November 24, 2008	2008-R-0648
Foreign—Educated Nurses
By: John Kasprak, Senior Attorney

You asked for an update of OLR Report 2002-R-0931 that provided information on the licensure process, in Connecticut and other states, for foreign-educated nurses.

Licensure requirements for Foreign-educated Nurses

Commission on Graduates of Foreign Nursing Schools (CGFNS)

There is basically a two-step process for obtaining a registered nurse (RN) license in the United States for a foreign-educated nurse.  (This process is separate from the process necessary for obtaining a work visa.)  The first step involves the Commission on Graduates of Foreign Nursing Schools (CGFNS).  CGFNS operates a certification program designed specifically for first-level general (registered) nurses educated outside the United States who wish to pursue a career in this country as RNs.  The certification  program has three parts: a credentials review of the individual’s  nursing education, registration and licensure; the CGFNS Qualifying Exam that tests nursing knowledge (offered four times a year in over 40 test sites worldwide); and an English language proficiency examination.  The CGFNS certification is designed to predict an applicant’s likelihood of passing the U.S. national licensure exam for registered nurses (NCLEX-RN).

Individual states are not required to recognize and use the CGFNS certification program or its other services (see the 2002 OLR report for more detail on CGFNS services).  The table below shows U.S. state boards’ of nursing CGFNS licensure requirements for foreign-educated nurses, both RNs and licensed practical nurses (LPNs).

Additional State Requirements

As a second step towards individual state licensure, every nurse must meet additional state requirements and take the NCLEX as established by the state board of nursing. (Each state has its own board of nursing.)  There are some state boards of nursing that will accept the Canadian Nurses Association Testing Service or the Canadian Registered Nurses Examination.  A few state nursing boards will directly endorse foreign educated nurses who have never taken the NCLEX.

U.S. State Board’s of Nursing CGFNS Licensure Requirements

For Foreign-Educated Nurses

State Board of Nursing	Type of Nursing License	Initial RN	Initial Licensed Practical Nurse (LPN)	Secondary School (refers to whether an evaluation of high school diploma is required for a CES Report)
Alabama	RN and LPN	CP and CES Full	CES Full	Yes
Alaska	RN and LPN	CP
American Samoa	RN and LPN
Arizona	RN and LPN	CES, VS or CP	CES or VS	No
Arkansas	RN and LPN	CP or CES Full	CES Full	Yes
California	RN
California	LPN		CES Full Accepted
Colorado	RN and LPN	CP or CES HP/S + English	CES HP/S+ English	No
Connecticut	RN and LPN	CP
Delaware	RN and LPN	CP
District of Columbia	RN and LPN	CP
Florida	RN and LPN	CES Full	CES Full	No
Guam	RN and LPN	CP
Hawaii	RN and LPN	CP or CES HP/S
Idaho	RN and LPN	CP or CES HP/S	CES HP/S Accepted
Illinois	RN and LPN	CP, CES HP/S or VS	CES HP/S or VS	No
Indiana	RN and LPN	CP		Yes
Iowa	RN and LPN	CP	CES HP/S	No
Kansas	RN and LPN	CES Full	CES Full	Yes
Kentucky	RN and LPN	VS	VS	Yes
Maine	RN and LPN	CP or CES HP/S		Yes
Maryland	RN and LPN	CES Full	CES Full	Yes
Massachusetts	RN and LPN	CP, CES HP/S or VS	CES HP/S or VS	No

-Continued-

Board of Nursing	Type	Initial RN	Initial LPN	Secondary School (refers to whether an evaluation of high school diploma is required for a CES Report)
Michigan	RN and LPN	CP or CES Full + English	CES Full + English (Accepted)	No
Minnesota	RN and LPN	CP or CES HP/S	CES Full	No
Mississippi	RN and LPN	CP or CES HP/S		No
Missouri	RN and LPN	CES Full	CES Full	No
Montana	RN and LPN	CP	CES HP/S	Yes
Nebraska	RN and LPN	CP		Yes
Nevada	RN and LPN	CP or CES HP/S	CES HP/S	No
New Hampshire	RN and LPN	CP or CES Full
New Jersey	RN and LPN	CP or CES Full + English	CES Full + English	Yes
New Mexico	RN and LPN	CP or CES HP/S Accepted	CES HP/S Accepted	No
New York	RN and LPN	CVS	CVS
North Carolina	RN and LPN	CES HP/S	CES HP/S	No
North Dakota	RN and LPN	CP
Northern Marianas	RN and LPN
Ohio	RN and LPN	CES Full	CES Full	No
Oklahoma	RN and LPN	CP or CES HP/S	CES HP/S	Yes
Oregon	RN and LPN	CP or CES HP/S or VS	CES HP/S or VS	No
Pennsylvania	RN and LPN	CP		LPN only
Puerto Rico	RN and LPN
Rhode Island	RN and LPN	CP	CES HP/S	No
South Carolina	RN and LPN	CES HP/S	CES HP/S	Yes
South Dakota	RN and LPN	CP	CES HP/S	Yes
Tennessee	RN and LPN	CP	CES HP/S	Yes
Texas	RN and LPN	CES Full	CES Full	No
Utah	RN and LPN	CP	CES HP/S	No
Vermont	RN and LPN	CP or CES HP/S	CES HP/S	No
Virgin Islands	RN and LPN	CP		Yes
Virginia	RN and LPN	CP	CES HP/S Accepted	Yes
Washington	RN and LPN	CES Full	CES Full
West Virginia (RN)	RN	CP		Yes
West Virginia (LPN)	LPN		CES Accepted
Wisconsin	RN and LPN	CP		Yes
Wyoming	RN and LPN	CP	CES Accepted	No

Key:

CES= Credentials Evaluation Service                        CP= Certification Program

Full= Full Education Course-by-Course Report          VS= VisaScreen

HP/S= Healthcare Profession and Science Report      CVS=Credential Verification Service for New York State

English= English Language Proficiency Report

Source:  CGFNS International, as of July 2008

Further Resources

For more information on this issue see:  The American Nurses Association (www.nursingworld.org).

The Commission on Graduates of Foreign Nursing Schools (www.cgfns.org).

The National Council of State Boards of Nursing (www.ncsbn.org)

JK:ts