How The Profession Is Organized In Florida
REGULATION OF THE NURSING PROFESSION
Nursing in the State of Florida is regulated by the Florida Board of Nursing (“Board”). The Board manages five types of nursing licenses:
- Autonomous Advanced Practice Registered Nurse
- Advanced Practice Registered Nurse (APRN)
- Licensed Practical Nurse (LPN)
- Registered Nurse (RN)
- Certified Nursing Assistant (CNA)
This 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 Florida license will be your first U.S. nursing license, so 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 Florida.
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 (ADN) – two years of study, typically in a community college
- Bachelor of Science in Nursing (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 APRNs or in healthcare management, consulting, research, or education roles.
THE JOB MARKET FOR NURSING IN FLORIDA
Nursing is a growing field in the U.S. due to factors including such as the aging U.S. population, nurse attrition (choosing to leave the job), and the increasing complexity of nursing practice. The State of Florida has an urgent need for nurses. A 2021 study prepared for the Florida Hospital Association and the Safety Net Hospital Alliance of Florida found that the state expects to see a 12% shortfall in RNs and 30% shortfall in LPNs between 2019 and 2035. Specifically, major metropolitan areas are expected to have enough RNs, but they are expected to have a shortfall of LPNs. Conversely, in rural areas, there is expected to be a shortage of RNs and an adequate supply of LPNs.
The U.S. Bureau of Labor Statistics estimates that employment of registered nurses is expected to grow 9% from 2020 to 2030. Most nurses practice in hospital settings, but also in physicians’ offices, home healthcare, and outpatient care centers. In 2020, the median pay for RNs was approximately $75,330 annually.
THE JOB SEARCH
Nursing is a growing field in the U.S. due to factors including such as the aging U.S. population, nurse attrition (choosing to leave the job), and the increasing complexity of nursing practice. The State of Florida has an urgent need for nurses. A 2021 study prepared for the Florida Hospital Association and the Safety Net Hospital Alliance of Florida found that the state expects to see a 12% shortfall in RNs and 30% shortfall in LPNs between 2019 and 2035. Specifically, major metropolitan areas are expected to have enough RNs, but they are expected to have a shortfall of LPNs. Conversely, in rural areas, there is expected to be a shortage of RNs and an adequate supply of LPNs.
The U.S. Bureau of Labor Statistics estimates that employment of registered nurses is expected to grow 9% from 2020 to 2030. Most nurses practice in hospital settings, but also in physicians’ offices, home healthcare, and outpatient care centers. In 2020, the median pay for RNs was approximately $75,330 annually.
Eligibility For Licensing
Below is an overview of the steps to apply for an RN license in Florida.
A. Prepare Your Application
You will submit an online application to the Board of Nursing through the Board’s website. Since your Florida license will be your first nursing license in the United States, you will need to take and pass the NCLEX examination. After reviewing your application, the Board will approve you to sit for the examination.
1. Transcript Verification
- As part of your application, you will need to submit your transcripts to the Board. Prior to submission, you will need to have your transcripts evaluated by one of the following providers:
2. English Proficiency Exam
If your nursing program was not given in English (taught in the English language and using English language textbooks), you will need to successfully complete one of the following English proficiency examinations:
- Test of English as a Foreign Language (TOEFL)
- Minimum score of 540 (207 on computerized version and 76 on the Internet-based version)
- International English Language Testing System (IELTS, academic version)
- Minimum score of 6.5 overall with a 7.0 on the spoken portion
- The Occupational English Test (OET)
- Minimum score of 300
- Michigan English Test (MET)
- Minimum score of 55 with a minimum speaking score of 55%
B. Take and Pass the NCLEX
After the Board of Nursing reviews your application and approves you to take the NCLEX, you will register with Pearson VUE, which will administer the exam. Pearson VUE will then email you the “authorization to test” (ATT) and allow you to schedule a date and time to take the exam.
Tests
To become an RN in Florida, you will need to take and pass the NCLEX-RN examination. Additionally, depending on what language your nursing training was taught in, you may need to complete and pass one of several English proficiency exams (i.e., TOEFL, IELTS, OET, or MET). This section will cover the NCLEX-RN test.
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 (6-12%)
- Psychosocial Integrity (6-12%)
- Physiological Integrity
- Basic Care and Comfort (6-12%)
- Pharmacological and Parenteral Therapies (12-18%)
- Reduction of Risk Potential (9-15%)
- Physiological Adaptation (11-17%)
3. Scheduling and Testing Site Procedures
Once you receive your ATT, you should immediately schedule your NCLEX-RN exam with Pearson VUE. The ATT is valid for only 90 days, and test centers may fill up quickly.
If it is your first time taking the exam, you will be offered an appointment within 30 days of your attempt to schedule the exam. Otherwise, you will be offered an appointment within 45 days. Notwithstanding the foregoing, you may decline those appointments and schedule for a later date within your ATT period.
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 the NCLEX-RN exam, you will receive a Candidate Performance Report that shows the areas that need improvement. You may retake the NCLEX-RN after waiting 45 days.
5. Preparing for the NCLEX-RN There are many different resources that can help you prepare for the content and the Computerized Adaptive Testing technology. Consider investing in test preparation, as it may save you money by not having to pay to retake the test.
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 Nurse in Washington depends on many factors, including:
- The completeness of your educational and professional records
- 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 financial resources
Other Careers And Credentials
Entry-Level Opportunities
You may want to consider taking a lower-level job in healthcare in the short-term that 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 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
Certified Nursing Assistants (“CNAs”) are also referred to as nurses’ aides or orderlies. CNAs have limited responsibilities and work under nurse supervision. To become a CNA in Florida State, you need to pass Florida’s nursing assistant competency examination. While you are not required to complete a state-approved nursing assistant training program in order to become a CNA, you may be required to complete such a training program if you fail the exam.
More information on the requirements for becoming a CNA is available on the Board of Nursing website and on Prometric’s Florida Nurse Aide Exam webpage.
2. Healthcare Interpreter
If you are bilingual and a strong communicator, you may want to research opportunities for work a hospital as an interpreter. Because the role is not specifically regulated in Florida, the standards for employment, pay, and benefits may vary differently 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
1. Advanced Registered Nurse Practitioner
After you receive your RN license in Florida, you may find that you want to continue your professional development and obtain master’s or post-master’s degree training to qualify as an Advanced Practice Registered Nurse (APRN). There are four advanced nursing roles: Certified Registered Nurse Anesthetist (CRNA), Certified Nurse-Midwife (CNM), Certified Nurse Practitioner (CNP), and Clinical Nurse Specialist (CNS). More information on becoming an ARNP is available on the Board of Nursing website.
Beyond Licensing
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 Florida 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 also provide Continuing Education to members as well.
- American Nursing Association (ANA)
- Florida Nurses Association (FNA)
There are many other professional associations for nurses that cater to specific disciplines, job types, ethnicity, gender, and religion of registered nurses.
B. License Renewals
Once you have obtained your license, you will need to renew your license every 2 years, based on which group you are assigned to (Group 1, 2, or 3). As part of the renewal process, you will need to certify that you have completed a certain number of Continuing Education hours.
C. Licensing Mobility (Reciprocity)
The State of Florida is signatory to the Nurse Licensure Compact. If you obtain a Florida nursing license, you will also be able to obtain a multi-state license that allows you to practice in any of the other states that have signed the Compact. Not all states have signed the Compact, however. Therefore, if you obtain your Florida state RN license and plan to move to another state, you should confirm whether that state is also signatory to the Compact or if it has separate licensing requirements.
The NCSBN website has more information about the Compact, including which states have currently signed the Compact.
