How to Get a Initial Nurse License in the US

Tanya Freedman, CEO Connetics USA: Hi everybody and welcome. Welcome to the Lefora talk show. This is Season Four, episode one, I cannot believe we've been doing the Lefora talk show for four years already. I am your host time your Tanya Freedman, CEO of Connetics USA, the number one companqay for direct hire in the United States. Our topic today is a really interesting one. And I'm really excited to get started. We're going to be talking about licensure. How do you apply to get an initial license in the United States? And when you've got an initial license, how do you go about doing an endorsement? This is a really important topic because without licensure, you cannot work in the United States. So if you are watching today, please put into the chat, your name and where you're watching from. We'd love to see everybody all around the world, who is watching them for a talk show. We host a talk show once a month. And please put into the chat any questions that you might have for the legal experts. We have some experts today who are going to be joining us and going to be taking your questions and answering any questions, any burning questions you have about licensure. So I'd like to welcome Holly. Hi. Hello, Holly. Welcome.

Good morning. Before our experts introduce themselves, I just want to give a shout out to the love for admin team the awesome love for our admin team. So to Paul and to Anna and to Kay and Louise and one and there's one and James and Jean is Jean, everybody on them for our admin team. Thank you so much for everything you do. The look forward talk show is about nurses helping nurses. And we're really excited to bring our experts in today who are going to be answering any licensure questions that you have. I have on my desk, lots of questions that have been sent in already. So we're gonna get started right away. Let's start off with introductions. Holly, do you want to go ahead and introduce yourself?

Sure. My name is Holly Musselwhite.  I work with Connetics USA as their clinical nurse educator. And in my role, I also have the opportunity to help a lot of our nurses through their licensure process, whether we're talking about those who are preparing to take NCLEX or those who are looking to endorse their license prior to or just on arriving to work in the US. So I've been a nurse for about 22 years and love it but also love learning and working with nurses from all over the world. That is definitely my passion. And I love seeing their dreams come true. So I'm happy to be a part of something so momentous, and also to see them grow way beyond maybe what their original dream was and establish themselves once they get here.

Thank you hobby. We love your passion and your expertise that you bring to the panel. And I think it really speaks a lot to the look forward therefore admin team, who are giving us this platform to bring in experts like highly Amanda and Michelle, who have the knowledge and expertise to be able to help nurses around the world. Educate yourself about licensure, which is the topic today. And then did you want to go ahead and introduce yourself?

My name is Amanda Krupa. I am the manager of the license routine for the International Division for AMN. I've been working with AMN since about 2012. And I've always loved healthcare, staffing and the capabilities we've had to be able to help get nurses to the bedside. And I've recently come over to our international side last year. And I am very happy to be here with you guys today to talk through some of the licensure, endorsement and examination questions you guys might have. I'm truly just very happy to be here to be able to help navigate because this is not an easy process. So we are just very happy to be here as experts to help guide the best that we can and answer whatever questions might pop up. So thank you for having me.

Thank you, Amanda. As everybody might know, Connetics are now part of the AMN and family. We are very proud to be part of the largest healthcare organization healthcare staffing organization in the United States. So the panel today really bring a lot of expertise to this topic. Michelle, do you want to go ahead and introduce yourself?

Sure. Good morning. I'm Michelle Kenny, and the senior director for immigration licensure and credentialing and I am in health care. I too am an immigrant. I came here 34 years ago. And my first job is this job. I worked in care staffing, internationally, bringing nurses on h1 A's back in the early 90s. And I love what I do. I'm still passionate about what I do. And we're here to offer guidance. today. It's on licensure. So my gamut is licensure, credentialing, and of course, immigration. And, and I'm not a nurse, but sometimes I feel like

you've got an idea, Michelle, after all these years of helping so many 1000s of nurses come to the United States. Okay, so everybody if you're joining us now, these are your experts on onwards and upwards on our Connetics Facebook page, we do once a month a an immigration Q&A. And here in the former talk show, we are doing a licensure Q&A. And you can hear the expertise, the passion, the love that our panel have for international nurses and helping them set them up for success and make your dreams a reality here in the United States. If you are only Joining us now, please put into the chat where you're watching from we love to see all our viewers from all over the world. And please put any questions that you have specifically for the licensure team. Okay, so we're going to start off with our success path. For many international nurses  It's really confusing, frustrating, a little bit overwhelming to know where to start with licensure for coming to the United States, because you can be licensed in your home country. But that doesn't mean that you're going to be licensed in the United States, you can check out our success path on our Connetics USA nursing agency website. Here are the seven easy, I'm gonna say easy steps, they're not really easy steps. But at least it gives you a roadmap of what to do first, second, third, fourth, fifth, etc. In order to come and live in the United States. The first step, as you can see is the NCLEX IPass. That's where we need to see if you qualify as an RN in the United States prepare for the NCLEX exam, take the exam and pass the exam. So that comes under that umbrella of licensure. If we look at step number four once you found an employer and gone through the immigration process, step number four is license licensing and credentialing. That is where we can talk about the English proficiency, license endorsement, US credentials and certifications and the visa screen certificate. So for today's topic, we're talking specifically about that first block, the NCLEX application through exam and the fourth block, which is licensing and credentialing. Okay, so let's get started with some questions I have on my desk, so many questions from so many nurses all over the world? Let's start off with you, Michelle, what is the  NCLEX? And why is it so important for international nurses.

