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Soon after the announcement that Manila had been selected by the National Council of State Boards of Nursing (NCSBN) as an NCLEX test site, the Commission on Graduates of Foreign Nursing Schools (CGFNS) dropped its own bombshell. The entire batch of Filipino RNs who passed the tainted June 2006 licensing exam will be denied Visa Screen Certification.
Is this the price we pay for having the NCLEX in Manila? Is this the trade-off in the very likely event that Filipino RNs decide to bypass the CGFNS certification in favor of the NCLEX?
The Visa Screen Certificate is issued by the International Commission on Healthcare Professions (ICHP), a division of the CGFNS, to foreign non-physician healthcare workers after successfully going through education analysis, licensure validation and English proficiency tests. Foreign RNs must further be tested for nursing knowledge.
The Visa Screen certification fulfills a requirement under the Illegal Immigration Reform and Immigrant Responsibility Act (IIRAIRA) of 1996. Under the relevant provision, health workers seeking admission to the US will be deemed inadmissible, unless they present a certificate verifying that their education, training, license and experience meet the requirements for entry to the US; are comparable with that required for an American nurse and are authentic; and in the case of license, unencumbered. Such workers must also be proficient in spoken and written English.
The Visa Screen is required in addition to (and is not a substitute for) the NCLEX, although both practically assess the same knowledge, skill, competency and English language proficiency of the foreign RN.
Generally, Filipino RNs go through all three hurdles before they can get to work in the USâ€"undergo CGFNS certification for the visa petition, obtain Visa Screen certification to satisfy the IIRAIRA requirement, and pass the NCLEX to be licensed to practice the nursing profession in the US.
It must be noted that the CGFNS administers both the CGFNS certification and the Visa Screen certification. The NCSBN administers the NCLEX.
Healthcare Worker Certification in the US
The law provides that the healthcare worker certification may be issued by the CGFNS (through its ICHP division) or an equivalent credentialing organization.
Credentialing organizations obtain their USCIS authorization upon proof that they comply with four criteria: first, independence and freedom from material conflicts of interest regarding whether an alien receives a visa; second, the ability to evaluate both foreign credentials and English language proficiency appropriate for the alienâ€™s healthcare field; third, ability to keep comprehensive and current information on foreign educational institutions, ministries of health and foreign health care licensing jurisdictions; and lastly, ability to conduct an examination outside the US in cases where a predictor examination is required.
The USCIS (a branch of the Department of Homeland Security, [DHS]), has set up standards which all credentialing organizations (including the CGFNS) must satisfy for such certifications. It monitors the certification program of credentialing organizations by reviewing them and reauthorizing them every five years. CGFNS is not exempt from USCIS monitoring of its certification program.
True, we cannot begrudge the CGFNS for its steadfast guardianship of the health care profession from unqualified workers. But it is also the duty of the CGFNS to ensure that qualified workers enter the US to ease the critical understaffing of health care facilities.
It is possible that the credentialing standards prescribed by law and authorized by the USCIS do not justify such a drastic reaction as the blanket Visa Screen denial on some 15,000 June 2006 passers who have been allowed to take oaths and be given licenses..
It must be noted that no effort was spared in ensuring that the June 2006 RN exam results were reviewed thoroughly by the Professional Regulatory Commission (PRC), the government agency tasked with professional licensing. The PRC actually recomputed the grades of 17,000 RN examinees. Administrative and judicial action had taken place eventually culminating in the Court of Appeals order for a re-take of the exam by 1,687 of those who passed. The Supreme Court upheld that decision.
Even the NCSBN was implicitly satisfied with the handling of the RN test fiasco. It finally decided to set up a test site in Manila despite previous concerns about security and RN competence.
Considering the RN test leakage issue had been examined thoroughly by practically all branches of the Philippine government, professional nurse organizations both in the Philippines and in the US and other concerned groups, it behooves us to question why these are not enough to convince the CGFNS that the 15,000 passers should not be barred from obtaining their Visa Screen.
The CGFNS reportedly conducted its own investigation into the RN exam leakage in Manila sometime in September 2006. Apparently, its findings during this visit led to the decision to issue the blanket denial. We have yet to find out the specific details of said investigation. How was it conducted? Who were the members of the investigation team? Were due process policies and procedures followed? What were their specific findings?
CGFNS Action Subject to Review
In the face of what appears to be the rash decision to deny all Visa Screen applications of the 2006 RN batch from the Philippines, we should be reminded that the CGFNS is not the ultimate authority on the healthcare workersâ€™ certification.
Under the law, the CGFNS is subject to ongoing review by the DHS and its credentialing status may be terminated for noncompliance with the statuteâ€™s universal standards
Although CGFNS has been designated in the law as an organization authorized to issue healthcare worker certifications, there is nothing that will prevent the DHS from determining whether CGFNSâ€™s authority to issue certification should be revoked.