Globalizing Standards and Increasing Mobility: The Future in Nursing

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Globalizing Standards and Increasing Mobility
The Future in Nursing

• Maryann Alexander, PhD, RN
• Associate Executive Director
• Regulatory Programs
• National Council of State Boards of Nursing
• Chicago, Illinois USA

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National Council of State Boards of Nursing

• Mission
• To Promote the Health, Safety and Welfare of the
  Public through Regulatory Excellence.

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NCSBN

• 60 State Boards of Nursing
• Set regulatory standards for the US and
  territories.
• Develop and Administer the National Council
  Licensure Exam (NCLEX).
• Provide Models for Nursing Licensure/Regulation.
• Promote Uniformity among the States.
• The Center of Research for Nursing Regulation.

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Roles of the State Boards of Nursing in U.S.

• Administer/Regulate the Nurse Practice Act in
  their State.
• Approval of Nursing Programs
• Issue Licenses.
• Investigate Violations of the Nurse Practice
  Act/Discipline.

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NCSBN Endorsement Model for Internationally
Educated Nurses

• Education Equivalent to U.S./Credentials Review.
• English Proficiency.
• Passage of NCLEX.
• Unencumbered License from Country of Origin.
• Additional state requirements.

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Advanced Practice Nursing

• Requirements for RNs.
• Master of Science Degree in Nursing from an
  accredited nursing program.
• Passage of a certification exam.
• Unencumbered license.

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Standardization of Licensure Requirements.

• States have diverse requirements.
• Countries have diverse requirements.

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The United States Nursing Shortage
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Reasons for Shortage 2000

• Aging workforce.
• Decreased Enrollment in Nursing Programs.
• Numerous career options for nurses. Large number
  of RNs not employed as bedside nurses.

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Reasons for Shortage 2006

• 150,000 applicants for nursing. programs were not
  accepted last year.
• Insufficient number of Faculty.
• Insufficient number of Clinical Sites.

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Pending Legislation

• Congressional bill that would remove the limit
  on the number of nurses that can migrate to the
  US.

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Global Nursing Shortage

• Canada
• Europe
• Ireland
• Great Britain
• Austria
• Norway

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Global Nursing Shortage

• Asia
• Japan
• Middle East
• Saudi Arabia
• Africa
• Sub-Saharan Regions

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Philippines, India and Korea

• Feb.2005 100,000 Filipino nurses working in
  non-professional positions.
• Nurses in India are unemployed.
• Korea also has an abundance of nurses.

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Affect on other Countries

• Raising nursing education standards in other
  countries.
• Philippines is designing curriculum to meet the
  standards of the US and other countries.
• Language of instruction is English.
• U.S. textbooks.

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European Organization of Nurse Regulators

• Seven Countries
• European agreement
• Free Mobility between countries.
• Standardization of licensure requirements

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Australia and Tasmania

• Mutual Recognition Agreement

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Role of NCSBN in Fostering Mobility and
International Standards

• NCLEX offered around the world for nurses wishing
  to practice in the U.S.
• Consultation to other countries
• Setting up organization equivalent to NCSBN.
• Licensure and Testing Requirements.
• Research on the Transition to nursing in the U.S.

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Affect on the U.S.

• Transitional Programs to acculturate nurses
  needed.
• Concern over language differences.
• Internationally educated nurses are acclimating
  and functioning in many roles including faculty,
  researchers and excellent clinicians.
• Meeting language and cultural needs of patients

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Affect on Other Countries.

• Concern that best nurses leave.
• Nurses return to country with new knowledge,
  more experience and leadership skills.
• 16 Billion US Dollars annually sent to the
  Philippines from nurses working in the U.S.

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Opportunities The Korean Model

• Provides for nurses to work abroad, gain
  knowledge and experience that is brought back to
  their own country.

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Summary

• Currently there are no mutual recognition models
  involving the US and other countries.
• Nursing programs/licensure requirements are not
  standardized.
• Nursing shortage is raising standards in nursing
  education in other countries. First step towards
  mutual recognition.
• NCSBN will be working in the coming years to
  assist state boards with international workforce
  issues, ensuring patient safety and collaborating
  with other countries to continue to assist in the
  development of international standards.

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Thank you!

• Gracias!

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Accreditation v. Approval

• Two accrediting bodies for nursing in the US
  (Professional Organizations).
• State Board of Nursing approves programs.
• Accreditation usually a part of the Approval
  Process.
• Approval is dependent on yearly performance of
  first time NCLEX takers.

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Licensure Requirements for U.S. Graduates

• Graduation from an approved Nursing
  Program/Credentials Review.
• Passage of the NCLEX.
• Unencumbered License from another state.

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Issues for Internationally Educated Nurses
Working in the United States

• Education is at Baccalaureate level, but
  transition can be difficult.
• Less focus on
• Independent Practice/Decision-making/critical
  thinking.
• Communication with the multidisciplinary team.
• Cultural Differences.

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What Needs to be Done?

• Standardize Curriculum.
• International Accreditation Process for Nursing
  Programs.
• Competency Exam that is accepted world-wide.

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Global Nursing Shortage

• Canada
• Europe
• Ireland
• Great Britain
• Austria
• Norway

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Global Nursing Shortage

• Asia
• Japan
• Middle East
• Saudi Arabia
• Africa
• Sub-Saharan Regions

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Pending Legislation

• Congressional bill that would remove the limit
  on the number of nurses that can migrate to the
  US.

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Affect on other Countries

• Raising nursing education standards in other
  countries.
• Raise standards related to working
  environment/salary.
• Raising awareness of the professional expertise
  of nurses.