Skip to content
Passing the NCLEX Exam is Great but…
Passing the NCLEX exam is the most important thing that international Registered Nurses (RNs) must do to be able to work and live in the U.S. However, passing the NCLEX exam by itself without meeting other key qualifications will likely bring you great frustration as the best U.S. employers repeatedly look past your application. Why would they do this if there is a nursing shortage and you have passed NCLEX?
The reality is that there is NO shortage of new graduate or inexperienced RNs in the U.S. In fact, the U.S. is graduating upwards of 200,000 new RN grads annually. These new nurses are readily hired and onboarded to the extent that an employer can accommodate new graduates. The urgent shortage that U.S. healthcare employers are facing is for RNs with 2–10 years or more of hands-on bedside nursing experience.
How a Typical U.S. Healthcare Employer Responds to Being Short-Staffed
Yes, there is a nursing shortage in the U.S. and in most parts of the country this shortage is increasing. To cope, U.S. healthcare employers typically take the following path in trying to respond to their staffing shortages:
- $ – They pay overtime to existing staff members. When existing staff are maxed out the next step usually is…
- $$ – Use a local staffing agency to contract per-diem staff for a few days at a time to fill open shifts. When casual use of local staffing agencies to supply per-diem staff is no longer effective in filling open shifts, the next step usually is…
- $$$ – Use local and regional staffing agencies to contract RNs for anywhere from a few weeks to a few months. This reduces the day to day stress of trying to fill open shifts. Eventually if this approach is no longer sufficient, the last resort is…
- $$$$ – Use regional and national travel nurse staffing agencies to fill positions for 13 weeks at a time. This is generally an employer’s last resort as this is also the costliest option available to them.
Ultimately, U.S. healthcare employers are looking for a DIRECT HIRE solution to their staffing shortages. It makes sense when you think about it. Why would an employer want to use international RNs when they are being contracted to them by a staffing or travel nurse agency? They do it only because they have a certain level of need and desperation that these organizations can sometimes respond to more quickly than a DIRECT HIRE recruiter. Ultimately, U.S. healthcare employers seek out a DIRECT HIRE solution as it is the proven strategy to best maintain quality of care with permanent staff. It is also a fiscally responsible solution as costly contract and travel staffing is minimized and then eliminated.
International RNs Are in a Global Competition
If you think passing the NCLEX exam alone will result in U.S. job offers just flowing in, you will soon be frustrated. Did you know that in the 4 years from 2016–2019 the number of international NCLEX passers around the globe increased by 214% to almost 10,000 new international NCLEX passers in 2019? We expect this trend to continue as nurses from all around the globe race to achieve their American Dream. It is important to understand that U.S. employers are looking for the very best applicants they can find with little regard to what country the applicant was born in.
Top priorities for U.S. healthcare employers when considering hiring international RN applicants
Priority #1:
Has the Nurse Applicant Passed NCLEX?
If not, their evaluation may end right here. There are very few exceptions to this. For example, WorldWide HealthStaff Solutions currently has a client that will consider non-NCLEX passers with dialysis experience.
Priority #2:
What is the Nurse Applicant’s Work Experience?
- Current experience is much more important than previous experience.
- Current hands-on bedside experience preferred over current work in any out-patient, clinic or teaching setting.
- While all current, hands-on bedside experience is valuable, the larger the facility you are working in, the more favorably your experience will be viewed.
- Current experience in an out-patient, clinic and even a teaching setting is preferred ahead of current experience in a BPO, Utilization Management or other similar ‘desk based’ work.
Priority #3:
Language Skills
It is essential to have good English language skills (written and spoken).
Priority #4:
Geographic Flexibility
- The more you are set on a particular city or location, the more restricted your opportunities will be.
- Some employers have facilities in multiple locations but all of their locations will be looking for international candidates.
- The more geographically flexible you can be, the more opportunities will be available.
It is important to be extremely cautious of any offer where these priorities are not at the forefront of the employer’s requirements.
NCLEX Not Required – Beware!
Until you have passed NCLEX, no U.S. employer (DIRECT HIRE, staffing or travel nurse agency) can file your U.S. immigration application. If you have not passed NCLEX and you are being offered a job but asked to pay money, run as fast as you can. Offers touting ‘no experience required’ should also be viewed with great suspicion. Remember there is no shortage of new grad or inexperienced domestic RNs in the U.S. The only type of employer willing to consider international RNs with no experience may be illegitimate or non-existent groups likely seeking money from you or an employer with such poor working conditions that they are unable to hire any quality staff domestically.
Any opportunity where you are told that you will receive an offer without interviewing with a representative of the U.S. employer is also a huge red flag. Again, run as fast as you can.
Lastly, beware of offers that don’t assign you to a specific, fixed location at the time the offer is issued, and include a general promise of ‘we have positions all over the country and can place you wherever you want to be’. Staffing and travel nurse agencies may have positions today in locations that are attractive to you, but there is absolutely no assurance that those opportunities will remain by the time you obtain your U.S. permanent residency visa.
Passing the NCLEX exam is essential, but remember it is only the first important step on your journey to the U.S. Yes, there is a growing shortage of nurses in the U.S. and at the same time there is a growing supply of international RNs pursuing those opportunities. Understanding what U.S. employers are looking for in international RNs can help you position yourself for success and avoid being lured into marginal or outright fraudulent opportunities.
