HOW THE PROFESSION IS ORGANIZED IN NORTH CAROLINA
Regulation of the Nursing Profession
Nursing in North Carolina is regulated by the North Carolina Board of Nursing (“Board”). The Board manages two types of nursing licenses related to increasing degrees of education, examination, and experience:- Registered Nurse (RN); and
- Licensed Practical Nurse (LPN).
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); or
- Bachelor of Science in Nursing or BSN (a 4-year university degree).
The Job Market for Nursing in North Carolina
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 U.S. Bureau of Labor Statistics estimates that employment of registered nurses is expected to grow 6% from 2021 to 2031. Most nurses practice in hospital settings, but also in physicians’ offices, home healthcare, and outpatient care centers. In 2021, the median pay for registered nurses was approximately $77,600 annually.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 North Carolina
Overview
Internationally Educated Nurses (IENs) need to meet several requirements to receive Licensure by Examination as a RN in North Carolina. Steps to licensing are as follows:Compile Transcripts, Translations, and Fingerprints
Transcript Verification The North Carolina Board of Nursing works with two organizations that can evaluate your foreign transcripts and foreign nursing licenses: International Education Evaluations (IEE) and CGFNS International (CGFNS). When having your materials verified, send your transcripts directly to the certifying organization—not to the North Carolina Board of Nursing! You should start the process of credentials evaluation as early as possible. You must provide the Board with your education documentation before taking the NCLEX. Getting your foreign documentation can be complicated and can slow down your application, especially if your nursing school has never had a graduate apply for a North Carolina license. Translations If your documents are in a language other than English, you must arrange for an official translation. You have a few options to consider: If your country has English as one of its official languages, you can ask your university to provide an English version of your transcripts—but the school must also provide the original language version. You can have a professional translator—who cannot be personally related to you—provide a certified translation. The translator will need to fill out and sign a special form. The Board recommends you look for a translator who is a member of the American Translators Association, a certified court interpreter or translator, or staff of a foreign consulate.Fingerprints
You will need to be fingerprinted as part of your application. Your fingerprints are used by both the State Bureau of Investigation and the Federal Bureau of Investigation to check if you have a criminal record. Once you successfully complete the online application process for an RN license by examination, you are eligible to request a fingerprint-based background check. You should take care of your fingerprinting early. Analysis times vary, and this is another step in which your progress through the licensing process can be slowed down. You may take the NCLEX before your criminal background check is complete, however. As of October 2022, there is a $38.00 fee to complete the criminal background check that is included in your initial application for licensure. The steps to complete the fingerprinting process depend on whether you are located within North Carolina or outside of North Carolina:- If you are within North Carolina, you will use Live Scan to obtain and transmit your digital fingerprints electronically. You can access the required forms (“Electronic Fingerprint Submission Release of Information” and “Application Information”) from the online application portal (Nurse Gateway) under the “Get Forms” button located on the Criminal Background tile. You should call your local sheriff office to confirm that they can complete the Live Scan process and set up an appointment, or see if they can refer you to another location. You must upload your signed copy of the Electronic Fingerprint Submission Release of Information form to the online portal once fingerprinting is complete or else your criminal background check cannot be processed. Live Scan results are usually received within 6 weeks and will be posted on the online portal.
- If you are outside of North Carolina, you must get a hard copy of your fingerprints on an official fingerprint card. This process must be completed by authorized fingerprinting personnel. Contact your local fingerprinting agency for assistance. The completed, official fingerprint card must be mailed, unfolded, to the address provided on your background check forms. Please note that law enforcement and fingerprinting agencies may charge an additional fee for taking your fingerprints.