So the NCLEX is the national exam for the United States and for Canada, which is every nurse domestic or international, must pass the NCLEX exam to be able to work as an RN in the United States. And, and on top of that, then an international nurse needs NCLEX in order to qualify for the visa screen, you can also get a visa screen with the CP cert. But if you want to actually work as a nurse, you're gonna have to have the RN license. And, and so a lot of people ask us, you know, what's the best state to apply for to for NCLEX? And we tell people to start to think we've questions that you should ask yourself. The main one is for NCLEX does that Board of Nursing issue a license IPASS NCLEX. And that's really important. We have a lot of nurses who come to us, I think I just saw one in the chat and nurse who passed through and North Carolina, and they can't get a license issue because they don't have a social. Same thing happens in Florida and California and Nevada. And so the first question you should ask yourself is, will that board issue a license at the end, once I pass NCLEX without me having to wait for a social? That's really helpful. There are ways around don't worry if you NCLEX tonight in North Carolina or Florida, and you only have a pass letter, yes, there are ways to get a license. So don't worry, it's just you have to sort of take the longer way around versus the board that you apply through. We'll just issue a license. Okay, so that's, that's a lot of great information. Michelle. And so basically for any nurse who's joining us right now, you cannot come as an orient to the United States unless you pass the NCLEX. So that's the first thing that we learned from our expert panel. If all of this is new to you, that's very, very important. Tip and pointed to understand and asthma. Michelle said different boards are set up in different ways. So you want to look for a board that will give you that license. Okay, so we have Akbar who's joining us from Ghana. Nathan, who's joining from South Africa. Oh my home country. Welcome Nathan, and nursing students hoping to work in the US after completing Nathan. We hope that you will be coming to the United States and we have another nurse from South Africa. Dima welcome Dima be here DRT. I hope I've got that right. He's saying hello. Muhammad Reza, from Iran. GAPI saying hi, everyone. Joe Valon is from Canada. And Maine has a question. And Hi, Tanya, I'm Elle Maine to be assigned in Dallas, Texas. I took my NCLEX and passed under North Carolina, but I'm in the process of endorsement. But the nursing board will not give license until they will be an act of Social Security. I think I must get first to Dallas and wait for my Social Security and preside proceed with my license endorsement. Holly, do you want to maybe give a little bit of input specifically for Maine's questions?

Yes, I'm so main, we have a lot of nurses who are in the same situation that you're in, they pass the NCLEX. Like Michelle said, they don't get a license issued when they pass. And so they're in a similar situation, what you want to do is find out how, what else besides the social security number North Carolina is going to require from you, at the time that you activate that license, you will need to be able to verify your NCLEX as well through to the state that you're going to. So that's part of that North Carolina license verification when you get here. And you also have to be thinking about how much time it might take when to wait to get your social security number, which depending on how your visa is processed, and how you pursue your social security number. When you get here, it may take a few days, two weeks, and then you would submit that to the south care or excuse me, North Carolina Board to have them issue you your license so that you can proceed with the rest of your endorsement. From your message. It looks like you're intending to endorse to Texas, Texas is a rather easy state to endorse too. But it still is going to need for you to have a license verification as part of your application for endorsement.

Thank you, Holly. So made hopefully that answers your question. And I know from the Connetics side and the Grady airmen international side, we have had 1000s of nurses go to Texas. And that's really one question that you might want to ask yourself when you're looking at opportunities is this an agency a company that's going to be able to help me to navigate that process? Because like means, you know, it means question, it's very confusing. And you really want to get that expertise from a team who's going to help you to get to the ultimate state that you are looking to go to. And Mark Jones is saying Michelle Kilkenny is the best in the business. There you go. Michelle, one of your superfans, and Richmond is saying hi from the Philippines. Ricardo is asking Hi, Good day, can I get a visa screen without my local license and just a New York license and IELTS Michelle and you do have to have a license in your home country you're supposed to have for visa screen. And what you don't need it you only need one current license. So if your foreign license is expired, as long as your US license is current, then that's fine. That being said for visa screen, you also don't need to have a license in the States. But you need to have NCLEX passed. So it doesn't matter if you've a Florida pass letter and you don't have a Florida license. As long as you've got a current license somewhere in the world. You need to have at least one current license on the application.

Okay, thanks Michelle. So that can put Ricardos mind at ease to know what to expect and how to go about getting his license. Check. He's sending us some hearts. Thanks Checky. And we've got a Sabbath is watching from the UK Nancy from Garner and Maine is from Dubai assigned in Baylor oh yay. One of our very prestigious employers. Congrats man. We excited for you. And Dennis is watching from Saudi Priscilla from Ghana. Clear is asking. I'm clear from the UK. I'm trying to endorse my New York license to Florida. And Amanda in answering and Claire's question she wants to know and I know I'll need the Social Security when I arrive in the US. Should I also wait until I'm in Florida. I'd have to get my fingerprints background checked on, or should I try and do that in the UK? Amanda?

