Which states are friendly to foreign nurses ?

[Nurse Beth, MSN]

Congratulations on becoming a permanent resident and welcome to nursing in the U.S.! Several states could be a good fit for you.

First, some other thoughts for you:

I worked with a nurse from Nigeria who initially had a rough time because of the difference in nursing. She was conservative when it came to pain management. She had worked in the Emergency Department in Nigeria, but did not have IV insertion skills because the doctors started all the IVs.

Culturally, she needed to be more assertive and collaborative with doctors than she was used to; she was also formal with patients. With extended orientation and willingness on her part, she is now thriving in the ICU and has become a unit leader.

All this to say that I wanted to include some social support information for you.

Many cities and states have active West African Nurses Associations or similar professional networks, such as the National Association of African American Nurses. These organizations often assist West African nurses with credentialing and licensure, and provide a platform for career development and networking. The groups may also offer resources for community support, advocacy, and cultural exchange.

Stringent States

California, New York, and Florida are considered by some to be stringent because of their strict requirements for credential evaluations, CGFNS (Commission on Graduates of Foreign Nursing Schools), TOEFL (Test of English as a Foreign Language) or IELTS (International English Language Testing System), especially if your nursing education was not in English, and sometimes additional educational coursework if the training doesn't meet U.S. standards.

More Lenient
Texas offers a little more flexibility regarding which agency conducts the evaluation and may not always require additional coursework if the foreign education is deemed comparable. 

While Texas is not as strict, it still follows a thorough process to ensure that foreign-trained nurses are qualified to practice in the state.

 Alternative Credential Evaluation Service Agencies

While CGFNS remains the more widely accepted agency for nurses, other recognized agencies that evaluate the equivalency of foreign nursing education include:

• Education Credential Evaluators (ECE). Often considered easier because they are faster, more streamlined, and easier to navigate in terms of processing times and online interfaces.
• World Education Services (WES). Texas may accept WES for credential evaluation. WES stands out for its quick turnaround times, simple application process, and clear reports.
•  International Education Research Foundation (IERF). Straightforward, with slightly longer processing times.
• ICHP (International Center for Health Professions).

Conclusion 

For the fastest and easiest general evaluation, WES is often preferred due to its speed and simplicity, although it may not meet the requirements for NCLEX eligibility in all states.

For U.S. nursing licensure, CGFNS CES may not be the fastest option in terms of processing speed, but it is the most essential and widely accepted for foreign-trained nurses. It may be the easiest in the long run to ensure NCLEX eligibility and successful licensure in the U.S.

Additional state-specific requirements may include background checks, fingerprinting, and continuing education.

Midwife Credentialing.

You'll need to check with the American Midwifery Certification Board (AMCB) for certification if you plan on working as a Certified Nurse Midwife (CNM). Nurse midwives must have their foreign education evaluated by the CGFNS or another approved credential evaluation agency and submit proof of licensure from their home country. Once the credentials are verified, you can apply for certification after passing the NCLEX. You must also consult your state's Board of Nursing for specific steps regarding credentialing and licensing requirements.

I wanted to give you some other things to consider, such as social support and job demand.

Why Foreign Nurses Choose Stringent States

Although considered stringent, many foreign nurses choose these states for other reasons.

• Job availability and high demand. These states have high employment opportunities for nurses, which makes it attractive despite the more rigorous licensing process.
• Diverse populations. With multicultural populations, these states offer nurses opportunities to work with patients from similar ethnic or cultural backgrounds, creating a more comfortable work environment.
• Cultural integration and community support. Very important. Foreign nurses find it easier to integrate into a society with a large immigrant community and a well-established support system to help them with licensure and career development.
• Higher wages. Nurses are drawn to states like California, where wages for nurses are higher, despite the higher cost of living.

Comparison

When comparing U.S. states several key factors should be considered: NCLEX eligibility, language verification, midwife credentialing requirements, and diversity. Here's an overview of some key states:

California

• NCLEX eligibility. California requires foreign-trained nurses to submit their credentials for evaluation by CGFNS (Commission on Graduates of Foreign Nursing Schools) or CES (Credential Evaluation Service). The state is strict about ensuring that your nursing education meets U.S. standards.
• Language verification. California may require proof of English proficiency. This could be through standardized tests like TOEFL (Test of English as a Foreign Language) or IELTS (International English Language Testing System), especially if your nursing education was not in English.
• Midwife credentialing. Nurse midwives must submit their foreign credentials for evaluation by the California Board of Registered Nursing (BRN). If your education is deemed equivalent, you can apply for certification after passing the NCLEX-RN.
• Diversity. California is one of the most diverse states in the U.S., with significant African, Latino, and Asian communities.
• Social support. California offers strong support through immigrant nursing groups and community networks, particularly in cities such as Los Angeles and San Francisco.

