Sunday, October 28, 2007

Update on the Visa bill

The proposed 61,000 visas for Schedule A workers in the US is caught in the middle of maelstorm involving Democrat lawmakers and President Bush. Read the latest news from the Washington Post about the state of US appropriation bills, one of which includes the proposed new visas for foreign nurses.

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Saturday, October 27, 2007

Becoming a nurse in the US

This post was initially intended as an answer to a question posted by one of my visitors, but I've decided to make it an entirely new blog entry so that others may also read it.

I often encounter a lot of people who get confused about the entire US nursing application process. Although there are many resources on the Internet that provide information on this, I guess many still get lost and don't know where to look. Others, perhaps, look for a crystal ball that can provide answers in a jiffy without making them sweat even just a little when searching. Still, questions need to be answered, regardless if you belong to the first or the second, so I hope this satisfies those who are looking for information.

Most of what I'll explain here was already discussed in previous posts, particularly in the NCLEX series of articles. Part 1 of the series is at the end of this link.

To be able to work as a nurse in the US, you must have the following:
1. US Nurse license
2. US Visa that allows you to live & work there
3. Employer, of course

Nurse licensure
To get a nurse license in the US, you must apply for licensure and pass the NCLEX-RN. Each of the fifty US states have DIFFERENT requirements. To learn about these requirements, just go to each State BON's Web site and download an application packet. You must meet all the requirements before you are ELIGIBLE to register for the NCLEX-RN. Please note that I used the word "register". If you are given an "Eligibility" by the state BON, you still can't take the NCLEX. Not just yet. Once you get the eligibility, you must register with Pearson-Vue, who will then confirm to the state BON that you are eligible to take the NCLEX-RN. Once Pearson-Vue makes the confirmation, it will issue what is called, the Authorization To Test or the ATT. After that, you can proceed to make an appointment for your exam.

Note that choosing a US State for your nursing licensure and taking the NCLEX exam are two different things. This is where most of the confusion arises. Each state will have its own requirements and US state BONS have varying processing times for licensure applications. Some states will probably issue an eligibility in as little as 2-3 months, while others may take 6 or more months. This depends on many factors--such as how fast you complete all your requirements, how many other applications are being processed, or how many people are working for the processing agency. Certain states process applications fairly quickly; Vermont, for example, has a reputation for fast processing. In California, applications are processed from as fast as 3 months to more than 6 months.

When deciding which state to apply for nursing licensure, make a decision based on where you really want to work, and not just how fast your papers will move. Although you can apply for ENDORSEMENT, this takes another set of requirements and another set of fees and you'll end up paying more than if you apply directly to the state where you want to live and work.

As I've said, choosing a State and taking the NCLEX are two separate events. When you have already chosen a US State and have been given an eligibility, you can choose whereever you want to take the NCLEX-RN test. When you register with Pearson-Vue, you can choose to sit for the exam either in the US, provided you already have a US visa to travel to the US, or you can take the exam in U.S. territories such as Guam or Saipan, or you can go to Hong Kong or other Asian countries where the NCLEX-RN is administered. You may also elect to stay here in the Philippines, where you can already sit for the NCLEX-RN. Click here to see where Pearson-Vue in Manila is located.

Before issuing a nursing license, most US state BONs require that you already have a US Social Security number. However, you CAN'T get a SSN unless you are an immigrant in the US, or a legal resident, either through student visas, working visas, or others. So, even if you pass the NCLEX-RN, you won't be issued a nursing license unless you have been petitioned for the US by an employer. And, so, the next step begins.

Getting a US visa
There are different types of visa issued by the US government that allows you to visit, stay, or work in their country. Nurses, being classified in the shortage occupations category or Schedule A, immediately get an immigrant visa, unlike other professions that can be petitioned through employment-based visas or working visas. To be eligible for sponsorship, you must have a legal US employer who will sponsor your visa petition. You must also submit certain documents; among these documents is the VISASCREEN Certificate, for which you must submit an application to CGFNS. CGFNS will only issue you a Visascreen if you have (A) either passed the NCLEX-RN OR have the CGFNS Certificate (through the CGFNS exam) AND (B) a passing score for an accredited English exam, such TOEFL or IELTS.