That's a really good question. So I will say, for Florida in addition to the license application, you'll be doing fingerprint a few times, what I do recommend is getting multiple copies of physical prints when you're international. And then as needed, you can mail them out and have them already ready to go. So it's not going to delay a license application or state background check. And it'll help process you get here faster. So really, what I recommend is getting it done internationally, unless they require the live scan in person digital prints. Usually, you can go to embassies, police stations, and have physical fingerprints done, and almost all the cards are identical. And all you need to do is update your information for what you'll be using it for. So if it's a license endorsement application, or Florida State background check, you can update the cards after the fact. And you can still hold on to your prints as time passes. So the fingerprints will still be good. And I do recommend doing multiple sets of prints while you're international and not have any delay when you're here in the US. I hope that answers the question.

Okay, Amanda, thank you for clarifying about the Florida Board. Everybody is so different. And that's really what the experts are so helpful, because sometimes the board's even changed their policy. There was a policy change. I know with Florida recently, Holly, do you want to share with everybody what that change was with anybody going through the Florida Board?

Yes, the Florida Board now expects that if a nurse takes the NCLEX, and it takes more than five years for the nurse to achieve a US license, then they will require the nurse to do a remedial course. And that would be done partially through online if you want. But also there are 90 clinical hours that they expect to be done within the state of Florida. So it is usually not very feasible for people to come into Florida and do that to be able to activate their Florida license. So if you are a nurse who took a very long time between your NCLEX and getting your licensure that five year mark is really important. And Florida looks at that very carefully. Now, they are still figuring out sometimes how to apply the rules. So you will see some variations in some of the scenarios that that may play out. But five years from NCLEX without a US license is a problem. So what we would advise if you think you're getting close to that is to activate your license with another State Board of Nursing so that you now have achieved that license before that five year mark happens. And then always, always, always, if you can keep that license active. So many state boards that will issue you a license before you get here will also allow you to continue your licensure until such time as you arrive and then get some of the other things like a security number and send that to the board.

Okay, thanks Tati. So that's why it's really important to keep abreast of all the changes because nursing boards make changes all the time. And you can learn one thing in one day, and a few months later, a few weeks later, even there can be a change at that nursing board. So it's really important to keep abreast of some of the changes that happen are happening. Michelle, you're nodding your head, as we say that. Can you think of any other boards maybe to share with the viewers that have changed in the recent maybe like six to eight months in terms of their requirements from international nurses?

Well, yeah, I mean, one of sorry, one of the main ones, I think from last year was the Michigan board, where they required the CP cert for international nurses, which didn't make sense when they'd already passed NCLEX. And that was changed through a lot of lobbying that has been changed in the regs. And people can now apply to Michigan, and get a credential report, which most a lot of boards now require. And that was a big change for us. But I do want people to understand, you may have roadblocks or don't start panicking if your your license expired and cannot be renewed because you don't have a social. That's why we're here that there. There are ways to correct that. And there you may have to take the long way around to get a license wherever you're going. But there are solutions, and we're here to help.

We love that. Michelle, we have a saying in the Connetics team. Everything is figure out trouble. A little difficult sometimes it might be a long and windy road, but every licensed nation has a question is figured out double. And then I have a question here for Maria. Maria is asking once I passed the NCLEX will I ever have to do that again? And what do I need to do? to keep my license active.

So once you pass NCLEX, depending on the state that you pass through, we do recommend going through and applying for examination applications with that board to activate an examination license, you do not need to repeat NCLEX if you activate a license, so I want to be sure for those that have passed, and it's been a little bit of time that you do whatever you can to go ahead and pass in, go ahead and activate an examination license, the bus stops is reaching out to the board that you passed through to see what you would need in order to pass and get a license active for that state. If it is one of the states that requires a social security number, you want to take steps to then get your NCLEX score to see if you can transfer it to another board that doesn't require a social so you can get either an examination or an endorsement application started. So I would go ahead and start that process. Even if you don't plan on working in that state. I do recommend getting a license activated. It is a little bit easier to go through that route rather than wait till you're right here.

Okay, thank you for that, Amanda. Okay, so j is from Abu Dhabi assigned to Baylor, Dallas and Baylor yay, Jay, we can't wait for you to start Dokie from Ghana. Oh, also Connetics nurse. Yay. Thank you for joining us Hamidreza. I've got that right. As a question about the New York Board. Heidi is New York. Okay, for licensure, I think Muhammad raises maybe talking about initial licensure. Okay.

So actually, New York is a very popular board for international nurses to go through. There is a little caveat to that, which is that if you're if you are wanting to test within a certain period of time, the New York boards processing timelines for your application are quite a bit longer than some of the other boards that may be available. So if you, for instance, plan to study for NCLEX for six months, your application typically run simultaneously with your study time. And so if you finish your study time, in six months, you're still going to be waiting a little bit longer, maybe 234 months, before you actually would have your eligibility and be able to get your ATT and sit the exam. So it is a board that does work with a lot of international nurses, you will get a license issued when you pass NCLEX through New York, you will be able to maintain that while you're still overseas. The one downfall if there is a downfall is that unfortunately, it does take quite a long time even for endorsement applications to New York with it's an NCLEX application or an endorsement. They take quite a while to go through your application documents, your transcripts and everything. Some Nurses also like York, because the board is the one who does the evaluation of your credentials, your transcripts and everything like that, instead of going through CGFNS, one of the other credentialing reviewers or Joseph, Sony and Associates, which is yet another one. And so because of that, they feel like they're saving a little bit of money. By not having to do that report. Just keep in mind, at some point, when you get to a visa screen, you are going to have to use those services of either Joseph Sony or CGFNS to submit your transcripts and go through all of that. So it's kind of like there's many roads to get where you want to go. You just have to think about what are your priorities? And what are you? What are you going to be doing as far as your study and the time that you have in which to take and prepare for your exam.

