N URS I NG E DUCAT I O N
IN THE UNITED STATES
The purpose of this text is to provide information on the nursing
education system, nursing qualifications and nursing licensure in the
US.
Nursing Qualifications
There are several types of nurses in the US, such as Licensed Practical Nurses (LPN), Registered
Nurses (RN) and Advanced Practice Nurses (APN) that concluded different programs of study and can
take different professional paths.
Each state has a Nursing Board (full list with contacts available at the National Council for State Boards of
Nursings web site: www.ncsbn.org/public/regulation/boards_of_nursing_board.htm). These state boards
serve as the authority for training and licensing. Upon the successful completion of a state-approved
program, a graduate must take the licensing examination given by the state. Only when this exam is
passed can a person work as an LPN, RN, or APN. As licensure is only valid in the state where issued,
anyone wishing to work in another state would have to contact the appropriate nursing board.
Licensed Practical Nurses (LPN)
An LPN program involves 12 months of training at a state approved vocational/technical school or
community college. Upon completion of a training program, students must sit the state licensure exam to
become a licensed nurse. Licensed nurses are usually employed in a hospital, providing basic bedside
care under the supervision of physicians and registered nurses. Their responsibilities and potential for
upward mobility are, however, more limited than the RN's.
Licensed Practical Nurses obtain their nursing education through technical/vocational schools,
community/junior colleges, or even high schools, hospitals or universities. The practical nursing programs
include both classroom study and supervised clinical practice (usually in hospital).
Registered Nurses (RN)
There are three types of training programs available for those wanting to be an RN. All successful
graduates are prepared to begin general nursing duties in hospitals, clinics, etc. Upon completion of a
training program, students must sit the state licensure exam to become a registered nurse.
Registered Nurses obtain their nursing education through the four-year Bachelor of Science degree in
nursing (BSN), a two-year Associate degree in nursing or a three-year hospital training diploma. Although
all three educational paths meet entry requirements for nurse registration and licensure, the primary path
to professional nursing is the BSN. The American Association of Colleges of Nursing (AACN) recognizes
the BSN as the minimum educational requirement for professional nursing practice.
Associate Degree:
These programs last approximately two years and combine nursing courses and supportive college
courses. They are usually available at community and junior colleges, although they are also offered at
some universities and technical institutes. Graduates receive an Associate of Arts or Associate of Science
degree. To obtain a bachelor's degree after receiving an associate's degree, a student will have to spend
at least two additional years at a university or college that offers bachelor's or combined
bachelor's/master's degrees. Please refer to our handout on Undergraduate Studies in the US for more
details on the associate's degree.
Diploma Programs
These are often run by hospitals or community health care centers and take two to three years to
complete. 12 years of school education are needed to apply to diploma programs. Diploma holders can
enroll in a bachelor's degree or a combined bachelor's/master's to upgrade qualifications.
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Associate's degree and diploma holders can begin practice as an RN, but may find that they are limited to
staff positions as health care generalists and not qualified for certain positions outside the hospital.
Bachelors Degree in Nursing (BSN)
These four-year programs are offered at colleges and universities and are equivalent to the Portuguese
licenciatura degree. The first two years are comprised of courses in natural sciences, humanities and
social sciences. The final two years concentrate on nursing courses and on-site clinical training in
hospitals, clinics and outpatient centers. Please refer to our handout on Undergraduate Studies in the US
for details on application procedures.
Bachelor's degree holders are prepared to practice in all health care settings like critical care, public
health, primary care and mental health. This is crucial, since health care is shifting from the hospital to
more primary and preventive care in community centers. In addition to providing greater employment
opportunities, the degree also serves as a basis for postgraduate education.
Advanced Practice Nurses (APN)
The master's degree is the standard educational qualification for Advanced Practical Nurses. The most
common APN is the Nurse Practitioner (NP). Nurse Practitioners are RNs with advanced clinical skills
such as conducting physical exams, prescribing medication, diagnosing and treating illness, interpreting
lab tests and counseling patients on health care options. 18 of the US states allow NPs to practice
independently of physicians. APNs also include Clinical Nurse Specialists (CNS), Certified Nurse
Midwives (CNM) and Certified Registered Nurse Anesthetists (CRNA).