The U.S. government allocates only a certain number of visa numbers every year, meaning only a number of visa applicants can be given a visa for a given year. Because of the huge number of foreign nurse applications to the US, there is a backlog of applicants who are still waiting for their visas to be issued. This backlog goes back a few years. For nurses, if I recall correctly, the backlog stretches as far back as 2002 (for confirmation). So, this means that current applicants can't be issued a visa yet. Nobody knows when visas will be available again. There are ongoing efforts to resolve this, but nothing is definite at this time. We, at the Filipino Nursing Herald, try to keep up with the latest news on retrogression, so check back regularly for updates.

Getting an employer
After passing the NCLEX, getting an employer should be your next goal. Although there is still retrogression, there are a number of employers who continue their recruitment drives, knowing that visas will be available again, hopefully, soon.

When choosing an employer, scrutinize contracts and agreements carefully if you have been given an offer. Consult with relatives, friends, and ask questions in public chatrooms so that you can gather as much information that you need to make a decision.

It is my hope that some questions about the US nursing application process has been answered. If you want to contribute other information that I may not have touched on, please feel free to send you comments.

For a more detailed article on the applying for the NCLEX, read the NCLEX Series here in the Filipino Nursing Herald.

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Friday, October 26, 2007

Understanding the White House-Congress standoff

We've written before that President Bush has threatened to veto the appropriations bill where the proposal to recapture 61,000 visas for nurses & PTs is attached. To understand why the White House and the US Congress is at a standoff on this issue, go through some of the statements released by Sen. Robert Byrd, chairman of the Senate Appropriations committee, to learn some history about the matter.

Read this statement to start your research.

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Full text of Amendment 3449

Here's a link to the full text of Amendment 3449 as submitted to the US Senate.

Full text of Amendment 3449.

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Thursday, October 25, 2007

Getting a grip on Senate Amendment 3449; proposal seeks 61,000 visas for foreign nurses, PTs, & their families

On Tuesday, the US Senate approved by unanimous voice vote to include Amendment 3449 to the budget appropriations bill of the Departments of Labor, Health & Human Services, and Education. Amendment 3449, introduced by Illinois Senator Dick Durbin, seeks to give 61,000 visas for nurses, physical therapists and their immediate families. Nurses and PTs are part of the Schedule A classification, which states that these occupations are shortage jobs in the US.

The approval of the amendment in the Senate is a major victory. The Senate was recently the battleground for the controversial immigration reform bill which was voted down.

The appropriations bill will now face a Senate-House conference for the final phase of the legislative process in Congress. If the bill gets through, it will be submitted to President Bush for final review and approval. At both levels, the bill faces very tough challenges. If the bill makes it past the joint conference, the President could still veto the bill and he has threatened to do so. Contentious provisions in the proposed budgets, and not the provisions on the Schedule A occupations, has grabbed the attention of the President. The bill proposes to allocate funds in excess of what he had originally asked and this is one of the major reasons for his veto threats.

Based on Amendment 3449, some 61,000 will be allocated for Schedule A occupations, but apart from that, there is also a proposal to require employers to pay a $1,500 fee that will go to Durbin’s NEED Act program "to provide grants to U.S. nursing schools for hiring nurse faculty, expanding training capacity and recruiting more students."

I guess the obvious question now is who will actually pay this new $1,500 fee? Although the bill says employers should pay for it, in the real world we know that nurses who are recruited from outside the US end up paying all the fees. On top of the other immigration fees, lawyers fees and recruitment fees, there is a new burden for foreign nurses. Of course, there are some employers who would take this up on their own, but there are probably several who will ask the nurses to pay for it or devise some scheme where nurses will end up paying for it in the long run.

We recognize the major achievements that have been accomplished and the approval of the Amendment is indeed very good news. Let us pray that this bill will see the light of day and hopefully visas could again be available at the start of the new year.

Read news about the passage of Amendment 3449 from Sen. Durbin's Web site.

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Wednesday, October 24, 2007

Bridge amendment attached to Labor bill

The US Senate approved a proposal to attach the Bridge amendment to the Labor Health and Human Services appropriations bill. The amendment would open up as much as 61,000 visas for nurses and their immediate families.

This is very good news indeed. There is still a long way to go, but this is a major step forward for all foreign nurses. There is a threat that President Bush might veto this bill if it passes the conference. Bush' displeasure with the bill is not directed against the bridge amendment, instead his attention is focused on other provisions of the bill, particularly with regard to the size of the proposed budget under the bill.

Read the full story from Hammond Law's blog.

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Tuesday, October 23, 2007

Bill amendments may recapture Sched A visas for nurses

Over the past week, two amendments were offered in the US Senate that would recapture unused visas for Schedule A applicants, particularly foreign nurses, and their families. Hammond Law Group, in its Web site, said these amendments could be tackled as early as this week.