Okay, so you raise an important point, Holly, and that is for that initial licensure that's that block one in the Success Path getting your NCLEX many nurses will look at some specific states. And we'll think well, which one's the cheapest because it's expensive. So which one's the cheapest and maybe go with a state like New York, but they are other not to say consequences. But there might be other steps that we need to take if you do go with it. A state like New York, there really are some important requirements that a nurse needs to take into account when you are looking at the exam application. Michelle, can you maybe take us through these required general requirements that somebody needs to look at or honestly to look at when they are starting that exam application process?

Sure. And here you've got your list of there's an app this application it's paper application, normally, there is a fee to be paid. And, and then most quite a few boards, especially for NCLEX require a credential report. And every board has different agencies they use most use CGFNS and now Joseph  they've really increased their coverage of boards. And we can provide a full list of those. But one of the things we look at is how long will an application stay valid, because it depends on how quick you are, you're going to be ready to take NCLEX. And some boards that are only valid for a year, and then you have to pay for the application again, other excuse me, other boards are valid for three years. So that comes into play for us. And then there's the board's processing times, New York, lovely state, but their processing time is just so long, whether it be NCLEX, or endorsement. And so we tend to steer away from that board, when we're guiding our nurses. And you need to have your transcripts either sent to the board or to the credentialing agency, you'll have to have your high school cert usually sent to the board or the credentialing agency, and your foreign Nurse License Verification, fingerprints are normally required. And those would be hard cards that you would have to get done, just like Amanda had advised, you can have them done in your home country and then submitted with the application. Most boards who don't require a social, there will be an affidavit form that you need to fill out. And then there are the boards, the English proficiency. And again, many of you on the line, wherever you're calling in from, I know that most of you whether you're in Ghana, or you're in the Philippines, you're educated in English with English textbooks. So many boards actually don't require you to have English, if they see on your credential report that you're educated in English with English textbooks. So that's something you have to take into consideration, you will unfortunately still need English to get a visa screen to get your immigrant visa. But maybe for applying to it for NCLEX, you won't need to have the English score at that time. But it's always advantageous to get the English taken care of and get your passing scores. Because that, that tells you that you will be able to get through the whole process.

Okay, thank you, Michelle. So there are a lot of steps. There's a lot of detail. There's a lot of questions in the process. And sometimes the terms can even be confusing, like, what is a CES? What is a visa screen? And why do I need to take the English? So there's a lot of questions that might be going through the heads up, you know, the minds of any of the nurses that are looking to come to the United States. Amanda, if you can maybe take us through some of the terms and what they mean that we're going to put this into the chat as well so that everyone can kind of understand what is the difference between like, what is credentialing mean? What is how is application by exam different to application by endorsement, lots of terms, they can be very confusing. And if you don't understand what the terms are, then it makes the whole process even more of a muddle in your mind. Go ahead, Amanda.

Yeah, absolutely. Okay, so application by examination, that's going to be your initial license in the US application by endorsement means you already have an active US license, and you're applying with that license for an endorsement for another state. The Board of Nursing, that'll be the state that you would like to apply for they are all referred to as so Board of Nursing. The licensure versus credentialing process is a very different process. So the licensure is going to be either your examination or endorsement license application process. And credentialing could include the visa screen, see, as are some of the requirements, you might need to get a license. And then the NCLEX details below, that'll be your initial test. If you pass through one state and need to transfer a score, then you can either do it via the nurses report, or you would call that for that you pass through and have them submit over a score transfer or pass verification. So a great example of this, if you happen to pass through Florida, they're one of the states where they will send a summary of your score but not the full examination breakdown. So depending on what board you need to apply to, they might not be able to accept the details from one of the boards submitted. And then I do see a lot of questions regarding PTE and the Maryland Board, whether it's a licensed endorsement question or examination, and I can answer that really quickly. So I do see that Maryland has updated their quarterly guidelines where they will accept PTE, but it's not on the application breakdown. So when you do submit an application with Maryland, I do highly recommend calling to let them know that you did pass with PT II but we have not submitted a nurse with PT through Maryland yet. It is a new change they did last quarter of the year. So it's not updated on their application, but it's my understanding that They are accepting it now. But I did see a few questions on that.

Yeah, thank you for raising that, Amanda. And that's, again, one of those changes that come about periodically. And from the Connetics side, I know that we have a lot of nurses that are going to Maryland. And Holly, do you want anything to add in terms of the Maryland Board and that change?

I think the only other thing I would add, we did hear through the grapevine, I think, Amanda, that they were also going to take the OET. So the one thing that on the credentialing side, when your documents are being reviewed for what we call a credentials evaluation service, if you use CGFNS, which you would for Maryland, the CGFNS team is still working on updating how they add in these new exams, to reports. So they have it for visa screen, we've yet to hear from CGFNS that they've updated, how they will add those newly accepted English tests to the credentials evaluations. So just be aware of that that's in process. And if you're just getting ready, you know, some nurses like to put their English exam results on a CES report or credentials report so that it gets sent directly to the board from a CGFNS instead of having to send it secondary. So just kind of keep that in the back of your mind as part of the process is CGFNS. Getting caught up with the credentials evaluations, although they certainly have it down pat for visa screen.

