1. HOW THE PROFESSION IS ORGANIZED IN NEW YORK
REGULATION OF THE NURSING PROFESSION
Nursing in New York is regulated by the New York Education Department – Office of the Professions with support from its Nurse unit. The Office manages three types of nursing licenses related to increasing degrees of education, examination and experience:
- Licensed Practical Nurse (LPN)
- Registered Professional Nurse (RN)
- Nurse Practitioner (NP)
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 (RN). It also assumes that your New York license will be your first U.S. nursing license, so you will need to show education and exam qualifications to earn your license in the state. 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 New York.
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 educational programs:
- An Associates Degree of Nursing or ADN (2 years of study, typically in a community college)
- A 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 Nurse Practitioners or in healthcare management, consulting, research, or education roles.
THE JOB MARKET FOR NURSING IN NEW YORK
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 New York Nursing Center reports that by 2020 there will be a nursing shortage of over 21,000 nurses in New York.
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), physicians offices ($62,880), hospitals ($62,690), home health care ($60,680) and housing 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
Internationally Educated Nurses (IENs) need to meet several requirements to receive Licensure by Examination as an RN in New York.
Steps to licensing are as follows
- CGFNS credential verification
- Office of the Professions application and credential evaluation
- Child Abuse Reporting and Infection Control courses
- Pass NCLEX exam
I. CGFNS CREDENTIAL VERIFICATION
CGFNS is the Council for Graduates of Foreign Nursing Schools, a national organization that offers several services related to nurse licensing.
Foreign trained nurses trying to earn a New York license are required to use the CGFNS Verification of Authenticity of Education Credentials to collect transcripts directly from foreign nursing schools. CGFNS will send information to New York licensing authorities. It is very important to note that this is only to receive the official documents and prove they are legitimate. This is not your degree evaluation.
The Important Links Section includes a link to the CGFNS website.
Cost: $335 through CGFNS online application
When your credentials have been verified, CGFNS will send your records to the state of New York.
II. OFFICE OF THE PROFESSIONS APPLICATION AND CREDENTIAL EVALUATION
At the same time you are verifying your credentials via CGFNS, you can also prepare your application for the state of New York Office of the Professions. Because this is your first license in the US, you will be applying for “Registered Nurse Licensure by NCLEX examination.”
Your application will include:
- Form 1, the basic application
- Form 3, with which you include with a copy of your foreign nursing license
- Form 1CE on child abuse reporting, or a Certification of Exemption
- A notarized signature
- $143 fee for licensure and your first 3 years of nurse license registration
This Office will also evaluate your degree once it receives documentation from CGFNS. If it finds that you have any missing courses, you will receive a letter confirming what courses or clinical practice you may have to take before you can qualify for the next step in your RN licensing.
III. CHILD ABUSE PREVENTION AND INFECTION CONTROL COURSES
Nursing candidates must take two short courses for their licensing process.
The Child Abuse Reporting course must be passed and proof sent with your application (Form 1CE). The course fee varies by provider but can average $35 for an online course.
The Infection Control Training Course, which informs you how to avoid the spread of HIV and Hepatitis, does not have to be turned in together with your license application. However, you must send proof of passing the course to the Office of the Professions within 90 days after getting your license.
Businesses that offer these trainings are listed in the Important Links section.
IV. PASS THE NCLEX EXAM
You will only be able to register for the NCLEX once the Office of the Professions has approved your education credentials and you have received an Authorization to Test. Once you have this permission you will be able to register with the Pearson company to take the NCLEX exam. The NCLEX costs $200 (as of 2012).
Your NCLEX scores should be available to the New York Office of the Professions within one month after testing. Once you have received a passing grade on the NCLEX you will receive a letter of passage and your licensure will be issued as soon as it can be processed, usually within a few months.
The National Council Licensure Examination for Registered Nurses (NCLEX-RN) is the only examination required in the New York Licensure by Examination process.
TEST TECHNOLOGY OF THE NATIONAL COUNCIL LICENSURE EXAMINATION FOR REGISTERED NURSES (NCLEX-RN)
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 items. You are not allowed to skip any questions, but you should avoid making random guesses, as this can quickly lower your score. 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 cannot bring reference materials or other testing aids to the exam. An on-screen calculator is provided for some problems.
CONTENT AREAS OF THE NATIONAL COUNCIL LICENSURE EXAMINATION FOR REGISTERED NURSES (NCLEX-RN)
The NCLEX-RN exam content is usually revised every three years, and concentrates on the patient as the focus of care. The exam introduced in 2012 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
- Coordinated Care (13-19%)
- Safety and Infection Control (11-17%)
- Health Promotion and Maintenance 7-13%
- Psychosocial Integrity 7-13%
- Physiological Integrity
- Basic Care and Comfort (9-15%)
- Pharmacological Therapies (11-17%)
- Reduction of Risk Potential (9-15%)
- Physiological Adaptation (9-15%)
SCHEDULING AND TESTING SITE PROCEDURES OF THE NATIONAL COUNCIL LICENSURE EXAMINATION FOR REGISTERED NURSES (NCLEX-RN)
Pearson Vue holds 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 acceptable 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, 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 90 days. If your score is far from passing you should consider additional test preparation or taking refresher courses so that you can pass in the three-year period after your first application.
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 New York 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 performance on the National Council Licensure Examination (NCLEX)
- Your free time and how much money you have to spend
We provide two hypothetical scenarios below to show some of the variety in results that immigrant professionals may find when they seek to become registered nurses in New York. Please consider these scenarios as two examples out of many possibilities. Your experience will vary.
