The Nurse-Practitioner Abroad: Working as an NP Internationally
Ever since the advent of the Nurse Licensure Compact, working as a registered nurse in half of the states in the United States has become almost seamless. The multistate license is particularly helpful for nurses who work as travelers and for nurses who live near state borders. The evolving APRN Compact will similarly provide for nurses in advanced practice as long as they continue to work in the United States.
As someone who lives in the Metropolitan DC area, I see friends and neighbors move from country to country as readily as many people seem to go to the grocery store. The area is, naturally, home to a large number of government and international agency employees. I started to wonder, how would I continue to work as a nurse-practitioner if my family needed to relocate overseas? I found my options limited. Few countries recognize the role of an advanced practice nurse (APN).
Registered nurses in the United States enjoy a broad scope of practice compared to nurses in much of the rest of the world. The concept of advance practice nursing? Virtually unheard of outside North America and Europe. In only a handful of countries would it be possible for me to continue working legitimately as an advanced practice nurse. Once I had met local requirements, that is.
Setting aside visa, work permit, and language-proficiency requirements, let’s look at what it would take to work as an APN in some of these places.
The APN role in Canada has come a long way during the past 15 to 20 years. It is similar to the APN role in the United States. Canada recognizes nurse-practitioners as autonomous providers. An APN license requires both graduate-level education and clinical experience. The process for foreign-trained APNs to qualify for licensure in Canada varies among Canadian provinces. In general, you would need to have your NP educational program approved, apply (a multi-step process) for and pass the appropriate NP exam, supply copies of your various licenses and pay fees in excess of $2,000.
Once you leave North America, your options for practicing as an APN are limited. In Nigeria, for example, where decades of wars, conflicts and political instability reduced medical manpower, the APN role has started to evolve. Nigeria recognizes only the advanced practices of midwives and certified registered nurse anesthetists. Licensure in those specialties requires application, verification of your state nursing license, a statement of good standing from your state board of nursing, official transcripts from the nursing school(s) you attended, approval of your educational program, taking and passing Nigeria’s licensing exams, and the completion of three months of orientation.
In Israel, where advanced practice nursing is still in its infancy, one must be a citizen or resident of Israel to qualify for nursing licensure. The process of obtaining licensure in Israel is not unlike the process in Canada and Nigeria – it requires paperwork, testing (including simulation testing) and fees. In fact, these requirements are fairly standard.
What is not standard is the scope of advanced practice nursing. In places like Nigeria and Israel, advanced practice nursing is restricted to certain specialties. In Finland, nurses work in advanced practice roles but do so without any standardization in education and without an advanced practice license. Thailand recognizes APNs, but the APN role is not well defined. One third of APNs in Thailand work in places where doctors are not present and often end up providing care beyond their legal scope.
Obtaining a license as an APN in another country will require planning and patience. The process can take as few as six months or as long as two years. Many countries do not recognize educational programs that are completed online. You should expect compensation to be much less than you would earn in the United States.
If the overseas licensing process is overly daunting, you might want to consider other career possibilities. You may not be able to work the way you do in the US, but you may be able to teach, do research or hold management positions in health care – all without going through the laborious licensing process. International healthcare jobs are plentiful owing to USAID, the US State Department, the CIA, the United Nations, and the World Health Organization and will generally not require a foreign license. International job listings can also be found at devex.com/jobs and reliefweb.int/jobs.