Okay, thank you, Holly, for adding that. And very helpful. So everyone has a question. I know for my initial licensure that I cannot apply to some states because I don't have social security number yet. But I also know that different boards have put different processing times, which are the states you would recommend to an international nurse to take that initial licensure by exam, Michelle.

So again, you ask those questions that we said to you, do you need a social, you don't want to need a social. But the processing times, if you're expecting NCLEX, in the next six months, I would say Texas is a great board, you need a credential report. But you don't need to have a social and they will issue a license. And if it's going to be longer, I would suggest other boards. We've talked about Montana, and Illinois. And there's plenty of boards that issue without a social and New York for example, if you're not going to take NCLEX in the next year, and it's going to take you longer to be ready to take the exam, then yes, you could start with New York boards. But I don't recommend starting with a board that needs a social for the license to be issued. Like your Florida's your Hawaii's Nevada to name but a few.

Okay, thank you for that. So they all options, which are the good news. And it's really about doing your research and looking for those boards that meet the criteria that Michelle has outlined at the beginning of the show. And Amanda, we have a question here from Crystal. Crystal is saying, Hi, I'm currently a New York license holder and I want to endorse my license to Utah, do I need to take the CGFNS exam? And for those people who don't know the difference, Amanda, maybe you can just clarify for people? What is the CGFNS exam? And how is that different from the NCLEX?

That's a great question. So I do see. And I think we had this question last time as well. So the New York license holder, they want to endorse over to Utah, if your New York license is active, you would submit by endorsement over to Utah, and you do not need the CGFNS exam. So the difference there NCLEX is used for all the states. So it essentially lets you know that you have an equivocal level as a registered nurse to work in the United States, CGFNS does have a baseline exam that you're able to take most of the boards do not accept that on its own, you do have to submit other items with it. And then I believe last time, we dropped resource links for Utah to help kind of guide that information over so I will drop it again here in a few minutes. So I would say start the application process go through the endorsement guidelines. I don't know the processing time for Utah, but I do think since you're already licensed in New York, it's not going to be too bad. New York usually has about five months to get licensed. So I think it'll be rather quick. So I'm going to drop that in in the next few minutes.

Yeah. Okay, perfect. So thank you for answering that that question because that's a very specific one. And jape is asking. I've recently passed my exam through Northern Marianas. So that's another one Michelle, that some This is might go for as the initial board for licensure, and I'm wondering what would be the next steps after passing? So JP, I would definitely refer you again to the Connetics USA success path, that will give you an indication of what steps come next. So once you've passed the NCLEX, first of all you do you're happy dance. So you are excited because you don't have to do that, again, as Amanda told us, that is done. And if you look at the success part, you can see that the next steps on the success path are to look at the preparing for the interview, and select the right match and the right employer, then you're going to go through your immigration framework, your visa framework, you're going to have your licensing and credentialing where you're going to look at your particular state where you're going to do an endorsement, have your get ready game plan, arrival sequence, and then you're going to enjoy and prosper, which is what we want for everybody who's watching today. Andrea has a question. I have my NCLEX scheduled for March. So best wishes, Andrea for your NCLEX. But I still don't have isles, I'm from Costa Rica. I can apply? I can apply valid for New York, and highly. Does Andrea, can she apply even if she hasn't got her IELTS yet?

It would depend on whether she has. Excuse me, sorry, my voice. So when it comes to applying to New York, it depends on where you were educate when you were educated for your nursing school where you educated with in English with English textbooks, which I don't know Costa Rica well. So if you were not, then the board would require you to fulfill that the time for which their application is good is usually longer. But you want to sort of send with all boards, you want to send your documents fairly close together. So when you piece mail requirements, just because the board allows you to, that's not always a good idea, because then as they trickle in your New York board or any other board team members who are evaluating those documents, may find that there's a little bit of a lag and a delay. So we typically recommend that if you know a board has certain requirements like that, that you achieve that required before you endorse or very close to the time that you're planning to endorse so that your requirements can be submitted mostly together to the board. And you don't have things being piecemeal submitted, some boards will even tell you that they won't accept things in that way where you send one thing and then another thing and then another thing they like everything to come in together so important, no matter which boards you're considering.

Okay, thank you, Holly. So I think that'll be helpful for Andrea, just as an answer to Andrea as well. It looks like she's already scheduled her NCLEX. So they've accepted her application. And you will need English to get an immigrant visa. So Correct.

