21 Guides for Canadian Nurses travelling in America

Detailed information on what Canadian Nurses need to ensure their travel experience on the TN Visa is as smooth as can be!

Resources to help you along your journey!

Nurses

Our Guides

Guide 1:
The top reasons to take your Nursing career to the USA

1. Better Salary & Travel Stipends

2. Working conditions & Patient Ratios

3. Scheduling & Time-off

4. New Travel Experiences, Cities and People

5. Better Lifestyle Opportunities

Are you a Canadian nurse considering a change in your career path? If so, you might want to consider taking your nursing career to the USA. Here are some of the top reasons why:

  1. Better Salary & Travel Stipends: The United States offers much better salaries and travel stipends than Canada.
  2. Working Conditions & Patient Ratios: In general, US healthcare facilities have better working conditions, facilities and patient ratios than those in Canada. This means that you'll have more resources and support to help you do your job effectively and safely.
  3. Scheduling & Time-off: One of the best things about working as a nurse in the US is the flexibility in scheduling and time off. The normalized contract is 3 Shifts x 12 hours a week on a 13-week contract, you have plenty of time to explore or make more, wherever your heart desires!
  4. New Travel Experiences, Cities and People: Lastly, working as a nurse in the US offers the opportunity to travel to new cities, meet new people, and experience new cultures. From the hustle and bustle of New York City to the laid-back vibes of Los Angeles, there are so many exciting places to explore.
  5. Better Lifestyle: Different cities provide different experiences and it’s important to find a city where you can thrive in and outside of work, and for most that means somewhere warm!!!

Whatever your reason is you can definitely explore and make more travelling the USA as a Canadian Travel Nurse, reach out to us with any questions you may have!

Guide 2:
How the American Healthcare System works

1. Hospitals & Healthcare are the largest industry in the USA

2. Private hospital systems use Managed Services Providers (MSP) to handle staffing shortages

3. The MSP implements a Vendor Management System (VMS) to source potential candidates

4. Multiple Agencies connect to VMS to source jobs

5. Recruiters find Nurses for their specific agency

6. Nurses are the most needed resource in America.

  1. The healthcare system in the United States is often considered one of the most complex in the world, with a unique structure and a variety of stakeholders involved in the provision of care. Healthcare and hospitals are the largest industry in the  USA,  generating  over  $1.3 trillion dollars in revenue every year.   
                  
  2. Private hospital systems use Managed Service Providers (MSPs) to help them manage staffing shortages. MSPs are companies that specialize in providing staffing solutions to hospitals and other healthcare facilities. They work with hospitals to identify areas where there are staffing shortages, and then provide a range of services to help fill those gaps.                         
  3. One of the key services provided by MSPs is a Vendor Management System (VMS). A VMS is a software platform that helps hospitals manage their staffing needs by providing a centralized system for managing vendor relationships, sourcing candidates, and managing the hiring process.
  4. Agencies that specialize in providing nurses and other healthcare professionals to hospitals can connect to the VMS to source job opportunities. These agencies typically have a pool of pre-screened nurses that they can quickly match to open positions.
  5. Recruiters help find and place nurses throughout facilities across the United States. They work with their respective agencies to identify open positions and then help to match qualified candidates to those roles. Some Recruiters tend to tell you what you want to hear, so choose wisely.and ensure you feel comfortable with your organization.
  6. Nurses are the most needed resource in America's healthcare system. The demand for nurses continues to grow as the population ages and more people require healthcare services. This demand is expected to remain high for the foreseeable future, making nursing an attractive opportunity for both work and play while you see new destinations. across the country.

If you feel like you need help navigating the American healthcare system, jump on a quick meeting and we’ll help you get started

Guide 3:
The TN Visa Process

1. Gain 1-2 years experience in the nursing specialty of your choice

2. Research target states

3. Apply for an ITIN (if heading to California)

4. Apply for a State license

5. Apply for Visascreen, Visa4Nurse or ERES

6. Find a nursing job

7. Prepare your TN Visa documents for border crossing

8. Apply for a SSN


The TN Visa Process for Canadian RNs is a series of steps that Canadian Registered Nurses (RNs) must follow to work in the United States. Here is a breakdown of the main steps involved in the TN visa process for Canadian RNs:

  1. Gain 1-2 years of experience in a relevant speciality at a local hospital in Canada. If you are just starting up as a nurse, you might want to pick a specialty that pays a higher rate in the states (OR, ICU, ER, ...).
  2. Research target states: Before beginning the TN visa application process, it's important for Canadian RNs to research which states in the United States have opportunities in their speciality.
  3. Apply for an ITIN : If you want to apply for a licence straight to California, you will need an ITIN for be able to file your application. An ITIN is a tax number from IRS. This step can be trick so don't hesitate to reach out to us if you need assistance. If you're not heading to California - skip this step!
  4. Apply for a state license: Canadian RNs must obtain a license to practice nursing in the state where they will be working. This involves meeting the educational and licensing requirements of that state, which may vary and can take from 2 weeks to 6 months - state dependant. Gather your documents: You will need to provide different documents to the Board of Nursing of your chosen state (including copies of your diploma and nursing license). Generally your transcripts need to be sent directly to the Board by your University. The required forms to fill and documents to send vary depending on the state. Also keep in mind that if you studied in a language other than English you will need to have your documents translated.
  5. Apply for Visascreen, Visa4Nurse or ERES: Canadian RNs must apply for a credential evaluation service (CES) to prove they meet the educational and licensure requirements for nursing in the United States.
  6. Find a nursing job: Get a job offer from a US agency or hospital who is willing to sponsor your TN visa application.
  7. Prepare your TN Visa documents for border crossing: Canadian RNs must prepare the required TN visa documents, including their job offer letter, educational transcripts, and CES certificate, to present to US border officials when they cross the border.
  8. Apply for a SSN: Once in the United States, Canadian RNs must apply for a Social Security Number (SSN) so they can be paid by their US employer and pay taxes.

It's important to note that the TN visa is valid for up to three years and can be extended for additional three-year periods. However, the TN visa is a non-immigrant visa, so it does not lead to permanent residency in the United States. If looking to permanently relocate, Hospitals in are always looking for Nursing staff and will usually sponsor a Greencard. 

