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 California license will be your first U.S. nursing license. 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 California.
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:
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.
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 California has an urgent need for registered nurses – a 2007 report estimated almost 60,000 full-time employees were needed in the system – even after large investments by the state in nurse education since 2005.
The Bureau of Labor Statistics predicted that from 2010 to 2020, the fastest growing jobs for RNs would be employment in physician’s offices, home health care, and outpatient care facilities. The highest average earnings are paid to nurses working in private industry ( $66,650), physician offices ($62,880), hospitals ($62,690), home health care ($60,690), and nursing care facilities ($58,180).
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.
Internationally Educated Nurses (IENs) need to meet several requirements to receive Licensure by Examination to be an RN in California.
Steps to licensing are as follows:
Transcripts
The California Board of Registered Nursing directly evaluates your foreign transcript and nursing license. Their application for RN Licensure by Examination (see Important Links section) includes forms you must use to get your transcripts sent directly from your foreign university to the Board of Registered Nursing for evaluation.
You should start your process by sending these forms out early. 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 California license.
You cannot send your transcripts directly to the board, even if they are official copies – your school must send them directly to the Board address provided in the request forms.
Translations
If your documents are in a language other than English, you will arrange for an official translation. You have a few options to consider:
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
Your fingerprints are used by both the Department of Justice and the Federal Bureau of Investigation to check if you have a criminal record.
You should take care of your fingerprinting early because analysis times vary and this is another way that your license can be slowed down. Another reason to start early is that a complete fingerprint analysis is now required before you can receive an Interim License – an attractive option as you relicense that will be explained in the next step about your licensing application.
For fingerprinting, you can use either a Live Scan digital print service or a “hard card” – two sets of fingerprints on paper cards. You are strongly advised to use Live Scan, because processing times are much faster. However, you cannot use Live Scan if you cannot go personally to one of the many California Live Scan sites.
Links to both options are in the Important Links section.
Your application should include:
By now you should also have sent your “Request for Transcript” form and the “Breakdown of Educational Program for International Nursing Programs” form to your nursing school, and had translations of your transcript, license, and any other supporting documents made if they are not in English.
Your application will be complete once your foreign nursing school provides your transcripts.
The Board of Registered Nursing will evaluate your education and licensing to see if it is comparable to its minimum standards for a California Registered Nurse program. This includes standards for coursework and clinical experience in:
If the Board finds some of your coursework to be incomplete, you may have to take courses before you can be given an Interim License or 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.
Once your application is complete, if your education and experience meets California RN standards, the Board will:
If you pass your NCLEX, the Board will process your RN license. If you do not pass, your Interim License will immediately stop being valid, and you will not be able to work in a nursing position until you receive a passing score on the exam.
Special Considerations
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. This notification is called the Authorization to Test (ATT). At that time, the Board will also send you information about the NCLEX and how to find a testing administration site. You must have your ATT to schedule an appointment and to be admitted to the testing center on the day of your examination.
The NCLEX costs $200 (as of June 2012). Your NCLEX scores should be available to the California Board of Registered Nursing within one month after testing. You will be issued your RN license as soon as it can be processed.
The National Council Licensure Examination for Registered Nurses (NCLEX-RN) is the only examination required in the California Licensure by Examination process.
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 a 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 questions.
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 are not allowed to skip any questions, but you should avoid making random guesses, as this can quickly lower your score.
You cannot bring reference materials or other testing aids to the exam. An on-screen calculator is provided for some problems.
The content of the NCLEX-RN concentrates on the patient as the focus of care. The NCLEX-RN exam (2011 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:
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 ($200), 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 90 days, so you should not delay scheduling an exam session.
On the day of the test, you must bring the ATT and 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.
If you fail your exam, the California Board of Registered Nursing will send you 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 90 days. If your score is far from passing you should consider additional test preparation or taking refresher courses.
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.
| Step | More Efficient Scenario Approximate Time and Cost | Less Efficient Scenario Approximate Time and Cost |
| 1 Transcripts, Translations, and Fingerprints | It takes you just 3 months to get your university to send documents to the Board. No translation is needed. You get your fingerprints done for $30 at a Live Scan office and they are processed in 2 weeks. 3 months + $200 | Problems with your documents take 6 months to resolve and are expensive since you must pay others in your country to visit institutions for you. Your pay $150 to translate your documents. You must use fingerprint cards and it takes 3 months and $49 to order and process them. 6 months + $1,000 |
| 2 Interim and RN Licensure by Examination Application | You get your complete application together quickly. You apply for both the RN and Interim license and they are processed in 2 months. 2 months + $200 | You get your application together quickly, but after 3 months the Board informs you that you must take a clinical practice course to meet your licensing requirements. Your course takes 4 months and costs $400. You apply for both the RN and Interim license. You submit your course information and the Board approves your Interim License in 1 more month. 8 months + $600 |
| 3 Pass NCLEX | You register for the NCLEX immediately. Your skills are fresh and you’ve been using a $300 self-study program; you pass the NCLEX on the first try. You receive your RN license 3 months after you take the exam. 5 months + $500 | You register for the NCLEX immediately. It takes you 2 tries to pass the NCLEX, and you lose your Interim license.In between tests, you enroll in a 4-month NCLEX preparation class for $1,000. You receive your RN license 3 months after you take the second exam.8 months + $1,400 |
| More Efficient Total About 1 year and $900 | Less Efficient Total About 2 years and $3,000 |
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 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:
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.
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 either ERES or CGFNS. You do not need to take a U.S. CNA course if you can provide the following materials to register for the written competency exam:
After you have the necessary materials to register for the CNA exam, you can find the exam site through the Southern Illinois University at Carbondale (SIU-C). Their website, www.nurseaidetesting.com, also offers practice materials, a study guide, and test locations. This exam is basic, but CNA test preparation materials are available to practice. If you fail the email 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 California.
Additionally, you must pass a test and a 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 $12 per hour. The profession is regulated by the California Board of Vocational Nursing.
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 California, 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.
After you receive your Registered Nurse license in California 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).
The advanced practice nurse is the highest licensure in nursing practice and involves graduate school education, examination, and licensing processes beyond the level required of Registered Nurses. APNs in most states are allowed a more independent nursing practice, which includes diagnosis and treatment of patients and the ability to prescribe medications. In California, APNs must have a joint agreement with a California licensed physician on record, but direct physician supervision is not required in order to practice. APNs can choose from specialties in one of 4 recognized practice areas:
A RN who wants to become an APN will find a variety of opportunities for education, including accelerated degree programs or courses designed for working professionals (e.g. weekend and evening courses).
