8 Steps Canadian Nurses Must Take to Work in the U.S.

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I learned I’d be part of the second Canadian cohort to take the National Council Licensure Examination for Registered Nurses (NCLEX-RN) instead of the Canadian Nursing Association exam while in nursing school. At first, we were completely thrown off, including the instructors, treading into this unfamiliar exam. 

But then, the excitement kicked in as we realized that passing the NCLEX would give us credentials to work in the U.S. If you graduated in Canada after 2015, you’ve already taken the NCLEX. As a Canadian nurse, passing the NCLEX is one of the biggest hurdles to becoming an internationally trained nurse able to work in the States. The pure accomplishment of passing this exam may spark your interest in becoming a U.S. travel nurse.

Let’s examine the key steps in transitioning from a Canadian nurse to a U.S. travel nurse and the major differences between nursing in the two countries. It’s important to note that this information only applies to registered nurses (RNs), as the process looks different for licensed practical/vocational nurses. 

Related: Why Canadian Nurses Should Explore the U.S. Travel Nursing Market

What’s the Difference Between Nursing in the U.S. vs Canada?

Before you pack your bags and head stateside, consider the differences in the nursing work you’ll encounter and whether you’re up for the challenge. 

First, the travel RN pay structure significantly differs between Canadian and U.S. travel nursing contracts. In Canada, you earn an hourly wage, receive agency-provided housing or a housing stipend paid directly to the landlord, and get a small tax-free daily per diem rate. In the U.S., contracts usually offer a weekly sum that includes your tax-free housing stipend (if you qualify), giving you the flexibility to choose your housing and potentially put more money in your pocket. Also, Canadian contracts generally start at four weeks, whereas U.S. contracts often require a minimum commitment of 13 weeks. 

To gain a deeper understanding, we discussed the contrast between Canadian and U.S. nursing with Manya Links, an experienced Canadian nurse who has been travel nursing in the United States for the past two years. 

In the U.S., funding is mainly privatized, leading to a focus on efficiency, documentation and meeting specific metrics to ensure reimbursement. Nurses often work under more pressure to meet these guidelines to achieve their institutions’ financial goals. In Canada, the government-funded system emphasizes patient-centered care, focusing on quality and continuity. Nurses may have more time for each patient, though they might also face resource constraints.

Links found it challenging to prioritize metrics over patient care. 

She explained, “Coming from smaller hospitals in Canada, I’ve never seen anything like these large organizations. I have a lot of appreciation that they’re implementing these tasks to keep patients safer. Initially, it was frustrating because I had to modify how I practiced and how I worked with patients in their rooms. I had to ensure the tasks were done. Over time and as I adjusted, I could see that I can do both: give great patient care and perform well according to metrics.” 

Links explained the difference in break culture between the two countries. Reporting that break culture in the U.S. is almost nonexistent. She said that during a 12-hour shift, you struggle to get a 30-minute break, but you must clock in and out for exactly 30 minutes to comply with state labor laws. 

“Although most nurses use this time to sit and eat at their desks and continue to work,” said Links.

The break culture of rarely sitting down during a 12-hour shift differs from Canada, where there’s usually a coffee, lunch and dinner break. 

Once you’ve considered your options and decided you’re ready to start working as a travel nurse in the U.S., you may wonder where to start. The process can be lengthy and complex, but the step-by-step guide below can help clarify things. Please note that all costs discussed are in U.S. Dollars.

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8 Steps Canadian Nurses Need to Take to Travel Nurse in the U.S.

1. Meet the Minimum Requirements 

According to the Commission on Graduates of Foreign Nursing Schools (CGFNS), the minimum requirements to practice in the United States as a nurse educated in Canada include:

• Graduating from an accredited nursing school 
  • Canada only has Bachelor of Science in Nursing programs to become an RN
• Currently licensed as an RN in Canada
• Minimum of 2 years of work experience as an RN

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2. Pass the NCLEX-RN

The NCLEX-RN is the standard nursing proficiency test used to obtain nurse licensure. Passing this exam is required to practice as an RN in the U.S. and Canada. If you’re a Canadian RN who graduated after January 1, 2015, you’ve written the NCLEX-RN exam, and if you haven’t taken it yet, you must do so before proceeding any further.

According to the NCLEX website, the registration fee for people seeking U.S. licensure is $200. You must allow yourself an appropriate amount of time to study and prepare for the exam. 

3. Obtain a Passport

If you don’t have a passport, you must get one before traveling to the U.S. According to the Government of Canada’s website, passport applications are currently being processed within 20 business days if you bring them to a receiving agency and 10 business days if you bring them to a passport office, not including mail time.

4. Complete a VisaScreen

A VisaScreen® is an in-depth screening of all your nursing education and credentials completed through CGFNS International. This screening is for international healthcare professionals wanting to work in the U.S. Part of the requirements includes taking an English language proficiency test. However, you won’t need to complete this step if you did your nursing education in English, using textbooks written in English. Most Canadian nurses are exempt from taking this test except those who completed their education in Quebec.

The application fee for a VisaScreen is $740. Plan for this entire process to take approximately 3 to 6 months from start to finish. There’s an option for an expedited VisaScreen service, which costs an additional $650 and has an estimated, but not guaranteed, completion time of 10 days. I found the primary and most timely challenge of the VisaScreen process was contacting all the necessary organizations for documents like transcripts and licenses, ensuring they were updated and sent to CGFNS. Once your VisaScreen® is issued, it’s valid for 5 years. 

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5. Obtain a State Nursing License 

Just as in Canada, where you need a different license for every province, a Canadian nurse working in the U.S. must obtain a separate nursing license for each state. 