If you need help navigating the process, reach out and we will pair you with an Adventure Mentor to get you started off on the right foot.

Guide 4:
Canadian RN Qualifications & Specialties

1. Previous nursing experience

2. NCLEX

3. Credential Evaluation Services (CES)

4. TN Visa

5. Charting Systems

6. Nursing specialities

7. English proficiency exam (if coming from Quebec)


1. Previous nursing experience

One to two years of experience as a nurse is typically required to work as a travel nurse because this type of nursing involves a higher level of responsibility and requires a significant amount of clinical experience. The training period is usually very short so you need to be able to adjust quickly to a new work environment. As a travel nurse, you may be working with unfamiliar equipment, procedures, and protocols. Adaptability is key.

Most agencies or hospitals won't consider your application if you have less than 1.5-2 years of experience. It is important to note that you can't try a new specialty while travel nursing. For example, if you have worked in Pediatrics for the last two years, you won't be able to take an ICU travel nursing assignment.


2. NCLEX-RN 

If you are working as a nurse is Canada, you will most likely have already passed the NCLEX. Your Canadian NCLEX is equivalent to the US NCLEX, so if you graduated in 2015 or later, you will only need to transfer you exam results when applying for a state license.

If you are from Quebec or graduated before 2015 and have never wrote the NCLEX, read the following for more information.

The NCLEX (National Council Licensure Examination) is a standardized exam that all registered nurses (RNs) in the United States and most of Canada must pass in order to obtain their nursing license. The exam is developed and administered by the National Council of State Boards of Nursing (NCSBN) and is designed to test the knowledge, skills and abilities that are essential for safe and effective nursing practice.

Check out the other guides for deeper dive on each state requirements, but before you can write the NCLEX, you will need to apply to a state license and to obtain an ATT (Authorization to Test) from the Board of Nursing before writing the exam.

You will need to register on the NCSBN website. You will be asked to enter the code of your nursing program. If you studied in Quebec, you will notice that Quebec is not part of the province's list. You will need to use a general program code for Canada which is CA99F00000

3. Credential Evaluation Services

Wherever you go, you will need to use a Credential Evaluation Service (CES) to ensure your Canadian nursing education is up to the American standard.

There is 3 main CES for international applicants:

  1. VisaScreen
  2. Visa4Nurses
  3. Education Records Evaluation Services

More on this in Guide 6 - Choosing your credential evaluator service


4. TN Visa

The TN visa is a nonimmigrant work visa available to Canadian citizens under the North American Free Trade Agreement (NAFTA). Canadian nurses who meet certain requirements can obtain a TN visa to work in the United States.

To qualify for a TN visa as a nurse, the applicant must hold a state license or have a Canadian nursing license that is equivalent to a U.S. state license, possess a diploma or degree in nursing, and have a job offer from a U.S. hospital, agency or employer.

Once the requirements are met and the TN visa is granted, it is typically valid for up to three years. It can also be renewed for periods of three years. The length of the visa will depend on the length of the job offer and the employer's need for the applicant's services.


5. Charting Systems

There are numerous different charting systems depending on the hospital system you will be working for. The 3 main charting systems you will encounter are:

  1. EPIC
  2. Cerner
  3. Meditech

If you are already comfortable using one of those, it will be an asset that makes your resume a little stronger, but its not 100% necessary. The hospitals offers on-site training but be ready to learn quickly as some hospital systems only give you 1-2 days to understand the charting system before starting your contract.


6. Nursing Specialities 

The most in-demand RN specialties in the USA can vary depending on the region and healthcare facility, but generally speaking, the following specialties are often in high demand:

  • ICU/CVICU
  • ER
  • OR/cath lab
  • Med-surg/tele
  • Peds/NICU
  • L&D

Higher demand generally equals higher rates. Keep in mind that the industry continues to shift depending on the market conditions in different regions & states.

If you don’t have one of those specialties, there are always options, feel free to reach out to a group admin to learn more!


7. English proficiency exam (if coming from Quebec)

As a Quebec Nurse, you will need to take an exam to demonstrate your proficiency in English. There are two tests available, the TOEFL and the IELTS. Each state has different requirements of scores but the baseline is around 83 on the TOEFL. We recommend doing the TOEFL over the IELTS, as some State BONs do not accept the IELTS.


States that only accept the TOEFL: California, Hawaii, Georgia, Kansas, Maine, Nevada, Ohio

For any questions, contact us!

Guide 5:
Recommended States and licensing process
  1. Washington - Simple process, Great opportunities
  2. Minnesota  - Quick and easy process for Canadians
  3. New York  - Great rates, Cross-border access
  4. Texas  - Warm weather,  relatively easy process
  5. California - Great rates and weather, longer timeline

See below for the simple steps to get your State license in each of these states!

There are many other options depending on your preferences and specific situation. Reach out to us if you wish to learn more about the licensing process in another state.

1. Washington
  • Timeline: 3-6 months
  • Fees: Approx $250 USD
  • TOEFL score: 84 (if necessary)


Steps:

  1. Have your documents evaluated by any CES.
  2. Complete an online Application and pay the necessary fees.
  3. Attach required forms and documents. Any “yes” responses to personal data questions must have supporting documents, such as court documents and written statements. If you have more documents to submit 14 days or more after your initial application, please email them to nurselicensing@doh.wa.gov.
  4. Submit NCLEX results from Canada or take the NCLEX if necessary.
  5. Complete the Declaration of no SSN form.
  6. Complete a Fingerprint-based criminal background check. Click here to learn more about your options: https://nursing.wa.gov/.../default/files/2022-06/669434.pdf
  7. Receive Washington State license & Apply for Jobs.


