Dear Claudienne

I attended nursing school in the USA and graduated from Salt Lake Community College (SLCC) in May 2011 with an Associate Degree in Nursing and subsequently passed the National Licensing Examination (NCLEX) to obtain my RN licence. After much thought and deliberation, I felt prompted to return to Jamaica to pursue my career. Before returning to Jamaica I attempted to get information from the Nursing Council of Jamaica (NCJ), via e-mail, on the procedure for obtaining my RN licence, as there was no information on their website. I received no response to the e-mail. Subsequently, I requested a family member to visit the council and complete the forms on my behalf. I returned to Jamaica in July 2011 and followed up on my application. After submitting additional requested documents and having them evaluated by the committee, I was told that I did not meet the “minimum requirements” for an RN licence. I requested documentation of the “minimum requirements” at the certificate level but was told that they did not give out this information. That did not seem right.

Having been through the rigour of nursing school in the US, I could not fathom what was lacking in my programme that I could not qualify for a licence in Jamaica at a lower level (certificate) than I had studied. Dissatisfied with the information I was getting from the NCJ, I took my concern to the Ministry of Health (MOH) in 2012. My question was simple: why does Jamaica not recognise a US RN licence? I received no response from the ministry.

Since 2011, I have attempted dialogue with the council and the MOH in an attempt to answer some basic questions in relation to the deficiency of my training in the US as evidenced by my inability to qualify for an RN licence in Jamaica.

The concern I have is the lack of transparency in moving from the US system to the Jamaican system or even within the Jamaican system. There is no posted information on what the “minimum” requirements are.

There is no information on their website that speaks to how US-trained nurses transition into the Jamaican system.

There is no document on their website that lists the requirements to train as a nurse in Jamaica (and it needs to list it course by course with credit hours). So that anyone is able to look at the transcript and see an agreement between what they have and what the council is requiring. For example: here is the information from my nursing school: ( catalog.slcc.edu/preview_program.php?catoid=3&poid=476). SLCC clearly states the courses and the credit hours attached. Now if I look on the Nursing Council’s site, I need to see a listing of courses along with credit hours so I can see where I have fallen short … without them even having to send me a letter.

How does one bridge the gap between the US and Jamaican system?

When I went to UTech, I was told that based on what was asked I would practically be doing the entire programme. This can’t be right? I am being asked to do classes again that I have already done. Plus their programme is full-time. I have to work. Not to mention the lack of information on the cost. I asked and got the runaround on how much I would be required to pay to do it based on the classes I needed. Which school offers this bridge? Is there a programme here that I can transition into without having to do the entire nursing programme?

There needs to be a way to determine what is the equivalent of 1 credit in the US to 1 credit in Jamaica.

The NCJ letter to me clearly stated “MINIMUM” requirement which implies that there is a maximum. What is the minimum and what is the maximum? Degree nursing in Jamaica is a relatively new phenomenon so what was the requirement previously for those who did not have Bachelor’s degrees? Surely it can’t be the same standard? In the US the associate degree is the minimum and the degree is the maximum. What is the equivalent in Jamaica? Is there an equivalent? What is the breakdown of the 3000+ hours you were given, course by course?

I have been asking questions from the first denial of my registration … even before that … and to date cannot receive a satisfactory reply or one that makes sense. No paperwork was given to me stating the requirements to be a nurse in Jamaica and I have NEVER seen one on their website. If you find one, please let me know.

My concern is that the hours are arbitrary and I have nothing to compare it against. I know another nurse who studied in the US and the required hours she was asked for are totally different from what was asked of me, yet the US has one standard. How is this possible?

I would also like to know why I have not been afforded the opportunity to sit the Regional Examination for Nurse Registration (RENR) even though the council indicated in a letter to the MOH dated February 13, 2012, that they were taking steps to put this in place for foreign-trained nurses.

I believe that if we were afforded the opportunity to sit the RENR examination, this would provide an accurate measure of our competency as nurses.

I would appreciate your help in this matter.

