HOW THE PROFESSION IS ORGANIZED IN VIRGINIA
REGULATION OF THE NURSING PROFESSION
Nursing in Virginia is regulated by the Virginia Board of Nursing (“Board”). The Board manages two types of nursing licenses related to increasing degrees of education, examination and experience:
- Registered Professional Nurse (RN); and
- Licensed Practical Nurse (LPN)
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 Virginia 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 Virginia.
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); or
- 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 VIRGINIA
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 USA has an urgent need for RNs and the American Nurses Association expects that, by 2022, there will be far more RN jobs available than any other profession. With more than 500,000 seasoned RNs anticipated to retire by 2022, the U.S. Bureau of Labor Statistics projects the need for 1.1 million new RNs for expansion and replacement of retirees, and to avoid a nursing shortage.
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 AS AN RN IN VIRGINIA
Internationally Educated Nurses (IENs) need to meet several requirements to receive Licensure by Examination as a RN in Virginia.
Steps to licensing are as follows:
1. Compile Transcripts, Translations, and Fingerprints
a. Transcript Verification
CGFNS International (CGFNS) evaluates your foreign transcript and nursing license. The Credentials Evaluation Service (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. CGFNS also offers a Certification Program which 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.
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 Virginia license.
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—who cannot be personally related to you—provide a certified translation. The translator will need to fill out and sign a special form. The Board recommends you 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.
Your fingerprints are used by both the Department of Justice and the Federal Bureau of Investigation to check if you have a criminal record.
Once you successfully complete the exclusive online application process for an RN license by examination, you are eligible to request a fingerprint-based background check. You should take care of your fingerprinting early. Analysis times vary, and this is another step in which your progress through the licensing process can be slowed down. Another reason to start early is that a complete fingerprint analysis required for an application to receive approval from the Board, which is required before you can receive an interim license—an attractive option that will be explained in the next step about your licensing application.
For fingerprinting, you will use Fieldprint, the official vendor for fingerprinting in Virginia. For applicants without a criminal history, results of the background checks should be available to the Board within 24-48 hours of fingerprinting. Applications with an associated criminal history record will take longer to process as they must be further reviewed by the Board. Fieldprint charges $38.95 for fingerprinting services.
2. Apply for RN Licensure By Examination and an Interim License
a. RN Licensure by Examination
Your application for RN Licensure by Examination should include:
- Licensure by Examination application;
- Completed fingerprint-based criminal background check;
- A Credentials Evaluation Service Professional Report or Certification Program Verification Letter from CGFNS, as applicable, with respect to your foreign nursing education program;
- Certified translations of any documents;
- Evidence of passage of an English language proficiency examination if your program was not taught in English; and
- Payment of the application fee of $190 by check or money order. This must be paid for your application to be reviewed by the Board. Fees are nonrefundable.
b. Interim Licensure
An applicant for licensure by examination who has successfully completed the eligibility requirements and submitted an application may practice as a nonsupervisory staff nurse for up to 90 days from the date of approval of an application. If you pass your NCLEX (discussed below), the Board will process your RN license. If you do not pass, your interim license will immediately stop being valid, and you will not be able to work in a nursing position until you receive a passing score on the exam.
3. 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. If you write on your application that you have no criminal record, but your fingerprint check shows even a minor offense, it can make you ineligible for a license. If this applies to you, you will need to provide specific information about your record and steps you have taken.
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.
4. Pass the National Counsel Licensure Examination (NCLEX)
The Board recommends that you do not register for your National Council Licensure Examination (NCLEX-RN) until the Board sends you a notice that your Licensure by Examination application is approved. At that time, the Board will also send you information about the NCLEX and how to find a testing administration site. You must have an approved application to schedule an appointment and to be admitted to the testing center on the day of your examination.
The NCLEX costs $200 (as of December 2021). 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.
The National Council Licensure Examination for Registered Nurses (NCLEX-RN) is the only examination required in the Virginia Licensure by Examination process.
A. National Council Licensure Examination for Registered Nurses (NCLEX-RN)
1. 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 mostly comprises 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 NCSBN implemented a number of changes to the NCLEX-RN due to the COVID-19 pandemic, including changing the length of the exam. The minimum number of items that will be shown during the exam is 75, while the maximum number of items is 145. 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.
2. Test Content
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 (12%)
- Psychosocial Integrity (6-12%)
- Physiological Integrity
- Basic Care and Comfort (12%)
- Pharmacological Therapies (12-18%)
- Reduction of Risk Potential (9-15%)
- Physiological Adaptation (11-17%)
3. Scheduling and Testing Site Procedures
Computerized Adaptive Testing (CAT) 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.
On the day of the test, you must bring the ATT and a government-issued photo 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.
More information regarding scheduling and testing site procedures are available in the Candidate Bulletin published by NCSBN.
4. 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.
5. 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 Virginia 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 fingerprint evaluation and criminal background check
- Your performance on the National Council Licensure Examination (NCLEX)
- Your free time and how much money you have to spend
OTHER CAREERS AND CREDENTIALS
A. Lower Level 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 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.
1. Certified Nursing Assistant
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 CGFNS. CNAs must complete state approved programs in order to register for the CNA exam. 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 Virginia.
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. CNAs in Virginia typically earn approximately $14 per hour. The profession is regulated by the Board.
2. 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 Virginia, 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.
B. Higher Level Opportunities
After you receive your RN license in Virginia 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).
1. Advanced Registered Nurse Practitioner
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)
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).
A. 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 Virginia 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 Virginia 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 RNs.
B. Licensing Mobility (Reciprocity)
Virginia is 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. There are currently 39 NLC jurisdictions in the U.S.
- 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 National Council Licensure Examination (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.
- 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 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.