See Official Washington BON information here:

https://nursing.wa.gov/licensing/apply-license/educated-outside-united-states

2. Minnesota
  • Timeline: 3-6 months
  • Fees: Approx $250 USD
  • TOEFL score: 84 (if necessary)

Steps:

  1. Provide documentation for the VisaScreen process with CGFNS. http://www.cgfns.org/services/certification/visascreen-visa-credentials-assessment/
  2. Submit an application for licensure by examination and pay necessary fees. https://mn.gov/boards/nursing/licensure/apply-for-a-license/apply-by-exam.jsp
  3. Complete Criminal Background Check. You will receive a fingerprint packet by email. Follow the instructions and submit your fingerprints as soon as possible.
  4. Submit verification of licensure from the original Canadian province in which you were first licensed. The verification must be sent directly from the licensing board to the Minnesota Board of Nursing.
  5. Submit an official transcript from your Canadian nursing education program or a Confirmation of Program Completion form. The transcript or confirmation of program completion form must be sent directly from the school of nursing to the Minnesota Board of Nursing.
  6. If you completed your nursing program more than 5 years ago or if you haven't passed the NCLEX, complete a Review course. https://mn.gov/boards/nursing/licensure/rn-pn-review-course/. A list of accepted courses is available here: https://mn.gov/.../RN_LPN_Review_Course_12-21_tcm21.
  7. Submit Canadian NCLEX results or take the NCLEX if necessary.
  8. The Board will mail your Minnesota state license approximately 10 business days after you take the examination or all documentation is provided and verified.
  9. Receive Minnesota State license & Apply for Jobs.

See Official Minnesota BON information here:

https://mn.gov/boards/nursing/licensure/apply-for-a-license/rn-lic-exam-canada-prog.jsp

3. New York
  • Timeline: 6 months or less
  • Fees: Approx $350 USD


Steps:

  1. Complete New York States Required Coursework : NYSED approved Infection control course and Child abuse identification and reporting course.
  2. Submit Form 1 - Application for licensure - RN.
  3. Complete Section 1 of Form 2 and send it to your nursing school. They must verify that you were granted a BN, BSN, or BScN degree on the form and mail it directly to NYSED. This form and transcript will NOT be accepted if submitted by anyone other than the nursing school.
  4. Submit NCLEX results from Canada or take the NCLEX if necessary.
  5. Complete Section 1 of Form 3F - Certification of professional education. Send it to the licensing authority that issued your license. The licensing authority will verify your license on Nurse Form 3F and then send it to NYSED.
  6. Receive New York State License & Apply for Jobs.


See Official New York BON information here: https://www.op.nysed.gov/professions/nursing/attention-canadian-educated-rn-license-applicants

Access the Forms here:

https://www.op.nysed.gov/professions/registered-professional-nursing/application-forms



4. Texas
  • Timeline: 4-6 months 
  • Fees: Approx $400 USD
  • TOEFL score: 83 (if necessary)


Steps:

  1. Complete the Online Examination Application and pay necessary fees.
  2. Complete the Criminal Background Check and submit fingerprints to MorphoTrust (IdentoGo) and fill out the form For Applicants without a Social Security Number.
  3. Take the Texas nursing jurisprudence examination.
  4. Submit Canadian NCLEX results or take the NCLEX.
  5. Access your license, you must go to the agency website at www.bon.texas.gov and complete an online verification.
  6. Provide documentation from an Approved Credential Evaluation Service provider.
  7. Receive Texas State License & Apply for Jobs.


See Link for a step by step in more detail: https://www.bon.texas.gov/licensure_examination.asp.html

5. California
  • Timeline: 8-10 months
  • Fees: Approx $850 USD
  • TOEFL score: 92 (if necessary)

Steps:

  1. Apply for an ITIN using the W7 form
  2. Open a Breeze account here: https://www.breeze.ca.gov/datamart/loginCADCA.do
  3. File an Application for licensure by Endorsement or if you have not passed the NCLEX, you must apply for licensure by Examination. Pay the necessary fees.
  4. Have your school of nursing send your transcripts (using the Request for transcript form) and the Breakdown of Educational Program for International Nursing Programs form directly to the Board. The Board also requires your school of nursing to send them a copy of the nursing program description in effect the years you attended and to fill up the additional form Questionnaire for schools.
  5. Have your fingerprints taken in a Live Scan facility if you are able to come to California (you can’t use a Live Scan facility in another state). If not, order a fingerprint card and pay the related fees, then have your fingerprints taken at a local law enforcement agency.
  6. Submit Canadian NCLEX results or take NCLEX Exam
  7. Receive California State License & Apply for Jobs.

See Link for a step by step in more detail: https://www.rn.ca.gov/applicants/index.shtml

Guide 6:
NCLEX

Writing the NCLEX-RN 

If you are working as a nurse in Canada and graduated in 2015 or after, you have most likely have already passed the NCLEX. 

Your Canadian NCLEX is equivalent to the US NCLEX, so if you graduated in 2015 or later, you will only need to transfer your exam results when applying for a state license.

If you are from Quebec or graduated before 2015 and have never written the NCLEX, read the following for more information.

If you have not already passed the NCLEX-RN, you must register to take the NCLEX-RN with Pearson VUE (the company that offers the NCLEX–RN in the U.S. and Canada). You may register online at: https://wsr.pearsonvue.com/nclex/

Before you can write the NCLEX, you will need to apply for a state license and to obtain an ATT (Authorization to Test) from the Board of Nursing before writing the exam.

You will need NCSBN's Canadian program code for your BN, BSN, or BScN program in order to register for the NCLEX. Canadian Program Codes and other NCLEX information are available at: NCLEX Exam Codes -  and check your jurisdiction with the dropdown menu here: https://www.regulatoryatlas.com/jurisdiction-selectio

RN’s from Quebec can use: CA99F00000

All Other provinces use School Codes

Need help along the way? Feel free to reach out to us!

