When nurses make aliya

‘Israel was asking people who are highly licensed and very skilled to give up their source of employment just to prepare to take an exam. Who could do that?’

By RIVKAH LAMBERT ADLER
Dr. Caryn Andrews (photo credit: CARYN ANDREWS)
Dr. Caryn Andrews
(photo credit: CARYN ANDREWS)
Before making aliya to Jerusalem in 2011, Dr. Caryn Andrews treated 400 patients a month in an outpatient oncology center and another 100 patients a month in a part-time family medicine practice.
When she got to Israel, she wasn’t even legally allowed to take a patient’s blood pressure.
That’s because she’s an advanced practice nurse and not a physician. Despite three decades of experience, three academic degrees, including a PhD, and four nursing credentials, she wasn’t able to get a nursing license in Israel.
The situation for nurses making aliya was so unfavorable that the aliya advocacy organization Nefesh b’Nefesh passively discouraged US-trained nurses from trying to get licensed as nurses in Israel.
Andrews wasn’t dissuaded. She realized that the problem wasn’t exclusively hers. So she put together a group of immigrant nurses who were stuck in Israel’s bureaucratic system and pushed forward, trying to make a change.
Thanks to her efforts and the work of Nefesh b’Nefesh, the licensing law for nurses recently changed, making it much easier for nurses who make aliya to work in Israel. Today, the Health Ministry is actively working to increase number of nurses making aliya.
But it wasn’t always that way.
When Dr. Andrews was recruited to teach in the Hadassah-Hebrew University School of Nursing, she was required to make aliya and get licensed as a registered nurse. She submitted all her credentials to the Health Ministry.
It took three months to examine her documents.
Once the ministry approved her documents, it required her to take the same general licensing exam new nursing school graduates take, an exam that covers all areas of practice, despite the fact that she had specialized decades before.
However, before she could even sit for the licensing exam, she had to pass a Hebrew proficiency exam. So she spent a whole year studying Hebrew, including taking a medical ulpan and another private ulpan, for which she paid out of pocket.
She tried in every way possible to work within the existing system. She had to give up her job in America to prepare for a year. Israel didn’t offer temporary licensure, so she wasn’t able to work as a nurse in Israel either.
“Israel was asking people who are highly licensed and very skilled to give up their source of employment just to prepare to take an exam. Who could do that?” Andrews asked.
The Health Ministry wouldn’t accept her ulpan or medical ulpan exam results.
It required that she pass a college entrance- level Hebrew proficiency exam.
On top of these two major hurdles, she would have to wait almost a year to take the nursing licensing exam in English, since it was only offered once a year and she just missed the cut-off.
That’s just one case. These hurdles stopped many immigrant nurses from working in Israel.
The first efforts of Andrews to address the problem at its root were not too successful. She put together a list of 10 immigrant nurses who were stuck in the bureaucratic system and presented her list to lawmakers and aliya advocates.
She was plainly told, “Come back when you have 100 nurses who are impacted.”
So she harnessed the power of social media and started a Facebook page called “Nurses Making Aliya.” Eventually, she and her team opened a Facebook group and a website with the same name, all in an attempt to advocate for, and to provide accurate information to, prospective immigrant nurses.
“We started with nurses in the US and Canada. Now we’ve opened up Nurses Making Aliya to the whole world – Spain, Gibraltar, France, Ireland, Australia, South Africa, etc.”
She quickly developed a list of 100 and went back to try again. Andrews’ goal was simple. She wanted “to get nurses working as soon as possible. People were going back to the US because they couldn’t feed their families.”
Eventually, she formed a team with Lizi Martin and Ronen Fuxman of the government advocacy department at Nefesh b’Nefesh. That was the winning formula.
“We wanted nurses to be able to apply for a license even before making aliya.
That’s what doctors and dentists did, so they could work immediately upon making aliya,” Andrews asserted.
“You used to need a teudat zehut [identity card] and teudat oleh [immigrant certificate] before the Health Ministry would even look at your documents.
Now, if you’re in the process of making aliya, you can apply to get your credentials reviewed and everything set and ready to go, so when you arrive in Israel – on aliya, as a tourist or on a work visa – you can take the exam.” In addition, the licensing exam is now offered in English twice a year.
Andrews highlighted another important change. Today, the requirement to pass a Hebrew proficiency exam can be completed before or after the nursing exam. If a nurse takes the licensing exam first, they can begin working, for minimum wage, while preparing for the Hebrew proficiency exam.
Asked what made her think she could change things, Andrews laughed and said, “I don’t like people telling me no.
When someone said it’s not going to happen in my lifetime, I responded, ‘Don’t ever say that to me!’” In truth, Andrews got a lot of support from Dr. Miri Rom, her dean at Hadassah.
“If not for her, I probably wouldn’t have kept going. When I was called into the office of the Chief Nurse of the country, Dr. Rom gave me some pointers. She also restored a review course nurses needed to take before they could sit for the license.”
Today, nurse supervisors all over the country are willing to hire nurses making aliya. “They get jobs now. It’s not a problem anymore,” said Andrews.
Thanks to these changes, 40 immigrant nurses are licensed annually. Before Andrews and her team addressed the issues, only one or two made it through the system each year.
Newly licensed immigrant nurses are effectively on probation for their first year working in Israel. Most have to start over in entry-level jobs in nursing homes or kupot holim [health funds]. Despite this, according to Andrews, once nurses start working, they are generally happy.
In addition to the work of Martin, Fuxman and lawyer Simon Seitz, Andrews gives credit to Shoshi Goldberg, Israel’s newest chief nurse.
“She pushed through most of these changes. She’s open to the idea of nurses making aliya,” Andrews explained.
Even though the fight is behind them and the resources are readily available to prospective immigrant nurses for free, Andrews still spends about 10 hours a week mentoring nurses making aliya, along with Fuxman and Seitz.
Nurses who have already been through the system now answer questions for prospective immigrant nurses.
“I’m so happy when I see nurses helping each other. I don’t have to answer every question anymore. Nurses are helping each other. That’s what making aliya is. Being there for each other,” Andrews remarked.
There’s still another battle to be waged.
“This is my next challenge. To get Israel to recognize and employ family nurse practitioners who will work as primary care nurse practitioners in kupot holim.
Sixty percent of all primary care physicians working in Israel are over the age of 60, so there’s a reason to think there’s going to be a shortage of physicians.”
Flush with success solving the nursing licensure problem, Andrews estimates it will take two years to make this happen.
“I think I can do this!” she said confidently.