AS

Dear AS

In 2015 when Tell Claudienne asked the permanent secretary in the Ministry of Health to respond to the issues you raised, we were informed that “the regulatory body for nursing practice in Jamaica was the Nursing Council” and that they should be contacted for clarification.

On September 22, 2015, the NCJ responded to requests for clarificaation from Tell Claudienne as follows:

“The Nursing Council is the regulatory body which controls the training and practice of nurses, midwives and assistant nurses. It also registers or enrols these persons when they have successfully completed the council’s qualifying examinations.

General nurses, midwives or assistant nurses trained abroad, seeking employment in Jamaica also have to meet requirements set by the council before they can be registered.

AS applied to the council for registration as a General Nurse. Her transcript of training was assessed by the responsible committee and found to be deficient for her to be registered as a General Nurse. By way of letter dated November 23, 2011 she was so informed and the deficiencies highlighted. She subsequently applied to be enrolled as an Assistant Nurse for which the length of training, topics covered and number of clinical and theory hours required are less than that of the General Nurse. Her application was again vetted to see if it met the requirements for her to be enrolled as an Assistant Nurse and was approved. Following the necessary processes, Ms AS was issued with her Assistant Nurse Licence.

AS was dissatisfied that she was not issued with a General Nursing Licence and wrote to the Minister of Health on the matter. A copy of the letter was forwarded to us through the then Chief Nursing Officer to whom we responded. Attached please see a copy of our response to her outlining the reasons AS could not be registered as a General Nurse.

Kindly contact me if you have any further questions on the matter.”

At your request Tell Claudienne asked the Nursing Council for their “minimum requirements for RN licensure at the certificate level. When the council sent the document to Tell Claudienne and we sent you a copy you observed that the information was erroneous as it was the minimum hours required for the nursing course of study at the bachelor’s degree level and not at the certificate level.

We note that you pointed out the discrepancy to the NCJ and that they acknowleged their error and agreed to re-evaluate your qualifications at their March 2016 committee meeting.

A letter the Nursing Council sent you on March 17, 2016 said that you had still not met the requirements.

However, you said that despite your requests, the council never provided you with the minimum hours required for the nursing course at the certificate level.

In May 2016, a new chairman of the NCJ was appointed and we note that you met with her on July 15, 2016 and was able to obtain documentation on the requirements for the basic nursing education programme at the certificate level.

From the document obtained from the NCJ chairman you learned that even though you had been told by the NCJ that your training was deficient by 875 clinical/105 theory hours the document stated that “Medical Nursing required 500 clinical/120 theory hours”.

On July 28, 2016 you received a letter that stated that your qualifications would be re-evaluated yet again at the council’s September meeting. The council requested your work history and on January 30, 2017 you were told that nothing had changed except for the discrepancy you had pointed out in the overstating of the medical clinical hours.

We note that you wrote to the Minister of Health Dr Christopher Tufton and that he asked the permanent secretary (PS) in the MOH to meet with you.

The PS met with you on October 9, 2017 and you informed Tell Claudienne that you mentioned the lack of transparency at the NCJ. You stated, “The PS indicated that this is one of the Hon Minister Tufton’s priorities. The PS agreed that more information should be available to the public on the NCJ’s website but indicated that she would not want to dictate to them.”

Tell Claudienne subsequently sent the PS a number of questions on June 29, 2018 and on July 5, 2018, the Access to Information Unit at the MOH sent Tell Claudienne the following responses to the questions:

Question: Kindly state the reasons why after this protracted delay the Nursing Council and MOH still denies foreign-trained nurses the opportunity to sit the RENR?

Answer: Discussions were held concerning foreign-trained nurses writing an examination to qualify them for registration, if they are successful. However, a decision for an implementation date has not been taken owing to a number of factors. One of which is the clinical examination which is a prerequisite for the current theoretical exam.

The council should provide further clarity as it relates to the arrangements to be made for the prerequisite clinical examination.