Guide 7:
Choosing your Credential Evaluation Service
  1. Visa4Nurses 
  2. ERES 
  3. CGFNS VisaScreen
1. Visa for Nurses
  • Cost: $585
  • Timeline: 15-20 days 
  • Expedited: $100
  • Timeline: 10 Business Days 
  • Translation Services: $100 - $300 total 
  • Pros: Fast & Cost effective
  • Cons: Only available in 26 states currently
  • States covered: Texas, Washington, California, New Mexico, South Carolina, Illinois, Colorado, Alabama, Arizona, Arkansas, District of Columbia, Florida, Hawaii, Idaho, Kentucky, Louisiana, Michigan, Missouri, Montana, Nebraska, Nevada, New Hampshire, North Dakota, Oregon, Pennsylvania, Wyoming

Link: https://www.jsilny.org/services.aspx/

2. ERES
  • Cost: $480
  • Timeline: 50-60 days 
  • Expedited: $120-$180
  • Timeline: 10-15  Business Days 
  • Translation Services: $110 - $330 total 
  • Pros: Integrated translation services, great web portal 
  • Cons: Only available in 15 states currently
  • States covered: Texas, Washington, California, New Mexico, South Carolina, Illinois, Colorado, Alabama, Arizona, Florida, Nebraska, Ohio, Oregon

Link: https://www.eres.com/services/professional-license/nursing-license

3. VisaScreen
  • Cost: $700
  • Timeline: 60-120 days 
  • Expedited: +$625 
  • Timeline: 10 Business Days
  • Translation Services: Yes but $85 per page 
  • Pros: Most known credential service 
  • Cons: Most expensive and slow moving 
  • States Covered: All 

Link: https://www.cgfns.org/professions/registered-nurses/

Guide 8:
Choosing your Hospital, Agency & Recruiter to find your perfect placement

As a travel nurse, choosing the right agency and recruiter is an important decision that can greatly impact your experience and success in the field. Here are some tips for choosing a recruiter:

  1. Communication: Communication is key when working with a recruiter, so make sure you choose someone who is easy to communicate with, responsive to your questions and concerns, and keeps you informed throughout the process.
  2. Trust & understanding: It's important to build a trusting relationship with your recruiter, so choose someone who is honest, transparent, and has your best interests in mind.
  3. Ask Questions: Make a list of questions before meeting your recruiter for the first time to evaluate if the fit is good.
  4. Specialties: If you have a specific nursing specialty or area of interest, look for a recruiter who specializes in that area and can help you find the best opportunities and assignments.
  5. Referrals: This is a tricky one, referrals are always good but the whole system is set up to reward Nurses to their recruiter, so there is always a little bias to make some extra cash. Keep in mind some Agencies will pay up to 1500$ for a nurse referral so it might be tempting for a nurse the embellish the situation.
  6. Availability: Choose a recruiter who is available when you need them, whether it's during business hours or after-hours in case of emergencies.
  7. Contract transparency: Ask for the bill rate of the contract, and what the cancellation policy is. Be careful with Agencies that change contract conditions at the last minute or without consulting you.
  8. Do your research: Start by doing some research on different Travel nursing agencies and recruiters. Look for reviews and testimonials from other travel nurses, and consider factors such as the agency's reputation, experience, and support resources.

Overall, take the time to research and choose a recruiter who has the experience, communication skills, availability, and trustworthiness you need to have a successful Travel nursing experience.

Check out our Bonus Guide 5: Questions to ask a recruiter!

Feel free to reach out to us with any questions you may have!

Guide 9:
The little details to check off before you leave!
  1. Certifications
  2. Banking
  3. American credit card
  4. Credit history transfer
  5. Phone plans
  6. Traveling with pets
  7. Health insurance
  8. Housing 

     1. Certifications

Depending on your specialty, you will need to have up to date certifications (eg. BLS, ACLS, PALS). Even if you took those courses in Canada, most employers will ask for you to retake the American classes from the American Heart Association (AHA).

The AHA offers a lot of course options, you can generally take most of the class online then book an in-person skills session to have your qualifications confirmed. See here: https://cpr.heart.org/en/cpr-courses-and-kits/healthcare-professional 

Some employers will allow you to start your contract before completing those courses if you agree to complete them in a set period of time after the start of your contract. Check in with your recruiter to verify what the best avenue is for you and the hospital you will be placed at!

Some courses are offered in an online-only format. Be careful if you decide to go that way because certain Hospitals don’t recognise those courses and you might have to retake them.

     2. Banking

To be able to receive your salary from the hospital or Agency hiring you, you will need to have a cross-border Canadian bank account or an American bank account. You can call your bank to see if they could change your bank account to a cross-border one.

If you choose to open an American bank account, you might need an American address. This type of bank account is required to obtain an American credit card (see American credit card post for more info).

When opening a bank account in the US, it’s better to go with a bank you already have an account with in Canada. Here are some banks doing business in both countries:

RBC:

TD:

BMO Harris:

     3. American credit card:

Having an American credit card is required if you wish to order anything online while you are in the US, because most websites will ask for a credit card number linked with an American Zip code for the transaction to go through.

Obtaining an American credit card can be tricky since credit card providers will generally require an American address. A lot of Travel Nurses won't have an American address, for example if they are living in an extended stay hotel. You could always use the address of a friend/relative who resides in the US or a mail address (as long as it is not listed as a commercial mail receiving agency).

Also, credit card providers often require applicants to have an American bank account.

Here are some options to obtain an American credit card:

The credit card can be linked with your Canadian cross-border account, but make sure you have an American Zip code on file, to be able to order online (as explained earlier).

They provide credit cards to Canadians, taking into account your Canadian credit history (see the post about credit history transfer for more information on that).

They have a partnership with Novacredit so they consider your Canadian credit history also.

     4. Credit history transfer

Transferring your Canadian credit history to the US will allow you to have a higher credit limit if you get an American credit card. Also, if you are looking for a mid-term rental, you will need a credit history report to provide to potential landlords.

Novacredit completes credit history report transfers from Equifax, so you can establish your US Based credit history for accommodations, rentals, ect. 

Learn more on their website: https://www.novacredit.com/

     5. Phone plans

Most nurse travelers will want to have an American phone number so they can stay in touch with their Canadian relatives while on assignment in the US.

It's always possible to have a Canada-USA plan on your Canadian phone that would allow you to call, text and use cellular data, but be aware that your new American friends may be charged when they contact you on your Canadian number.

Here are some available Canadian phone plans deals:

  • Bell: $95-105/month unlimited Can/US
  • Rogers: $105/month unlimited Can/US

You can also use Apps like WhatsApp to text/call in Canada or the USA, be this requires a wi-fi connection so this might not be a reliable option.

