U.S. Registered Nursing Re-Licensing Process
Re-Licensing Refugee Nurses
Nursing licensure standards and regulations for international and domestic nurses in the U.S. are established by individual states. The National Council of State Boards of Nursing (NCSBN), whose membership includes nursing boards from all 50 states, the District of Columbia, and four of the U.S. territories, has developed the National Council Licensure Examination for Registered Nurses (NCLEX-RN) examination. NCLEX-RN is a standardized examination that U.S. and foreign nursing school graduates must successfully complete before a State Board of Nursing will issue a license. In addition to passing the NCLEX-RN examination, each applicant must fulfill other requirements as outlined by individual State Boards of Nursing. For refugee nurses and other foreign graduates of nursing school, the state licensing requirements generally include professional evaluation of the applicant’s credentials, proof of English proficiency, and possibly, additional nursing courses (See diagram).
Registered Nursing Re-Licensing Process
Four Steps to U.S. Nursing License
The actual re-licensure process for international nurses also varies by state. Some licensing boards insist that a complete application for licensure be submitted first, whereas other States suggest that the applicants complete the credential evaluation before applying for licensure.
The registered nursing licensure process includes four distinct steps, including contacting the State Board of Nursing for information; applying for RN licensing with the State Board of Nursing; passing the NCLEX-RN exam; and receiving the license from the State Board of Nursing. These four steps are described below in detail:
Step 1: Contact the State Board of Nursing for Licensure Information
Each State Board has specific instructions on how foreign graduates must complete the licensure process. For example, State Boards may provide a list of their preferred credential evaluation services provider and the type of evaluation they require. Additionally, the State Board may require a set passing score on a specific English proficiency exam. Before applying for licensure, applicants are encouraged to contact the State Board of Nursing for information and guidance. State Board of Nursing information can be found on the National Council of the State Board of Nursing (NCSBN) website: https://www.ncsbn.org/index.htm
Step 2: Apply for RN Licensing with State Board of Nursing
In order to take the NCLEX-RN exam, the applicant must first apply to the Board of Nursing in the state where they wish to practice nursing. Once the state requirements for application have been met, the State Board of Nursing will approve the applicant to take the NCLEX-RN exam. Applicants whose education does not meet the state requirements may need to take additional courses before they can register for the NCLEX-RN exam. When the license application, including all the supporting documents for credential evaluation, verification, and completed coursework, have been submitted some states may allow applicants to begin work using an Interim or Temporary Permit under the supervision of a licensed Registered Nurse.
The license application for refugee nurses and other foreign nursing school graduates generally includes the following:
Evaluation and Verification of Licensure and Educational Credentials:
- State Boards of Nursing require credential evaluation services by Commission on Graduates of Foreign Nursing Schools (www.cgfns.org/) or other recommended service providers. The Board of Nursing may also specify the type of acceptable evaluation services. Some of the evaluation services and approximate costs are listed below:
Health Care Profession and Science Report ($278)
Full Education Course by Course Report ($328)
CGFNS Certification − includes CGFNS Qualifying Exam, Credentials Review, and English Language Proficiency ($368)
Credential Verification Service for New York State ($275)
Verification of English Proficiency:
Licensure applicants must demonstrate English proficiency by passing standardized English tests at a level as required on one or more of the exams that are accepted by the State Board of Nursing. Those whose nursing education was based on English text books and/or have extensive nursing experience in English may be exempt from the English proficiency exam.
Some of the English proficiency examinations that may be acceptable to a State Board of Nursing include the following:
- Paper-based Test of English as Foreign Language (TOEFL) ($140) www.ets.org/toefl
-Internet-based (iBT) TOEFL ($150) www.ets.org/
- Test of Spoken English (TSE) ($125)
- International English Language Test Service Academic Examination (IELTS) ($155) www.ielts.org/ or Test of English in International Communication (TOEIC) ($65) www.ets.org/toeic
Completion of Additional Courses (if necessary)
If courses taken in the applicant’s country of origin are not transferable, the applicant may need to complete additional classes to satisfy the educational requirements mandated by the State Board of Nursing. Check with the State Board to determine where the required courses may be taken.
Apply for Interim or Temporary Permit (optional)
Some State Boards of Nursing will issue Interim or Temporary Permits to applicants who have completed the nursing license application and are registered and waiting to take the NCLEX examine. With an Interim or Temporary Permit, the applicant may begin working under the supervision of a licensed nurse.
Register for NCLEX-RN Examination:
Pearson VUE is the official provider of licensing examinations for Registered Nursing. The NCLEX-RN exam costs approximately $200. Following is an outline of the NCLEX-RN exam registration process:
1. Meet the Board of Nursing eligibility requirements to take the exam.
2. Register with Pearson VUE (http://www.pearsonvue.com/) to take the exam.
3. Receive Confirmation of Registration from Pearson VUE. State Board of Nursing confirms the candidate’s eligibility to take the NCLEX-RN examination.
