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What's New in Nursing and Healthcare Visa, Immigration and Certification 
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CGFNS Certificate

The CGFNS Certification Program (CP) is designed specifically for first-level general (Registered) nurses educated outside the United States who wish to pursue a career in the U.S. as registered nurses. The program is comprised of three parts: a credentials review of your nursing education, registration and licensure; the CGFNS Qualifying Exam testing nursing knowledge (offered four times a year in over 40 test sites worldwide); and an English language proficiency examination. In order to be eligible for the CGFNS Qualifying Exam, you must have completed a minimum number of hours of both classroom instruction and clinical practice in Adult Medical/Surgical Nursing, Maternal/Infant Nursing (Obstetrics), excluding Gynecology, Care of Children (Pediatrics), and Psychiatric/Mental Health Nursing, excluding Neurology. If you have not completed any and/or an insufficient number of hours in each of the above areas, you will be ineligible to take the CGFNS Qualifying Exam until you complete an entire course (both theory and clinical) in the deficient area from a government-approved nursing school. You must also have been registered (1) as a first-level (Registered) nurse in your country of education, and (2) currently hold a registration/license as a Registered Nurse in some jurisdiction. Verification of both registrations must be sent to CGFNS directly from the licensing body(ies). Please see more details on the CGFNS website.

A CGFNS certificate will help nurse applicant qualify for a permanent Alien Registration Receipt Card (green card) or, alternatively, the applicant must pass the NCLEX-RN exam. The CGFNS Certification is a three-part program designed to predict an applicant’s likelihood of passing the NCLEX-RN examination and becoming licensed as a registered nurse in the United States. Most states require the CGFNS Certificate from nurses educated abroad before they can take the NCLEX-RN examination.

Note: The exceptions are 6 states that do not require the CGFNS exam (while still requiring credentialing verification and English language exams): California, Florida, New York, Alaska, Hawaii, and Indiana. While these states do not require the CGFNS exam, federal law, however, requires that all foreign nurses obtain the CGFNS VisaScreen certificate, which can only be obtained after passing either the CGFNS or NCLEX-RN exam. Given that NCLEX-RN exam is not yet offered abroad, in the end foreign nurses have to take the CGFNS exam anyway). Canadian nurses, on the other hand, can take advantage of these exemptions when looking for temporary employment in the United States.

Note: There are 18 so-called ‘compact states’ (plus a few states pending) that share licensure. If you are seeking Compact licensure, you need to contact your state board of nursing for primary state of residence requirements. U.S. Boards of Nursing by State.

CGFNS VisaScreen Certificate

There is also a CGFNS VisaScreen certificate. The CGFNS VisaScreen certificate is required by federal law for all foreign healthcare professionals (except physicians) who are seeking a permanent immigrant visa ("green card" based on occupational EB-3 visa) or a change in status to permanent residency.

In every day practice, the two terms - the CGFNS certificate and the CGFNS VisaScreen Certificate - are often used interchangeably in the context of foreign nurse recruitment, but it is always the CGFNS VisaScreen certificate that is required from foreign nurses. The VisaScreen certificate includes two additional English language tests - the TSE and TWE - that the CGFNS certificate does not require. All other components are virtually identical in both certifications.

The CGFNS certifications are comprised of three parts:

1)       educational/credentials review of the nurse's education, registration and licensure;

2)       CGFNS Qualifying Exam, a one-day qualifying exam testing nursing knowledge (NCLEX-RN exam can be taken instead of the CGFNS exam, but the NCLEX-RN exam will only be offered outside the United States beginning 2004);

3)       English language proficiency exam(s).

The CGFNS VisaScreen certificate will need to be presented to a U.S. Consular office abroad, or in the case of adjustment of status, the attorney general, as part of an immigration visa application. 

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CGFNS: Part 1 - Educational and Licensure Review

Educational Review

The educational review ensures that the applicant's education meets all applicable, statutory and regulatory requirements for the profession the applicant intends to practice, and is comparable to that of a U.S. graduate seeking licensure.

In order to meet the educational requirements for the program, applicants must have:

1)       Successfully completed a senior secondary school education that is separate from their professional education;

2)       Graduated from a government-approved, professional healthcare program of at least two years in length; and

3)       Successfully completed a minimum number of clock and/or credit hours in specific theoretical and clinical areas during their professional program.

Note: Physical Therapists must include a self-reported, typewritten summary of their supervised clinical experience.
                 