It's good to know that you can carry 2 SIM cards in a single Iphone: 1 E-SIM & 1 SIM. This allows you to have a Canadian and an American phone line in a single cell phone.

Here are some of the best American phone plan deals for Canadians:

  • MintMobile (subsidiary of T-Mobile): 5GB for $15/Month, unlimited for $40/month
  • Google Fi: $65/month unlimited Can/US
  • FirstNet: Exclusive offer for healthcare providers: $45/month unlimited US only

      6. Traveling with pets

If you are bringing a pet with you on your travel nursing journey, make sure to have their health file while crossing the border. Their shots and certifications have to be up to date to the American standard.

Check out what you need to know about about your pet crossing the border with you here on the USDA website: https://www.aphis.usda.gov/aphis/pet-travel/bring-pet-into-the-united-states

     7. Health insurance

If you plan on traveling for less than 6 months a year, a good option is to subscribe to travel insurance. Here are two travel insurance options:

Allianz Global: 

Manulife:

If you are going to the USA for more than 6 months of the year, your Canadian travel insurance may not be valid based on your provincial health care. You can get health Insurance through your agency or hospital, or alternatively can get a health insurance stipend from the agency or hospital you work with.

     8. Housing

Refer to Bonus Guide 6: Housing & Stipends

Guide 10:
Crossing the border for a TN visa

Documents you will need to bring:

  • Letter of offer & Contract from employer
  • Support letter from employer (with wet ink signature)
  • Credential Evaluation Service verification
  • Copy of Birth certificate
  • Original nursing Diploma (translated in English if applicable)
  • Nursing transcript (translated in English if applicable)
  • Passport & copy of passport
  • Any paperwork or documentation for your pets (vaccinations, etc.)

We highly recommend you organize all your documents in a folder to ensure a smooth process.

After you cross the border, ensure you go to a Social Security office to get your SSN as soon as you can. You usually need it before you can start your contract.

Keep in mind you can only cross the border 10 days or less before the starting date of your contract.

Guide 11:
Resource guide on the road!
  1. Gym memberships
  2. Cross Border tax accounting
  3. Foreign exchange services
  4. Apps
  5. Car Insurance
  6. Liability Insurance
  7. Renters Insurance
  8. Support
     1. Gym memberships

Keeping active while on assignment will benefit your body and mind, as well as help you build your social network. There are a number of gym membership options in the states.

Here are a few to get you started:

ClassPass: Allows you to check out different facilities in your new city. It runs on a point system. Depending on the options available in your city, you will have access to a ton of gyms, yoga studios, spinning classes, aesthetics services and so much more.

  Low cost, nationwide providers:

  Luxury facilities:

     2. Cross Border tax accounting

Here are some options to take care of your accounting needs:

PPA Tax: https://ppatax.com/

  • Specialized in Canadian & U.S Tax returns for Canadians
  • Karan Narang: 519-946-2921

  TravelTax: https://traveltax.com/about-us/

  • Specializes in Travel Nurse taxes and knowledgeable in Canadian cross-border taxes as well
  • US: 402-379-7818
  • Canada: 902-482-8128

  Throwbridge: https://www.trowbridge.ca/

  • Tel: 416-214-7833

  Dimov: https://dimovtax.com/tax-services/expat-international-taxation/

  • Tel: 866- 996-4306

     3. Foreign exchange services

You will want to avoid transferring your money back and forth between Canada and the USA because you will lose money every time with exchange fees.

Wise Online Money Transfers specializes in converting foreign currencies, and sending international bank transfers. If you want the best rates for your international money transfers, open an account with them, they have lower rates than all major banks!

    4. Apps

There are a couple apps that can help you during your journey:

  

  Volo: Local sports & activities in 12 cities 

  MedVenture: Meet Travel Nurse friends (Westcoast mostly)

  Venmo: The American E-transfer

  Quickbooks: Keep your accounting up to date for cross border

  AllTrails: Local Hiking Trails

  5. Car insurance 

If you are taking your car with you on your American journey, it’s good to know that your Canadian car insurance is usually valid in the USA (we recommend checking in with your company before you go because your policy might have some exclusions). If you are staying in the states more than 6 months, you will need to subscribe to American car insurance.

Canadian insurers that have affiliates in the USA: Both these companies operate in Canada and the USA but are registered as different operational entities. If you're currently insured with one of these companies, check in with your broker to see if they can do an international transfer to their affiliate.

  All State:

  Wawanesa:

USA car insurance companies: Based on rates we compared, here are two of the bigger name agencies with the lowest rates that will accept an international driver's license (you may need to order your drivers abstract from your provincial DMV):

     6. Liability Insurance 

If your agency or hospital does not cover liability insurance, it is advisable to purchase liability insurance while working in the USA, it costs around $100 per year and one option is here: https://www.nso.com/Get-a-Quote.

     7. Renters insurance 

If you are getting a mid-term rental, it's wise to subscribe to renters insurance. Here are some companies you could use:

     8. Support

Building a support network is critical to ensure you feel secure and fulfilled in your new city. Here are some tips we gathered from seasoned Travel Nurses:

  • Keep in touch with your best friends and family. It’s easy to get overwhelmed by the ups and downs of your new job. A quick call or regular texts from a close one will help to keep you grounded.
  • Make new friends. It’s time to step out of your comfort zone! Go out with your new colleagues after work or try out a local gym. Experiences are always better when shared. You will be surprised how many opportunities are out there if you dare to grab them.

Use social media in a meaningful way. We all are a little guilty of wasting time on social media, gazing at cute pups' pictures for longer than we would like to admit. But socials can also be a great way to connect with other Travel Nurses and access valuable resources, advice and support. There are a ton of local Facebook groups you could join based on your lifestyle interests. And of course we recommend you keep in touch with our Facebook page to share your Travel experiences and learn for other Nurses journeys.

