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Experience America: New Directions for International Nurses

Katharine Eves, an RN from the United Kingdom, always had been interested in working as a nurse in America. When her husband was offered a job in San Francisco a few years ago, she began seeking out agencies that would help her obtain the necessary work visas and match her with the right position in the Bay Area. After 18 months in the United States, she's amazed by what she's been able to see and experience.

Like Eves, nurses from around the world are finding new opportunities to learn and explore in America, all while earning money and receiving benefits. And many are turning to American-based agencies to help them through the daunting tasks of getting their nursing qualifications, filling out government papers, and figuring out where to go in this vast country.

"It's exciting," says Sylvia Mullarkey, director of international staffing agency Assignment America. "The initial process does require hard work and commitment, but those [who] apply themselves can have unlimited career possibilities here."

The process of getting permission to work in the United States usually takes at least 21 to 24 months because of licensing issues and immigration rules but can be substantially shorter if you are already CGFNS qualified. In addition to having one year of acute-care experience and proven English language competency, nurses must undergo a series of tests in order to work here. They must study for and pass the national licensure test, called the NCLEX–RN, which tests candidates' medical knowledge and abilities. They also need to become certified in the state in which they'll be working, and must pass a state board examination. Preparation for testing usually takes three to four months.

After successfully passing the licensure tests, nurses then undergo an immigration process that allows them to work in the country under a permanent residency visa, also known as a green card. An employer (an employment agency or hospital) in the United States must sponsor the candidate, and the process is currently taking approximately fourteen months to complete.

While the process can seem complex, specialized agencies like Assignment America can help international nurses. In return for a 12, 18, or 24-month contract, Assignment America assists nurses by providing NCLEX study guides and walking them through the visa application process.

Nurses won't be left on their own once they've received their work visa—a good agency dedicates itself to ensuring a successful transition for the participant and the hospital by offering acculturation orientation, as well as offering advice on moving to a new country. It also provides complete benefits to its new international employees, including reimbursement for travel to the United States, housing supplements, healthcare insurance, and retirement plans. Additionally, some placement agencies offer professional development opportunities, including courses in advanced nursing techniques and educational programs that can help nurses from other cultures better understand the healthcare system in America.

The personal rewards also are hard to beat. A green card allows nurses and their spouses the opportunity to work in the United States for as long as they choose and to bring with them any children under the age of 21. They are free to stay in one area or move around to explore the country. Typical placements are for six months and usually are renewable upon the agreement of the nurse, her agency, and the placement hospital. Wages are on par with equally qualified colleagues, and the opportunity to explore new techniques and cultures is unparalleled.

Professionally, international nurses have the chance to try new techniques and learn new ways of doing things. As long as you are open to change, advises Eves, every day can be a learning experience. Eves enjoys learning the differences in patient care in the U.S., noting there are more opportunities to do patient assessment in the United States. She also enjoys working with a lighter patient load than she had in the United Kingdom.

In turn, American staff learn from working with those of another culture. "I found the nurses on the ward to be very welcoming," says Eves. "They were equally interested in what I could offer from my learning and my experience in the UK."

Opportunities abound in the United States for international staff, especially in warm areas like Florida, Arizona, and California, according to Mullarkey. If you are willing to commit to the application process and make the adjustment to a new and exciting culture, there are 50 unique states to be explored and lots of opportunity to learn and advance your career.