How The Profession Is Organized In New York
REGULATION OF THE NURSING PROFESSION
Nursing in New York is regulated by the New York State Education Department – Office of the Professions with support from its Nurse unit. The Office manages four types of nursing licenses related to increasing degrees of education, examination and experience:
Licensed Practical Nurse (LPN)
Registered Professional Nurse (RN)
Nurse Practitioner (NP)
Clinical Nurse Specialist (CNS)
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 New York license will be your first U.S. nursing license, so you will need to show education and exam qualifications to earn your license in the state. 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 New York.
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 Nurse Practitioners or in healthcare management, consulting, research, or education roles.
THE JOB MARKET FOR NURSING IN NEW YORK
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 Center for Health Workforce Studies reports that demand for RNs in New York is expected to grow between 2015 and 2025, especially in long-term care settings.
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 New York
Overview
Internationally Educated Nurses (IENs) need to meet several requirements to receive Licensure by Examination as an RN in New York.
Steps to licensing are as follows:
I. CGFNS CREDENTIAL VERIFICATION
CGFNS is the Council for Graduates of Foreign Nursing Schools, a national organization that offers several services related to nurse licensing.
Foreign trained nurses trying to earn a New York license are required to use the CGFNS Verification of Authenticity of Education Credentials to collect transcripts directly from foreign nursing schools. CGFNS will send information to New York licensing authorities. It is very important to note that this is only to receive the official documents and prove they are legitimate. This is not your degree evaluation.
When your credentials have been verified, CGFNS will send your records to the state of New York.
II. OFFICE OF THE PROFESSIONS APPLICATION AND CREDENTIAL EVALUATION
At the same time you are verifying your credentials via CGFNS, you can also prepare your application for the state of New York Office of the Professions. Because this is your first license in the US, you will be applying for “Registered Nurse Licensure by NCLEX examination.”
Your application will include:
Form 1, the basic application
Form 3, with which you include with a copy of your foreign nursing license
Form 1CE on child abuse reporting, or a Certification of Exemption
A notarized signature
$143 application fee for licensure and your first 3 years of nurse license registration
This Office will also evaluate your degree once it receives documentation from CGFNS. If it finds that you have any missing courses, you will receive a letter confirming what courses or clinical practice you may have to take before you can qualify for the next step in your RN licensing.
III. CHILD ABUSE REPORTING AND INFECTION CONTROL COURSES
Nursing candidates must take two short courses for their licensing process.
- A NYSED approved child abuse reporting course must be passed and proof sent with your application (Form 1CE). The course fee varies by provider but can average $35 for an online course. If you graduated from a nursing education program registered by NYSED as licensure qualifying for RN after September 1, 1990, you have already completed the child abuse reporting coursework requirement as part of your studies.
- All practicing RNs must complete NYSED approved infection control coursework every four (4) years or qualify for an exemption. When you apply for a license, you will be required to show that you completed NYSED approved infection control coursework or qualify for an exemption.
If you graduated from a nursing education program registered by NYSED as licensure qualifying for RN within the past four years, you already completed the required infection control coursework as part of your nursing studies. You do not have to take additional infection control coursework when you apply for a license.
IV. PASS THE NATIONAL COUNCIL LICENSURE EXAMINATION (NCLEX)
You will only be able to register for the NCLEX once the Office of the Professions has approved your education credentials and you have received an Authorization to Test. Once you have this permission you will be able to register with the Pearson company to take the NCLEX exam.
Your NCLEX scores should be available to the New York Office of the Professions within one month after testing. Once you have received a passing grade on the NCLEX you will receive a letter of passage and your licensure will be issued as soon as it can be processed, usually within a few months.
Tests
The National Council Licensure Examination for Registered Nurses (NCLEX-RN) is the only examination required in the New York Licensure by Examination process.
NCLEX-RN TEST TECHNOLOGY
The NCLEX-RN is a 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 THE NCLEX-RN
The NCLEX-RN exam content is usually revised every three years, and concentrates on the patient as the focus of care. The 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 12%
Psychosocial Integrity 12%
Physiological Integrity
Basic Care and Comfort (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, 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, 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 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. 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 New York 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
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 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 ERES or CGFNS. You do not need to take a U.S. CNA course if you submit the following materials to the New York State Department of Health and receive approval to register for the written competency exam:
A copy of your nursing license.
Documentation of your nursing school coursework.
A copy of your diploma translated into English.
Copy of your official transcript in English, including the number of hours of training your received for each course.
Social Security card.
A copy of your admission letter or score report if you have taken or will take the New York State RN or Licensed Practical Nurse examination.
After you have the necessary materials to register for the CNA exam, you can find an exam site through Prometric, which is contracted by the New York State Department of Health to administer the exam. The CNA 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 New York.
Additionally, you must pass a test and 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.
HEALTHCARE INTERPRETER
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 New York, 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.
HIGHER-LEVEL OPPORTUNITIES
After you receive your Registered Professional Nurse license in New York you may find you want to continue your professional development and qualify to train as a Nurse Practitioner in the state.
NURSE PRACTITIONER (NP)
The Nurse Practitioner (NP) is the highest licensure in nursing practice in the state of New York and involves graduate school education, examination, and licensing processes beyond the level required of RNs. NPs in most states are allowed a more independent nursing practice, which includes diagnosis and treatment of patients and the ability to prescribe medications for one or more specialties they have become qualified to practice in. In New York, NPs must have a joint agreement with an New York licensed physician on record, but direct physician supervision is not required in order to practice. NPs can prepare to practice in the following specialties:
Acute Care
Adult Health
College Health
Community Health
Family Health
Gerontology
Holistic Care
Neonatology
Obstetrics and Gynecology
Oncology
Palliative Care
Pediatrics
Perinatology
Psychiatry
School Health
Women’s Health
A RN who wants to become a NP will find a variety of opportunities for education, including accelerated degree programs or courses designed for working professionals (e.g. weekend and evening courses).
Beyond Licensing
KEEPING YOUR LICENSING CURRENT
Your New York nursing license is valid for your lifetime unless action is taken against you by the Board of Regents. However, you need to re-register every three years and should keep your address information current in order to receive notifications by mail.
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 New York 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.
STATE:
New York State Nurses Association
NATIONAL:
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 New York 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 New York requirements for licensing). Fortunately, since NCLEX is accepted by all states, a registered nurse looking to relocate to New York 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.