Illinois

• NCLEX eligibility. Illinois requires foreign nurses to apply through the Illinois Department of Financial & Professional Regulation (IDFPR) and have their credentials evaluated by CGFNS.
• Language verification. Illinois may require proof of English proficiency if your nursing education was not in English. Acceptable tests include TOEFL or IELTS.
• Midwife credentialing. Foreign-trained midwives must submit their educational credentials to the IDFPR for evaluation. Once the evaluation confirms your qualifications, you can apply for licensure after passing the NCLEX-RN.
• Diversity. Illinois, particularly Chicago, has a large international community, providing a culturally rich environment.
• Social support. The state offers a wealth of support for immigrants, especially in urban areas with active African, Caribbean, and Latino communities.

New York

• NCLEX eligibility. New York allows foreign-trained nurses to apply for licensure through CGFNS or other equivalent services for credential evaluation. After the evaluation, passing the NCLEX-RN is required.
• Language verification. If your nursing education was not conducted in English, New York may require proof of English proficiency via TOEFL or IELTS.
• Midwife credentialing. Nurse midwives must have their education verified by CGFNS or another approved agency, submit proof of licensure from their home country, and pass the NCLEX-RN.
• Diversity. New York is one of the most diverse states, particularly in New York City, with large immigrant populations comprising African, Caribbean, and Asian communities.

Texas

• NCLEX eligibility. Texas is more lenient regarding credential evaluations. You must submit your credentials to CGFNS or another acceptable agency for evaluation. After meeting the educational requirements, you can take the NCLEX.
• Language verification. Texas may require English proficiency tests, such as the TOEFL or IELTS, if your nursing education was not conducted in English.
• Midwife Credentialing. Nurse Midwives need to have their foreign credentials evaluated by the Texas Board of Nursing. If they meet the state's educational requirements, they can apply for licensure after passing the NCLEX.
• Diversity. Texas has a significant immigrant population, especially in cities like Houston and Dallas, with large Hispanic and African communities.
• Social Support. Texas is generally friendly to international workers, offering many social and professional resources for foreign nurses and midwives.

Florida

• NCLEX Eligibility. Florida requires foreign-trained nurses to submit their credentials for evaluation by CGFNS or a state-approved agency. After the evaluation, passing the NCLEX-RN is required for licensure.
• Language Verification: If your nursing education was not conducted in English, you may need to demonstrate English proficiency through TOEFL or IELTS.
• Diversity. Florida has a diverse immigrant population, particularly in cities like Miami, which is home to many Caribbean and Latin American immigrants.
• Social Support. Florida's diverse population provides great social support, primarily through established immigrant networks, particularly in Miami.

Minnesota

• NCLEX eligibility. Minnesota requires foreign nurses to have their credentials evaluated by CGFNS or another approved agency. After meeting educational requirements, passing the NCLEX-RN is necessary.
• Language verification. Minnesota may require TOEFL or IELTS if your education was not conducted in English.
• Midwife credentialing. For foreign Nurse Midwives, credential evaluation is required by CGFNS or another evaluation service. Once your credentials are verified, you must pass the NCLEX-RN and meet other state-specific requirements for midwifery.
• Diversity. Minnesota is becoming increasingly diverse, particularly in the Twin Cities area, with significant African and Somali communities.
• Social Support. There are growing immigrant communities and a network of resources for foreign nurses, especially in urban areas like Minneapolis.

Other Foreign Nurse-Friendly States

• North Carolina. Known for its growing healthcare sector and immigrant communities. CGFNS evaluation is required, and language verification might be necessary if your education was not in English.
• Georgia. Georgia has a strong healthcare industry and a growing demand for foreign nurses. You will need to have your credentials evaluated by CGFNS and may be required to provide proof of English proficiency through the TOEFL or IELTS.
• Ohio. With its growing demand for healthcare professionals, Ohio is open to foreign nurses, and established support networks are available. You'll need to pass the NCLEX and submit credential evaluations.

Key Takeaways

New York, Texas, and Maryland stand out as top destinations for West African nurses due to their large immigrant populations and strong healthcare systems.

California and Georgia also have notable West African communities and are home to a variety of professional networks.

Other states, such as Minnesota, Ohio, Illinois, and Florida, also offer good opportunities for West African nurses, with growing populations and increasing healthcare demand.

These cities offer great job opportunities for West African nurses and a supportive environment with strong immigrant communities.

Social Support

In summary, states like California, New York, Texas, and Florida are particularly foreign-nurse-friendly with social support, diverse populations, and strong healthcare demands.

CGFNS is typically the best credential evaluation agency for foreign midwives, and meeting language verification requirements (via tests like TOEFL or IELTS) may also be necessary.

I hope this helps, and best wishes,

Nurse Beth