Nurse furloughed due to pandemic shares step-by-step experience
By Kelly Arraf
October 3, 2022
There is no shortage of news about the pandemic leaving nurses overworked, exhausted and disillusioned. Less acknowledged, however, is that many nurses found themselves unemployed or underemployed during this time. Hospitals cancelled surgeries, delayed inpatient procedures and resorted to bed-blocking to keep beds and staff available should COVID-19 waves continue to spike. As a result, many casual and part-time nurses, particularly those in surgical preoperative, operating and recovery rooms and day procedure units, found their employment in jeopardy when cancelled elective surgeries were the norm.
As a seasoned 22-year nurse working in the recovery room and as a nursing instructor, I was unemployed during the initial wave (on furlough) and highly underemployed for each subsequent wave. This situation was a direct result of slowing or halting elective surgeries to manage staff and bed shortages. Out of necessity, it prompted my curiosity about travel nursing in the United States. Unfortunately, I discovered a lack of detail on how a seasoned Canadian nurse should prepare for the National Council Licensure Examination for Registered Nurses (NCLEX-RN). Additionally, there was little guidance on which state to register with, the process of having credentials evaluated, and the cost.
The following are my recommendations and details on the process, budget and timeline. I have passed the NCLEX-RN and am now registered to work in the states of Montana and Texas. I hope this helps streamline the process for others thinking of post-pandemic travel nursing.
Step 1: Study for the NCLEX-RN
The first, and by far the most intimidating, step is to begin to study. The NCLEX-RN is a requirement for registration with any state. For nurses who graduated pre-2015 (when Canada adopted the NCLEX-RN), the Canadian Registered Nurse Examination (CRNE) will not be accepted. Having been out of nursing school for two decades, my knowledge deficit for the NCLEX-RN was considerable. Therefore, I sought study materials that worked for my learning needs. Using an NCLEX-RN question book (found in most bookstores) would not have been prudent for my knowledge gap. Should you find a question booklet sufficient, be aware that in April 2023, the NCLEX-RN format is changing and confirm that the questions are in the Next Generation NCLEX-RN (NGN) layout.
After some research, I found the Hurst Review. The Hurst Review is a fully comprehensive online review with tutorial-style videos. The tier I chose came with a workbook (to fill out as you watch the tutorials) and access to a large exam bank. The videos are guided almost entirely by one narrator. Additionally, Hurst touts a 98 per cent first-attempt pass rate. Another excellent resource is the UWorld program. UWorld has a massive exam bank (almost 2,400 questions, in the NGN format) that can be accessed on the computer or a phone app (making it highly convenient). UWorld’s questions are extremely challenging but explained in tremendous detail with diagrams. UWorld compares individual scores against standard scores, which I found very helpful in tracking my progress. Should you only have the time (or the budget) for one program, I recommend UWorld.
Step 2: Choose a state
The next decision is which U.S. state to choose. I began my state application the same week I ordered my study materials. Canadian graduates (with a successful CRNE) will need to apply to a U.S. board of nursing to obtain a Licensure by Examination to qualify to write the NCLEX-RN. Each nursing board has a website containing application forms and details on registration. I suggest choosing a state with fewer applicants to help expedite the process. For example, Montana has substantially fewer applicants than California. Furthermore, Montana does not require an English proficiency exam, which would be an additional step and further cost. I also considered applying to Colorado, Wyoming and North Dakota (with smaller nursing bodies and fewer applicants). Each state will have slightly different registration costs and requirements, so be sure to research one that fits your goals.
Step 3: Verify your post-secondary credentials
Be prepared to have your post-secondary credentials verified by a credentialing company. This was the most expensive and time-consuming requirement. Most states recommend one or more companies that they recognize on their website. Montana, for example, currently accepts credential verification from only two companies. One is CGFNS, which provides a Credentials Evaluation Service (CES) Professional Report, “a detailed analysis of the credentials earned at multiple levels of nursing education received outside the United States. It includes a statement of comparability of a healthcare worker’s education when assessed against U.S. standards.” Be aware that once the credentialing company receives your transcripts, preparing the actual report can take months. After a 14-week wait for CGFNS to submit my CES report, I upgraded to an expedited report (for fear the delay would postpone my preferred NCLEX-RN date). Expediting the report was costly, but it was then completed promptly. Once your state verifies your registration requirements, they will communicate with Pearson VUE (the company that administers the NCLEX-RN). The state will then issue an Authorization to Test (ATT) code.
I suggest choosing a state with fewer applicants to help expedite the process.
Step 4: Register with Pearson VUE
This company administers the NCLEX-RN exam in Canada and the U.S. You can register with Pearson VUE at any time, but once you receive your ATT code, the process is straightforward. You enter the code on Pearson VUE’s website and pick your preferred location and NCLEX date to test. You do not need to write the NCLEX in person in your registered state. I chose to write in Calgary so as not to incur more costs associated with travelling.
Step 5: Order your post-secondary transcripts
Your transcripts will be sent directly from your institution to two locations: your state and the credentialing service. In my case, the State of Montana and CGFNS required my university to provide original transcripts (detailing classes and my GPA) and a breakdown of how many hours I had spent in each clinical practicum. The transcript office indicated that this is a common request of U.S. credentialing companies, and there was no delay in meeting this detailed request.
Step 6: Get your fingerprints
Fingerprints will be required. These are for a criminal background check and may be sent electronically, or a fingerprint card may be requested. IdentoGo is a convenient and inexpensive company with locations across Canada. The same company operates throughout the U.S.
Step 7: Prepare for the cost
Be prepared for the financial cost. The overall cost will vary based on what study materials you use, the state you register with and the credential evaluation company. It will be expensive. Here is a breakdown of the expenses I incurred:
US$109–$399: Hurst Review
US$100: State of Montana Licensure By Examination fee
US$420: CGFNS Credential Evaluation Service report
US$300: Expediting the CGFNS report
US$350: Pearson VUE, registration fee for Canadian candidates seeking U.S. licensure
C$100: Two sets of Canadian university transcripts (sent internationally)
My total cost was approximately C$1,900 (US$1,470). I recommend submitting all receipts as professional expenses with your taxes (learning materials, course registrations, etc.). Bear in mind that the average travel nurse in the U.S. has the potential to make US$3,000 per week.
Time-wise, I spent 20 hours researching (which materials to use, what state to choose) and filling out applications (State of Montana, CGFNS, Pearson VUE). I allotted 200 hours to study over four months (50 hours for Hurst Review, 150 hours with UWorld). Looking back, I was perhaps overprepared, but I have no regrets about the commitment as I passed on the first sitting with 75 questions.
Once you complete the process and pass the NCLEX-RN, maintaining a U.S. licence is relatively simple and inexpensive. For example, I hold a State of Montana licence, which I renew every 24 months, with a US$50 registration fee, that requires 24 clinical education hours. Clinical education hours, required by every state, can easily be acquired with online courses. Furthermore, once you have a licence in a state that adheres to the Nursing Licensure Compact, you can apply to another state with a streamlined Application By Endorsement. Ahead of my most recent move to Texas, I applied for a Texas licence — an application by endorsement from the State of Montana. It was a substantially less expensive and time-consuming process.
With nursing shortages worldwide, there is no better time to explore and see if travel nursing is your next opportunity.
Kelly Arraf, RN, MN, is a PhD student at Liberty University and a former clinical instructor at Mount Royal University. She is exploring travel nursing in Texas and Montana.