Pass an English Proficiency Examination
You must pass an English Proficiency Exam, even if your nursing courses were taught in English and/or used English textbooks. The only exception to this requirement is if you completed your entry-level professional nursing education program in the United States, Canada (except Quebec), the United Kingdom, Ireland, Australia, New Zealand or the U.S. Territories of Samoa, Guam, the Mariana Islands, and the Virgin Islands. The U.S. Territory of Puerto Rico is not eligible for this exemption. You can meet this requirement by taking and receiving a passing score on either the Test of English as a Foreign Language (TOEFL) or the International English Language Testing Service (IELTS). Note that you may have already taken the TOEFL or IELTS (Academic) if you had your education evaluated by CGFNS for a CGFNS Certificate or VisaScreen. TOEFL’s registration fees vary by testing location, but can range from $180 to $325. The cost to take the IELTS varies by testing center and ranges between $245 and $255. An English Proficiency Examination must be taken before you take the NCLEX. Note that English Proficiency Exam results will expire 2 years after the date of the examination, so you should plan your application timeline carefully. You must have the testing agency send your exam results to the Board, as results will not be accepted from the applicant.Apply for RN Licensure By Examination
Your application for RN Licensure by Examination should include:- Licensure by Examination application;
- Completed fingerprint-based criminal background check;
- Valid Social Security Number or Card;
- A Credentials Evaluation Service Professional Report, Certification Program Verification Letter, or VisaScreen Verification Letter from CGFNS, or an Education Report from IEE, with respect to your foreign nursing education program;
- Certified translations of any documents;
- Evidence of passage of an English Proficiency Examination, even if your program was taught in English, unless you qualify for an exception; and
- Payment of the application fee by credit (only MasterCard or Visa) or debit card, certified check, or money order. The certified check or money order must be made out to the North Carolina Board of Nursing. This must be paid for your application to be reviewed by the Board. As of October 2022, the application fee is $75.00. Fees are nonrefundable.
Special Considerations
Apply early: you should expect your application to take several months, not including any time spent by your university preparing and sending documents to CGFNS or IEE. Be truthful in your application: There are serious consequences for false or incomplete information in the application. If you write on your application that you have no criminal record, but your fingerprint check shows even a minor offense, it can make you ineligible for a license. If this applies to you, you will need to provide specific information about your record and steps you have taken. Be sure your names match on all of your documents: If they do not match even in small ways (for example, your driver’s license shows your middle name, but your application shows the initial only), this can complicate your licensing process. You should take steps early to identify any differences and see if they need to be fixed.Pass the National Counsel Licensure Examination (NCLEX)
The Board recommends that you do not register for your National Council Licensure Examination (NCLEX-RN) until the Board sends you a notice that your Licensure by Examination application is approved. At that time, the Board will also send you information about the NCLEX and how to find a testing administration site. You must have an approved application to schedule an appointment and to be admitted to the testing center on the day of your examination. The NCLEX costs $200 (as of October 2022). Your NCLEX scores should be available to the Board within one month after testing. You will be issued your RN license as soon as it can be processed.TESTS
English Proficiency Examination
The North Carolina Licensure by Examination process requires you to pass an English Proficiency Examination (unless you meet an exception described above in “Pass an English Proficiency Examination”) and the National Council Licensure Examination for Registered Nurses (NCLEX-RN). The Board accepts two English Proficiency Examinations. For more information on the tests, please visit the webpages for Test of English as a Foreign Language (TOEFL) and the International English Language Testing Service (IELTS).National Council Licensure Examination for Registered Nurses (NCLEX-RN)
Examination Requirements
Before you can take the NCLEX-RN, you must (i) complete your Licensure by Examination Application, (ii) submit acceptable documentation of your education (either through IEE or CGFNS, see “Transcript Verification” for more information), (iii) complete an English Proficiency Examination, if applicable, and (iv) register on Pearson Vue and pay the required $200 fee.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 is mostly comprised of 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 minimum number of items that will be shown during the exam is 85, while the maximum number of items is 150. 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.Test Content
The content of the NCLEX-RN concentrates on the patient as the focus of care. The 2023 NCLEX-RN Test Plan, which is effective between April 1, 2023 through March 31, 2026, tests the following content areas: Safe and Effective Care Environment Management of Care (15-21%) Safety and Infection Control (10-16%) Health Promotion and Maintenance (6-12%) Psychosocial Integrity (6-12%) Physiological Integrity Basic Care and Comfort (6-12%) Pharmacological Therapies (13-19%) Reduction of Risk Potential (9-15%) Physiological Adaptation (11-17%)Scheduling and Testing Site Procedures
Computerized Adaptive Testing (CAT) administers the NCLEX-RN in testing centers across the U.S. and internationally. You can register information with Pearson and pay for the test, but you cannot schedule the NCLEX-RN exam until your application for Licensure by Examination has been processed and you have received an Authorization to Test (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 180 days from your date of eligibility, so you should not delay in scheduling an exam session. On the day of the test, you must bring the ATT and a government-issued photo 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. More information regarding scheduling and testing site procedures are available in the Candidate Bulletin published by NCSBN.Retaking 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 refresher courses.Preparing 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 sooner. 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 North Carolina depends on many factors, including:- 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 fingerprint evaluation and criminal background check;
- Your performance on the National Council Licensure Examination for Registered Nurses (NCLEX-RN); 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 RN. Preparing for the National Council Licensure Examination (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.
