Add your 2C's on these bills affecting PA nursing, esp Spanish assisted NCLEX

Home Health Columnist / Guide · Oct 31, 2005

position paper on nurses educated in puerto rico august 2005

background

legislation has been introduced in pennsylvania that would grant reciprocity to registered nurses and licensed practical nurses educated and licensed in puerto rico . this legislation also mandates that the national council licensure exam (nclex) be conducted in spanish. currently nurses educated and licensed in puerto rico can apply for a temporary practice permit to practice in pennsylvania . they are then required to pass the nclex after a one year period. the temporary practice permit is non-renewable.

nurses educated and licensed in puerto rico are practicing in the federal health care system and have for many years. examples are the va hospitals or the indian health services. the only state that has granted licensure by endorsement with no requirement to take the nclex is florida . a 2004 study conducted by the florida state board of nursing found that nurses in that state who earned their licenses in puerto rico, other us territories or canada made fewer errors than new graduates of us based nursing schools. these nurses did require additional orientation for medication orientation, communication and understanding physician orders.

there are 8 baccalaureate nursing programs, 4 associate degree nursing programs and 2 practical nursing programs in puerto rico that are accredited by the national league for nursing's accreditation commission which is the same agency that accredits the nursing programs in the united states. the nurses educated at the baccalaureate program take the puerto rican rn licensing exam. only one of the universities in puerto rico teaches classes in both english and spanish with the utilization of predominantly english textbooks.

due to the inability to obtain accurate data, the national council of state boards of nursing (ncsbn) cannot provide a definitive assessment whether the puerto rican exams are substantially equivalent to the nclex-rn exam. according to the national council of state boards of nursing, puerto rican nurses fail the nclex-rn at a much higher rate. according to the pa state board of nursing , the pass rate for puerto rican nurses is less than 20% with the pass rate for candidates educated in pa is 83%. anecdotally they assume that this is related to english proficiency.

position statement

the position of the pa state nurses association is that nurses who are educated and licensed in puerto rico and have worked in the federal health system in the united states for the last two years as a full time rn should be granted licensure by endorsement provided there have been no claims against their license or employment terminations due to performance.

nurses who are educated and licensed in puerto rico but have not been working in the united states for two years should meet the following criteria:

1.pass the nclex.

2.pass the toefl (test of english as a foreign language) with a minimum or higher score.

pa nurses strongly encourages health care agencies that employ nurses educated in foreign countries where english is not the primary language to conduct in-depth interviews to ensure english comprehension as well as an individualized orientation program that would assist in the success of these nurses.

rationale

nurses educated and licensed in puerto rico who have been working in the federal health system without incident have shown their competence in both work performance and english proficiency. in the study conducted by the florida state board of nursing , the conclusion was that nurses endorsed under their special provision statute performed better than new graduates in many areas, made fewer than half of the errors of newly licensed nurses and encountered no major problems in english competency. the study demonstrated that work experience may be used as a substitute for passing the nclex in the licensing of nurses.

nurses educated and licensed in puerto rico that have not practiced in a federal or military health system in the united states have not proved competency or english proficiency thus need to pass the nclex to show competency and pass the toefl to reflect knowledge of the english language.

in a survey conducted by pa nurses on offering a spanish assisted nclex, respondents predominantly leaned towards not offering a spanish-assisted nclex as our health system is in english. examples given were physician orders, medication system, monitors and pumps. patient safety was the key and consensus was that one had to be proficient in english to work in a health system in pennsylvania . the committee on cultural diversity supported a spanish assisted nclex if validated by the licensing agency as being a reliable translation of the medical concepts.