Career Path

Certification required. To earn the Certified Nurse Midwife (CNM) credential from the American Midwifery Certification Board (AMCB), you must have a master’s or doctoral degree from a program accredited by the Accreditation Commission for Midwifery Education (ACME). For those with existing equivalent education from another country, meeting this requirement may involve as little as taking a single additional course from an ACME-accredited program. You must also hold an RN license at the time of your certification exam.

• If you do not hold an RN license at the time of your exam, you can earn the Certified Midwife (CM) credential instead. Unlike CNMs, who can legally practice in every state, CMs are only recognized to practice in 11 states and the District of Columbia. CMs are not APRN level professionals, and so cannot prescribe medications or perform certain other tasks, but this can be a good career option if you do not hold RN licensure and live in a state that allows CM practice.

Many state boards of nursing require that internationally trained RN candidates complete the CGFNS Certification Program in order to take the NCLEX-RN exam, which is required for licensure as an RN (and is also a requirement for the higher designation of APRN). This three-part program includes a credential evaluation, a nursing exam, and verification that you have passed one of the accepted English language exams.

• NOTE: The exam component of the program also fulfills the examination requirement for the federal VisaScreen: Visa Credentials Assessment for immigration.

Registered Nurse (RN) licensure is required for RNs and Advanced Practice Registered Nurses (APRNs). Each state has a board of nursing that regulates licenses, and requirements vary by state. To be eligible for licensure, most states require that you pass the NCLEX-RN exam.

• Some states allow recent graduates of RN programs to practice nursing under supervision for a limited period of time while they await their NCLEX exam date, under a temporary or limited permit or license. Check with your state board of nursing to find out if this can be an option for you.

You must obtain a credential evaluation of your international education in order to take the NCLEX-RN exam. Many states require that you obtain your credential evaluation from CGFNS International (formerly the Commission on Graduates of Foreign Nursing Schools). Some states may also accept evaluations for RN or LPN/LVN licensure from Educational Records Evaluation Service (ERES), Josef Silny & Associates, or the International Education Research Foundation (IERF). Currently, IERF only performs evaluations for applicants educated in Canada, India, Mexico, Philippines, and Puerto Rico.

• Puerto Rico is the only U.S. territory that is NOT a member of the National Council of State Boards of Nursing (NCSBN). Therefore, any nursing education completed in Puerto Rico must be evaluated for licensure purposes the same as it would have to be for any education completed in a foreign country. Exceptions to this rule may exist on a state-by-state basis, such as in New York, which does recognize nursing education completed in Puerto Rico as being a U.S. education.

In most states you will need to pass an English language exam if your degree program was not taught entirely in English and in a country where English is the primary language. Accepted exams and scores vary by state, but may include the IELTS Academic, the PTE Academic, the TOEFL iBT, or the TOEIC.