By Mary Ann Hellinghausen
Posted Date: January 13, 2000
Photo: Ruth Rios

Not being able to work as a nurse in the United States has been frustrating for Laura Rodriquez. An emergency room nurse for six years in Monterrey, Mexico, Rodriquez married an American and moved to the United States in 1997. To become a licensed RN in Texas, she must first pass the National Council Licensure Examination for Registered Nurses (NCLEX-RN)—a difficult feat for many foreign nurses due to cultural and language barriers.

Graciela Arrendondo, RN, a certified rehabilitation nurse, and Ada Granado, RN, both members of the Dallas chapter of the National Association of Hispanic Nurses (NAHN), saw the difficulties Hispanic nurses faced in becoming licensed in the United States. They also saw the high demand for bilingual and bicultural nurses in Texas.

“[Potential nurses who speak Spanish] are here in our own backyard. I see hospitals going outside the country to recruit, when we have people right here,” said Arrendondo, staff development specialist with the VA North Texas Health Care System (VANTHCS) in Dallas.

“Nurses from Latin America are here working as maids, baby sitters, or in factories,” added Christina Frias, MS, RN, director of clinical education at the VANTHCS and president of the Dallas chapter of NAHN. “Some are highly skilled nurses, but they have many barriers [to becoming licensed]. And I was getting calls weekly, asking for bilingual nurses.”

Plan of action

To help break down cultural and language barriers, last year Arrendondo, Granado, and Frias organized a nursing review course for Latin American nurses, which helps them prepare to take the NCLEX and get their RN licenses.

“This is a great model of nurses helping nurses,” said Antonia M. Villarruel, PhD, RN, FAAN, past president of NAHN. “They have identified a potential pool of bilingual and bicultural nurses, and they’re helping the Latino population.” Villarruel said she knows of only one other such effort, a Connecticut program through which local nurses are helping nurses from Puerto Rico pass the state boards.

The Texas course started in February 1999 by advertising with local Hispanic media. Much to the organizers’ surprise, 200 people showed up at the first information meeting, Frias said, including foreign-born physicians and psychologists. Following an interview for English proficiency, the group of potential nurses was narrowed to 20 candidates.

The NCLEX is written in English, so those not proficient were encouraged to take English-as-a-second-language classes before the nursing review course. Foreign nurses must also take English proficiency exams and undergo an assessment of their nursing knowledge by the Commission on Graduates of Foreign Nursing Schools—the CGFNS test—before they can take the NCLEX.

Program participants came from Mexico, Peru, Ecuador, Venezuela, Brazil, Nicaragua, and Puerto Rico, and were charged $100 to cover course expenses. The 120-hour training and education course was offered in two-hour blocks, three days a week for five months. About 40 volunteer instructors reviewed U.S. nursing practices in med/surg, maternal and child health, psychiatry, and pediatrics. The VANTHCS provided library resources, basic supplies for the course, and—together with Parkland Health & Hospital System and Children’s Medical Center of Dallas—space for the classes to meet. Volunteers also helped participants fill out application forms for the tests.

Looking forward

Of the 20 who took the course, three are preparing for the NCLEX, including Rodriquez. “I feel happy and ready to take the test,” said Rodriquez, who is working as a wound care technician in the burn unit at Parkland.

About 30 participants are already signed up for the next course, which will be offered in February with all-day Saturday sessions at the VANTHCS facility. The organizers have applied for a grant to fund a full-time instructor position so they will not have to rely on volunteers in the future, Frias said.

“I think the impact of this is not big yet, but if we have a structured program with paid teachers and a system to follow up on our participants, we will be able to make a huge impact,” Arredondo said. “[Foreign-born nurses] will be able to make a difference in this country, and we will help fill the need for bilingual and bicultural nurses. It’s a win-win situation.”