Licensure Review 

The licensure review evaluates initial and all current and past licenses. Validations provided directly to the CGFNS department called ICHP by the issuing institution, affirm that the applicant has completed all practice requirements and that the registration/licensure has no encumbrances. Be advised that ICHP is unable to accept any transcript or licensure documentation sent by email, fax or via the Internet. All documentation must be a hard copy sent by mail/courier to ICHP.  Please see more details on the CGFNS website.

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CGFNS: Part 2- English Language Proficiency Assessment                 

Government-approved Language Testing Bodies and Exams

The English language proficiency assessment confirms that the applicant has demonstrated the required competency in oral and written English by submitting passing scores on tests approved by the U.S. Departments of Education and Health and Human Services.

Currently, to fulfill the English language requirement, applicants may take either

• the Test of English as a Foreign Language (TOEFL), which includes Test of Written English (TWE) and Test of Spoken English (TSE), administered by the Educational Testing Service (ETS). Registration information is available on the TOEFL web site; or
   

• the Test of English for International Communication (TOEIC), administered by the Chauncey Group, along with the TSE and TWE, administered by ETS; or
   

• the International English Language Testing System (IELTS), administered by Cambridge ESOL Examinations, the British Council and IDP Education Australia. Website: www.ielts.org.There is a general module and academic module of this exam.

  • All registered nurses, physical therapists, occupational therapists, speech pathologists, audiologists, physician assistants and medical technologists must take the academic module. Licensed practical nurses and medical laboratory technicians may take the general module.
     

• Note: According to the English Language Institute (ELI), the MELAB program has officially requested that the MELAB no longer be recognized for the purpose of certifying healthcare workers, as of November 2002. Inquiries by email: melabelium@umich.edu

Note: The IELTS is easier to pass, especially the speaking part of the exam. But if you fail this exam, you will have to wait 2 months before taking it again, as opposed to TOEFL which can be re-taken immediately.

Note: Physical Therapists and Occupational Therapists may sit the TOEFL, TSE and TWE only.

Acceptable English Language Exam Scores 

The TOEFL exam and other English language exams can be taken before or following the CGFNS Qualifying Exam, but nurses must take and pass the English exams within a 2-year period from the start of the VisaScreen application. Test results are mailed to CGFNS approximately 5 to 6 weeks after the exam, on applicant's request. Please see more details on the CGFNS website. The fees for TOEFL exam are US $130.

1. Passing TOEFL scores:

For registered nurses (RNs):

• 540 paper-based TOEFL or 207 computer-based TOEFL (some Nursing Boards require a score of 550, such as in California, for example)

• 4.0 TWE

• 50 TSE
   

For licensed practical nurses (LPNs) and licensed vocational nurses (LVNs):

• 530 paper-based TOEFL or 197 computer-based TOEFL

• 4.0 TWE

• 50 TSE
   

For physical and occupational therapists:

•  560 paper-based TOEFL or 220 computer-based TOEFL

• 4.5 TWE

• 50 TSE.

Note: A new TOEFL test will be introduced in September 2005. The Next Generation TOEFL will be delivered on the Internet at official test centers worldwide. There will be four sections-Reading, Listening, Writing, and Speaking. Examinees will be allowed to take notes and use the notes to answer test questions. Each section will be scored on a scale of 0-30 points, for a total of 120 points. The Writing and Speaking sections will be evaluated by expert raters. The Computer-Based TOEFL will be discontinued when the Next Generation TOEFL is introduced. Although a Paper-Based TOEFL will still be offered at test centers where an Internet-Based test is not practical, the Next Generation version of the Paper-Based TOEFL will include all four sections-Reading, Listening, Writing, and Speaking.

2. Passing TOEIC score is 725 for RNs and 700 for LPNs and LVNs.

• 4.5 TWE

• 50 TSE
   

3. Passing IELTS score for RNs is 6.5 Overall (Academic Module). There is a general module and academic module of this exam.

• All registered nurses, physical therapists, occupational therapists, speech pathologists, audiologists, physician assistants and medical technologists must take the academic module.

• Licensed practical nurses and medical laboratory technicians may take the general module with the passing score of 6.0.

The English language exams are waived for countries in which English is the primary language and used in all nursing classes, textbooks, exams, etc. This includes Canada (except Quebec), Australia, Ireland, United Kingdom, New Zealand, and most recently Tobago and Trinidad (in limited circumstances), or the United States. Please see more details on the CGFNS website.

