NNAS & CRNBC - Useful information and commentary for U.S.-educated RN's and IEN's

  1. Hello,

    I decided to make this post to share my unique experiences with NNAS and CRNBC as an U.S.-educated RN who recently passed assessment for licensure in BC.

    I did not have to to an SEC or OSCE. I was granted my BC Canadian license rather seamlessly. The most time consuming and annoying aspect of all of this was NNAS. I do agree with some of the posts that others have shared that the NNAS could potentially be doing a disservice to certain areas of need for IENs in Canada by putting up unnecessary hurdles.

    Here is my bio:

    U.S. license granted: July 2013
    - No criminal history
    - No investigations or infractions on my license
    (clean record and history of practice)

    1.5 years of rehabilitation ("after the hospital" aspect of nursing home, respite, and a limited amount of in-nursing-home hospice)
    1.5 years of pediatric home care (picked up part time)
    3 months of psychiatric nursing
    1.5 years of emergency room / ED nursing

    Certs:
    BLS
    PALS
    ACLS
    TNCC (Emergency Nurses Association) - Also recognized in Canada

    Once you get to the final step in CRNBC's assessment, your employer is allowed to make positive or negative remarks about you, your current job, and your performance. It is entirely free-reign and the types of remarks your employers/HR department make (or don't make) will likely be governed by your own institution's HR policies. Luckily my employers have been friendly and helpful (although in one I had to get a corporate HR member involved, because the other institution was dragging their feet), so I anticipate my remarks were either positive or blank.

    No worries if you were "between jobs" and one or a few did not work out for you. CRNBC does not require you to list jobs you have held for less than 3 months and you can always call them with concerns regarding waiving required paperwork from a past employer. However, you will not receive any credit towards your assessment if you don't have the forms completed. You might as well have a long employment gap without them.

    STEP 1 - NNAS



    The National Nursing Assessment Service (NNAS) is new, started in 2014 and is -------- a big mess in its current iteration. Each time they receive a document, it takes roughly 2-4 months for their systems to reflect they have actually received it. I started my application in August 2014 and did not rush through the process. Hence, even though I only recent obtained my registration, I probably could have gotten passed the competency assessment within 1 calendar year if I had sent all proper documentation immediately. A big factor in your assessment depends on your current and former employers' HR departments and whether or not they are competent and timely with submissions. If the HR person sends the wrong document, or sends it incorrectly, that alone can delay your competency assessment by a few weeks to a few months. The same goes for you. If you do not have your forms notarized properly, you could inadvertently delay your application by several weeks or months -- ditto if you send documents but they are missing components.

    Another time-dependent and potentially lengthy process:
    - 1.) Your university / school of nursing
    --- You'll have to trust them to not mess up when sending your past proof of completed coursework and clinical work.
    --- I got very lucky here because my University is used to dealing with international licensing on a regular basis. They are a relatively large university and used to offer a dual certification at their Madrid, Spain campus. Unfortunately the dual certification option in international nursing is not offered anymore, but students may still complete part of their RN education in Spain, and finish in the States. I highly recommend this route if your life and financial circumstances allow it.
    This is a one-of-a-kind innovative curriculum in the U.S.

    - 2.) Your professional licenses.
    --- If you have licenses in many states this can be lengthy and costly. You will likely have to pay a fee to each state in which you hold a nursing license so that you can prove to CRNBC that you don't have negative actions against your license in any state. This includes inactive licenses you may have held in the past (you must still prove you held an RN license there). This could be even lengthier and costlier if you have already practiced in more than one country. For example, imagine you are an RN in the US who has worked in NY, CA, and Sydney Australia. You will have to have international correspondence to prove your license history and satisfactory license history for Australia as well.