Each state has a Board of Nursing (BON) with varying requirements for obtaining nurse licensure. Each BON also has varying fees and associated wait times to process your application, ranging from 4 weeks to 6 months. 

Fees are generally much cheaper in the U.S. than in Canada. Also, U.S. licenses are valid for 2 years or longer in all states but Connecticut, Kentucky and Washington, where they’re only valid for a year, like in Canadian provinces. 

You’ll likely be required to do a criminal record check with fingerprints. Usually, the BON you have applied to will send you a hard fingerprint card you must get done at your local Royal Canadian Mounted Police detachment. These cards must be returned to the BON in a sealed envelope.

The BON may ask you for a Credentials Evaluation Report that you obtain through CGFNS to be sent directly to the nursing board you’re applying to. This requirement is why getting your VisaScreen first is an essential step.

Your next step is deciding the best travel nursing state for your first assignment. If you don’t have a Social Security Number (SSN), you should pick a state that doesn’t require an SSN to obtain a license for your first assignment. Currently, 16 states and Washington, D.C., don’t require an SSN to get your initial license, including:

• Colorado
• Connecticut
• Idaho
• Illinois
• New York
• Massachusetts
• Minnesota
• Michigan
• Montana
• New Jersey
• Oregon
• Pennsylvania
• Texas
• Virginia
• Washington
• Wisconsin

However, the BON might require you to provide proof that you don’t have an SSN. To do this, apply for an SSN, which will be denied. You will receive form SSA-L676, which proves your status as a nonimmigrant and not eligible for an SSN. The BON may also ask for an I-94, which is easy to obtain online. You can usually send a screenshot of both forms to the BON. 

Before it’s time to renew your RN license, look at the continuing education requirements by state. This process is different than it is in Canada, and each state has its own requirements.

Related: How to Find Free CEUs for Nurses

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6. Pick a Travel Nurse Agency and Get a Job Offer

Once you have an active nursing license, you’re ready to land your first travel contract. Start looking for open travel jobs on Vivian or set up your profile to receive job alerts matched to your needs. 

Although it can be tempting, Links encourages new travel nurses not to get caught chasing the highest-paying contract. 

“The best thing I did was try a few recruiters and companies so that I knew what shady felt like, and I knew what being respected and taken care of felt like,” she said. “If you can find someone to refer you to a recruiter who has been in your shoes, it’s a great start.” 

Links reiterated the importance of a good recruiter, as they help you avoid unrealistic contracts by informing you if positions are oversaturated, housing is hard to find or the hospital has a poor reputation or safety issues. When you face a practice issue or workplace drama, having a recruiter and company that knows you and can vouch for you is invaluable. Their support and familiarity with your work provide consistency as you transition through new units and practice environments every few months. 

It’s also vital to work with a recruiter who has experience working with Canadian nurses. If your recruiter isn’t savvy on the process for Canadian travel nurses, it can take way longer to figure everything out. Not having the proper steps or paperwork in place can severely waste your time and money.

After receiving an official job offer, your employer must provide you with written documentation of the offer to obtain a TN visa to enter the U.S. to work. Per PassportUSA, this letter must include your job title, a description detailing your role, pay information and the amount of time requested to work in the U.S. 

You can request a maximum of 3 years of access at a time, but Links reminds readers that, “Being Canadian, you have to get a new visa for every company you work for–another reason to stay with the same company once you find a good fit.” 

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7. Obtain a Nonimmigrant NAFTA Professional (TN) Visa for U.S. Entrance

Obtaining a TN visa is the quickest and most straightforward way for Canadian healthcare professionals to work in the U.S., making it the best option for those wanting to take travel nursing contracts. The TN agreement was created as a special economic and trade relationship between the U.S., Canada and Mexico. This agreement allows Canadian citizens in certain professions, such as RNs, to enter the country for work. Once obtained, TN status is valid for up to 3 years. 

There are two ways to obtain your TN visa: through the mail/online application or in person.

According to U.S. Citizenship and Immigration Services, if you choose to obtain your TN visa by mail or online, there’s a non-refundable filing fee of $460. Your employer must complete form I-129, Petition for a Nonimmigrant Worker. 

The more popular and straightforward option is directly at the U.S./Canadian border. Be sure to bring your passport, proof of your U.S. state nursing license, your IHCP certificate from your VisaScreen and the letter from your employer with your job offer details. It’s crucial to bring the original documents, as they may or may not accept copies. 

Getting your TN visa at the border is very border guard-specific. Some people breeze right through, while others get put through the wringer. It’s best to have all your paperwork in order and be prepared for a tough border guard. This route only costs $56, and you wait while an agent completes the process on the spot.

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8. Obtain a Social Security Number

After entering the U.S., apply for an SSN. You’re only permitted to enter 10 days prior to your contract start date. Bring all relevant documents, including your visa and job offer letter, to a Social Security Administration (SSA) office. You must wait to begin work until you receive your SSN. Often, you can go to an SSA office the day after you apply, and they’ll write your number down for you. You receive your SSN card at your home address in Canada. 

Once you have an SSN, you can begin your first contract. Plus, you can apply for licensure in additional states, broadening your travel nursing opportunities for your next contract. Obtaining your SSN opens many doors in your U.S. nursing career.

When considering travel nursing in the U.S. as a Canadian, there are many factors to keep in mind. One major consideration is the timeline. Getting everything in order takes significant effort, including all your documentation and verifications. The CGFNS process can be a hassle, and landing your first contract is often the toughest part of navigating the ups and downs of it all. However, once you overcome those hurdles, the rest becomes much easier.

Sign up for the Vivian app to search for U.S. travel nurse jobs and set up job alerts for when new jobs that match your needs post on our jobs marketplace.

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Editor’s Note: This post was originally published on August 23, 2022, and was updated on July 2, 2024.
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