Guest Post from Ambassador Kate:
So you want to work as a travel nurse in the US but are currently working in Canada? The process is quite complex and can seem overwhelming so I’ll try to breakdown the steps.
Timing – A Year in the Making
The process of getting licensed and ready to actively look and submit for current jobs could take almost a year depending on processing times. Some travel companies advertise expedited service but unfortunately there is not a quick way to move the process along.
I would caution about having a company reimburse you upfront for the costs due to the length of time from initial application to being able to work is long if you decide not to travel you will ultimately have to reimburse them for the costs. The specific company many not have work in the location you want to go to when you are authorized to work in the US and having to fulfill a certain number of assignments with them.
Also, as other travel nurses will advise you any company reimbursement for car rentals, licenses, etc all comes out of the ‘total pay’ and you would get less pay as the company would deduct those costs from the package. Either way technically you pay for it as sadly it isn’t free. The expenses of getting licensed is a deduction though on your tax return if you weren’t reimbursed by a company.
It is a big change from nursing in Canada but can provide a great experience. If you’ve been a nurse for at least 2 years and have steady experience in your specialty then you may want to head south for a new adventure.
NCLEX and Licensing
The first step is take the NCLEX exam. The majority of RNs in Canada took the CRNE which unless you took in the 1970s is not recognized. In 2015, the NCLEX replaced the CRNE in Canada as the national license exam. If you are like me, it may have been many years since you took the CRNE. There are many helpful resources (books, courses, tutorials, etc) to help you study for the exam. The exam is very different from how nursing is practiced in Canada and I recommend that you study and do take the test lightly!
In order to take the NCLEX, you need to register with a US state board of nursing (BON) and apply for ‘Licensure by Exam for Foreign Educated Applicants’. Here is where Canadian nurses can be frustrated. Every state board has different requirements for what they require on the application. Many require a Social Security Number (the equivalent of the Social Insurance Card in Canada) but some do not. Although you may not have any desire to work in your initial state you can apply to endorse the license after to your desired states (discussed below).
I was personally licensed in Minnesota as they do not require a SSN for foreign applicants. I always recommend nurses to check with the individual boards as their requirements can change often. Fill out the application as specified and mail in the documents requested.
Canadian License Verification
You will need to have your Canadian licenses verified by the provincial registration authority along with your school transcripts. Most charge a varied fee for that service and can take up to a month in my experience to be processed and mailed out. These need to be mailed directly from to the state board from the nursing authority or school or will be rejected.
Authorization to Test
Once all the required documents and fees have been approved the BON will issue you the authorization to test (ATT) which allows you to register with Pearson Vue and take the NCLEX. It is only valid for 90 days so you need to be ready to test quite soon.
You then register online for a testing date and pay the exam fees. After testing you will be notified if you are successful or unsuccessful at the test. If you passed, you will be officially licensed in that state but if you are unsuccessful you will need to repay the fees to the BON and the exam fees to retake it.
If you did take the NCLEX and not the CRNE in Canada you will still need to apply with a state in the US to be licensed in the US. You will need to contact the specific boards on their requirements and required forms to complete as the having nurses in Canada writing the NCLEX is still new.
The Visa Screen
Once you’ve passed the NCLEX and are officially licensed you are now able to apply for your Visa Screen. The Visa Screen is Homeland Security document screening process that is mandatory for foreign educated nurses wanting to work in the US. It is NOT optional and you will be unable to get a TN visa without it. CGFNS (is the company that you apply for the visa screen with. It is $540 and you apply online and then print and mail off the required documents to the nursing authorities and schools.
Be warned this takes a long time (6 months or longer on average). I have found that once a document is received in their office it takes around a month to be entered in your file. Once all the documents they require and are entered in your file you have the option to pay another $500 for expedited processing. Without the expedited processing it commonly takes 1-3 months to be approved.
Ready to work!
Once you have passed the NCLEX, have a state license, and Visa Screen you are now able to look for travel nursing jobs and connect with companies and recruiters. I have completed many travel assignments. The first thing I always ask prospective recruiters and companies is whether they work with Canadian nurses and are familiar with the TN process. Not all companies are. Asking in advance can save you time with those who don’t.
License by Endorsement
If you don’t intend on working in the state you are licensed in you will need to ‘Apply for endorsement’ to the state you are wanting to work in. You will hear many states are ‘Quick licenses or Walk through’ by US trained nurses. It has been my experience that unfortunately it is not the case for nurses not educated in the US.
Board of Nursing Requirements
All BON have varying requirements from fingerprinting, transcripts, wanting Canadian license verifications, etc. Also, if working in New York is your plan be aware you will need to reapply for a New York state screening with CGFNS again ($465) and takes 6 months. Also some states require a Certified Education Screening (CES) Professional Report from CGFNS for Canadian nurses which is ($350). I always advise nurses to not agree to a job without having a license in hand. Some boards will grant a license but only within a few days of starting a job (AZ for example).
So you have the NCLEX, Visa Screen, License(s), and contract…now it is time to get the TN visa. The TN visa is granted at the border only on the day you officially leave Canada and enter the US. You are not able to get it ahead of time or they will reject your application. You will need to have the original paper copies of the following to present to the officer:
- TN letter from your company
- Visa Screen
- Nursing Degree
Once you have the visa and are your new city you then take all the paperwork to the Social Security Administration office and apply in person for a SSN.
What I wish I’d Known
While I have learned a ton while traveling and working in the US. There are however, a few things that I wish I knew previously.
One major difference from Canada to US nursing is that hospitals here can and do cancel shifts if the census is low. You will have no sick time or paid vacation time which is different from Canada.
You may find that many hospitals want to see US nursing experience. Many times they will overlook your Canadian experience or previously completed travel contracts. Don’t give up. It may mean you need to take a contract somewhere other than your dream location to start with.
Keep in mind that your Canadian credit score doesn’t count here. You will start with zero credit. This means you will need to be prepared for high deposits for housing rentals, cell phones, cars, etc. Over time you will build your US credit score. You will also need to get a US bank account. Travel nurse companies will require a US account to deposit your pay.
As you can see the process to becoming approved to work in the US is complex. I don’t regret making the investment. I have learned a lot and made lasting friendships and had some wonderful experiences.