HOW THE PROFESSION IS ORGANIZED IN ILLINOIS
REGULATION OF THE NURSING PROFESSION
Nursing in Illinois is regulated by the Illinois Department of Financial and Professional Regulation (IDFPR) and its Division of Professional Regulation. IDFPR manages 3 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 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 Illinois 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 Illinois.
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 Associate’s 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 APNs or in healthcare management, consulting, research, or education roles.
THE JOB MARKET FOR NURSING IN ILLINOIS
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. In 2007, when the Illinois Nursing Center was initially established, it estimated that by 2020 there would be a nursing shortage of over 21,000 nurses in Illinois.
The American Nurses Association (ANA) estimates an 11% growth rate for RNs, significantly higher than the average for most professions. ANA also predicts that there will be far more nursing positions available than any other profession. Furthermore, nursing shortages nationwide are expected to increase to more than half a million vacancies by 2026. On average, RNs in the United States earned $71,730 in May 2018, according to the Bureau of Labor Statistics. The highest average earnings are paid to nurses working in government ($78,390) followed by RNs who work in hospitals ($73,650), ambulatory care services ($68,320), nursing care facilities ($63,990) and education ($61,850).
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 ILLINOIS
Internationally Educated Nurses (IENs) need to meet several requirements to receive Licensure by Examination as a RN in Illinois.
Steps to licensing are as follows:
I. EVALUATE FOREIGN DEGREE
The Illinois Department of Financial and Professional Regulation allows you to have your foreign nursing degree evaluated by one of two organizations: the Commission on Graduates of Foreign Nursing Schools (CGFNS) or the Education Records Evaluation Service, Inc. (ERES). We recommend CGFNS for its long-established service, web access by regulation officials, and fast turnaround times.
The Commission on Graduates of Foreign Nursing Schools (CGFNS) instructs you on the steps necessary to evaluate your foreign degree and licensure. Here are the steps:
Apply for evaluation by either registering online or downloading an application form and sending it by mail.
Request the “Healthcare Profession & Science Report.” Make sure that you ask for your report to be prepared for the Illinois Board of Nursing – this will make your record available to the State electronically.
Use CGFNS forms to send requests for official academic records and licensing confirmation to the educational institution(s) you attended and your country’s nursing regulation agency. These records must be delivered from the institutions directly to CGFNS – you cannot handle them yourself.
Provide translations for any documents not in English. This is most often done through your foreign school(s) or licensing agency. You will need to research how to do this and what you will be charged by these institutions.
You must show proof that you graduated from high school (a photocopy of a high school diploma or exit exam will work). You must submit this directly with your application, accompanied by a translation and special translator statement.
CGFNS will evaluate your education and licensing to see if it is comparable to the minimum standards for an Illinois Registered Nurse program. This includes standards for coursework and clinical experience in five areas of nursing practice:
Adult medical nursing
Adult surgical nursing
Obstetrics (maternal and infant health)
Pediatrics (care of children)
Psychiatric or mental health nursing
After evaluation, CGFNS may decide that:
Your degree is comparable except for a missing clinical component in one of the five areas of nursing OR that
Your degree is not found as comparable.
In the first case, you will need to have your training pre-approved by IDFPR and choose a school or other training provider from a list of approved nursing education programs (the list is available on the IDFPR website). After completing this clinical requirement and sending transcripts to IDFPR, you will be able to continue your licensing process.
In the second case, you will need to return to school for a degree program to qualify you for licensure as a Registered Nurse. You should research nursing education programs in your area, and bring your transcripts and credential evaluation to the program coordinators to see if you can receive advanced standing for a Bachelor of Science in Nursing (BSN). The quickest route to becoming an RN may be to earn an Associates Degree of Nursing. However, if you choose this option you will be settling for a U.S. degree that is not as advanced as your foreign degree, and you will have to continue studying for a BSN if you want better career opportunities.
If you hold a BSN from another country, your degree might be determined comparable to the minimum standard required by the State of Illinois. However, sometimes different standards in nursing practice can affect your degree evaluation, such as male nurses not practicing obstetrical nursing, or nurse midwives not receiving training in other areas of nursing.
A list of service providers approved by IDFPR and the Illinois State Police is listed in the Licensure by Examination application. Costs vary by site. Call to set up an appointment. It is critical that you save the receipt as proof that you have taken this step: You must include it in the Licensing by Examination application package you will later send to Continental Testing Services (CTS).
III. LICENSE APPLICATION TO CTS
CTS manages licensing applications for the Illinois Department of Financial and Professional Regulation (IDFPR). You should call the CTS help number for application assistance: (708) 354-9911. There are two steps involved:
First, register online and arrange for payment.
Then mail all required documentation to CTS. Illinois requires notarized translations of any foreign-language documents.