As stated the decision for an implementation date has not been taken owing to a number of factors, one of which is the clinical exams which is a prerequisite to sitting the theoretical examination (RENR). This has to do with where they would do the exams as well as the matter of what permission would be given since they would not be indexed or licensed to carry out any hands-on procedure on patients here. There is also the question of where these individuals would do the examination, would they be required to come to Jamaica or would they have to sit the examination at an overseas venue which would prove prohibitive for the council.

Although a decision was taken that people trained abroad would be asked to do the written exams for the RENR, there was and continues to be deliberations on the clinical aspect. Additionally, if and when this decision is ratified it will impact the bilateral programmes between Jamaica and other foreign countries; the expectation is that these nurses would also have to sit the examination to be registered and licensed to be employed in Jamaica.

Currently, there have been some preliminary discussions on e-testing for the theoretical exam and as such people trained abroad may be able to sit the RENR in this format. However, there still has been no final arrangements/agreement for the processes to be employed for the clinical part of the exams.

Question: After a five-year delay can the MOH and Nursing Council at this time give a definitive date when foreign nurses will be able to sit the RENR?

Answer: A definitive date has not been set as discussions are still ongoing

Question: Could the council kindly provide the MOH with an update regarding which committee has been given the task to address this matter and its progress to date.

Answer: The council had appointed a Committee for Persons Trained and Educated Overseas and after meeting several times, the committee recommended to council that everyone requesting registration and licensing in Jamaica should do the RENR. The delay in implementing this recommendation is due to that which is stated at No 1.

The committee has had no further meetings since then.

Question: In the event that foreign-trained nurses sit the RENR exam and are successful will they then be granted the RN licence?

Answer: This question cannot be answered at this time as the matter is still being discussed.

Question: Please clarify why there is no information indicating the courses and hours for licence requirements, at the various levels (Enrolled nurses and RN, on the Nursing Council website?

Answer: The coursework is in the blueprint which is available online.

The blueprint document is not found on the NCJ website.

The blueprint document for the RNs can be found on the CXC’s website not NCJ; the course for the EANs is not online at this time.

Question: Is there information on the Nursing Council’s website indicating the coursework requirements that nurses in Jamaica must complete before sitting the RENR exam?

Answer: The coursework is in the blueprint which is available online.

Question: Has the Nursing Council and the MOH ever had dialogue with the National Accreditation Board of Nursing Schools that establishes the standards for all US nursing programmes?

Bachelor’s programmes: American Association of Colleges of Nursing: www.aacnnursing.org/.

Associate Degree programmes: Accreditation Commission for Education in Nursing: www.acenursing.org/.

Answer: Each jurisdiction/boards of nursing has their own requirements. The Nurses and Midwives Act, 1964 and the Regulations, 1966 gives the council authority to register those who meet its requirements. Please see the Nurses and Midwives Regulations 1966.

Question: Has the Nursing Council and the MOH ever verified the accreditation of the nursing school attended by AS or other foreign-trained nurses?

Answer: Whenever the council is in doubt about an overseas training institution we ask for verification from the relevant regulatory body. The question is answered in the statement, “Though the name of courses and hours assigned to each course may differ from college to college, each has to meet the national standard before the sitting of the exam or granting of an RN licence.”

The council should indicate the source of the quotation.

This was a direct quote taken from the e-mail letter Tell Claudienne originally sent to the Minister of Health for action and which was forwarded to NCJ. (The quote was from information found by AS on the US RN website.) The council is aware that national standards must be met, likewise the national standards of Jamaica must be satisfactorily fulfilled before the council will register and license an individual whether they are trained in Jamaica or abroad.

Question: Are the Nursing Council and MOH aware that all the US nursing programmes must meet this national US criteria, established by the above-mentioned bodies, before participants in their nursing programmes can sit the National Licensing Examinations (NCLEX) and be granted an RN licence?

Answer: The Nursing Council is aware of the regulations

Question: Are the MOH and Nursing Council of the view that all of the US training programmes are inferior to the nurse training programme in Jamaica? If some meet local standards, could the Nursing Council state which US programmes meet the local standards?