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CGFNS: Part 3 – Nursing Qualifying Exam

The CGFNS nursing exam is a one-day exam which is conducted in designated locations (more than 40 exam centers) in various countries. In many cases, nurses will be required to travel either to another city or even to another country to sit this exam.

Note: In case of travel abroad, employers often sponsor 3-day hotel accommodations for nurses (shared or individual) and meals.

The CGFNS exam was designed to *predict* the future potential of a nurse to pass NCLEX-RN (an official U.S. nursing exam required for permanent licensure). The CGFNS exam is structured very closely to the NCLEX exam. 95% of nurses who have passed the CGFNS exam, pass the NCLEX-RN exam as well.
 

CGFNS Qualifying Exam Description

The CGFNS exam is offered in English. The exam lasts a full day, from 7 a.m. to 3 p.m.. The maximum length is 300 minutes, including an introductory practice and rest breaks.

The scope of the exam is a minimum of 75 questions and a maximum of 265 questions or 5 hours, whichever comes first. The level of difficulty of each question is dynamically generated by computer depending on the previous answers given by the candidate. The length of an individual exam varies every time.

The length of the exam does not reflect the overall outcome: a nurse can fail the exam after answering only 75 questions and equally, a nurse can fail after answering all 265 questions. This dynamic method ensures that each exam is unique and reflects the capacities of each particular candidate.

A nurse must open a file with the CGFNS office and register for the exam by sending all the required documents and fees. The CGFNS office must receive all the documents 3 months before the exam, by the pre-established exam registration deadline. The CGFNS sets the date of the exam, and the nurse must visit the CGFNS website to confirm her/his registration for the exam. For instructions, please see page 2 of this CGFNS booklet.

The cost of the CGFNS exam is $325 plus $30 for forwarding transcript information. There is a $75 charge for a returned check. No changes are allowed. To make a change, a new exam must be scheduled and a new fee must be paid (no refunds).

The CGFNS exam is effective for 2 (two) years, as opposed to the NCLEX exam, which is only effective for 365 days. (The cost of the NCLEX exam is $200 and changes are allowed at a $50 per change).

The results of the CGFNS exam are calculated by computer immediately but they are NOT given to the candidate immediately after the exam, because the results are also verified by hand. It takes 8-10 weeks for the results to arrive to the nurse candidate by surface mail (the results are mailed directly to the candidate).

Previous Statistics: 54% - an average passing rate for foreign nurses taking the NCLEX exam for the first time, based on the state of California over the last 3 years (Source: California Nursing Board, 2003).

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CGFNS Exam Overseas

The CGFNS Qualifying exam is conducted in various countries. There are more than 40 test sites worldwide. But in some cases, nurses need to travel to another city or even another country to sit the CGFNS exam, if there are no local exam centers available. Each exam center has a three-digit number assigned to it. View complete list of the CGFNS exam centers worldwide.

 

CGFNS Examination Schedule 

The CGFNS qualifying exams are offered only a 3-4 times a year, and the deadline to register for this exam is three (3) months prior to the exam date. As of February 3, 2003, one can register and pay for the CGFNS exam online!

To find out CGFNS exam dates for 2005 and deadlines for registration, please review this 4-page CGFNS information booklet. It is advisable to visit this CGFNS "Special Notices" section on a regular basis to keep up-to-date with licensing regulations and avoid potential problems. For example, the CGFNS no longer sends applications exam registrations by surface mail. Instead, nurse applicants are required to visit the CGFNS website and confirm their registration for a specific exam date.

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Special Notice for Canadian Nurses

SPECIAL NOTICE FOR CANADIAN NURSES
Source: CGFNS press room

Jointly Prepared by The Commission on Graduates of Foreign Nursing Schools (CGFNS) & The National Council of State Boards of Nursing (NCSBN)

Philadelphia, PA - January 20, 2005 - The final rule implementing Section 343 of the Illegal Immigration Reform and Immigrant Responsibility Act (IIRIRA) of 1996 became effective on September 23, 2003. This rule requires that Canadian nurses entering the United States to work under Trade NAFTA or applying for a temporary or permanent occupational visa must obtain a VisaScreen™ Certificate. To date, CGFNS is the only recognized entity to provide such services by the U.S. federal government. The final rule allowed for a transition period during which the Canadian nurse must obtain the VisaScreen™. That transition period ended on July 25, 2004. However, the Department of Homeland Security has provided an extension of that deadline for health professionals working under Trade NAFTA who were employed and licensed in the U.S. prior to September 23, 2003. The new deadline for healthcare professionals who qualify is July 26, 2005.