Your final application package should include:
(1) Licensure by Examination application from the Illinois Department of Financial and Professional Regulation (IDFPR);
(2) CT-NUR forms completed by the licensing agency or board of any jurisdiction(s) in which you were first licensed, are currently licensed, or have been licensed in the last 5 years;
(3) Credential Evaluation Service report (your foreign degree and licensing evaluation);
(4) Receipt from fingerprinting appointment; and
(5) Scores from the Test of English as a Foreign Language (TOEFL) if you are not a native English speaker and the language of instruction and textbooks in your nursing program was not English.
The Illinois Department of Financial and Professional Regulation (IDFPR) requires minimal scores of 560 on the paper-based test, 220 on the computer-based test and 83 on the Internet-based test.
This application is valid for 3 years. If you have not passed the National Council Licensure Examination (NCLEX) or met other licensing requirements within these 3 years you will have to submit a new application and pay the processing fee again.
IV.REGISTER FOR PEARSON NCLEX
Register with Pearson for the National Council Licensure Examination (NCLEX) at the same time as submitting your application to CTS. The NCLEX costs $200 (as of 2021). If you choose to schedule your NCLEX at any of the international test centers, you will have to pay an additional international scheduling fee of $150 plus a Value Added Tax where applicable.
V.GET ATT AND SCHEDULE NCLEX
You have only 90 days from receipt of the Authorization to Test (ATT) to take the NCLEX. Set up your appointment immediately. Instructions are included in the ATT notice.
VI. IDFPR PASS LETTER
Your NCLEX scores should be available to the Illinois Department of Financial and Professional Regulation (IDFPR) within one month after testing. Once you have received a passing grade on the NCLEX you will receive a letter of passage from IDFPR and your licensure will be issued as soon as it can be processed, usually within a few months. Your passage letter will give you details that allow you to practice nursing for up to 3 months pending receipt of Illinois licensure, provided that you work under the direct supervision of a registered nurse or an advanced practicing nurse.
The National Council Licensure Examination for Registered Nurses (NCLEX-RN) is the only examination required in the Illinois 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 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 NCLEX-RN
The content of the NCLEX-RN concentrates on the patient as the focus of care. The current 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 (6-12%)
Psychosocial Integrity (6-12%)
Basic Care and Comfort (9-12%)
Pharmacological Therapies (12-18%)
Reduction of Risk Potential (9-15%)
Physiological Adaptation (11-17%)
SCHEDULING AND TESTING SITE PROCEDURES OF THE 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 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, the Illinois Nursing Board 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 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. The Chicago Bilingual Nurse Consortium offers a variety of test preparation resources for low cost. 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.
TIME AND COSTS
Evaluating your foreign degree and achieving licensing as a Registered Professional Nurse in Illinois 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 NCLEX.
Your free time and how much money you have to spend.
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 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.
Copy of official transcripts in English, including the number of hours of training you received for each course.
Social Security card.
Proof of employment authorization.
After you have the necessary materials to register for the CNA exam, you can find an exam site through Southern Illinois University at Carbondale (SIU-C). Their website, www.nurseaidetesting.com, also offers practice materials, a study guide, and test locations. This exam is basic, but CNA test preparation materials are available to practice. If you fail the exam 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 Illinois.
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 $15 per hour.
If you are bilingual and comfortable acting as a translator between English and your native language, you may want to research opportunities for work in hospitals as an interpreter. This type of role is not regulated in Illinois, 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 Illinois 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 (APN) 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 Illinois, APNs must have a joint agreement with an Illinois 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).
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 Illinois 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.
Illinois 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 Illinois 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 Illinois requirements for licensing). Fortunately, since the NCLEX is accepted by all states, a registered nurse looking to relocate to Illinois 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. As such, there are currently 34 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.
The Chicago Bilingual Nurse Consortium is a non-profit organization working with foreign trained nurses to assist in navigating the health care, immigration, and education systems to secure licensure as registered professional nurses in Illinois. They offer TOEFL classes for nurses, NCLEX preparation courses, and CPR courses, as well as coaching in the relicensing process specific to nurses
The Illinois Health Care Worker Registry shows the required steps of licensing as a CNA in Illinois
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). It is also, coincidentally, headquartered in Chicago, Illinois. Its website also has an up-to-date map of states which 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 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 an online subscription service that includes extensive NCLEX preparation resources, including skills assessment to identify knowledge gaps, plus curriculum, test questions and interactive exercises
The Illinois Nurses Association is the largest nursing association in the state
The American Nurses Association is its national counterpart
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 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 the state regulations, organize your questions, CTS, Pearson Vue, or Illinois Department of Financial and Professional Regulation (IDFPR), and ask for assistance.
INVEST IN TEST PREPARATION
If you can afford it, invest 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 CTS, because the events that follow are sensitive to deadlines and you will lose money if you delay.
BE FLEXIBLE IN YOUR JOB SEARCH
Build professional networks and 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.