Table of Contents
Nursing
Qualifications
Undergraduate Nursing
Education
Postgraduate Nursing
Education
Accreditation
Obtaining a License
to Practice Nursing
Additional Resources
This document provides an overview of the nursing
education system, nursing qualifications and nursing
licensure in the US.
Nursing Qualifications
There
are various types of nurses in the US, including Licensed
Practical Nurses (LPNs), Registered Nurses (RNs) and
Advanced Practice Nurses (APNs). Educational programmes
for each are given at different types of institutions.
Individuals should consider their personal and professional
goals and interests when choosing a particular educational
path.
Each US state has a nursing
board, which serves as the authority for training
and licensing. Upon the successful completion of a
state-approved programme, a graduate must take the
licensing examination given by the state. Only when
this exam is passed can a person work as an LPN, RN,
or APN. As licensure is only valid in the state where
issued, anyone wishing to work in another state would
have to contact the appropriate nursing board.
Licensed Practical Nurse (LPN)
An
LPN programme involves 12 months of training at a
state approved vocational/technical school or community
college. Upon completion of a training programme,
students must sit the state licensure exam to become
a licensed nurse. Licensed nurses are usually employed
in a hospital, providing basic bedside care under
the supervision of physicians and registered nurses.
Their responsibilities and potential for upward mobility
are, however, more limited than the RN's.
Registered Nurse (RN)
There are three
types of training programmes available for those wanting
to be an RN: an associates degree in nursing (ADN),
a bachelor of science degree in nursing (BSN), and
a diploma programme . All successful graduates are
prepared to begin general nursing duties in hospitals,
clinics, etc. Upon completion of a training programme,
students must sit the state licensure exam to become
a registered nurse.
Advanced Practice Nurse (APN)
The
master's degree is the standard educational qualification
for Advanced Practical Nurses. The most common APN
is the Nurse Practitioner (NP). Nurse Practitioners
are RNs with advanced clinical skills such as conducting
physical exams, prescribing medication, diagnosing
and treating illness, interpreting lab tests and counselling
patients on health care options. 18 of the US states
allow NPs to practice independently of physicians.
APNs also include Clinical Nurse Specialists (CNS),
Certified Nurse Midwives (CNM) and Certified Registered
Nurse Anaesthetists (CRNA).
Undergraduate
Nursing Education
Licensed Practical
Nurses obtain their nursing education through technical/vocational
schools, community/junior colleges, or even high schools,
hospitals or universities. Many LPN training programmes
require a minimum of five academic GCSEs at grade
C or higher to apply. The practical nursing programmes
include both classroom study and supervised clinical
practice (usually in hospital).
Registered Nurses obtain their nursing education
through the four-year Bachelor of Science degree in
nursing (BSN), a two-year Associate's degree in nursing
or a three-year hospital training diploma. Although
all three educational paths meet entry requirements
for nurse registration and licensure, the primary
path to professional nursing is the BSN. The American
Association of Colleges of Nursing (AACN) recognises
the BSN as the minimum educational requirement for
professional nursing practice.
Associate's Degree
Courses last approximately two years and
are similar in qualification to British HND courses.
A minimum of five academic GCSEs at grade C or higher
is needed to apply. Associate's degrees combine nursing
courses and supportive college courses. They are usually
available at community and junior colleges, although
they are also offered at some universities and technical
institutes. Graduates receive an Associate of Arts
or Associate of Science degree. To obtain a bachelor's
degree after receiving an associate's degree, a student
will have to spend at least two additional years at
a university or college that offers bachelor's or
combined bachelor's/master's degrees. Please refer
to the US Educational Advisory Service's (EAS) Two-Year
Colleges page for details on the associate's degree.
Diploma Programmes
These are often
run by hospitals or community health care centres
and take two to three years to complete. 12 years
of school education are needed to apply to diploma
programmes. Diploma holders can enrol in a bachelor's
degree or a combined bachelor's/master's to upgrade
qualifications.
Associate's degree and diploma holders can begin
practice as an RN, but may find that they are limited
to staff positions as health care generalists and
not qualified for certain positions outside the hospital.
Bachelor's Degree in Nursing (BSN)
These four-year programmes are offered at
colleges and universities and are equivalent to the
British Bachelor Honours degree. A minimum of five
academic GCSEs at grade C or higher is needed to apply,
and many competitive programmes also require two or
three A levels. The first two years are comprised
of courses in natural sciences, humanities and social
sciences. The final two years concentrate on nursing
courses and on-site clinical training in hospitals,
clinics and outpatient centres. Please refer to the
EAS Guide to
Undergraduate Study in the United States for details
on application procedures.
Bachelor's degree holders are prepared to practice
in all health care settings, such as critical care,
public health, primary care and mental health. This
is crucial, since health care is shifting from the
hospital to more primary and preventive care in community
centres. In addition to providing greater employment
opportunities, the degree also serves as a basis for
postgraduate education.
