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The latest immigration and visa news for the USA, Canada, Australia, New Zealand, Ireland, and select European countries - straight from the leading immigrant advocates in the Philippines.

How to Practice as an RN in 5 Countries

Filipinos and other internationally educated/trained Nurses usually pursue work or migration to the five countries: Australia, Canada, New Zealand, UK and the U.S.A. We have checked the most current requirements and are sharing this with our RN friends at no cost.

Crispin Aranda

How to Practice as an RN in 5 Countries

How to Practice as an RN in 5 Countries

Filipinos and other internationally educated/trained Nurses usually pursue temporary work or permanent migration to the five countries: Australia, Canada, New Zealand, UK and the U.S.A. We have checked the most current requirements and are sharing this with our RN friends at no cost. 

Australia Registration

Pathway to registration and practicing as an RN in Australia for Internationally Qualified Nurses (IQNs) and midwives.

  • Whether intending to work only or apply for Skilled Migration, an Internationally Education Nurse (IQN) must register with the Nursing and Midwifery Board of Australia (NMBA).
  • NMBAis the registration and regulatory agency for Nurses and Midwives including Internationally Educated Nurses. NMBA is one of 15 boards under the Australian Health Practitioners Registration Authority (AHPRA).
  • AHPRA is the agency that registers and regulates all healthcare practitioners in Australia, Registered Nurses included through the NMBA.In addition to this, AHPRA works with and supports 14 separate boards, that are specific to each individual healthcare profession. 
  • An AHPRA registered nurse may work in Australia after meeting all the requirements. To apply for permanent residency, however, an IQN must seek evaluation of credentials and qualifications through ANMAC.
  • ANMACis a skills assessment authority used for the purpose of migration. The agency evaluates the IENs qualification, skills and experience to make sure s/he meets the requirements to be considered a skilled migrant, eligible to apply for the appropriate Australian provision al or permanent resident visa.

Practicing the Nursing Profession in Australia.

Internationally qualified nurses (IQNs) or midwives interested to work in Australia or migrate to Australia must meet both the registration and immigration requirements.

  1. Registration. To work as a nurse or midwife in Australia, an IQN must apply for and be registered with the Nursing and Midwifery Board of Australia (NMBA). All applicants for registration and currently registered nurses and midwives need to meet thecore registration standards of NMBA:
    1. Criminal historyregistration standard relating to any offense related to the IQNs practice
    2. English language skillsregistration standard in accordance with changes on 1 March 2019. The revised NMBA English language skills registration standard (2019) outlines three pathways that an IQN can use to demonstrate competency in the English language: The pathways include the:

1. Primary Language Pathway

2. English Language Test Pathway, or

3. Extended Education Pathway intended to be an exceptional pathway to clarify the existing requirement for an IQN to complete at least five (5) years (full-time equivalent) education as continuous education.

  1. Continuing professional development (CPD)- you must complete a minimum of 20 hours of CPD per registration period.
  2. Recency of practice. Your practice hours will be recognized as meeting this standard if:

• you hold or have held current and valid registration with a recognized nursing or midwifery regulatory authority (either in Australia or overseas), or

• your role involves the application of nursing and/or midwifery knowledge and skills, or

• you have carried out postgraduate education leading to an award or qualification that is relevant to the practice of nursing and/or midwifery.

  1. Professional indemnity insurance arrangementsto cover all aspects of IQN’s practice (full time, part time or self-employed, unpaid or voluntary), location, whether in the private or public sector or any combination of these factors.
  1. Immigration. After successful registration and assessment by NMBA and AHPRA, the Internationally Education RN (IERN) may then (a) apply to work.  International RNs intending to apply for permanent residency must be assessed separately by the Australian Nursing and Midwifery Accreditation Council (ANMAC).  The temporary (work) or permanent (migrant) visa is lodged with the Australian Department of Home Affairs (DHA), formerly the Department of Immigration and Border Protection (Australian Immigration Department - DIBP). 

ANMACassesses the skills of nurses and midwives who want to migrate to Australia under the Australian Government’s General Skilled Migration program towards permanent residency.

Important note for international applicants who are registered in New Zealand:

Applicants who have the legal authority to practice as a nurse or midwife in New Zealand may apply for registration with the NMBA through AHPRA subject to certain entitlements under the Trans-Tasman Mutual Recognition Act 1997.

