It is global knowledge that healthcare systems all over the world has an increased demand for nurses. The United States Bureau of Labor Statistics (BLS) projects that there is a need for about 194,500 nurses per year until 2030. As states struggle to fill those needs due to nursing shortages, they look to hire foreign nurses for those positions. If you meet the requirements to practice in one of the states, here are some things to consider prior to migrating to the US.

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First Things First

You need to be a graduate of an accredited nursing school in your country. In addition to that, you need to have an active license. While it is not a pre-requisite that you are working at the bedside, most of the hiring agencies prefer that you have some relevant clinical experience. In a nutshell, they are looking for nurses who are ready to take on the responsibility by day 1.

Some nurses inquire if the clinicals they had in school qualify as experience. The short answer is NO! Hiring agencies aim to deliver nurses who can independently function with minimal to no supervision. Clinicals, in contrast, are viewed as highly supervised experiences.

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Passing The Required Examinations

As I stated in the previous paragraph, you need to be currently licensed in your country. That basically means that you have passed your local nursing boards. Or that you have renewed your license as necessary.

Next, you need to also pass the National Council Licensure Examination (NCLEX). Prior to taking the NCLEX, I would strongly suggest that you review the requirement of each state’s board of nursing. You have to keep into consideration what your ultimate goal is. The reason for that is you need to look into how you can obtain license reciprocity if you are planning to move from one state to another in the future.

For example, you applied for the Illinois NCLEX. However, you actually plan to migrate to California. It is not that easy to convert that Illinois nursing license into a California one. It will entail time, money, and effort.

In short, you will be saving yourself that headache if you already did your homework at the get-go!

Aside from the nursing licenses, you have to also pass an English language proficiency examination. Some examples are the International English Language Testing System (IELTS) and Test of English as a Foreign Language (TOEFL).

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The Credentialing Process

An agency like the Commission on Graduates of Foreign Nursing Schools (CGFNS) then needs to validate your academic and professional credentials. The agency has to verify that your documents are authentic and that your education is comparable to the US standards. The CGFNS, after finding that your credentials are satisfactory, will then issue you a Visa Screen certificate. This certificate meets the Federal screening requirement.

Simply said, having that Visa Screen proves that your documents have met the requisites for an occupational visa.

Finding an Employer

There are many agencies that are hiring nurses right now. This fact can get nurses very excited so much so that you can easily fall for the honeyed words and promises of the very first agent who approaches you. STOP!

You owe it to yourself to be discerning and know what you are actually getting yourself into!

Know that there are different kinds of employers.

1. Direct hire employers – These are organizations that hire nurses from foreign countries directly. Upon your arrival in the States, you will be working for them and enjoy all the benefits similar to those of their other local employees. Some direct hire employers use a hiring agency initially but it just serves as the facilitator. The agency’s responsibilities cease once you have migrated and started working for your employer.
2. Nursing Recruitment Agencies – These agencies recruit nurses as their employees. They hire nurses, help them settle in their new locales, and assist them in any other way necessary during the duration of the contract. Then they deploy these nurses to healthcare facilities. In essence, the immigrant nurses working for the agency may not necessarily have the same benefits as the other nurses employed by the facility itself.

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Ask Relevant Questions Before Signing the Contract

You have to weigh your options before settling with your employer. Recruiters are gifted in such a way that it is easy to take their words as credible and reliable. Rather than be swept off your feet right away, take notes. Then, review those notes several times over after you are more rational and not too overly excited about the prospect of finally realizing your American dream. In addition, also list down your own questions to ask during the interview process. Here are some questions to ask

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Contract Questions

1. How long is the contract? – Some employers define this in terms of months, while others in hours.
2. When I work overtime, will those hours be deducted from my contracted hours as well?
3. Will I be violating my contract if I work for another organization during my days off?
4. In case I won’t be able to meet the required number of hours/months in my contract and I opt to transfer employers, what are my liabilities? Do I have to pay the agency (or organization)? If so, how much? Would that fee be pro-rated if I have met part of my contract?

Visa Processing and Fees Questions

1. Does my employer petition allow my immediate family to migrate with me? If yes, am I responsible for all their expenses?
2. Speaking of expenses, what will you cover (visa processing, fare)? Will you reimburse me for my NCLEX and other fees?
3. Do I pay the placement fee? If so, what are the terms of payment?

Settling In Questions

1. When I arrive in the States, will you provide housing or help me find one?
2. Will someone meet me at the airport or am I expected to travel on my own?
3. Do I need a car where I will be working? If yes, will you help me find a dealer and secure a loan?
4. Are you able to help me obtain a driver’s license? Do you provide driving lessons?
5. Will you help me process my social security number?
6. Whom will I be able to reach out to if I have difficulties adjusting to work or to my new life?

Financial Planning Questions

1. How much pocket money do I need since I won’t be able to work right away?
2. Do I start getting paid during training or orientation?
3. How much salary are you offering me? Will I and my family be able to live with that in the State that we will be going to?
4. How often will I get paid?
5. What other benefits (medical, dental, vision, retirement), if any, do you provide? What are my out-of-pocket deductions per paycheck?
6. How many percent are the taxes in my destination state? Do I only pay for federal or also state taxes?

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The Process of Obtaining a Visa

Discuss your questions with your prospective employer. Sign your contract if their answers are satisfactory. By that, I meant reading every single detail, particularly the fine print. You don’t want to start your life in America not knowing minor details that your employer can throw at you that may hamper your transition process.

The agency will then submit a petition on your behalf to the appropriate government agencies for processing. Chances are, you will have an interview in your local US Embassy or Consulate. Prior to that, you go for a medical check-up from an accredited healthcare facility. Once everything is in order, they will grant you a visa. Your visa may either be that of an Employment-Based Third Preference (EB 3) permanent resident or of a skilled worker (H1B visa) depending on your filed petition.

Words of advice: Renew your passport prior to your embassy interview appointment if the current one has only six months until expiration. Having an updated passport will help you prepare for any eventualities like trip postponement.

Coming to America

At this point, you are preparing to migrate, maybe with your family. You have to mentally condition yourself that this will not be an easy move. It will be full of challenges, but you are ready for them. You are a nurse, and are a resilient one at that!

YOU CAN DO IT!

For more practical advice, you may refer to my previous article linked here. Hopefully, these will help you build that resolve that no matter what, you are here to start and live your American dream!

Please share your comments and reactions below. I would love to hear your own version of the American dream or reality.