Graduate Nursing Education
In the US nursing professionals can prepare for specialization only at graduate level. Please refer to our
handout on Graduate Studies in the US for details on the application procedures to US universities.
Master's degrees in nursing last 18-24 months and involve classroom and clinical work. The curriculum
generally includes nursing science theory and application, health care management, research and
courses in the student's specialization. Admission requirements vary but typically include an accredited
bachelor's degree, RN licensure, clinical work experience and the Graduate Record Examination (GRE),
www.gre.org. International applicants may be required to have the Commission on Graduates of Foreign
Nursing Schools (CGFNS) certification, www.cgfns.org/. See below more details about this certification.
There are masters for BSN graduates, condensed bachelor's-to-master's degree programs for RNs who
have associate's degrees or Hospital Diplomas, programs for RNs with non-nursing degrees, programs
for non-RNs with non-nursing degrees, and joint-degree programs like Nursing/Public Health.
As for doctoral programs, they vary in length and can take up to 5-7 years. Admission requirements are
often an accredited bachelor's degree, an accredited master's degree, RN licensure and clinical work
experience and the Graduate Record Exam (GRE). Doctoral programs prepare nurses for health
administration, faculty positions, clinical research and advanced clinical practice.
The curriculum generally includes nursing history and philosophy, nursing technique development and
testing, data management, research methodology and socio-economics of nursing.
When choosing a program, nurses should check to see if the overall institution is regionally accredited in
the US and if the nursing school is approved by the State Board of Nursing and accredited by a
recognized nursing accreditation agency. Accreditation is a voluntary, non-governmental process but
many postgraduate programs only accept degrees earned at nursing-accredited schools.
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Licensure to Practice Nursing
Commission on Graduates of Foreign Nursing Schools (CGFNS) Certification
Nurses qualified outside the US who would like to practice as a registered nurse in the US, must
complete the Certification Program, which includes three parts:
1. A review of the applicant's credentials. Applicants must be a first-level, general nurse and must
have graduated from a government-approved nursing program, which included at least two years
of general nursing training. Applicants must also be registered as a first-level general nurse
('registered' or 'professional' nurse) in their country.
2. A one-day qualifying exam. Nurses whose credentials meet the CGFNS requirements can
register to take the CGFNS Qualifying Exam, which measures basic knowledge in nursing
(www.cgfns.org/cgfns/index.html). The exam is administered in March, July, and November with
applications due 3-4 months before the date of the exam. The exam costs $295 and applicants
must contact the Commission on Graduates of Foreign Nursing Schools, 3600 Market Street,
Suite 400, Philadelphia, PA, 19104-2651 USA, (215) 349-8767 for registration. Grading is
pass/fail although a numerical score is reported and the results of the examination are available
in 8-10 weeks.
3. Test of English as a Foreign Language (TOEFL). The CFGNS requires a score of 540 or higher
on paper-and-pencil version, a score of 207 or higher on the computer version. Registration
information is available on the TOEFL web site, www.toefl.org and at the Fulbright Information
Center.
All nurses must be licensed in the state where they wish to practice. Most US states require a CGFNS
Certificate from foreign nursing graduates before they can take the US registered nurse licensing exam the NCLEX-RN. Nurses need to contact the relevant state board of nursing for information on registration
for the NCLEX-RN exam. The NCLEX-RN exam is offered in the US only.
Visas
Those nurses who gain licensure for a particular state and have an offer of employment for a US health
care organization are eligible to apply for a non-immigrant (H1-B) or an immigrant occupational visa. The
CGFNS, through its International Commission on Healthcare Professionals (ICHP) division, is qualified to
administer a VisaScreen program for nurses who plan to apply for an immigrant visa. Nurses should
contact the US employer and CGFNS for more information.
Additional Resources
American Association of Colleges of Nursing - www.aacn.nche.edu/
National League for Nursing - http://www.nln.org/
Occupational Outlook Handbook - http://stats.bls.gov/ocohome.htm. A hard copy of the Handbook is
available at the Fulbright Information Center.
Nursing Programs, Petersons, available at the Fulbright Information Center.
Free copies of the TOEFL bulletins are also available at the Center.
This text was adapted from the information available at the US-UK Fulbright Commissions web site.
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