Answer: The Nursing Council is not of the view that US training programmes are inferior to the Jamaican training programme. However, all applicants who wish to acquire a Jamaican nursing licence must meet the same requirements. When they do, they are registered or will be registered according to the requirement of the NCJ, as set out by the law. Please see the Nurses and Midwives Act, page 6, section 9, subsection 1, 2(a, b) and 3.

Question: Is there currently a tribunal to which nurses in disagreement with Nursing Council decisions can appeal?

The council is aware that there is an appointed tribunal. However, this question would best be answered by the Ministry of Health as the minister appoints the members of the tribunal and also makes the rules for them.

However, we must point out that this tribunal as set out in Second Schedule of the Nurses and Midwives Act, page 16 deals with disciplinary matters, such as cases where nurses, midwives and assistant nurses are struck off the Register or Roll (see page 8, section 12) Appeals to Nursing Appeal Tribunal and subsection 1, 2, 3, 4.

Question: Please clarify what instructions were given to AS regarding registration and whether or not they have been carried out.

Answer: The council has been in frequent dialogue with AS by way of letters, e-mails and telephone calls. Our last correspondence to AS dated March 20, 2018 advised her to show evidence for hours completed in the operating theatre. She was also advised that as soon as all outstanding hours were submitted she would be registered and licensed as an RGN. The council awaits the submission of the hours to license and register AS as an RGN.

Question: If there is a tribunal, can you kindly list its members, state how often they meet and how they can be contacted?

Answer: Please contact the Ministry of Health.

Based on the Nurses and Midwives Act 1964, the Appeals to Nursing Appeal Tribunal meets to address matters in respect of persons who are registered or enrolled under the Act.

AS is not yet registered.

Members of the tribunal are appointed by the Hon Minister of Health and as far as we are aware the Tribunal usually handles matters of a disciplinary nature. Please be advised that AS is the holder of an enrolled assistant nurse’s licence.

Question: Could you please state how many times in 2017 this nurses’ tribunal met?

Answer: We are not aware of the tribunal meeting in 2017. However, please contact the Ministry of Health for information regarding this matter.

The MOH has verified that the tribunal did not meet in 2017.

The NCJ informed Tell Claudienne on Thursday that in March 2018, you were notified that you had satisfactorily completed all the required coursehours to be licensed as a general RN, except for the operating theatre hours. You were told that you would not get the RN licence until you completed the operating theatre hours.

The council said that you have not communicated with them since then.

When Tell Claudienne contacted you on Thursday to find out if you were going to do the operating theatre hours to get the RN licence you sent us the following e-mail:

“This thing has just dragged on too long and I moved on with my life.

My life in Jamaica was extremely hard for the years I was there especially the going back and forth with the Nursing Council. To this day I don’t know why the fight. Try as they might to act as if nursing in Jamaica is superior to that of the US, it isn’t. But that is not even the matter. I am disenchanted with the system in Jamaica. There is such a culture of rudeness and the crab-in-the-barrel attitude. I don’t know why it is so hard for us to help each other rise rather than constantly actively tearing each other down.

When I took my first nursing job in Jamaica with other new graduates as myself I was on par with them in knowledge and needing, as they did, experience. Sadly I received a fight at every turn because I had attended nursing school overseas. Instead of being welcomed back for my decision to work in Jamaica, I was constantly asked why I came back, as if I had been forced to return due to deportation and had no other choice.

Instead of being helped I was hindered and taken advantage of by every institution I worked at. I was paid an unliveable wage. I made on average $50,000 per month and struggled to make ends meet. But by the grace of God they met.

I have no desire to pursue nursing in Jamaica and would leave the profession rather than work a day there at any of those institutions, with the MOH or interact with the NCJ.

It’s not about the licence, it never was. Had I been treated with any form of respect or courtesy from day one, this could have had a more pleasing outcome.

Thank you.”

We wish you all the best.

Have a problem with a store, utility, a company? Telephone 936-9436 or write to: Tell Claudienne c/o Sunday Finance, Jamaica Observer, 40-42 1/2 Beechwood Avenue, Kingston 5; or e-mail: edwardsc@jamaicaobserver.com . Please include a contact phone number.