So that brings up a really important point because we're talking today about the licensure process and what might be required from the nursing boards for that initial licensure by exam or licensure by endorsement. But there is the other piece Michel, which you correctly bring up, which is the immigration piece, where if you're not trained in English, you're going to have to do the one of the English exams and the CGFNS has now brought in other English exams that international nurses can do in order to make meet that requirement. Michelle, can you talk a little bit about some of the countries that are not going to require English

so that we have five main countries that are exempt always and those are Canada, Ireland, Great Britain, Australia, New Zealand. So those five countries are always exempt from English. But there are several other countries where if you have a current license in one of five states, where you can be exempt also, and they can get a visa screen, but it's called a 212 R. So those nurses are educated in Jamaica, Trinidad and Tobago, Barbados, and South Africa. And so if they have a current licensing, for example, New York, and excuse me, Illinois, Florida, Georgia, and Michigan, I believe in the five states and they actually can be exempt from English also. But everybody else you are going to need English and one of those new any of those tests whether it be PTE OET, IELTS, TOEFL, there are several others also, and you will need English to get the visa screen. And yes, I've seen lots of questions on here. You do need a visa screen in order to get an immigrant visa. So you do need the visa screen to submit it at your artwork provided at your end. grant, your interview of your embassy. I mean, you can attend your interview, I'm just giving this as an off because they asked the question, you can attend your interview, but your visa will not be issued, they will wait until they see the visa screen cert.

Yeah, so that's a requirement, no way of getting around that. So if you meet the exemptions, which Michelle has just gone through very well with everybody today, then the English can be an option that you don't have to take. But for most nurses, you're going to have to take the English exam. And that's something really important to focus on. I think I know most international nurses are more scared about the English, then the NCLEX exam. And if so, I would definitely encourage you to watch the Connetics college every Monday, we have free classes on all of the different English exams to help prepare you to take that examination and get the visa screen which as Michelle said, which is a requirement. Okay, so Nicole is saying hi, from the UK, char is watching for her Hi char no char from Memphis. And Jen is asking a bit about medical lab technicians. Yes, we do have positions for medical lab technician. So please go online and apply. And okay. Brian has a question about California, California is one of the more tricky states to deal with. So Brian is asking, I'm an RN in Canada, and I'm hired through an employer in California through Connetics I am in I have my embassy interview next month, I need to get a Social Security before I apply for my RN license. What is the process for the California RN license application? If I have a Canadian RN license? And how long is the process? And this is what everyone on the panel because California is a big topic. And there are a lot of questions about it kind of like a dance of how international nurses can navigate the California in endorsement. Michelle, I saw you nodding your head, do you want to go ahead and give some input to Brian? You on mute Michelle?

Sorry, Ryan, yes, you will need a social to apply to the California Board. And so once you are an immigrant, you'll come to the States, you will get a social, usually within the first two weeks of arrival. But you will not see that you can then only apply for the license. And they are taking I want to say five months, you can be lucky if you're educated in Canada origin. If you're educated in another country, it depends on how fast your transcripts get to the board. Their evaluators, they tend to take a long time, it's not a Texas board, where it's you know, within four or five weeks, you'll have a temporary license. With California, there is no temporary license for internationally educated, and they normally take on a good day, we might get one in four months, on a bad day could be six months. But you're talking and there's a decent timeline where you will have to wait for the license. One thing would be to, you know, return we work out you'd work with your specialists to decide what the plan would be for you.

Yeah, exactly. And that's where it really California is a little bit of a dance, Brian and for anybody coming to the state. And because of the timing, and also the fact that California you cannot do apply for the endorsement until you've got the social security number. California in the old days. I mean, you know, a lot of us have been doing this for many, many years, California was actually one of the better states to work with, in trying to get an initial license or license endorsement. But these days it is it has got some steps in it that are a little tricky. And Holly, yeah, Holly, I think you got your mind your hand up. To add on California Board,

I would just advise any people who are looking to apply to California, you can start sending some of your transcript documents about three no more than four months before you're due to apply. So they will hold them for a little bit of time, but they will also trash them if it's been four months and no application has shown up that they can match those documents to so there is a bit of an opportunity for you to kind of get going you can't apply until you have the social. So you know if your school you know is going to take a little while then you might start doing some of the documentation if you're really close to arrival, and to start that process if you haven't already. The other thing is when you're applying to California, you will see the option as an internationally educated nurse to apply for temp license. The reason why Michelle says it's really not allowed Trouble is that it requires for internationals only that your transcripts and your related learning experience. And all of that gets evaluated before they issue the license. And since that's what takes the longest, there really is no point to you spending extra money on requesting a temporary license when in fact, it's going to have to wait until they're done evaluating your transcripts.

Okay, thank you, Holly. So a lot more steps for California than other states. And Mark is saying great information. Holly and Amanda. I think Mark didn't want Holly and Amanda to feel left out when he was a Michelle superfan there. And thank you, Mark, and okay Dokie is saying I'm an international nurse with NCLEX pass and I want to endorse to Pennsylvania board, but they require Social Security. And who can I? How can I proceed without that my Social Security, Amanda.

So any board that requires a social security number, you do have to have one in order to start an application or to be issued a license. So for California, specifically, you have to have it in order to start an application. Other boards will let you start an application and you would need to submit it prior to a license being issued. So Missouri is one of those states where you would just need it in order for them to issue the final license. So if the state you're applying to does have it on the list of requirements, you will need one in order to get a license.

But Pennsylvania does not require social. Thank you, Michelle, they don't they will give you a one year temporary license.

It's just that, like we said earlier, you would have to have an affidavit. So there's usually an extra document that you have to sign. And it may depend on, you know, maybe the roadblock of you getting a social to get your NCLEX license issued. I don't know if we're maybe misreading that a little bit. So yeah, but yeah, you can get a temporary before you get to the US for Pennsylvania for one year.