The National Council of State Boards of Nursing (NCSBN) will grant qualified candidates eligibility to take the NCLEX® examination to help satisfy the VisaScreen™ requirements through September 30, 2005. If currently licensed by a state or territorial board of nursing, candidates may choose to apply to either NCSBN at http://www.ncsbn.org/testing/nclexforvisascreen.asp or to one of the following boards of nursing: Arkansas, Connecticut, Maine, Maryland, Minnesota, North Carolina, New Hampshire, or the Virgin Islands. For more information on registering with a state board of nursing to take the NCLEX® examination, contact any of the above states through the following link: http://www.ncsbn.org/regulation/boardsofnursing_boards_of_nursing_board.asp . It should be noted that this is for immigration purposes only, and applicants seeking a state or territorial license should contact the board of nursing in the state they intend to work in for the specifics of what they need to obtain a state or territorial license.

A VisaScreen™ Certificate is issued after a complete evaluation of the nurse's credentials to verify that he or she meets the minimum federal requirements. The International Commission on Healthcare Professions (ICHP), a division of CGFNS, administers this screening process. The VisaScreen™ program consists of the following parts:

• A credentials review of the nurse's entire professional education. Federal law requires that educational documents be sent to CGFNS directly from the nursing school.
• A validation of all registration/licensure that the nurse held and currently holds. Federal law requires that license verification be sent to CGFNS directly from the licensing agency.
• Successful completion of either the CGFNS Qualifying Exam or the NCLEX-RN®.
  Note: For Canadian nurses, for the purpose of the VisaScreen™ requirements, successful completion of the State Board Test Pool Examination (SBTPE) that was administered in Canada is an acceptable alternative to the NCLEX-RN®.
• Successful completion of a group of English language proficiency examinations. Nurses educated in Canada (except Quebec) are exempt from the English language proficiency examinations if their instruction and textbooks were in English. If the nurse is not exempt from the English language proficiency examinations she or he will need to successfully pass one of the following English exams: TOEFL which includes TWE and TSE, or TOEIC which includes TWE and TSE, or the Academic module of the IELTS.

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Road Map to the CGFNS Certificate and VisaScreen Certificate

The CGFNS certificate and VisaScreen Certificate require similar steps and require very similar information from the applicant, but they use different forms.

In every day practice, the two terms - the CGFNS certificate and the CGFNS VisaScreen Certificate - are often used interchangeably in the context of foreign nurse recruitment, but it is always the CGFNS VisaScreen certificate that is is implied, because the VisaScreen certificate is required by federal law for all healthcare professionals (except physicians) seeking an employment-based permanent immigrant visa. More...

In order to obtain the VisaScreen certificate, foreign nurses must do the following:

Step 1. Complete and sign the appropriate application form. This includes documentation about the applicant's senior secondary school education with word-for-word English translation and a statement of accuracy signed by the translator.

Step 2. Prepare and send a request for validation of registration/licensure to the licensing authority in the country of the applicant's nursing education and to the licensing authority where the applicant is currently registered. For VisaScreen, the applicant must obtain validation for all past and current registration/licenses.

Step 3. Prepare and send a nursing education form to the applicant's school, which the school must complete and send directly to CGFNS.

Note: Nurses should contact their school and licensing authorities to follow up on requests, urging them to complete and send documents to CGFNS as soon as possible. Then, the applicant should call every week to check again until the schools and licensing authorities confirm that the requests have been completed and forwarded to CGFNS.

Step 4. Complete the photograph identification card section of the application form, including a passport-sized photograph and an additional two copies of the photograph.

Step 5. Enclose required fees with the application form (credit card payment, international money order or certified check in U.S. dollars, drawn on a U.S. bank).

Step 6. Nurses apply to take the test of English as a Foreign Language (TOEFL) exam, which is administered worldwide. After registering for the TOEFL exam, applicants must complete the TOEFL form in the CGFNS/VisaScreen application packet, including the TOEFL registration number and the exam date (or score, if the TOEFL results have already been obtained; the TOEFL results are valid for 2 years), and return it to CGFNS.

Step 7. Nurse applicants must successfully pass either the CGFNS Qualifying Exam or NCLEX-RN exam.

Note: CGFNS has an automated voice response system available 24 hours a day to check the status of an application.