Friday, March 7, 2014

The nursing/midwife saga update

My blogging efforts of late have been pathetic. But, to cut to the chase, I feel I need to update those curious on the details of my continued quest to work in Norway as a midwife. I apologize if this seems really disjointed (and not at all funny). I have written it several times over in the last few weeks as information evolves.

In mid-February (2014), I posted on Facebook that my final appeal for a nursing license had been denied. At that time, I thought that was true, and believed it was as black and white as “go start your education over again”. The actual decision, which we learned a few days later once it finally arrived in the mail, was that I must repeat 6 months of clinical training in geriatrics, home health care and psychiatric nursing. Then I can be authorized as a nurse. Then I must work for one year as a nurse in Norway. Then I can re-apply for the fourth time as a midwife. . . wait 6 months for a decision. . . perhaps need to appeal. . . .perhaps need to re-train 6-12 months, as was once originally recommended. . . and then 2-3 years down the road I might be able to work as a midwife. But, no guarantee. ‘Cause I’m not going to get that answer for another 1.5 years.

In May 2012, the appeals board had upheld the recommendationof SAK (the Norwegian authorization board) that I begin my entire nursing education from the beginning. They suggested I contact a nursing school and that perhaps I could get credit for a few of my American nursing courses.

That’s what we did. And what we found when contacting Norwegian nursing schools and nursing educators is that they were overwhelmingly supportive of my education and, after doing thorough reviews of my coursework and job experience, maintained that I did not need to repeat any nursing education. 

By September of 2013, with the help of an attorney, we finally managed to send in the following information to the appeals board, demanding that they do what is essentially an appeal of the original appeal (an omgjøringsbejæring), something that we didn’t know was an option until we actually spoke with an attorney.
*A four-page letter from a former dean of a local nursing program that explains how the number of credit hours I have earned as a nursing student in the United States actually exceeds the Norwegian hours. She points out that although I have fewer clinical hours than Norwegian, my 12 years of work experience can compensate for this.
*A letter from the fiery PhD-educated Norwegian nurse educator, stating the above as well.
*A letter from a third nursing college educator, stating that he agreed with the other two evaluations, and recommends that I become authorized as a nurse.
*A letter from a midwife who started the first and only master’s degree program for midwives in Norway, (of note: I have my master’s degree, nearly all midwifery programs in the US are master’s programs, and many are becoming doctoral programs), stating that my midwifery education and work experience is equal to a Norwegian, and she believes I should be authorized as a nurse and midwife.
*A letter from the regional office of the Norsk Sykepleierforbund (the Norwegian nurses union/professional organization) stating that they support my authorization as a nurse and midwife.
*A letter from the Norsk jordmorforbund (Norwegian midwife organization/union) supporting my authorization as a nurse and midwife.
*A letter from the Norsk jordmorforening (a second Norwegian midwife organization/union) supporting my authorization as a nurse and midwife.

In November, we heard that the appeals board would review my case in December, but they were first sending my paperwork to two new nurse educator/experts to review my application. They were not given any of the three letters from their fellow nurse educators to review, contradict, argue against, or agree with. We felt this was not a fair or complete evaluation, but there was nothing we could do, even with an attorney helping us out.

A day after the deadline for the new nurse experts to turn in their evaluations to the appeals board, one of them asked to see the “reading list” (essentially the syllabi) from my nursing classes at St. Olaf. This is despite the fact that she had detailed descriptions of every prerequisite class and every nursing class I took at St. Olaf. Needless to say, getting ahold of syllabi from 1995-97 was nearly impossible. The nursing department at St. Olaf bent over backwards trying to locate these, but were only able to find one

In mid-January we finally received the two reviews from appeals board’s experts. The first was completely in agreement with our four—that while Norwegian and American nursing education programs are different in their approach, if one looks at the entire content and the final result, combined with a decade of work experience—I should be granted authorization. The second evaluation—from the nurse educator who wanted the syllabi—focused on the number of hours that differed in our clinical training, and felt that if I did 24 weeks of supervised clinical training in geriatrics, home-health care and psychiatric nursing I could be authorized as a nurse.

The appeals board said they could not give any weight to the four evaluations that we had submitted, as they were “privately engaged” (even though they were supported by one of their own independent evaluations). And so they focused entirely on the evaluation that recommended I repeat 24 weeks of clinical training, and additionally took phrases out of context from the more favorable evaluation and used them to support the less favorable evaluation.  