And if you signed an affidavit for it, but it's a license requirement, they usually will ask it for the permanent license to be issued. So it might be a stipulation for the temp to perm to be issued. So if that is the case, monitor your application as time goes on. So even though Pennsylvania will give you a one year tap, don't forget to send them a copy of your social in that time span. You don't want to forget anything that might hinder the permit to be issued.

I don't want to go too long with the Pennsylvania thing. But one thing to keep in mind is that with some of these applications and processes, you may not realize when you're filling out the application that there's a box that says do you want a temp. And if you don't click that box for that application for that state, and yet you are eligible, they're not going to automatically issue you the temp and Pennsylvania is one of those I have had experience where a nurse didn't realize they were doing the application didn't check the box for the temp. And so they got processed on the only path to a permanent license, which is where some of those hiccups came in. So it can be corrected, but you will have to contact the board directly to do that.

Okay, thank you for adding that Holly. And just a question that's coming up in the chat and actually was sent to me as well is an I see Mohammed Reza is also asking that is talking about eligibility. Michelle, can you explain the difference between eligibility and an ATT? What is that? What is the difference when you're doing your license endorsement, license for exam,

for example. So eligibility is when the board deems that they have everything they need to, to let you test take NCLEX and that's when you then go and register with Pearson VUE and pay you for the ATT. So the board has to make you eligible to test there's no point registering with Pearson until you know that you're eligible to take the test through New York or, or Texas or wherever. So eligibility just means that the board has received everything they want. And they're ready now to move ahead with you.

Okay, thank you for that. Amanda, I have another question that was sent to me. Can you talk a little bit about the difference between CGFNS and Josef Silny?

Yes, I can't. So these are the two vendors that are accepted for the immigration process. CGFNS is accepted by all the state boards. Where's Josef Silny accepted by I think it's 24 right now. So it really depends on personal preference. If you already have any documents on file with either CGFNS or Josef and long-term where would you like to go? So Joseph Sony's not accepted by all the states, so Virginia for one. So if you're looking to go for a very specific path for not only the visa screen for the immigration process, but also the state application Shouldn't for your license, you need to think long term, which would be the best fit for you. And I also highly recommend looking at the cost, price difference, processing time in what you need, specifically for your needs. So they do have the same items up for the immigration process. One is the visa screen with CGFNS and the other visa for nurse with Josef Silny. So again, it really just depends on where you're going long term, and what your preference is. So best of luck to you with either one. And if you're looking at cost savings, that would be Josef Silny.

Okay, thank you, Amanda. So more to come keep listening to the Lefora talk show, and our licensure Q&A with the experts because things are changing and evolving. And we can see that Joseph cylinder obviously is a new development on the licensure spec landscape. And but there are a lot of changes that we anticipate to come over the next year. Let's see. I see there was a question about Kentucky. Judy has a question. I have an Arizona license. And but it expired in 2011. What should I do to get the Kentucky license highly. I've been selected through Connetics USA at one of our employers.

So I believe Kentucky doesn't actually require you to have that license still be active. But you will have to do a verification of your Arizona license to Kentucky, you will also send them a copy of your visa screen. And their process is actually pretty easy to get a temp license even before you arrive. And I believe that temp license is good for six months. But during that time, they'll review everything else that you have. So we do give some very specific instructions on how to navigate the process. The one thing is that some nurses like to do their fingerprints once they're here. Fingerprints are required for you to get the temp license. So if you do them overseas, you can arrive and have that tamp. But if you do them here, Kentucky is pretty quick to issue the license even if you wait until you're here. So food for thought.

Okay, so Kentucky I think is one of the easier and I put that in quotes sports, right? Everybody's nothing. Nothing's ever easy licensure, but it's easier. Okay, and Democrats are saying Michelle, can you can you repeat the exempted countries from English? I'm South African and got my NCLEX through New York. So Democrat Sue Michelle will go into the chat after the this show and just answer and we will all everybody on the panel are so helpful and so supportive have agreed to go into the chat if we were not able to get to your specific question on the show, because I see we already coming up towards the end of the show. And okay, so, um, we've got a lot of questions coming up about credential evaluation CES. Michelle, can you maybe talk a little bit just about this topic? What is the CES? And why is it so important for and when is it important?

So the credential CES is the CGFNS term for a credential evaluation service. And for Joseph, Sony, it's called FC. And it's out of my head what that stands for right now. But anyway, it's a credential report. And that is the credential report breaks down, and your educational history. So it makes sure that you have attended schooling for 12 years. And some people run into issues because they may have only done 12 years or 11 years of schooling. And they are quite specific about 12 years of schooling before you go to nursing school. And it breaks down your education, your general nursing education, and any post grad work that you've done as well. And basically, it's the front page that matters, it says you are the equivalent to a US diploma nurse, a US Bachelor of Science and Nursing nurse. And but that's the phrase that matters at the beginning. That's what tells the board and then also the part of the breakdown of hours. And the credential evaluation is making sure that you have hours, both theory and clinical in all five areas of nursing, that's medical surgical, pediatrics, maternity and RSV and obstetrics and psychiatry, or psychology. And it's very important to us basically, we don't know what the rules are for every board. But the basic rule of thumb is 15 theory to 30 clinical, we know you have a lot more than that, especially in medical and surgical. But if you haven't done any pediatric training in your nurse training, that's an issue You will, you may not, or you probably won't qualify to take the NCLEX because you're missing those hours. And, and you have to have hours in all five areas. So that's very important that you talk to somebody, whether it's your Connetics specialist, your AMN, specialist, but about your background, that's the first question we ask, do you have training in all five areas of nursing? And most of you do, because that's how education, that's how nurses have been trained. But sometimes there's a nurse that's only trained in we had in Ireland, mentally handicapped, trained nurses, and they did not have certain areas of nursing, and therefore could not qualify for America. So just remember to ask the questions.