Difference between ANMAC (immigration) and NMBA (registration) assessments

ANMAC takes into consideration qualificationsin assessing an applicant’s qualifications.  These qualifications in turn are used to determine suitability for skilled migration

NMBAon the other hand, evaluates the  equivalency of an IQNs qualifications to meet an Australian qualification for nurses to practice their profession based on five registration standards: criminal history, English language skills, recency of practice, continuing professional development and professional indemnity insurance arrangements.

This is why some applicants may be approved for skilled migration but do not meet the registration requirements of the NMBA.

Employment

Meeting both the registration and immigration does not guarantee employment. The registered nurse would have to apply directly with an employer or agency to be sponsored for temporary work under the specific subclass. An RN with a positive skills assessment and approved for permanent residency through a specific subclass must have sufficient funds until he or she gets full time employment as part of the pathway to successfully settle in Australia.

The following chart from the Department of Home Affairs shows the different types of work and skilled migration visas through employment.

Sponsored skilled visas

All visa categories in the table below require sponsorship by an employer.

The visas listed in the table immediately below:

·       require sponsorship by an employer, with subclass 187 requiring sponsorship by a regional employer

·       are not points-tested

·       do not require a mandatory Expression of interest (EOI) in SkillSelect.

Visa type

Visa duration

Required to work in regional Australia

Skill/qualification requirements

Other main visa eligibility requirements

Temporary Skill Shortage (TSS) visa (subclass 482)

From one year to four years depending on occupation and any international trade obligations.

No, unless the occupation is only available where the position is located in regional Australia.

Applicants must have the skills necessary to perform the nominated occupation, as well as at least two years' work experience in that occupation or a related field. Some applicants are required to undertake a mandatory skills assessment.

The nominated occupation must be on the list of eligible skilled occupations for the TSS visa or specified in the relevant labour agreement. Applicants must also have the necessary English language skills unless exempted.

Employer Nomination Scheme (ENS) visa (subclass 186)

Permanent

No, unless the occupation is only available where the position is located in regional Australia.

Unless exempt, Direct Entry stream applicants require a skills assessment by the relevant assessment authority.

Skills assessments may be required if you are applying for a different stream.

Relevant registration or licensing must be held if required.

You must have three years' work experience.

The nominated occupation must be on the list of eligible skilled occupations for the ENS visa or specified in the relevant labour agreement.

Unless exempt, must:

  • be under 45 years of age
  • have at least competent English.

Regional Sponsored Migration Scheme (RSMS) visa (subclass 187)

Permanent

Yes

Currently, overseas qualified trades workers applying for the Direct Entry stream must have their skills assessed by Trades Recognition Australia (TRA). Skills assessments may be required if you are applying for a different stream.

Note: From 1 July 2018, all Direct Entry streamapplicants, will require a skills assessment by the relevant assessment authority and three years' work experience, unless exempt.

Relevant registration or licensing must be held if required

You must have three years' work experience.

The nominated occupation must be on the list of eligible skilled occupations for the RSMS visa.

Unless exempt, must:

  • be under 45 years of age
  • have at least competent Englsh

 

Internationally Educated Nurses Guide to Registration in Canada

An internationally educated RN (IERN) trained overseas may have “much of the basic requirements to work in Canada.” However, since the nursing associations/colleges in each province and territory establish province-specific requirements, the IERN must meet the registration standards in the province where he or she intend to practice or migrate.

For Filipino and other internationally educated nurses who have passed the NCLEX-RN exam, registration of licensure in Canada just made a giant leap for nursing-kind in 2011 when Canada adopted NCLEX as the first step towards practicing in Canada.

The NCLEX-RN® was adopted by Canadian regulators in 2011 as the test which entry-level nurses – both those in Canada or RNs from overseas - must meet or comply with in order to be certified to practice in the country.

In adopting the exam, the Canadian regulators considered two studies conducted by the National Council of State Boards of Nursing (NCSBN): (1) Determine the applicability of the NCLEX-RN® test plan to the Canadian testing population (NCSBN, 2014), and (2) the NCLEX-RN® providing "a fair, valid, and psychometrically sound measurement" of nursing competencies of entry-level RNs in Ontario, Canada (NCSBN, 2012 , p. 8). 

While NCLEX-RN is the entry level exam for all of Canada, an internationally educated nurse (IEN) must still meet certain requirements from the province of intended practice. 