Guide 12:
Taxes & the Canada-US tax treaty

The key points addressed in that treaty are:

  • There is no double tax
  • You maintain your tax-free benefits
  • You maintain your residency status

The Canada-US tax treaty is a bilateral agreement between Canada and the United States that provides guidelines for the taxation of income earned by residents of one country who also earn income in the other country. The treaty is designed to avoid double taxation, which occurs when the same income is taxed in both countries.

For Canadian Travel Nurses working in the USA, the tax treaty has several potential implications.

First, it determines which country has the right to tax the income earned by the nurse. Under the treaty, income earned in the USA by a Canadian resident is subject to US income tax, but the nurse may also be required to pay Canadian income tax on that income. However, the treaty provides a mechanism for avoiding double taxation through a foreign tax credit, which allows Canadian residents to claim a credit for taxes paid to the US government on their Canadian tax return.

Second, the treaty may affect the nurse's eligibility for certain tax benefits, such as deductions and credits. For example, the treaty may limit the nurse's ability to claim certain deductions or credits on their US tax return if they are also claiming the same deductions or credits on their Canadian tax return.

Third, the treaty may impact the nurse's residency status for tax purposes. Under the treaty, the nurse's residency status may be determined by factors such as the length of time they spend in each country, their ties to each country, and their intention to return to Canada. Depending on their residency status, the Nurses may be subject to different tax rules and obligations.

It is important for Canadian Travel Nurses working in the USA to consult with a tax professional to ensure compliance with both US and Canadian tax laws and to take advantage of the benefits provided by the Canada-US tax treaty.

A basic breakdown of some of the things to keep in mind while traveling can be seen here: https://www.travelnursing.org/travel-nurse-taxes-comprehensive-guide/

If your personal accountant has limited knowledge of the cross-border tax system, you can contact some of the following contacts:

PPA tax, who is great for Canadian travel nurses and have cost effective rates for both Canadian and American tax returns, helping advising on best practices to maximize returns for Canadians. Karan Narang: https://ppatax.com/ - 519-946-2921

TravelTax: https://traveltax.com/about-us/ as their staff is knowledgeable, especially Joe Smith, their founder, from a Travel Nurse perspective!

Reach out to any us for ask any questions you may have!

Bonus Guide 1:
Factors affecting the travel nurse industry in the USA
  1. Unsustainable Agency growth rates
  2. Changes in Hospital policies
  3. Everyone and their sister wants to become a travel nurse
  4. Changes in Government policies & funding
  5. Changes in Healthcare policies
  6. Fluctuations in seasonal and geographical demand
  7. Technological advancements
  8. What this means for Canadians Nurses


  1. Unsustainable Agency growth rates: As noted in a 2022 report by SIA states, the largest healthcare staffing firms in the US generated a total of $39.2 billion in healthcare staffing revenue in 2021, which is more than double the revenue generated in 2019 of $18.1 billion in revenue. During this time the big healthcare Agencies saw enormous growth rates and recruited as many nurses as possible to join the Travel Nursing Industry.
  2. Everyone and their sister wants to become a travel nurse: Nurses who have worked as Travel Nurses themselves have shared their experiences on social media and to their colleagues and friends. Agencies also used different marketing techniques to spread the word about Travel Nursing in the USA
  3. Changes in Hospital policies: The industry has seen a major growth in the rate the Agencies are charging the hospital on top of the price of the nursing contracts, sometimes up to 150% of the value of the contract. This unsustainable growth of expenses has led the Hospitals to develop new policies to try to limit the rates and explore different ways to hire nurses. Many hospitals or hospital systems are turning to in-house agency services and are focusing on incentivizing more permanent placement positions.
  4. Changes in Government policies & funding: The US Government has provided a significant amount of funding to hospitals and healthcare providers during the COVID-19 pandemic. The funding has been provided through a variety of channels, including the Coronavirus Aid, Relief, and Economic Security (CARES) Act, the Paycheck Protection Program (PPP), and other federal relief programs. According to the American Hospital Association, hospitals and healthcare providers have received more than $400 billion in federal aid during the pandemic, as of mid 2022. This funding has been used to cover a range of COVID-19-related expenses, including increased staffing for Nurses. This funding has decreased significantly in the last months leading to the burden of the nursing-related expenses being put back on the Hospital systems.
  5. Changes in Healthcare policies: Healthcare policies and regulations can also impact the demand for travel nurses. Changes to the Affordable Care Act, for example, affected the number of patients seeking medical care, which in turn had an impact on the need for Travel Nurses.
  6. Fluctuations in seasonal and geographical demand: The demand for Travel Nurses can vary greatly depending on factors such as seasonality, COVID-19 waves and fluctuations in the healthcare industry. For example, during flu season, Hospitals may need more ER, ICU and peds Nurses to handle the increased influx of patients, while during the summer months, demand may decrease. Rural areas and regions with a shortage of healthcare workers may have a higher demand for Travel Nurses than urban areas with a larger healthcare staff. This is also an historic fluctuation in the relationship between the staffing Agencies and the Hospitals. Every so often Hospitals will try to push away Agencies to cut their costs but then will welcome them with open arms when their staffing needs become critical.
  7. Technological advancements: Technological advancements in healthcare can also impact the demand for Travel Nurses. For example, telemedicine and other digital health technologies can enable healthcare providers to deliver care remotely, reducing the need for Travel Nurses in certain settings.
  8. What this means for Canadian Nurses: There is a nursing shortage everywhere in North America and the services provided by Nurses are still one of the most valuable resources America will need over the next decade. The nursing rates in the USA are lower now than they have been in the last couple of months, but they remain good, especially when compared to the nursing rates offered in Canada. The working conditions, abundance of options and attractive weather are other good reasons to take your nursing career to the USA. With a little bit of work and the right information, you will be able to find the placement that suits your needs and personality, for 13 weeks or 3+ years, it depends on what you want out of your nursing journey!


CollectivCare is a non-profit organization working to inform and guide Canadian Nurses interested in exploring what the nursing market in the USA has to offer. We are working on innovative models of care that can benefit the well-being of nurses. We are dedicated to providing Canadian Nurses with the opportunity to find the environments best suited for their lifestyle and needs. We focus on what really matters to each Nurse, whether it be maximizing their stipends or connecting them with trusted Nurses in their new city of choice in the USA.

