In our Ask a Nurse series, experienced nurses provide an insider look at the nursing profession by answering your questions about nursing careers, degrees, and resources.
Question: How can a person with a foreign medical degree become a nurse practitioner (NP)? How will this person's medical background be valued when it comes to admission to the NP program? What path should that person follow and which U.S. state would be more appropriate?
These are all great questions, and you are not alone. In 2018, 2.6 million immigrants were employed in the healthcare field, and 1.5 million of those were working as doctors, nurses, and pharmacists.
Yet, there are still a significant number of immigrants with health-related degrees that are underutilized in low-skill jobs. This is referred to as "brain waste" and affects 263,000 immigrants who could help fill the gaps in U.S. healthcare.
Let's begin by answering how immigrants with health-related college degrees can go on to become nurse practitioners in the U.S.
How to Become a Nurse Practitioner With a Foreign Medical Degree
International nurses, doctors, and healthcare students are coming to the U.S. in record numbers. According to the American Medical Association, 25% of the licensed physicians in the U.S. are international medical graduates (IMGs). Yet, not all physicians with a foreign medical degree achieve this goal.
Foreign physicians must first be certified to enter a U.S. residency program of at least three years, regardless of the education they received in their home country. This is called the IMG Match program, which matched 7,508 participants in the 2020-2021 cycle.
This process is lengthy, highly competitive, and expensive. Some physicians choose to move to European countries where the prerequisites for practicing medicine may not be as inaccessible. As a result, many physicians with foreign medical degrees in the U.S. take less qualified positions. This includes certified nursing assistants or phlebotomists, who then may move on to train as a nurse practitioner or physician assistant.
On the other hand, there are U.S. students who choose to complete their medical degrees abroad. St. George's University in the West Indies actively recruits U.S. students to their program. They cite several student benefits. For example, students are exposed to a wider variety of illnesses. This is an advantage for doctors who plan to work in missionary positions, such as Doctors Without Borders.
Prospective students also have more flexibility with admission. This is because many programs have rolling admission and different graduation dates. Students can also become more culturally aware and learn about different healthcare systems.
The challenges of entering the healthcare field in the U.S. are no different for U.S. citizens who were educated in a foreign country. So, while there are benefits, students may find their education doesn't pass U.S. benchmarks. This means they could be required to complete additional academic work. Additionally, they will also compete for residency programs in the U.S.
Foreign-educated nurses must also pass specific benchmarks. The process starts with the Commission on Graduates of Foreign Nursing Schools (CGFNS) International for nurses educated outside the U.S. who want to practice as nurse practitioners in the U.S. The nonprofit organization helps healthcare professionals live and work in their country of choice by assessing and validating their credentials, both academic and professional.
To legally immigrate to the United States, a foreign-educated nurse must first meet federal requirements. They must also get a registered nurse (RN) immigrant visa. To practice in the U.S. and continue through a nurse practitioner program, the nurse must:
Graduate from an accredited nursing program in their country of education
Be licensed as an RN in another country
Practice as an RN for two years
Demonstrate English language proficiency (sometimes done by passing an exam, such as the Test of English as a Foreign Language)
CGFNS evaluates the credentials as mandated by the state boards of nursing. This includes academic and professional credentials. They ensure that the education is comparable with U.S. nursing standards. Some state boards of nursing also require foreign-educated nurses to tpass the CGFNS qualifying exam.
Nurses will then be required to take and pass the National Council Licesnure Examination for RNs to be licensed as a registered nurse by the state board. The final step is to apply and be accepted by a nurse practitioner program.
Featured Online MSN Programs
The Value of Having a Medical Background
There is significant value in patient care and cultural awareness when healthcare professionals with a foreign medical degree become nurse practitioners in the U.S. According to the Migration Policy Institute, immigrants represent 17% of the overall U.S. population but 28% of physicians, 24% of dentists, and 38% of home health aides. The organization expects immigrants to continue to play a significant role in the future of healthcare in the U.S.
There are significant benefits to having a medical education before coming to America. Some online nurse practitioner programs work with doctors who wish to become nurse practitioners. This allows them to draw on their extensive education and clinical experience.