Jurisprudence Examination. In addition to the registration exam, IENs must successfully complete a separate jurisprudence exam designed to evaluate her/his knowledge and understanding of the laws, regulations, and College by-laws, practice standards and guidelines that govern the nursing profession in the province

All IENs must pass the NCLEX-RN exam.  In addition, each province has specific requirements for an IEN to complete registration and subsequently practice the profession. There is no national registration/licensure process for nurses in Canada. Each province has its own regulatory body and assessment process.

The following steps apply to all IEN applicants seeking registration and practice as an RN in Canada. Certain specific requirements for a province is included.

Step 1:Apply to the National Nursing Assessment Service (NNAS), pay the assessment fees. NNAS confirms your identity and evaluates your nursing education, qualification, licensure in the country of practice and English/language proficiency,

Step 2:Create an account & apply for registration after being advised of eligibility for assessment by the provincial regulatory authority. 

Step 3:Provincial registration body (School or College of Nursing) assesses your application.

Step 4: IEN is referred to the specific provincial service provider to evaluate competency to practice since evaluation of education alone is not sufficient. In British Columbia, the IEN is referred to the Nursing Community Assessment Service (NCAS). In Alberta, it is ARNAP.

Practice hours:Regulatory authorities for RN in Canada usually require 1,125 nursing practice in the last 5 years or 450 hours in the most recent year of practice (e.g., Saskatchewan Alberta-and Nova Scotia). In lieu of the minimum practice hours, an IEN may provide evidence of having graduated from an approved nursing education program; or completed an approved nursing re-entry program. 

Restrictions.Manitoba has specific instructions for Philippine nurse applicants who wrote the June 2006 licensure examination in the Philippines. Said applicants must provide proof of having successfully completed the special voluntary examination, which was authorized by the Philippine Department of Labor and Employment (DOLE), Parts III (3) and V (5). Successful completion is the achievement of a score of 75% or better on these sections. If an applicant has not written the special voluntary examination or cannot provide proof of such, they may not be considered as an applicant for registration.

Step 5: The assessing body of the province where an IERN intends to practice sends the authorization to either take the NCLEX, take a bridging course prior to interim registration approval, interim registration or temporary class to practice until applicant successfully passes the RN exam.

Step 6: Register to write/take the NCLEX with Pearson Vue. You will need a program code to register. Schedule your exam appointment either online (recommended option due to high call center volume) or by telephone and provide an email address to correspond with Pearson Vue. 

Pay the fees by credit, debit or prepaid card (VISA, Mastercard or American Express). Third-party payments are allowed from nursing schools, agencies or employers.

Registration Time Limit  An NCLEX registration file remains open for 365 days until the Nursing Regulatory Board (NRB) determines the applicant’s eligibility.  Once declared eligible, the IERN must take the test within the validity dates on the Authorization to Test (ATT) email.

Denial of eligibility forfeits the registration and exam fee. The IERN would then need to re-register and pay another fee after the current registration expires. IERN will need to reregister and pay another exam fee after the current registration expires. 

Step 7:Receive your exam results. Official results are sent the NRB approximately 6 weeks after the exam. Results are only available through the NRB.  

Step 8:Comply with or meet the corresponding Jurisprudence examination (as applicable of the province where you intend to practice as part of an IERN’s continuing competence program as a newly registered nurse in the province. Each province has its own jurisprudence exam and/or compliance requirements after passing the NCLEX and prior to practicing the profession.

Step 9: Confirm your registration status from the NRB of the province of intended practice. Pay the corresponding non-refundable fee.

Step 10– Start your RN practice in Canada. Check the post-registration continuing competency programs or continuing professional development to meet current practice standards.

Northwest Territory and Nunavut - Internationally Educated Nurseswhowish to work in the North as an Active-Practicing Nurse must must be registered in another Canadian jurisdiction and in good standing in order to obtain a registration with RNANT/NU

New Zealand Registration: 7 requirements for Internationally Educated RNs

If you are a nurse who is registered overseas, and you want to practice as a Nurse in New Zealand, you must meet the 7 requirements - set by Nursing Council of New Zealand (NCNZ)  - to ensure that the internationally educated RNs (IERNs) are safe, competent and well-prepared to nurse in New Zealand.

1. Proof of identity by submitting certified copies of identity documents – such as current and valid passport, birth certificate.

2. Completion of an appropriate nursing qualification equivalent to level 7 or 8 on the New Zealand Qualifications Framework. Nurse applicants from the Philippines are required to submit related learning experience.  If the qualification is not considered the equivalent of an NZ nursing degree, completion of a bridging course would be required.