Two Hypothetical Scenarios for Licensing as a Registered Nurse:
|Step||More Efficient Scenario|
Approximate Time and Cost
|Less Efficient Scenario|
Approximate Time and Cost
|1 CGFNS Credential Verification||It takes you just 3 months to get your home country documents to a credentialing organization to complete your degree evaluation|
No translation is needed
3 months + $550
|Problems with your documents take 6 months to resolve and are expensive since you must pay others in your country to visit institutions for you|
Your documents must be translated
8 months + $1,100
|2 Office of the Professions application and credential evaluation||You get your complete application together quickly|
The Office of the Professions authorizes you to take the NCLEX in 2 months total
2 months + $143
|You get your application together quickly, but after 3 months, the Office of Professions informs you that you must take a clinical practice course to meet your licensing requirements - your course takes 4 months and costs $400|
You submit your course information and the Office authorizes you to take the NCLEX in 1 more month
8 months + $543
|3 Child Abuse and Infection Control Prevention Courses||You take online courses and receive your certificates after 2 weeks|
2 weeks + $70
|You take online courses and receive your certificates after 2 weeks|
2 weeks + $70
|4 Pass NCLEX||You register for the NCLEX immediately|
Your skills are fresh and you've been using a self-study program throughout the process; you pass the NCLEX on the first try. You receive your RN license 3 months after you take the exam
5 months + $500
|You register for the NCLEX immediately|
It takes you 2 tries to pass the NCLEX. In between tests, you enroll in a 4-month NCLEX preparation class for $1,000. You receive your RN license 3 months after you take the second exam
8 months + $1,400
|More Efficient Total|
About 1 year and $1,250
|Less Efficient Total|
About 2 years and $3,100
5. OTHER CAREERS AND CREDENTIALS
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 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
- Copy of your official transcript in English, including the number of hours of training your received for each course
- Social Security card
- Proof of employment authorization
CNA training programs are short course that last only 1 or 2 months. They are offered through many community colleges or larger healthcare facilities in New York.
Additionally, you must pass a test and 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 $12 per hour.
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 New York, 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 Registered Professional Nurse license in New York you may find you want to continue your professional development and qualify to train as a Nurse Practitioner in the state.
NURSE PRACTITIONER (NP)
The Nurse Practitioner or NP is the highest licensure in nursing practice in the state of New York and involves graduate school education, examination, and licensing processes beyond the level required of RNs. NPs in most states are allowed a more independent nursing practice, which includes diagnosis and treatment of patients and the ability to prescribe medications for one or more specialties they have become qualified to practice in. In New York, NPs must have a joint agreement with an New York licensed physician on record, but direct physician supervision is not required in order to practice. NPs can prepare to practice in the following specialties:
- Acute Care
- Adult Health
- College Health
- Community Health
- Family Health
- Holistic Nursing
- Obstetrics and Gynecology
- Palliative Care
- School Health
- Women’s Health
A RN who wants to become a NP 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
KEEPING YOUR LICENSING CURRENT
Your New York nursing license is valid for your lifetime unless action is taken against you by the Board of Regents. However, you need to re-register every three years and should keep your address information current in order to receive notifications by mail.
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 New York 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.
- New York State Nurses Association
- American Nurses Association
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 New York 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 New York requirements for licensing). Fortunately, since the National Council Licensure Examination (NCLEX) is accepted by all states, a registered nurse looking to relocate to New York 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. There are currently 22 states that participate 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
- The New York Education Department – Office of the Professions processes and
regulates licensing for Licensed Practical Nurses (LPN), Registered Professional Nurses (RN) and Nurse Practitioners (NP) in the state. It includes
specialized offices where you can get assistance:
- Contact information
- Office of the Professions basic contact information for phone assistance and mail:
Office of the Professions
Division of Professional Licensing Services
89 Washington Avenue
Albany, NY 12234-1000
- Office of the Professions Nurse Unit – for
questions about very specific questions about your licensing application
and case file
Phone: 518-474-3817 ext. 280
- Bureau of Comparative Education, for questions about foreign credentials evaluation
Phone: 518-474-3817 ext. 300
- Office of the Professions basic contact information for phone assistance and mail:
- Application forms for RN licensing
- Child abuse prevention course provider list
- Infection Control Training provider list: due a maximum of 90 days after licensure
- Nurse practice is defined by a variety of New York Laws, rules and regulations including scope of practice and professional conduct
- The Commission on Graduates of Foreign Nursing Schools (CGFNS) in Philadelphia, PA is used by the Office of the Professions for two purposes:
- Its Credential Verification Service is required for licensure; it checks only the validity of your documents, then sends them to the Office for evaluation
- Its CGFNS certification program is used by foreign-trained RNs who want to get a 1-year Limited Permit before they take the NCLEX.
Phone: (215) 349-8767 ext. 476. One resource is their useful CES Application Handbook
- Pearson Vue administers the National Council Licensure Examination (NCLEX)
- Download the latest NCLEX Examination Candidate Bulletin as well as a small software program that offers a tutorial on the NCLEX computer-based exam interface – this will familiarize you with the appearance and operation of the interface including the variety of possible question formats (multiple choice, ordering, fill in the blank)
- 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 v5.4 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 New York State Nurses Association is the largest nursing association in the state
- The American Nurses Association is its national counterpart