Strangers in a Familiar Profession

Wendy Mejia became a labor and delivery nurse in her home country of Honduras in 1993. Five years later, after Hurricane Mitch devastated her homeland, she packed up her life and moved to the United States to be with her husband, leaving her professional career behind in Honduras. Though her husband encouraged her to seek her nurse's license so that she could work in the area, Mejia said the process was too expensive to afford and too difficult to manage on her own.

Now, with the help of a local community college and a county government outreach program, Mejia is a newly minted nurse in surgical intensive care at Holy Cross Hospital in Silver Spring, Md., a suburb of Washington. Ten other foreign-trained nurses in Montgomery County, Md. are now also fully certified and finally back to work in their chosen profession. Organizers of this pilot program argue that participants, particularly Latino immigrants, are an untapped resource and can help diversify the health care workforce to meet the needs of the increasingly diverse communities it serves.

A local government report notes that 40 percent of Hispanics in the Washington metropolitan area do not speak English proficiently and nearly 30 percent live in linguistically isolated households, making hospital visits difficult and even dangerous if there are not Spanish speakers involved in patient care. Mejia, for one, said her nursing and bilingual skills are both valued at Holy Cross.

“The Spanish-speaking community is growing every day,” she said. “A lot of people understand a bit of English, but it’s not the same when it’s about their own health. The patients feel such relief that someone else is there that speaks their own language.”

Mejia is just one of the success stories from a pilot program for the licensure of foreign-trained nursing professionals started in 2006 by the Latino Health Initiative, an outreach program of the Montgomery County Department of Health and Human Services. The main goal of the program -- which had 25 participants in its first class -- was to address the severe nursing shortage in Maryland by utilizing foreign-trained professionals and helping them through the certification process, said Sonia Mora, manager of the Latino Health Initiative. Immigrants are often confused and frustrated by the multi-step process, she said, adding that without help many abandon their ambitions of returning to the nursing field.

Nurses in Maryland must apply for licensure with the state’s Board of Nursing, request credential evaluation service, pass an English competency oral exam and pass the National Council of Licensure Exam (NCLEX) before they are officially certified. This process alone can cost almost $900 in fees. Still, Mora said most foreign-born nurses need additional English as a second language (ESL) courses to pass the required oral exam and refresher courses to pass the NCLEX. All of these costs, as well as the burden of finding time away from work and childcare, if needed, can price many prospective nurses out of certification, she said.

In addition to providing financial assistance for everything from the refresher course tuition and licensure fees to transportation and child care costs, the Latino Health Initiative provides support and guidance for all of the participants in the program, said Mora. She notes that the program takes a case management approach to its assistance. While this is work-intensive and restricts the number of participants the program can accommodate, Mora said it assures that individual concerns can be addressed in a timely and efficient manner.

Montgomery College, a two-year institution, provides the academic support for the program, hosting the ESL and NCLEX review courses. Linda Jennings, the college’s program director for occupational ESL, developed an ESL course specifically for the program focused on health care issues and terminology. She said she has a wide variety of students at different levels of proficiency. Some students do not need the course and can continue in the certification process, while others have weak English skills and find great value in the way in which the intensive course is taught.

“I think the course is highly motivating for them because they are taking an English course specifically related to their professions,” said Jennings. “The content is very motivating.”

While occupational ESL in not new -- there are courses for every job from car mechanic to police officer -- the college’s specially structured course demonstrates its commitment to the community and its needs, said Angie Pickwick, dean of health sciences. Aside from the ESL program, to which graduates like Mejia attribute to their ability to pass the oral exam, the college’s NCLEX review course has inspired some of the program’s graduates to give back. Pickwick said a recent graduate who is now working at a local hospital has offered her assistance to teach a review course specifically geared toward foreign-trained nurses this fall. Currently, the program makes use of a previously existing review class for all nursing students at the college.

The program in Montgomery County modeled itself after a California-born program called the Welcome Back Initiative, which not only helps foreign-trained nurses seek certification but also other health professionals from doctors and dentists to pharmacists and psychologists. Stephen Robinson, director at the Initiative’s San Francisco center, said it has helped groups in Colorado, Massachusetts, Minnesota, Rhode Island, and Texas establish programs similar to the one in Maryland. At the San Francisco center, students take courses at the two-year City College of San Francisco and the four-year San Francisco State University in order to reattain licensure. Mora said her program hopes to further model the Welcome Back Initiative by expanding to help other professionals and those from other language backgrounds.

Unlike the California program, however, Mora said participants in the Montgomery program are placed at one of two local hospitals to serve as nurses-in-training -- with full pay and benefits -- before they take the NCLEX. She said this unique experience is invaluable and only further assists these nurses in their transition to work in American hospitals.

So far, all 11 of the program's graduates have been hired by the two participating local hospitals who took them on as nurses-in-training. Mora said the average change in wages for these participants from the time they entered the program until they were hired as registered nurses was 150 percent. The remaining 14 nurses are still in training or refining their ESL skills and none have dropped out of the program, giving it a rare 100 percent retention rate.

The program has filled the 11 spots vacated by the successfully hired nurses with new students and is still limited to 25 participants. Mora said the program is fully funded by the county government with $170,000 annually, adding that the state has expressed interest in expanding the program with the potential for additional state funding in the future.

Right now, Mora and others hope the program's small size can make a big difference in their community.

“For the longest time, we have looked at immigrants as a burden on the system,” Mora said. “We never think that these people have assets that we can put to use not just to serve Latinos but everyone. People come into this country and leave a lot of things behind: family, language, food, etc. When you lose your sense of who you are as a professional, it’s devastation for some people. My dream is that we will be able to help more people to bring them into the system.”