3. Required standard of written and spoken English. Evidence includes OET or the IELTS Academic Test to prove proficiency in the language. The minimum score you must achieve is: (

     a) OET test: at least B for each band (listening, reading, writing, speaking).  After September 2018, the band score is 350 for each band  

     b) IELTS Academic test: at least 7.0 for each band (listening, reading, writing, speaking)

The IERN may get these results in a single test, or across several tests, by taking them within 12 months of the first test, and using the same candidate number. The test results must be less than 3 years old when the IERN applies for registration.  IERNs already registered in the United Kingdom, Ireland, Canada or the United States of America, can request a waiver for the English language requirement. The waiver form must be completed this upon application.

4. Current registration overseas. NCNZ checks IERN registration from the nursing board or professional licensing body in the country where the applicant nursed in. Must have two years nursing practice in the last five years (from the date of application with NCNZ) and 2,500 practice hours in the required two years.

5. Fitness to practice.   Applicant must notion have or disclose any disciplinary action by a regulatory authority overseas. NCNZ clarifies that an applicant’s conviction of an offense is not always a barrier to NZ registration,.  However, the applicant should discuss the offense or criminal record before applying.

6. Competence to practice in the New Zealand context  It is rare for a Philippine-educated and licensed RN to be registered by NCNZ without completing a Competency Assessment Program (CAP) The 6 to 12 week CAP program prepares overseas-trained nurses for the registered nurse role and healthcare context of New Zealand, which is different to many other countries. IERNS with current registration in the United Kingdom, Ireland, Australia, Singapore, the United States of America or Canada, may not have to complete a CAP program because “the registered nurse role and healthcare context in these countries is similar to New Zealand.” The cost of the CAP program ranges from NZ$7,000 to NZ$9,000.

7. Two years' post-registration experience working as a registered nurse overseas is required. NCNZ will request confirmation in writing from the IERNs previous employer/s must confirm in writing the applicant’s years of nursing experience.

UK Registration with the Nursing and Midwifery Council

Information for nurses and midwives who trained outside the European Union or European Economic Area (EEA) – Non-EEA RN Applications.

To check that a Non-EEA RN is capable of practicing safely and effectively in the UK, NMC will assess their qualification, training and experience against NMC standards to determine with part of the NMC Registry the applicant would appropriately qualify for.

New applicants must complete an online self-assessment of their eligibility to apply before beginning the application process.

Application process and fees

There are different fees for different stages of the application process:

·       Application for nursing/midwifery - £140

·       Part 1 test of competence (CBT)     £130

·       Part 2 test of competence (OSCE)  £992

·       Admission onto NMC register          £153

·       Total £1,415

Each professional field of nursing, including adult (general), children’s, learning disabilities, mental health and the midwifery profession, is examined by our test of competence. 

Part one is a multiple choice examination and part two is a practical examination called an OSCE (objective structured clinical examination).

Test of competence

Each field of nursing and midwifery in the UK (shown below) is separate and distinct. “Each requires three years of specialist pre-registration education and practice. The test of competence requires extensive preparation and study to make sure you can demonstrate knowledge, understanding and application of professional skills at the right level.

  • Adult (general) nursing
  • Children's nursing
  • Learning disabilities nursing
  • Mental health nursing
  • Midwifery

Part 1 and 2 test of competence

The NMC test of competence for Non-EEA RNs consists of two parts.

Part 1 is a computer based test (CBT). The CBT is multiple choice and can be taken at a Pearson VUE test centre available in most countries around the world. Candidates will be given a short tutorial on how to use the computer before startingthe examination.

The CBT comprises 120 multiple-choice questions. All questions are scored as correct or incorrect and there is no partial credit. A small number of questions will not be scored as they are pre-test questions, these questions will not be indicated to candidates.

A proportion of questions will be critical and relate to patient and public safety.

Critical questions must be passed.

The time limit for direct testing is four hours and this includes any breaks from testing, which are optional.

Part 2 is a nursing or midwifery objective structured clinical examination (OSCE) – The OSCE can only be taken after the Non-EEA RN successfully passes the CBT. The OSCE is only available in the UK at a designated test center.

Approved OSCE Test Centres

The following universities are currently approved as test centres:

  • University of Northampton
  • Oxford Brookes University
  • Ulster University

Taking the test of competence

For applications started after 6 April 2017:

CBT

·       Applicants can sit the first part of the test of competence (the CBT) twice as part of one application.