    The competency assessment is silly. My assessor was an American based in Philadelphia, who ended up contacting me by email and stated my school didn't send out all of my course syllabi to him. The reality of the situation is that they did. But apparently they didn't send out some graduate-level coursework that I had completed (Advanced Patho, Family Development). I still had to send those out anyway as it couldn't hurt my assessment. [probably wasn't necessary though]

    Like many other U.S. nurses have reported, my 4 year BSN brick-and-mortar university (Saint Louis University) which is a pretty established and reputable school in the Midwest. The assessors are not nurses, nor are they members of licensing bodies. They are basically employees paid to go through your undergraduate degree program's information (e.g. syllabi, competencies, clinical hours) and see if they match nearly verbatum to a Canadian syllabus.

    For an American nurse, the competency assessment is pointless. I was given "not comparable" with less than 50% comparability. Out of all potential U.S.-licensed nurses, I should be the "poster child" of a U.S.-educated nurse deemed equivalently educated.

    If you went to university in the U.S. assume you will be deemed "not comparable" and move on. You still have a high chance of being accepted.

    Now for the hope..........

    Even though NNAS thought my school didn't prepare me for the rigors of Canadian nursing, CRNBC did not agree with NNAS. :-)

    STEP 2 - CRNBC


    Regardless of your "not comparable" foreign education, you are then free to apply to the provincial Colleges of Nursing (in my case CRNBC).
    The provinces have full autonomy and authority for making such determinations


    The folks at CRNBC were very professional, very fast to respond, and I cannot emphasize enough how wonderful my process was once I got past NNAS. Any time I had a question or concern it was easy to get transferred to the appropriate person, and the one instance where a representative did not answer, I left him a message and he returned my call just 10 minutes later, suggesting they are indeed on top of things and follow up as soon as they can. Paperwork was usually processed on the same day it was received and emails were replied to either the same day or within 1 business day.

    If you are not having a good experience with NNAS, please remember CRNBC has nothing to do with the NNAS process. Also, I emphasize that you must respect CRNBC's mandate to protect the public. I was more than willing to travel and do an in-person assessment and/or exam if necessary (though I did dread having to buy the airfare and pay the fees). I felt the exam would have been superfluous but I am studying nursing education at the graduate level, so it honestly would have been a fun field trip for me (other than the cost!!!).

    My education included semesters abroad in Spain through part of an international nursing program. I studied abroad in Madrid, learned a decent amount of Spanish (and also French!) as I lived with a bilingual French-speaking host family.

    I spoke with an assessor by phone with some inquiries and fears about having to fly out to Vancouver and pay $$$ for an OSCE/SEC. The assessor could not answer personal questions as per policy, but assured me that CRNBC looks at the entire profile of the candidate.

    They will consider:
    - Practice setting (varied use of skills?, recent skills?, does the country in which you practice focus on strong communication, assessment and critical thinking rather than simply 'tasks'?)
    - Amount of experience in terms of hours within the past 5 years
    - Did you write the NCLEX (IEN will have to write the NCLEX unless coming from a country that already used the NCLEX-RN e.g. USA)
    - Concerns about English and/or French proficiency and whether or not you are deemed competent to understand the laws and regulations governing nursing practice in BC
    - You might have to take the IELTS exam to prove English fluency or the TEF for French
    - Remember that even though BC is an English-speaking area in Canada, many governmental positions including in nursing will highly desire a French speaker as French is an official language of all of Canada; thus French can supplement English for official purposes even though it is highly advisable a nurse can speak English at B2/C1 level or higher
    - The assessor hinted that for-profit and online BSN programs are likely not held in high esteem (I cannot prove this assertion, but I kind of got a nod)
    - If you hold an ADN or diploma degree and later completed an online ADN-to-BSN or Diploma-to-BSN program, your mileage will likely vary (you will probably have to do an in-person assessment of skills [OSCE/SEC]



    *I do not want to instill doubts in people's minds. If you are a recently licensed RN in Canada who went the ADN-to-BSN or Diploma-to-BSN route, including online or for-profit please share your experience and help others. I personally believe that there is nothing inherently wrong with for-profit schools as long as the students meet the necessary competencies and try to gain as much as they can from their experiences.