Thank you, Michelle, that gives a lot of insight because that can be really confusing. Okay, I'm just looking at the clock. And we are almost at time. So I see we've got a few more questions in the chat. If we are not able to get your question to your question, I apologize. And our panel have agreed to go into the chat afterwards and answer your question. So we're going to just try and zip through these last ones as quickly as possible. And but before we do, I just wanted to answer heavenly who said, Hi, why does it take Connetics so long to reply after sending in my resume? So I apologize, heavenly, that's the last thing that we would ever want is to take long to reply to your resume. Thank you for your application. I think it's just that our team are so inundated with applications right now, but we will definitely respond to you and thank you for your interest. And okay, so she is asking about the NCLEX from Australia, Holly, you nodding your head. Will I have difficulty during the license endorsement to Pennsylvania? Holly, what would you say to sharp isn't shy? I think?

Yeah, I wouldn't be concerned. So the good thing about Nami, although we don't actually use them as much, but they are an option to do your NCLEX score transfer to. And so if you're doing that when NMI issues you a license, the license will be what Amanda referred to earlier as an exam license that actually is really important, not only for boards that maybe want that exam license, but you never know where you might end up wanting to work in the future. So actually, in making that choice, you've set yourself up well, well, and just fine to be able to navigate eventually to Pennsylvania for endorsement. Okay, thank

you. So shine, no need to worry. And Varion has a question, Amanda. Hi, is it okay that I avail Josef for visa screen? And CGFNS CES for the Maryland license endorsement.

Yes. So they do need the CGFNS CES report. So since you do have that you would be okay to proceed with the Maryland application. And right now they're taking about two weeks to issue. So as long as that's an over, you should be on track for a license.

Perfect. And last question is for Brian about the California Board. Michelle, follow up to my question about California license. I'm internationally educated and I can start submitting back. And can I start submitting my documents to California Board as early as now to get started to get started? I cannot submit them through Greece online account as I need a Social Security. What's the process of I want to submit outside Greece account?

Holly actually answered this question earlier on and its timing, you can submit you can submit them manually your wealth from your school of nursing. But the point is the timing is fine. If you're not going to be here for another if you're not going to have a visa for another six months. Do not submit your documents. Now. They do shred documents in the California Board. They don't keep them for a year like other boards might do. And so if your documents are there four months or more before you know you're going to have a social and can apply through Brees. Do not submit your documents yet. It's all about timing. Work with your specialist and lets you know review your file to see when is the best time for you to start the process. Because one thing I just want to quickly say a lot of boards issued temps but don't get a temp issued if you're not coming for a year. It's timing. You want that temp to be valid when you arrive and to have at least several months so that you have time to get your social to get the perm. So you don't want to Kentucky expiring just before you arrive and then you have to wait for your social to get the perm.

Just everybody's nodding their head Michelle, great advice there. So thank you so much to our expert licensure panel for all of the answers and we know that licensure can be a headache for many nurses whether it's getting your license initially, whether it's a license endorsements, so we hope that today would be was helpful and the we will be back on the Lefora talk show to take more love your questions. Again, shout out to the love for admin do team that do such an awesome job of helping nurses all over the world with all of the questions that they need to know about coming to live in the United States. Just one thing to finish off with before we end. And it's just a reminder to everybody to check out the way I see we have a lot of questions about the English exam. So please check out the Connetics College, where we have free classes every Monday on the Connetics Facebook page. On the first we have an influx class by Aspire our esteemed partner, and Dr. Paul who's one of the admin of Lefora. And then we have an NCLEX class on the third by IPASS also one of the agenda for Miss Jean when it also the NCLEX admin. On the second Monday is PTE through Aspire partners Swoosh on the fourth Monday, we have Niners check the time in your local country. And last but not least is also watch out on for every Friday, the Connetics USA show onwards and upwards. This Friday, we are talking about California, one of the most popular states, so so please check that out. We're going to be talking about what it's like to live in California, what the climates like what the taxes are like What the What is fun to do in the state cost of living all of those important things on the 27th we're going to be talking about taxes. This is free information for all nurses coming to live in the United States. We are now in tax season. So the 27th is taxes. On the third we do one of our clients showcases which is Advent health in Florida very popular state to come to on the 10th we have our second part two of our spousal support program on the 17th. We have our immigration Q&A. And on the 14th of February, which is Valentine's Day as everybody said knows, we have the next episode of the Sephora talk show thanks to the awesome love for our admin team, which is the love for love game show. So lots of fun things coming up. Please join us and we look forward to continuing the education and support to help all nurses around the world wanting to come to America to make your American dream a reality. Thank you for joining us, everybody. See you next month on the Lefora talk show. Thank you everybody. Bye bye