Globalization meets the healthcare workforce: Training, recruitment, and integration for health professionals

Since 2002, The Chicago Bilingual Nurse Consortium (CBNC), a 501 (c) (3) non-for profit organization, has provided leadership, advocacy, support and educational programs for internationally educated nurses (IENs) residing in Illinois who are not licensed as RNs. (Lebold and Walsh, 2006). The CBNC is the only centralized resource for IENS in Illinois and one of the few in the U.S. that offers programs and services to enable IENs to adapt to the U.S. health care systems and culture. These nurses are frequently unemployed or underemployed.  To date, the CBNC has served 325 IENs from 50 countries, mostly in an advisory capacity. Forty-one students have taken courses offered by the CBNC. Thirty-nine of our candidates have taken the NCLEX-RN and thirty-four have passed for a current pass rate of 86%, far above the national average for IENs (73.8%) as reported by the NCSBN. In addition, seven candidates initially screened as not being eligible for RN licensure were re-screened as qualified for LPN status. Two candidates have completed the LPN process. Our annual yearly budget is approximately $150,000. Paid staff members include a half-time Executive director, a full-time Assistant Director and a 0.4 FTE Academic counselor/advisor. The yearly budget includes salaries, some support for student scholarships and some support for course faculty. Office space, utilities and office supplies are donated by one of the consortium member organizations.

The International Bilingual Nurse Alliance was formed in 2002 as it became apparent that there were other programs facing these same issues. As a member of the International Bilingual Nurse Alliance, CBNC reports results similar to other programs in the alliance. Denver, CO reports a pass rate of 100% for its candidates; Dallas, TX reports a rate of 65.5%; Mesa, AZ has a pass rate of 72.7%; and Portland, OR has a pass rate of 87.5%. The result of these initiatives is the formation of a community of well-qualified, bilingual, bicultural RNs to serve our increasingly diverse ethnic communities. This organization has no paid staff and no yearly budget at the organizational level. Our yearly conferences are supported by local grants and the agency hosting event.

Our curriculum and learning plan is under constant revision as we learn from each group of candidates what works and what does not. What makes our program successful is the combination of close contact and support of each candidate, small classes with lots of individual support and conversation, use of the ATI system for learning materials and testing, both proctored and un-proctored. Sticking close to the ATI outline and program guidelines have proven successful for our candidates even when candidates are discouraged with their own progress. If candidates will work with their ATI program materials until the proctored tests reach the predictive scoring level, they will be successful in taking the NCLEX-RN. When talking to others about our program and how it has developed over time, the first thing we tell those individuals is to start with the nurse practice act in their state. Any course development has to conform to the laws governing the licensing and practice of IENs in that particular state. Also, funding for the program is something that must be addressed and planned. Many programs are placed in the local junior colleges and those seen to work well. We also stress that IENs usually have good nursing skills. What they lack is an understanding of the US healthcare culture, computer skills, and English skills. Review for the NCLEX-RN examination is important but candidates will not be successful without those major skills. We have found that conversations in English related to the work situation are helpful because candidates can see the relationship of that practice to what they will be doing after licensure. However, any conversational practice is beneficial if the situation is non-threatening and includes everyone in the room. One thing that our new Academic Counselor/Advisor has done is to use the evening news as a starting point. Everyone in the class watches an assigned portion of the news on Friday evening and then comes to class on Tuesday to discuss the content presented. We have found that this is well received by our candidates and provides noticeable improvement in their English capabilities. Because TOEFL is required in Illinois we try to aim any work in English improvement directly to the content of that exam. This works better for us than extended classes through ESL programs.

Over the past six years we have learned that patience is a virtue! We had originally set a very aggressive time table for our students and hoped for a 28 week turnaround from acceptance into the program to passage of the NCLEX-RN exam. This was an unrealistic time table, and we have come to know that it will take approximately 24 – 30 months for the candidates to work through all the requirements set by Illinois. The process includes review of credentials by CES, improving English usage, improving test-taking skills, learning about the U.S. healthcare system, taking the TOEFL examination and preparing to take the NCLEX-RN. It is a long process and one the hardest parts is keeping the candidates from becoming discouraged with an apparent lack of progress. What usually happens is that it seems that nothing is happening and then all the pieces fall into place at once. Candidates require support and encouragement throughout the process. We have become more inclusive over time instead of exclusive. We have struggled with lack of financial support for the program and continue to work to improve our financial situation.

When the board members become discouraged with our “lack of success” we look to our outcomes for encouragement. The CBNC has been cited as a best practice by the State of Illinois New Americans Council, been listed in the Illinois Nurse Practice Act as an example program helping IENs become licensed, developed a system to track candidate progress, developed a web site: www.chicagobilingualnurse.org, helped to create the International Bilingual Nurse Alliance, established working relationships with governmental and private agencies that work with IENs both in the US and in other countries, developed IEN peer advising seminars, established working relationships with several community colleges and other agencies, published several articles and made a variety of presentations, and testified before the Joint Legislative Committee on Disparity in Health Care in Illinois.