    Every employer for whom you have worked in the past five years must complete a form indicating that you were indeed employed as a Registered Nurse and how many hours per year you worked. Make sure that you communicate this to your employers / HR departments clearly. For example, I was employed as a graduate nurse in June 2013; these hours did not help in my assessment. Once I got my license in July 2013, the hours did count toward my assessment. Luckily I have been a nurse for more than 3 years, so this lack of one month was not too consequential for me.

    I am fully convinced that if I were not working in the ER I may have been required to come and do a OSCE/SEC. There is no way to verify for that for certain, but that is the general impression I had.

    If you are a nurse who works in a highly specialized area of nursing, I suggest that you review physical health assessment and areas of weakness. For example, if you are an experienced geriatric nurse, you might need a refresher on OB assessment and intrapartum. If you are a pediatric nurse, you might need a refresher on assessment and expected laboratory findings in an acute-care geriatric patient presenting with respiratory distress (e.g. A-fib vs CHF vs Pneumonia vs PE signs and symptoms).

    I am curious as to how nurses who have practiced exclusively in psychiatric nursing are assessed, as BC has a separate RPN certification. The Canadian RPN does indeed include medical aspects of basic nursing care.

    If you have questions or concerns, I might be able to help clarify some concerns or alleviate some anxieties -- but remember.... I only have experience with NNAS and CRNBC from a U.S.-educated nurse's point of view.
    Last edit by sorensic on Mar 19, '17
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  2. 6 Comments

  3. by   dishes
    Thanks for sharing your experience sorensic, it's good to know that even though a NNAS report may be non-comparable, CRNBC takes into consideration that the country in which an applicants practices focuses on strong communication skills, assessment and critical thinking skills, rather than simple tasks. If this information wasn't clearly communicated in an IENs curricula content, maybe it can be communicated via a letter from an employer.
    Last edit by dishes on Mar 19, '17
  4. by   dishes
    What would be the benefit of having a nurse assess the NNAS applications? The duties and responsibilities for a job as a NNAS international credential evaluator are administrative duties, they critically evaluate documents and supporting materials of applications; to insure completeness and authenticity of credentials/records. The qualifications for the job are experience in international education credentials evaluation.
    The NNAS evaluation tool was designed by nurses, who were/are members of the Canadian nursing regulatory bodies, plus six nurses who were in a working group and six nurses who were the subject matter experts.
    http://www.srna.org/images/stories/C..._July_2013.pdf
  5. by   nicu_gal
    Hi,
    As @dishes knows, I have posted in other NNAS-related threads but I just came across this one for the first time. As a US-IEN now licensed in BC I just wanted to add that BC is no longer using SEC but rather NCAS for equivalency testing. I came from an exclusively NICU background and thought for sure I would have to do at least the computer-based portion. Much to my relief, I did not have to do any equivalency testing before my license was granted. I'm not sure whether this decision was related to my "comparable" NNAS Advisory Report.
    It is nice to see that others have had a positive working with CRNBC, as I also found the staff to be responsive and helpful.
  6. by   Gloriani19
    sorensic,

    Thank you a ton for such a comprehensive review of the process you had to go through! I am currently looking into this, already filled out NNAS application but now discovering the dreadful side of NNAS. I'm curious to see how it all will go as I went to a for-profit university with a substantial track record but the program was Accelerated BSN for those who already hold Bachelor's degrees in something else. So my nursing education lasted only one year. Of course I had to complete prerequisites beforehand.
    My question to you is about employment hours. Nobody on allnurses discussed this in more detail like you did. I have been working part-time in L&D since 2015 and full-time at a blood bank (clinic type of job) for 1.5 years before that. I have no lapses between my jobs. From what you gathered how many of work CRNBC would want to see in the last 5 years? I worked 2800 hours in L&D and have no idea how many at the blood bank.
  7. by   sorensic
    To address your concerns:

    1.) I am honestly not at all sure how they will assess you in light of having an accelerated BSN. My hope is that they do not give you any issues. There are regulatory assessment frameworks that might work against you. I hope they simply assess you as equivalent to a 4 year bachelor degree in nursing.