Postgraduate
Nursing Education
In contrast to the UK where
students may specialise in certain areas such as midwifery
and mental health nursing without a general nursing
qualification, nursing professionals in the US can
prepare for specialisation only at postgraduate level.
Please refer to the EAS
Guide to Postgraduate Study in the United States
for details on the postgraduate application procedure
to US universities.
Master's Degree
Master's degrees in nursing last 18-24 months
and involve classroom and clinical work. The curriculum
generally includes nursing science theory and application,
health care management, research and courses in the
student's specialisation. Admission requirements vary
but typically include an accredited bachelor's degree,
a RN licensure, clinical work experience and the Graduate
Record Examination (GRE). International applicants
may be required to have Commission
on Graduates of Foreign Nursing Schools (CGFNS) certification.
There are many different types of master's degrees
to cater to different applicants. There are programmes
for BSN graduates, condensed bachelor's-to-master's
degree programmes for RNs who have associate's degrees
or Hospital Diplomas, programmes for RNs with non-nursing
degrees, programmes for non-RNs with non-nursing degrees,
and joint-degree programmes like Nursing/Public Health.
Doctoral Degree
Doctoral programmes
vary in length and can take up to five to seven years.
Admission requirements are often an accredited bachelor's
degree, an accredited master's degree, RN licensure
and clinical work experience and the GRE. Doctoral
programmes prepare nurses for health administration,
faculty positions, clinical research and advanced
clinical practice.
The curriculum generally includes nursing history
and philosophy, nursing technique development and
testing, data management, research methodology and
socio-economics of nursing.
Accreditation
When
choosing a programme, nurses should check to see if
the overall institution is regionally accredited in
the US and if the nursing school is approved by the
State Board of Nursing and accredited by a recognised
nursing accreditation agency. Accreditation is a voluntary,
non-governmental process but many postgraduate programmes
only accept degrees earned at nursing-accredited schools.
Obtaining
a License to Practice Nursing
Council on Graduates of Foreign Nursing Schools
(CGFNS) Certification Program
Nurses qualified outside the US who would like to
practise as a registered nurse in the US must complete
the Commission
on Graduates of Foreign Nursing Schools (CGFNS) Certification
Program. The Certification Program includes three
parts:
-
1. A review of the applicant's credentials. Applicants
must be a first-level, general nurse and must
have graduated from a government-approved nursing
programme, which included at least two years general
nursing training. Applicants must also be registered
as a first-level general nurse ('registered' or
'professional' nurse) in your country. Nurses
who specialised in one area without being educated
and registered/licensed as a general nurse (e.g.
midwife, paediatric nurse, psychiatric nurse)
are not eligible.
-
2. A one-day qualifying exam. Nurses whose credentials
meet the CGFNS requirements can register to take
the CGFNS Qualifying Exam, which measures basic
knowledge in nursing. The exam is offered in the
UK (London) and in other countries. Registration
and information is available online at www.cgfns.org
.
-
Test of English as a Foreign Language (TOEFL).
Nurses educated in the UK, Ireland, Australia,
New Zealand or Canada are exempt from this requirement.
The exam is offered in many UK cities and in most
countries. Registration information is available
on the TOEFL
website and at the Educational Advisory Service
(for postal requests, please send an A4 SAE with
60p postage).
Licensure for Nursing Graduates
All nurses must be licensed in the state
where they wish to practise. Most US states require
a CGFNS Certificate from foreign nursing graduates
before they can take the US registered nurse licensing
exam - the NCLEX-RN.
Foreign nursing graduates with CGFNS certification
and nurses with US nursing qualifications need to
contact the relevant state board of nursing for information on registration
for the NCLEX-RN exam. The NCLEX-RN exam is offered
in the US only.
Visas
Those nurses who gain licensure
for a particular state and have an offer of employment
for a US health care organisation are eligible to
apply for a non-immigrant (H1-B) or an immigrant occupational
visa. The CGFNS, through its International Commission
on Healthcare Professionals (ICHP) division, is qualified
to administer a VisaScreen programme for nurses who
plan to apply for an immigrant visa. Nurses should
contact the US employer and CGFNS for more information.
Additional Resources
Other On-Line Resources
American
Association of Colleges of Nursing, One Dupont
Circle, NW, Suite 530, Washington, DC 20036 USA. Tel:
001 202 463 6930, fax: 001 202 785 8320,
Commission
on Graduates of Foreign Nursing Schools, 3600
Market Street, Suite 400, Philadelphia, PA 19104-2651
USA. Tel: 001 215 349 8767
Occupational
Outlook Handbook
National
League for Nursing
Off-Line Resources
The US Educational Advisory Service's reference
library contains a directory of nursing programmes,
undergraduate and postgraduate course directories
and prospectuses, standardised test bulletins and
test preparation guides, a US State Boards of Registered
Nursing list, CGFNS and TOEFL registration bulletins,
and Official Study Guide for the CGFNS Qualifying
Examination.
You are welcome to consult these materials during
our opening hours.