Feel free to reach out if you have any questions or want some advice about your journey to Travel Nursing or finding the American cities best suited for you. We can match you with opportunities based on your skill set, timeline and lifestyle needs.

Bonus Guide 2:
Largest Agencies in America (Based on Market Share)
  1. Aya - 12% - $5.7 Billion annual revenue
  2. AMN Healthcare - 7% - $3.4 Billion annual revenue
  3. Medical Solutions - 5% - $2.3 Billion annual revenue
  4. CHG Healthcare - 4% - $1.9 Billion annual revenue
  5. TNAA - 2% - $1 Billion annual revenue


  1. Aya Healthcare


The Good

One of the best-paying agencies, and they cover or reimburse most expenses. They have the biggest network by a large margin across the USA. They are based out of California and have facility relationships in the west coast’s and southern states with coverage all across the country for contracts. They also have knowledgeable recruiters on the TN visa process.

The Bad

Contracts rates have been cut halfway through contracts, albeit not as much as some other providers. Some recruiters are great, and some are not as much.


  1. AMN Healthcare


The Good

They provide a wide range of job opportunities in various healthcare settings. You’ll see some contracts on Vivian and they have an extensive network on the upper east coast. They operate under numerous different brands throughout the continental USA.

The Bad

The agency's communication and transparency regarding job placements or issues with scheduling and workload management can be suspect depending on the nurse you talk to. Also known to cut contracts at a moment’s notice.


  1. Medical Solutions


The Good

Nurses may appreciate the agency's personalized approach to finding suitable job placements, competitive pay rates, and support throughout the hiring and placement process. The Agency also owns Host Healthcare, who has a similar approach. They have contracts across the nation.

The Bad

History of recruiters saying they have knowledge of TN Visa but have been known to misinform, which can lead to border issues, Tendency to lower rates or stipends, not as vast of a network of MSP and VMS systems in hospitals and therefore rates can be a little lower than agencies with a larger network.


  1. CHG Healthcare


The Good

Nurses may appreciate the agency's supportive and open communication, and some recruiters have knowledge of the TN visa process, make sure you ask! They operate under a couple of different brands throughout the continental USA, and most of their hospital connections are throughout the eastern USA.

The Bad

Slightly lower rates than agencies with a larger reach, especially in the southern and western USA, recruiters can be hit or miss, and can lower rates midway through the contract.


  1. TNAA


The Good

TNAA has a strong presence in several states, including Texas, Florida and Arizona. They have a relatively good reputation and also have made a significant equity investment into the Gypsy nurse.

The Bad

Limited to no knowledge of the TN Visa process, Recruiters also can sometimes bait and switch contracts and have been known to reduce contract rates mid-term. Becoming equity owners of the Gypsy Nurse, there may be some biased opinions in there.



Side note

It's important to do your own research on specific staffing companies to make your own informed decisions - speak to other nurses traveling but remember there is always some bias with the referral fees making each nurse some extra cash. At the end of the day, find someone you have a good connection with and have access to the right contracts in the locations you want to work in!

Connect with us if you have any questions or want some deeper insights.

Bonus Guide 3:
How Agency bill rates work

Let's talk about bill rates! As a Travel Nurse, you might be aware that you're paid one amount, but the Travel Nursing Agency bills the healthcare facility where you work at a higher rate. But do you know why there's a difference, and where that extra money goes? This guide is here to inform you. It offers an overview of where the money goes and why, with some insider information.

First things first, what are bill rates? Bill rates are the total amount a Travel nursing Agency charges a healthcare facility for supplying them with a Travel Nurse to fill a specific role. This rate isn't the same as your pay rate, which is the amount you actually receive. The markup is the difference between the two rates.


Let's break down the numbers. The typical breakdown of where the bill rate goes is as follows:

  • Vendor Management System (VMS)/Managed Service Providers (MSP) fee: 2%-6%
  • Interest on invoices (for Line of credit/Factored receivables): 1%-3%
  • After those expenses, the amount left for the Agency to pay the Nurse, to cover their staff’s salary, to pay for their insurances and to make a profit is around 91%-97% (of original bill rate)
  • The gross profit for the Agency is generally around 20%-35%


The amount left for the Nurse’s pay and related expenses is between 56% and 77% of the original bill rate. The expenses related to hiring a Nurse include:

  • Employer's salary taxes on the taxable wages paid to the Nurse. This percentage is state-dependent but with federal taxes included, it can range from 15.3% to 25.3%
  • Insurance based on taxable wages paid to the clinician (professional liability, general liability, worker's compensation). Again this depends on the state and can vary widely, but around 5% to 10% would be a fair estimate
  • Nurse’s taxable wages and tax-exempt stipends: 46.5%-73% of the original bill rate


It's important to note that bill rates can vary by Hospital in the same city and even by Agency for the same position at the same hospital. Agencies try to negotiate higher pay packages, resulting in higher bill rates, because when you make more money, they make more money.

There are three primary types of bill rates: standardized, negotiated, and bid. Standardized bill rates are set at the time the Agency and the Healthcare facility execute a Master Service Agreement (MSA), which is typically good for 2 years. Negotiated bill rates are similar to bid bill rates but differ in the fact that they can be negotiated on a broader spectrum than just an individual submission. Bid bill rates occur when facilities and MSPs allow agencies to 'bid' on the bill rates upon submitting a Nurse candidate.

At the end of the day, Agencies typically have a 8 to 18% net profit margin after the Nurse receives her earnings and all the bills have been covered from the original bill rate.

Hope this helped you understand the system a little better. Understanding bill rates can help you advocate for yourself and ensure you're receiving fair compensation for your hard work.


Bonus Guide 4:
States licensing timelines

Each state has its own Board of Nursing (BON) that regulates nursing practice and issues nursing licenses. The time it takes to get a nursing license varies by state and can depend on several factors, including the state's requirements for education, testing, and background checks, as well as the volume of applications being processed by the state nursing board. 