Programs, such as Florida National University (FNU), can directly admit doctors with a foreign medical degree into one of four master of science in nursing (MSN) tracts:
- Family nurse practitioner
- Adult nurse practitioner
- Pediatric nurse practitioner
- Psychiatric nurse practitioner
They also allow transfer credits from the student's general education courses. The coursework is first evaluated to meet U.S. standards. FNU also enrolls professionals who were registered nurses in the bachelor's or MSN program. Its mission is to prepare students for success and foster quality education in nursing.
The program attracts foreign-educated physicians from many countries, which the school finds are older and 50% men. IMG graduates of FNU and other MSN programs are sought after by hospitals and clinics.
They are essentially doctors and nurses rolled into one practicing healthcare provider. Additionally, foreign-educated doctors and nurses who become nurse practitioners are bilingual. In some cases, they are fluent in three or four languages, which is a significant advantage to the hospital or clinic where they are employed.
As population diversity rises in the U.S., patients with limited English-language skills require treatment in the emergency room or hospital unit. When no one can interpret, it can be a challenge to understand the patient's symptoms. This can lead to misunderstandings, frustration, and an incorrect diagnosis.
Although many hospitals have translation services, they are often over the phone. This is an inefficient means of communicating physical problems. Patients may have more questions later. Their family may call with questions about medications, wound dressings, or other treatments.
Bilingual nurses offer a source of comfort to the patient and a layer of safety in patient care. Bilingual nurses who also understand the culture, values, and family traditions of the patient can help not only do direct translations of conversations but can also contribute to home treatment care plans.
Programs like the FNU one can improve diversity in the nursing profession. They create opportunities for healthcare professionals to continue to use their education and skills.
There is an added benefit of being bilingual with an extensive healthcare background. It can increase a nurse practitioner's salary and benefits packages.
What States Are Best to Become a Nurse Practitioner?
Many larger university nursing programs offer hybrid or online MSN programs for students to be certified as nurse practitioners. Some hybrid programs only require 1-4 visits to the campus throughout the entire program.
Students who can travel may be able to complete a nurse practitioner program online from another state. There are advantages to practicing as an NP in several states, especially those states where NPs have full-practice authority.
Each state determines how the state laws and regulations impact an NP's practice. In states where a nurse practitioner has full authority, the practitioner sees patients and works under the authority of the state board of nursing. This means they assess, diagnose, order and interpret diagnostic tests, and order and manage treatment independently.
A state with reduced-practice laws requires a career-long collaborative agreement with another healthcare provider to allow the NP to provide patient care. It may also limit one or more elements of an NP's practice. States with restricted practice require career-long supervision by another healthcare provider for the NP to provide patient care.
More states are moving toward giving NPs full-practice authority. Currently, the majority of full-practice states are in the Midwest (except California and Utah) and Northeast coast.
However, according to the U.S. Bureau of Labor Statistics, more nurse practitioners are working along the East and Southeast states, Texas, and California. The top-paying states for nurse practitioners are:
- California - $151,830
- New Jersey - $137,010
- New York - $133,940
- Washington - $130,840
- Massachusetts - $129,540
- International nurses, doctors, and healthcare students are coming to the U.S. in record numbers. Foreign-educated physicians may need additional coursework and will be required to complete a minimum three-year residency program.
- The process for a foreign-educated physician to be become a U.S. doctor is lengthy, highly competitive, and expensive. Many choose to be educated as nurse practitioners or physician assistants due to the process's inaccessibility.
- Foreign-educated nurses must pass several benchmarks before applying to and completing a nurse practitioner program.
- Foreign-educated nurses are highly sought after by hospitals as they are knowledgeable about different cultures, traditions, and values and can contribute to treatment care plans.
- Foreign-educated nurses are often bilingual and may know 3-4 languages. This can help patients feel more comfortable and accurately communicate their symptoms to reduce the potential risk of misunderstandings and misdiagnosis.
- Students can often complete their NP program online with minimal travel for on-campus assessments. Graduates should evaluate the practice authority and salary range in the state where they wish to practice.
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