·       If an applicant is unsuccessful at their first CBT they must wait a minimum of 28 working days before they can sit the CBT again.

·       If an applicant is unsuccessful after their second CBT, their application will close. They will be required to wait six months before submitting a new eligibility application to take the test again.

OSCE

·       Applicants may sit the second part of the test of competence, the OSCE, up to three times as part of one application.

·       If an applicant is unsuccessful at their first OSCE, they must wait a minimum of 10 working days before they can take the examination again.

·       If an applicant is unsuccessful at their second OSCE, they must wait a minimum of three months from the date of their second attempt before they can take the OSCE for the third time.

·       If the applicant is unsuccessful after their permitted attempts, their application will close. They will be required to submit a new application but will not be able to sit the OSCE again for a minimum of six months.

Click this link for the NMC Registration and Application procedures - https://www.nmc.org.uk/globalassets/sitedocuments/registration/candidate-information-guide-toc-part-1-pearson-vue.pdf

UK immigration processes

Completion of the NMC registration process enables a Non-EEA RN to apply for a work visa under the Tier 2 category. -  https://www.gov.uk/tier-2-general/extend-your-visa

There is no direct pathway to apply for permanent residency (called Indefinite Leave to Remailn (ILR).  The Non-EEA RN becomes eligible to apply for ILR after legally working for at least five years.

The qualifying periods for the different Tiers are shown below:

·       5 years in the following routes: 

Tier 1, Tier 2, employment not requiring a work permit, representatives of an overseas business, UK ancestry and retired persons of independent means.

·       3 years in the Tier 1 (Entrepreneur) - accelerated route. Applicants must ensure that they qualify for the accelerated route before submitting an application for indefinite leave to remain on that basis.

·       2 or 3 years in the Tier 1 (Investor) - accelerated route, depending on the level of investment in the UK. Applicants must ensure that they qualify for the relevant accelerated route beforesubmitting an application for indefinite leave to remain on that basis.

·       4 years or 5 years in the highly skilled migrant category. The 4-year qualifying period applies only to applications made under the terms of the HSMP indefinite leave to remain judicial review policy document. Those terms apply only if you applied successfully under the highly skilled migrant programme (HSMP) before 3 April 2006. All other highly skilled migrant applications are subject to the 5-year period. 

Working, Migrating to the USA

Just like with the Commonwealth Nations, a foreign-educated RN (FERN) must register to apply to practice as a licensed RN.  The exam taken by international nurses is the NCLEX, administered by the National Council of State Boards of Nursing (NCSBN).

Two-Step Registration Process for the NCLEX

1.    Submit an application for licensure/registration to the board of nursing/regulatory body (BON/RB) where you wish to be licensed/registered. This is in order to be made eligible to take the NCLEX*.

2.    Register for the NCLEX with Pearson VUE, utilizing one of the methods below. You will need a program code to register, and an email address must be provided with your registration. Correspondence from Pearson VUE will only be available via email.

After passing NCLEX, the FERN must obtain the VisaScreen Certificate, a requirement by the U.S. Citizenship and Immigration Serviced (USCIS) whether the nurse intends to work (temporarily) or migrate (as a permanent resident).

Required Documents for the VisaScreen® include the following :

·       A secondary school diploma or an external exam certificate showing the highest level of secondary education received. Secondary school (high school) is a school intermediate between elementary (primary school) school and university, usually offering general, technical, vocational, or university-preparatory courses.   All documents must be in English. Secondary diplomas can be translated by an applicant or someone chosen by an applicant. This requirement is waived if the applicant completed secondary school education for more than ten (10) years.

·       License, Registration and Diploma Information The VisaScreen® Report verifies the validity of all licenses, registrations, and diplomas, including: Licenses, registrations, and diplomas that are currently held or that have been held in the past by the applicant from all jurisdictions, including foreign and domestic.

·       Professional Education Information. A complete academic record or transcript from each educational institution attended for the profession being screened is required. (Some professions also require syllabus / course descriptions). These documents must be in English and must be translated by an official registered translator. CGFNS can translate documents for an additional fee.

For updates on working or immigrating to the U.S. as an RN, click here - https://www.visacenter.org/page/primer-for-foreign-rns-intending-to-practice-in-the-us---2018/837

Authors & Contributors

Crispin Aranda

Crispin Aranda

Crispin R. Aranda is an established International Visa Conselor and Immigrant Advocate. He is the president of IVC and is in several migration radio programs.

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