consider whether taking a lower-level job in healthcare in the short-term can help you meet longer-term goals of licensing as an RN.
Preparing for the NCLEX-RN 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-RN and licensing
- more energy to focus on studying
- the opportunity 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 they have benefits such as tuition reimbursement or schedule flexibility that will support your goals.
CERTIFIED NURSING ASSISTANT (CNA)
CNAs are commonly referred to as nurses’ aides or orderlies. CNAs have very limited responsibilities and work under nurse supervision. 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 $18 per hour. The profession is regulated by the D.C. Board of Nursing.
As a foreign trained nurse, you can become a CNA in D.C. fairly easily once you have completed your degree evaluation through CGFNS. To become eligible to apply to take the National Nurse Aide Assessment Program (NNAAP) Examination for certification, you do not need to take a U.S. CNA course if you have trained as an RN or an Licensed Practical Nurse within the last 36 months. You will need to attach a copy of your foreign credentials certification to your application. You must also attach the CGFNS report that confirms you were trained as a nurse in your home country. Additionally, you must pass a criminal background check before working as a CNA.
The NNAAP Examination requires a written (or English or Spanish oral) examination and a skills evaluation. An oral examination may be taken in place of the written examination if you have difficulty reading English. You must request an oral examination when filling out your application to take the Examination. Both the written (or oral) and skills tests will be administered on the same day. Exam sample questions and self-assessment materials are available for practice (see link to Candidate Handbook below). If you fail the exam 3 times, you must take a CNA training course in order 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 training centers in D.C.
Refer to the Candidate Handbook for D.C. Nurse Aides published by the NNAAP for more information.
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 D.C. 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.
After you receive your RN license in D.C. 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 Registered Nurse (APRN).
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. APRNs in most states are allowed a more independent nursing practice, which includes diagnosis and treatment of patients and the ability to prescribe medications. APRNs 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 APRN will find a variety of opportunities for education, including accelerated degree programs or courses designed for working professionals (e.g. weekend and evening courses). Refer to these instructions for becoming certified as an APRN in D.C.
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 D.C. 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.
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)
Washington D.C. 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 guide) or endorsement (where a registered nurse licensed in another state must meet all D.C. requirements for licensing). Fortunately, since the NCLEX-RN is accepted by all states, a registered nurse looking to relocate to D.C. will not have to retake the exam.
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 (NCSBN).
The D.C. Board of Nursing issues licenses for Registered Nurses (RN) and Advanced Practice Registered Nurses (APRN) of several varieties. Their RN license application webpage has instructions for foreign-educated nurses on how to meet D.C. requirements.
The National Council on State Boards of Nursing (NCSBN) represents member Nursing Boards for all 50 states, Washington D.C., and four U.S. territories. It develops the National Council Licensure Examination (NCLEX-RN). Its website also shows an up-to-date map of states that have formed a Nurse Licensure Compact.
The NCSBN Learning Extension is a portal for e-learning for the nursing community that includes continuing education for practicing nurses at all levels.
NCBSN has discontinued its NCLEX-RN review courses, as The Princeton Review purchased the practice questions developed by NCSBN in November 2021. The NCLEX-RN QBank offered by The Princeton Review is the resulting test preparation resource that includes the questions purchased from NCSBN.
PROVIDE COMPLETE DOCUMENTS
Nursing foreign degree evaluation services require that your university and licensing authority send transcripts and validations 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, if accepted, 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 D.C. 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. 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 be prepared to take the NCLEX-RN by the time your licensure by examination application is ready to submit to the D.C. Board of Nursing.
BE FLEXIBLE IN YOUR JOB SEARCH
Focus on building your 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 opens up 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.