4. Receive Authorization to Test (ATT) from Pearson VUE.
5. Schedule to take the NCLEX-RN examination at one of the available test sites.
Step 3: Pass NCLEX-RN examination
In order to receive a RN license in any U.S. state, graduates of U.S. and foreign nursing schools must pass the NCLEX-RN examination.
Step 4: Receive Registered Nursing License
Questions & Answers
Q: How do I get started?
A: Contact the Board of Nursing in the state where you want to practice nursing for licensure application information. Contact information for the State Board of Nursing can be found on the National Council of the State Board of Nursing (NCSBN) website: www.ncsbn.org
Q: What if I don’t have the documents (e.g. transcript, license, etc.) as required by the State Board of Nursing?
A: Contact your State Board of Nursing to determine if a special exemption is available. The only alternative to becoming a Registered Nurse is to attend an accredited nursing school in the U.S.
Q: Does the State Boards of Nursing provide any financial assistance to qualifying applicants?
A: It is not likely that the State Board of Nursing will offer financial assistance to licensure applicants. However, the applicants may consider directing this question to the State Board.
Q: I was a doctor in my country. Can I practice nursing in the U.S. with a medical license from my home country?
A: No, you cannot work legally as a registered nurse without a State Board of Nursing issued license. A medical degree or license does not permit you to work legally as a nurse in the U.S. In order to practice nursing, you need formal training and education in nursing from an accredited college or university and the appropriate licensure from a State Board of Nursing. Doctors interested in pursuing a career in nursing should contact the State Board of Nursing for licensure requirements and a list of state approved nursing schools (https://www.ncsbn.org/index.htm). In addition, internationally educated physicians may consider contacting the Educational Commission for Foreign Medical Graduates (www.ecfmg.org/) for evaluation and testing services. These physicians are not eligible for evaluation services through CGFNS.
Q: I have a nursing license from my home country, but I’m not ready to apply for licensure in the U.S. Can I get a job in a health care setting without becoming re-licensed in nursing?
A: Yes, there are other job opportunities in healthcare. For example, Certified Nursing Assistant (CNA) and Licensed Practical Nurse (LPN) provide basic care and assistance to those who are ill, injured, convalescent, and disabled under the supervision of physicians or registered nurses. Refugee professionals preparing to apply for a registered nursing license may use their CNA/LPN experience as an entry toward achieving their goal of re-licensure. For listings of job opportunities in medical clinics and hospitals, contact your refugee employment specialist or the One-Stop-Career Center in your community.
Q: Where can I find more information on nursing education and nursing professions?
A: A wide range of nursing education and professional/career tracks is available in the U.S. From a diploma that can be earned through a hospital to an associate degree in nursing from a community college, from bachelor’s degree in nursing to a doctoral degree in nursing that requires university training and education, nursing offers refugee professionals and others an array of employment opportunities in the health care field. For more information on nursing education and professional careers/tracks, please review the nursing section of “Occupational Outlook Handbook: 2006-2007 Edition” developed by Bureau of Statistics, Department of Labor: www.bls.gov/oco/
Q: I am proficient in English and I do not need additional coursework. How quickly can I get a nursing license?
A: The length of time necessary to obtain a nursing license will depend on various factors, including the requirements for the State Board of Nursing and the individual applicant’s readiness. Even if you are fluent in English and have taken all the required courses, you will still need to provide documentation to support your claim in a manner that meets the State Board’s requirements. For example, English proficiency may need to be measured and documented using a standardize test such as TOEFL or TSE. Please see Step 2, section b) for cost estimates on English proficiency exams.
Q: How soon after arrival can I apply for a nursing license?
A: There is no waiting period for refugees to apply for a nursing license in the U.S. However, those interested in applying for licensure should consider how prepared they are to successfully complete this process. If you answer “No” to any of the following questions, you may need more time to prepare before applying for licensure:
- Am I proficient in English enough to pass the required language test?
- Do I have the financial resources to pay for all the licensure related expenses?
- Do I have all the documents necessary for credential evaluation?
- Am I ready to take the NCLEX-RN exam?
NCLEX Examination Information: www.ncsbn.org/nclex.htm
How can I find out more?
Office of Refugee Resettlement
Administration for Children and Families
U.S. Department of Health & Human Services
901 D Street, SW
Washington, DC 20447
* This fact sheet is only an overview of the U.S nursing licensing process. For the most current information, please contact the National Council of the State Board of Nursing (www.ncsbn.org) or your State Board of Nursing. All costs noted in this fact sheet are estimates.