The first amendment seeks to recapture 61,000 unused visa. This amendment is being attached to the Labor Health and Human Services appropriations bill co-sponsored by Sen. Schumer and Sen. Hutchison.

The second amendment seeks to recapture visas not just for Schedule A workers and their family members but also for other Employment-based visa applicants.

We hope these amendments get approval and their parent bills later being signed into law.

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Wednesday, October 17, 2007

Still a waiting game for foreign nurses

It seems all is quiet in the frontlines of the US immigration struggle. After the failed push to reform US imigration policies earlier this year, talks of new immigration bills have been relegated to the sidelines and talked about in hushed tones. There is simply too much drama associated with immigration in the US that any debate on the matter sets off fireworks.

Despite this, we're all hoping proposals to give more freedom for foreign nurses to enter the US would still be moving forward. Advocates for the nurses' cause are expecting things to inch forward by November until early next year. We're hoping Congress will look at this issue more favorably and then let's pray for the US Senate to follow suit.

But until then, let's all be patient. Now is the perfect time to get your own papers ready; now is the time to hone your skills and add weight to your stock. So that when the road opens up again, you'll be all set.

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Saturday, October 13, 2007

Schedule of upcoming US career fairs for nurses

Filipino nurses who are already in the US, might be interested to visit these scheduled career fairs organized by Nursing Spectrum. Although retrogression is still in effect, it won't hurt to meet possible employers when the visa restrictions are resolved:

Upcoming Career Fairs for 2007
October 18 Oakland, CA
October 23 Las Vegas, NV
October 24 Baltimore, MD
October 24 Tinley Park, IL
October 26 Edison, NJ

November 6 Dallas, TX
November 8 Ft. Lauderdale, FL
November 13 Seattle, WA
November 13 San Diego, CA

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Thursday, October 11, 2007

Nurse with poor English suspended from job

Here's a sad case of a Filipino nurse who was suspended from the hospital he worked for in the U.K. Based on the charges brought against him, it was said he "lacked competence" both in his nursing skills and his English communication skills. I feel sorry for this man and I hope we all get some lessons from his experience.

I know a lot of people who've taken up nursing so that they can take advantage of the many opportunities for nurses in other countries, but before you set out for greener pastures, I urge you to try to keep the high standards that Filipino nurses have been known for.

Assess yourself, see where you're weak at, and seek ways of improving your skills. Try to get some hospital experience, even if some employers don't require you to get one. There are good training programs out there. If that doesn't work out, do some volunteer work; a couple of these volunteer programs are very good. Do this for yourself so that you'll be more confident when you find a real nursing job.

If you have poor English skills, just keep practicing. Even if you've already passed your IELTS or TOEFL exams, continue to improve your communication skills. My English skills are not so bad, but even I struggle to talk in English if I have to use it everyday at work or at other places outside home.

It is my hope, and the hope of many Filipinos I'm sure, that this will the last time we'll hear about a Filipino being suspended or fired for having poor nursing and English skills.

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Monday, October 8, 2007

Nurse volunteer program

A couple of hospitals in Manila offer nurse volunteer programs. Some collect a small fee, some allow you to volunteer for free.

St. Jude Hospital & Medical Center in Dimasalang St. (Just after UST Hospital and Infant Jesus Hospital) offers a good program for new nurses. There's a small fee of 2,000/month but they will give you a certificate at the end of your program.

East Avenue Medical Center offers a free volunteer program for new nurses. Registration is conducted every Wednesday. Just bring all your credentials with photocopies.

As with any training programs, you have to be aggressive and try to do as much as you can to learn. Be perceptive and don't be afraid to ask staff nurses or even the doctors so that you'll learn a lot.

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Friday, October 5, 2007

Shoutout for Joey A.

Here's a shoutout for my good friend, Joey A. of the Inquirer. Thanks for featuring The Filipino Nursing Herald in Blog Addicts. Check out Joey's own Babel Machine blog.

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Technique on answering TOEFL, IELTS questions

Here's a useful technique I learned from an English teacher that you can use for your own English exam. This can be used either when taking the Writing or Speaking modules in TOEFL iBT or IELTS.

When being asked your opinion on any subject matter, you can use a simple formula. For example, if you were asked: "What are your favorite tourist destinations in Manila?" You can answer this by using a formula: General statement + List + Explanation of each subject on list + summary.