    2.) Work requirement --- I'm not sure (or I don't recall) what the hours/years required are. I would assume they want 1 year of full time work experience in the last 5 years, or a minimum of 1400 or so. My 1400 hours comment comes from my experience getting a job offer in BC. The BC nurses union seems to require about 1400 hours of work per step on their union contract. This is just a rough estimate and I'm not sure exactly what CRNBC requires.

    Unlike the US, nearly all jobs in BC (at least through a health authority) are union jobs. They have a pay grid that is public knowledge. Less nepotism is always a good thing. I've always thought nurses should be paid based on years experience and education instead of whose cousin is the health administrator at XYZ for-profit hospital.

    I'm sure 2800 hours is more than enough. If you had problems vouching for blood bank experience, I'm sure they'd only need your L&D certification of hours from your current/past employer. They will still recommend that you get ALL hours certified to help maximize your chance for success.

    3.) I have heard from some other nurses, that CRNBC seems to treat U.S. educated nurses as if they were from another province (assuming they're done with the NNAS part). I don't think it matters what specialty area you worked. I think they will likely deem you equivalent assuming you are assessed satisfactorily as addressed in part 1.) This is good news, as many new nurses have to take what they can get (e.g. nursing home only, private duty only, etc.)





    ---- Note for American nurses wanting to go to BC ----

    If you are coming to BC, I specifically recommend HealthMatch BC to help with placement. They will not be able to help you until after you get registration in BC. After such time, if you are a U.S. citizen, assuming The Orange Great One does not do away with NAFTA, you can basically move to BC with a work offer via NAFTA and then upon arriving in Canada, they can sponsor you for permanent residency. This is much quicker and way cheaper than going through the express entry system, but it only works for NAFTA eligible nurses. HealthMatch helped me get job interviews in remote areas and they were willing to hire after Skype interviews and phone interviews.

    Northern Health specifically uses a 3rd party reference check service called BackCheck and they will do a GlobeX check on your international criminal history. They will check your USA references, past employers, etc. it's very streamlined and international hire friendly.

    I just accepted a position with Northern Health and I will be going to BC as soon as I graduate my MSN program in May!

    One really interesting thing about BC is that their ER nurses are expected to get a certificate in emergency post-graduation. So, while I'm waiting to arrive in BC, I took a formal 2 credit-hour ECG course which including topics such as troubleshooting pacemakers. They then have 3 ER theory course (1, 2, and 3) and two ER clinical courses. For experienced ER nurses like myself (at 2+ years now), they let me test out of the ECG class by scoring 80%+. The ECG cousre went above and beyond ACLS and asked some detailed free-response questions (e.g. implications on cardiac output, atrial kick, ventricular filling time, etc.). They also went into the pharmacology in quite a bit of detail, e.g. how does atropine affect ion channels. I loved it because it solidified what I already knew to the point I can basically be an ER nurse educator.

    They will also allow me to test out of Theory 2 and I can do a portfolio assessment for ER Clinical 1.

    I am taking the full version of ER Theory 1 because it goes over the Canadian assessment framework CTAS, and some differences, so they thought that would be in my best interest. CTAS is similar but not equal to ESI in the states.

    ER Theory 2 seems more pathophys/system heavy and will likely be review. I think ER Theory 3 is more akin to an advanced TNCC.

    The program is through British Columbia Institute of Technology (BCIT). I'm very impressed that Canada has such higher standards for their critical care nurses. It's almost like a formal CEN and CCRN (they have a critical care specialty that you combine with the ER cert.)

    More here for any interested people (this will make it much easier for you to get a job offer if you are interested in ER or ICU):
    400 Bad Request
  8. by   dee_sg29
    Hi! Maybe you can help me out. I'm planning to go to Canada as student and I'm just wondering after the nnas what is the next step. Would it depend on the the province of Canada whether I need to take bridging program?

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