Nurse Aide (NA)
NAs are also commonly referred to as certified nursing assistants or orderlies. NAs have very limited responsibilities and work under licensed nurse supervision. North Carolina has two categories of Nurse Aides: Nurse Aides I (NA I) and Nurse Aides II (NA II), both of which are regulated by the Board. As a foreign trained nurse, you can become a NA I fairly easily once you have completed your degree evaluation through CGFNS or IEE. NAs must complete a state-approved Nurse Aide I training program and competency exam in order to be listed on North Carolina’s Nurse Aide I Registry and provide nursing care activities. Nurse Aide I training programs are available at various high schools, community colleges, healthcare facilities, and private businesses in North Carolina. These programs require a minimum of 75 clock hours of training. North Carolina’s state-approved competency exam is the National Nurse Aide Assessment Program (NNAAP) and is administered by Credentia. You must pass both the NNAAP and a criminal background check before working as a NA I. Working as a NA 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. If you are registered as a NA I and in good standing with the Board, you can complete an additional Board-approved Nurse Aide II program to get listed on North Carolina’s Nurse Aide II Registry. This program includes classroom, laboratory, and clinical components and focuses on more advanced nursing tasks. Approved Nurse Aide II programs are available at most community colleges and some private companies.Healthcare Interpreter
If you are bilingual and a strong communicator, you may want to research opportunities for work in hospitals as an interpreter. This type of role is not regulated in North Carolina, 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 RN license in North Carolina you may find you want to continue your professional development. Once you hold a valid, unencumbered RN license, you can qualify to train as an Advanced Practice Registered Nurse (APRN).Advanced Practice Registered Nurse (APRN)
The advanced practice registered nurse is the highest licensure in nursing practice and involves graduate school education, examination, and licensing processes beyond the level required of RNs. APRNs in most states are allowed a more independent nursing practice, which includes diagnosis and treatment of patients and the ability to prescribe medications. APRNs can choose from specialties in one of 4 recognized practice areas: Certified Registered Nurse Anesthetist (CRNA) Clinical Nurse Specialist (CNS) Certified Nurse Midwife (CNM) Nurse Practitioner (NP) A RN who wants to become an APRN 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
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 North Carolina 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. The North Carolina Nurses Association is the largest nursing association in the state. The American Nurses Association is its national counterpart. Additionally, there is a large variety of professional associations for nurses that cater to specific disciplines, job type, ethnicity, gender, or religion of RNs.Licensing Mobility (Reciprocity)
North Carolina is a member of the enhanced Nurse Licensure Compact (eNLC), which allows qualifying nurses living in compact states to practice in all other compact states with a single multistate license. As of January 2023, there are 39 NLC jurisdictions in the U.S.TIPS
- Provide Complete Documents: Nursing foreign degree evaluation services require that your university and licensing authority send transcripts directly to them. Invest the time and money early to facilitate this process. Providing additional documentation about your program of study, such as syllabi or course descriptions, can make the most of your degree evaluation. Making an effort here can result in significant savings of time and money by minimizing the gaps in comparing your degree to its U.S. equivalent.
- Get Your Questions Answered: Be your own advocate throughout the licensing process. Seek clarification about questions and concerns directly from official sources. If you feel your degree has been misinterpreted or you do not understand a fine point of the state regulations, organize your question and contact the Board or Pearson Vue and ask for assistance.
- Invest in Test Preparation: If you can afford it, invest some money in test preparation. There are online and in-person formats available, including a moderately priced subscription service by the makers of the National Council Licensure Examination (NCLEX). Investing money wisely now to make your licensing process a success will get you into a job that pays well that much faster. You should feel prepared to take the NCLEX by the time your Licensure by Examination application is ready to submit to the Board.
