How The Profession Is Organized In Maryland
Regulation Of The Nursing Profession
Nursing in Maryland is regulated by the Maryland Board of Nursing. The Board manages two types of nursing licenses that are different in terms of increasing degrees of education, examination and experience:
Registered Nurse (RN); and
Advanced Practice Nurse (APN)
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. It also assumes that your Maryland license will be your first U.S. nursing license. You will become an RN through Licensure by Exam. 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 Maryland.
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 degree programs:
Associates Degree of Nursing or ADN (2 years of study, typically in a community college)
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 APNs or in healthcare management, consulting, research, or education roles.
The Job Market For Nursing In Maryland
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 state of Maryland has an urgent need for registered nurses – based on projections from 2018, the Maryland Department of Labor estimated that Maryland will need more than 13,000 additional registered nurses by the year 2028 to meet rising demand. Nationally, employment of registered nurses is project to grow 9 percent from 2020 to 2030, about as fast as the average for all occupations.
The Bureau of Labor Statistics predicts that from 2020 to 2030, the fastest growing jobs for RNs will be employment in medical and surgical hospitals, physician’s offices, home health care, and outpatient care facilities. The median annual earnings for nurses in the following sectors are: government ($84,490), hospitals ($76,840), ambulatory healthcare facilities ($72,340), and nursing care facilities ($68,450).
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 Maryland
OVERVIEW
International Educated Nurses (IENs) need to meet several requirements to receive Licensure by Exam as a RN in Maryland. See Licensure Process for International Educated Nurses.
Steps to licensing are as follows:
File A Maryland Board Of Nursing Application For Licensure By Exam
Maryland Board of Nursing Applications for Licensure by Exam can be found online at the Maryland Board of Nursing website or can be requested by email at mdbon.nbexam@maryland.gov. You will be required to pay a $100 non-refundable application fee when you submit your completed application.
Note that when you submit your Maryland Board of Nursing Application for Licensure by Exam you should quickly thereafter complete steps B-E below. Any application that is not completed within one year will be destroyed and you will be required to apply again
Complete A Criminal History Record Check
All new RN applicants must pass both a State and Federal criminal history record check. Your fingerprints will be used to check if you have a criminal record. The Maryland Application for Licensure by Exam will include fingerprint cards that are preprinted with a return address. Your fingerprints must be taken at a State Police barracks, a Maryland Criminal Justice Information System office, or another certified site. Certain locations that are equipped for electronic fingerprinting will return results in one week. Sites offering manual fingerprinting will return results in about 3 to 4 weeks. Any flagged criminal history record checks will be reviewed by the Maryland Board of Nursing and additional information may be requested.
Once fingerprinting is completed, keep the purple printed postcard that is attached to the fingerprint card as this will serve as evidence that fingerprinting has been completed for purposes of sitting for your NCLEX exam (see below).
Complete A Credentials Evaluation Service Application
The Maryland Board of Nursing requires you to obtain a Credentials Evaluation Service Professional Report (CES Professional Report) through an organization called CGFNS International. This report will analyze your foreign credentials and provide an assessment of their comparability to U.S. standards. This includes standards for coursework and clinical experience in:
Medical Nursing
Surgical Nursing
Obstetric Nursing
Pediatric Nursing
Gerontologic Nursing
Psychiatric Nursing
If the Board finds some of your coursework to be incomplete, you may have to take courses before you can qualify to take the NCLEX. This is especially common if your country has different standards in nursing practice – for examples, male nurses not trained in obstetrical nursing, or nurse midwives not receiving training in other areas of nursing.
