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18 N O V E M B E R 2 0 0 5 C A L I F O R N I A N U R S E Purpose T his home study provides informa- tion on contemporary issues fac- ing international nurses and the lack of leadership shown by the national and international "nurs- ing community" in seeking ethical and eq- uitable solutions. Background Throughout the history of United States nursing, swings of shortages and oversup- ply of RNs have existed. Current and pre- dicted supply and demand for RNs predict significant shortages of RNs in the U.S. workforce. The United States since World War II has relied on foreign nurses to fill gaps in the supply of labor. Today, sever- al private and public entities have devel- oped and implemented policies on the migration of foreign nurse graduates. The Commission on Graduates of Foreign Nursing Schools The Commission on Graduates of Foreign Nursing Schools (CGFNS) is a not-for- profit, immigration-neutral, internation- ally-recognized authority on the education, registration, and licensure of nurses worldwide. CGFNS was established to protect the public trust by ensuring that nurses educated in other countries who wish to practice nursing in the United States are eligible and qualified to meet li- censure and other practice requirements. The story behind the Commission on Graduates of Foreign Nursing Schools (CGFNS) begins in the late 1960s when the United States experienced an increase in nurse migration from other countries. Immigration officials had a difficult time identifying which of these nurses educat- ed abroad, and applying for nursing occu- pational visas, would be eligible for licensure as a registered nurse in the Unit- ed States. On average, only 15 to 20 per- cent of nurses educated outside the United States passed the U.S. registered nurse li- censure exam on their first attempt. This led the Division of Nursing of the then-Department of Health, Education, and Welfare (DHEW) to commission two studies regarding RN licensure of foreign- educated nurses in the United States. The findings of these landmark studies on foreign nurse immigration led to the establishment of a private, independent, nonprofit organization. The organization created in 1977 was CGFNS. The Com- mission's dual mission is to help ensure safe patient care for the American pub- lic and to help prevent the exploitation of graduates of foreign nursing schools who come to the United States to prac- tice nursing. CGFNS protects the public trust by ensuring that nurses educated outside the U.S. are eligible and qualified to meet licensure and other practice re- quirements in this country. To remedy the low passing rate, CGFNS developed a preimmigration cer- tification program that identifies an in- ternational nursing population likely to pass the U.S. licensure examination. The CGFNS Certification Program consists of three components: a credentials review, a test of nursing knowledge (the CGFNS qualifying examination), and an English- language proficiency examination. Since its inception in 1977, CGFNS has administered more than 350,000 tests to approximately 185,000 applicants at 43 test sites worldwide. Cumulative data from 1978 to 2000 indicate that the ma- jority of CGFNS test takers have been ed- ucated in the Philippines (73 percent), followed by the United Kingdom (4 per- cent), India (3 percent), Nigeria (3 per- cent), and Ireland (3 percent). In more recent years, this profile has been changing. While Philippine-educat- ed test takers continue to be in the ma- jority, their overall percentage rate has declined from a high of 88 percent in 1995 to a low of 55 percent in 1997-1998. In 2000, Philippine-educated nurses consti- tuted 71 percent of CGFNS applicants. This pattern of sharp decline followed by a rise in applications is most likely due to U.S. immigration policy. The sunsetting in 1995 of the Immigration Nursing Relief Act effectively decreased nurse immigra- tion to the United States. This act, in place from 1989 to 1995 to relieve the then nursing shortage, had created a special oc- cupational visa category for nurses enter- ing the Untied States. CGFNS Mission The CGFNS mission is to protect the pub- lic by assuring the integrity of health pro- fessional credentials in the context of global migration. The mission of CGFNS focuses on four key objectives: To develop and administer a predictive testing and evaluation program for foreign- educated nurses. CE Home Study Course Contemporary Issues Facing International Nurses Adopting a CNA/NNOC Code of Practice for International Nursing Recruitment Submitted by Hedy Dumpel, RN, JD and the Joint Nursing Practice Commission. Part II of the CE Home Study titled "Critical Patient Advocacy Issues Fac- ing Correctional RNs in California," the first part of which was published in September 2005, has been postponed to a later issue. Please check back here at a future date for the continuation of this home study.