Starting this week Massachusetts is offering the written exam that certifies nursing assistants in Chinese, Spanish as well as in English.
Advocates for immigrants say they also want the English to be easier to understand.
Laurie Millman, executive director of the Center for New Americans said offering the exam in more languages is a step in the right direction, but it doesn't address all barriers.
"They need to take the written part of the exam and make it more accessible to highly qualified immigrants," she said. "They need to make it more accessible for English language learners to demonstrate how qualified and capable they are."
Asani Furaha, of Northampton, was a refugee from the Democratic Republic of Congo, where she was a registered nurse. She worked as a nurse for Doctors Without Borders in Burundi.
She passed the clinical part of the test that certifies nurse aides the first time she took it in 2019.
But it took her four times before she passed the part of the exam taken in English on a computer. The way the questions were worded in English was difficult to understand.
"You know things, but you don't understand what [it] means," she said about the test.
She works now as a CNA in western Massachusetts in two facilities.
The Executive Office of Health and Human Services said according to the test's vendor, D & S Diversified Technologies, the test is written in a 6th grade reading level.
The state is working on offering the test also in Haitian Creole, as part of an effort to reduce the shortage of health care workers in the state.
Employers will be able to see in which language a CNA passed the exam.
The test is free for people taking it for the first time.
The State House News Service contributed to this report.