The TV journalist who originally reported on my case back in November 2012 has been hot on this case. The nurses who wrote the independent positive evaluation have been interviewed, the midwives in charge of the midwife organizations and midwife education programs have been interviewed, as well as some of the members of the appeals board. Our house was full of four journalists a few days ago—TV journalist, print journalist for the online version, and two camera people—still and film, interviewing Erik and me, and capturing the darling American children speaking English and Norwegian. But I digress. . . The questions are, how can an appeals board of lawyers and judges, not one with an educational background, an only one nurse, feel that they are more qualified to evaluate a foreign nursing education than 6-10 nursing professionals? And how can they give so much weight to the most negative evaluation over the other 4-5 that are in agreement with one another?  

Erik and I don't know exactly where this is going. The report will likely air within the next few weeks, and it appears that it will be going national (writing that makes me sick to my stomach). Officially, we don't have any recourse in regards to the appeal aside from a lawsuit, which would cost us somewhere around $18,000 and another 9 months of waiting. That is not going to happen. But, there are enough very angry and powerful nursing professionals out there that, well, who knows what will happen. I am not alone in this fight--these nursing professionals are not fighting for my case alone--there have been dozens of other American-educated nurses turned away because of SAK's inability and unwillingness to recognize and understand the American credit system and acknowledge that there are other countries in the world that can adequately educated a nurse. What this case means for me, and for my fellow RNs. . . .? Only time will tell. 

And hopefully not too much time. To say that I am sick of waiting is the understatement of the century. I need a paycheck, like, yesterday. Those lawyer bills aren't going to pay themselves. 


  1. Sorry to hear that your struggle is still ongoing. I read your blog awhile back when you were engaged in all of the above.

    It is crazy to think that you could go back to the States and work effectively as a nurse/midwife but that Norway won't accept you as a nurse.

    Good luck with it all! I hope you are successful.

    1. Thanks Enie! What is also rather ironic is that if I don't work here in Norway as a nurse soon (like in the next few years) I'll have to do some re-certification training back the States as both a nurse and midwife, because I will have been out of practice for so long. But. . . nurses and midwives in Norway? No re-training, no continuing education necessary for them--for life!!!

  2. Wow. Sorry to hear of your troubles getting certified. I came across your blog by googling "American nurse in Norway" hoping to find someone writing about their experience practicing as a nurse in Norway. I’m surprised the SAK is so unfamiliar with the BSN education in the US. Given the large number of Norwegians who study in the US, I thought it was a given that a fair number of these had completed a BSN and gone through the process with SAK. I am, however, not at all surprised by the SAK’s resisting your appeals. Norwegians are, in my humble opinion as a native Norwegian, very rigid and will resist, to a fault, admitting they were wrong even when it is obvious to any reasonable person. This appears especially true of public entities. So sorry for your headaches with all of this.

    Your story is also personally concerning for my family. My wife is a certified geriatric RN (with a BSN) in the US and we have been discussing moving back to Norway. We thought the biggest hurdle for her would be finding a job with her limited Norwegian ability. I guess we were wrong. Ugh. Either way, thanks for documenting your story. It is disheartening, but helpful to us.

    1. Dan, thanks for writing. As awful as this situation is, and as much as I hate all the negative emotions writing about it brings up, I am so very glad that I can help other people as they navigate through this system, or consider the possibility. It is possible that after my news story aires that something will change within SAK and helsepersonnelnemnd that will make it easier for americans to gain authorization here in Norway. Perhaps one benefit that your wife has is that she is a geriatric nurse, and that is one of the areas that SAK considers Americans to be deficient in in their basic nursing education. The fact that she has years of experience as a geriatric nurse will perhaps help her out. Stay tuned to this blog, and I will continue to update my readers on what's happening in Norway! If you want to contact me personally, send me an email at em (dot) stange (at) gmail (dot) com.

    2. Thanks for your reply. We'll be in touch via email when we get a moment to think/breathe (we have a newborn)

    3. Congratulations on the new baby, Dan! I certainly understand how they can take up all your time and energy. I just put all this on the backburner when my son was born, as all I wanted to focus on was happy, positive things, and not the sucky work stuff when there was so much goodness in life.

  3. Emily, I need to be in touch with you personally. I am finishing up my final year at NYU College of Nursing Masters in Nurse-Midwifery and plan on moving back to Norway immediately after. I am freaking out, and so are my family and friends in Bergen, Oslo, etc.. You don't have an email address posted so I don't know how to be in touch more privately. What do you suggest?

  4. Hilde, please leave another comment with your email address and I will contact you. As you may be aware, now is not the time to apply for licensure in Norway. You are sure to be denied, I'm afraid.

  5. Hi Emily --

    I found you also by searching ''american nurse in norway''...because I'm applying for the second time around. :) Did you ever get a positive response? Do you know of any American nurse who has ever gotten 'godkjent'?? Thanks for taking your story to the press and for working so hard to try to rectify this incredibly illogical system.

    -- Kim Lyngstad (kleyrer at gmail dot com)