The cost of a CES Professional Report is $365.00, though additional fees may apply. You will request licensure validation and/or your academic records directly from your original licensing agency or school and have them sent to CGFNS. The Maryland Board of Nursing will not accept these documents directly; all transcripts and licensure validations should be sent directly to CGFNS:
CGFNS/Attn:CES
3600 Market Street
Suite 400
Philadelphia, PA 19104, USA
Once CGFNS has completed your CES Professional Report, they will send the completed report to the Exam Department at the Board of Nursing. Be sure to indicate the Maryland Board of Nursing as the “Report Recipient” when submitting your CES Professional Report request and direct CGFNS to send the completed CES Professional Report to the Board at the following address:
Exam Department
Maryland Board of Nursing
4140 Patterson Ave
Baltimore, MD 21215, USA
Demonstrate Competency In Oral English
You must demonstrate your competency in oral English by either:
- graduating from an onsite 3-year or longer nursing program in the United Kingdom, Australia, Canada (except Quebec), Guyana, New Zealand, or Ireland, or
- passing an English language fluency exam (Test of English as a Foreign Language, Internet-Based Test (TOEFL iBT) or International English Language Testing System (IELTS)).
Applicants who choose to take the TOEFL iBT are required to pass with a score of at least a 26. Applicants who choose to take the IELTS must pass with a score of at least a 7 on the speaking module and must score at least a 6 on all other modules.
The TOEFL iBT may be taken in person at a testing center or remotely. You can register for the TOEFL iBT online at www.ets.org. You may alternatively register to take the IELTS at www.ielts.org. Note that you must request that the results of your chosen language fluency exam be sent to the Maryland Board of Nursing.
Pass The National Council Licensure Examination (NCLEX)
Once you have submitted your Maryland Application, Criminal History Record Check, TOEFL iBT or IELTS score, and CGFNS CES Professional Report, you should register for the NCLEX exam with Pearson VUE. Once your application materials have been approved by the Maryland Board of Nursing, you will receive an Authorization To Test letter (ATT). This ATT will allow you to schedule your NCLEX exam date. Your ATT will also be required for admission into the testing center on the day of your examination.
The NCLEX costs $200. Your NCLEX scores should be available to the Maryland Board of Registered Nursing within six weeks after testing. You will then be issued your RN license as soon as it can be processed.
NCLEX Test
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 145 items.
The exam is mostly multiple-choice but other question formats are also included. A tutorial is provided to help candidates become familiar with the exam and different question types. You must provide an answer for each question, so if you are unsure of the correct answer, consider all response options and chose what you believe is the best answer. Note that you will not be permitted to return to previous questions.
You cannot bring reference materials or other testing aids to the exam. An on-screen calculator is provided for some problems.
NCLEX CONTENT AREAS
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%)
Scheduling And Testing Site Procedures Of The NCLEX-RN
The NCLEX uses Computerized Adaptive Testing (CAT) to administer the NCLEX-RN in testing centers across the U.S. and internationally. You can register information with Pearson and pay for the test ($200), but you cannot schedule the NCLEX-RN exam until your application for Licensure by Exam has been processed and approved by the Board 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. You must test within the validity dates on your ATT, so you should not delay in scheduling an exam session.
On the day of the test, you must bring the ATT and an acceptable form of government-issued photo identification. The first and last names on your photo identification must match exactly with those found on your ATT. You will be required to present a digital signature, take a palm vein scan, and have your photograph taken before your test. You will also be required to provide a palm vein scan when you re-enter the testing area after breaks. You should arrive at least half an 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 five 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 can schedule to re-take the examination after at least 45 days have elapsed since your original examination date. A reschedule application will be sent with your NCLEX failure results or may be requested from the Maryland Board of Nursing Exam Department by email at mdbon.nbexam@maryland.gov.
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 the Important Links section below for test preparation options.
Time And Costs
Evaluating your foreign degree and achieving licensing as a Registered Nurse in Maryland 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 criminal background check,
- Your ability to demonstrate competency in oral English,
- Your performance on the NCLEX, and
- Your free time and how much money you have to spend.
Other Careers And Credentials
Transitional 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, and
- a chance to adapt to the U.S. healthcare system and workplace culture in a lower-pressure environment.
- Certified Nursing Assistant (CNA)
- Healthcare Interpreter
Higher-level Opportunities
After you receive your Registered Nurse license in Maryland, you may find you want to continue your professional development. If you have the equivalent of a Bachelor of Science in Nursing, you can qualify to train as an Advanced Practice Nurse (APN).- Advanced Practice Nurse (APN)