To apply this formula,this is how I would answer the question:
(1) Manila is a beautiful city with many tourist attractions. (2)Among these attractions, my favorites are Luneta Park, Intramuros, and Manila Bay. (3)I like Luneta Park because I can just sit down on the grass and relax and enjoy a picnic. (4) I like Intramuros because I can look at many historical artifacts displayed there and get to see different products from the provinces that are being sold at a fair inside Intramuros. (5) Lastly, Manila Bay is also my favorite tourist spot because I can watch one of the country's most beautiful sunsets. (6)These are my favorite tourist places in Manila.

As you can see, I started out with a general statement, which basically is just a restatement of the question. Then I enumerated the places I liked. For short answers, particularly when speaking, just mention two things. Then if you have time, add another, but it is best to keep it down to two. Then explain each topic you mention. Just keep it simple, don't try to use heavy words. Always remember that you don't need to impress the test scorer, your goal is to communicate your thoughts and you can do that by using simple words. Then after explaining, summarize your thoughts. If you run out of time, you can skip the summary because you've already said the main points of your speech.

Try practicing this technique and have someone else ask you questions and then ask their feedback. A great lesson I learned in English review school is that you need to be comfortable when speaking. Try not to be intimidated by the computer or by the test scorer asking the questions. Imagine that you're just talking to a friend so that you'll be more comfortable when answering.

I hope this tip helps you. Just send me questions if you need additional help with this simple technique.

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Tuesday, October 2, 2007


I get asked a lot about what English exam is best to take when applying for a license in the US. People who read my blog know that I took the TOEFL iBT for my own licensure application but most people I know take the IELTS.

The Test of English as a Foreign Language (TOEFL) is administered by ETS, a private nonprofit organization that develops and administers tests for educational measurement and research. The TOEFL and its latest product, the TOEFL iBT, was primarily developed to test English skills of foreign nationals to see if they would be able to communicate effectively in an academic setting in the US. That's why the content of the test simulates situations on campus that potential students would like encounter.

On the other hand, the International English Language Testing System (IELTS) is jointly managed by the University of Cambridge ESOL Examinations, British Council and IDP Education Australia. Unlike TOEFL which is geared primarily for an academic setting, IELTS offers two modules: one for academic and the other for non-academic training and immigration purposes.

Although both will test your English language proficiency, they offer different testing techniques and content. US schools and immigration will accept either TOEFL or IELTS scores, but in the UK, Australia, and New Zealand, only the IELTS is recognized.

Both TOEFL and IELTS will measure your English proficiency in four areas: reading, listening, speaking, and writing. However, TOEFL iBT is administered entirely through the computer, while the IELTS Speaking module requires that you talk in-person to an examiner who will evaluate your skills based on questions that you, the examinee, select.

The Speaking module is the bane of most Filipino examinees and most find it comfortable talking to a real person instead of just speaking through a microphone connected to a computer or recording device. This is the reason most reviewers advice examinees to take the IELTS instead of TOEFL iBT.

In my own experience, the TOEFL iBT's Speaking Test was quite daunting. Although the test content or the tasks themselves were not difficult at all to someone who's comfortable using the English language, the anxiety that goes with the preparation when answering a question may become overwhelming. For example, a typical question would have you listen to a conversation between two students. For one of the tasks, you will be asked to summarize the conversation, explain which optional actions were suggested during the conversation, choose which action is best for the student to take, and then explain why this is your choice--all in 40 to 60 seconds. A good answer would use up all the time alloted for the question; too short or too long responses usually get minus points. For this task, you'll only be given 30 seconds to prepare your answer. The time constraint puts pressure on the examinee to answer quickly and groping for words can be disastrous.

I don't have personal experience with IELTS, as I have neither taken it nor answered sample exams on the Internet, so I can't give you an opinion on this test. I would love to have someone who has experience in the IELTS share their comments here so that others would be enlightened as well.

To answer the original quesion of this entry: which is best to take, TOEFL iBT or IELTS. My short answer is: it really depends on which English test is recognized by the country you want to apply for. In the US, both IELTS and TOEFL iBT is accepted by US immigration for Visascreen purposes. In Australia, New Zealand and the UK, IELTS is recognized but not TOEFL. Then, you also have to choose based on your level of English proficiency. If you believe you can hurdle the Speaking and Writing tests in TOEFL, then by all means, go for it. Otherwise, try to gauge yourself by answering sample tests for both IELTS and TOEFL iBT to see where you're most comfortable in.

Here are links to useful resources:

You can search and buy reviews books from our Amazon Store.

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Sample NCLEX Training Videos


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