Other factors can add time to the process, for example, if you were educated in Quebec, you may have to take an English proficiency exam, have your nursing documents translated and write the NCLEX.


These are 10 states and the licencing timelines,  that do not require an SSN, according to the article here:

  1. Texas: 2-4 weeks
  2. Washington: 4-6 weeks
  3. Minnesota: 2-4 weeks
  4. Colorado: 4-6 weeks
  5. Illinois: 5-6 weeks
  6. New York: 6-8 weeks
  7. Montana: 2-4 weeks
  8. Ohio: 4-16 week
  9. West Virginia: 2-4 weeks
  10. Idaho: 4-6 weeks


Other states that may require an SSN (or ITIN), and how long it typically takes to get a nursing license there

  1. California: 8-20 weeks
  2. Alabama: 3-5 weeks
  3. Alaska: 6-8 weeks
  4. Arizona: 2-4 weeks
  5. Arkansas: 3-4 weeks
  6. Connecticut: 2-4 weeks
  7. Delaware: 4-5 weeks
  8. D.C.: 4-5 weeks
  9. Florida: 2-5 weeks
  10. Georgia: 2-3 weeks
  11. Hawaii: 2-3 weeks
  12. Indiana: 4-6 weeks
  13. Iowa: 2-6 weeks
  14. Kansas: 2-4 weeks
  15. Kentucky: 2-3 weeks
  16. Louisiana: 3-5 weeks
  17. Maine: 4-8 weeks
  18. Maryland: 4-8 weeks
  19. Massachusetts: 5-7 weeks
  20. Michigan: 6-8 weeks
  21. Mississippi: 2-3 weeks
  22. Missouri: 2-4 weeks
  23. Nebraska: 2-4 weeks
  24. Nevada: 4-6 weeks
  25. New Hampshire: 3-4 weeks
  26. New Jersey: 6-7 weeks
  27. New Mexico: 3-4 weeks
  28. North Carolina: 6-8 weeks
  29. North Dakota: 2-4 weeks
  30. Oklahoma: 2-4 weeks
  31. Oregon: 4-6 weeks
  32. Pennsylvania: 3-6 weeks
  33. Rhode Island: 3-4 weeks
  34. South Carolina: 2-3 weeks
  35. South Dakota: 2-3 weeks
  36. Tennessee: 3-6 weeks
  37. Utah: 2-4 weeks
  38. Vermont: 2-3 weeks
  39. Virginia: 4-6 weeks
  40. Wisconsin: 2-4 weeks
  41. Wyoming: 2-3 weeks


It's important to note that these time frames are estimates and can vary based on individual circumstances and any additional requirements imposed by the state's nursing board for international requirements. Some states have expedited processing options available for an additional fee.

Bonus Guide 5:
Questions to Ask Recruiters

Working with Canadian RNs

  • Have you ever worked with Canadians?
  • Where/in which states have you placed them?
  • What is your understanding of the TN Visa?
  • Does your agency draft and issue a TN Visa Employment Letter for Canadians?
  • Do you cover fees for TN Visas?
  • Do you cover state license reimbursement?
  • Do you cover ACLS, PALS and BLS reimbursement?

Pay

  • How are your pay packages broken down?
  • What is the hourly rate, call-back (if applicable), overtime/holiday rate, and extra time rate?
  • What are the hours like?
  • Say what shifts you are looking for (e.g. 3x12, 5x8, etc.)
  • We advise against choosing a 4x12h contract as you can pick up the extra shifts in OT for a better rate and you will have more flexibility on when you want to work.
  • Are weekly stipends maxed out based on local GSA rates?    Local GSA Rates
  • What is the travel reimbursement to the destination?
  • What is the taxable amount of the contract?
  • What is the highest gross pay rate in (insert state you have a license) for (insert your specialty)?
  • Does the company also contract per diem work?
  • Are there bonuses for extending assignments?
  • Are my hours going to be guaranteed?
  • What are your missed and canceled shift policies?

Hospital Relationships

  • What destinations does your agency serve?
  • How many hospitals in (state) does your agency have direct relationships with?
  • Is your (company) the managed service provider for these hospitals?
  • How competitive is the landscape right now for (my nursing specialty)?
  • Do you have ‘exclusive’ contracts? Where?
  • Are there penalties for early termination of contract? What are they?
  • If you’re looking for a transitional contract that will turn into permanent, ask if there are penalties/or exclusion clauses for you or the hospital. Any non-compete clauses you should be aware of?

Benefits

  • What type of benefits do you offer?
  • What types of work-related costs do you reimburse for? (scrubs, work supplies, etc.)
  • Do you offer health insurance? How much do you charge for it?
  • If I don’t take health insurance, do I get a healthcare stipend?
  • What about 401K?
  • Is there liability coverage – under the agency or hospital or do I get myself?

  • Are there education funds for CEs?

Housing

  • What options do you offer for housing? Does the agency offer furnished housing / stipend / option of either?
  • Will you provide pet-friendly housing (if applicable)?

Some travel nurse companies provide housing assistance, but if they offer housing stipends, you can use websites like Furnished Finder, Airbnb, VRBO, Facebook or Craigslist to find your own housing. However, be sure to compare costs with agency housing, especially if the city is known to be expensive. Taking the stipend and finding cheaper housing can result in tax-free cash in your pockets, if you have a tax-home in Canada and do not commute to work.

Others

  • Do you pay for parking? Reimburse for hospital parking? This is especially important in a large densely populated city.
  • How will I get support as a travel nurse? If there is an emergency?
  • Do you guys have an emergency hotline? What if I work a night shift, and something crazy happens?
  • Do you guys have a nurse advocate or a nurse liaison that's going to advocate for me?
Bonus Guide 6:
Housing & Stipends

Travel stipends are a type of reimbursement provided to Travel Nurses to help cover the costs associated with their Travel and lodging expenses while they are on assignment. Travel stipends are typically paid in addition to the Nurse's regular hourly wage or salary and can vary depending on the location of the assignment, the length of the assignment, and other factors.

GSA rates, also known as General Services Administration rates, are the maximum allowable per diem rates for employees and contractors who travel for work within the United States.

The GSA sets the per diem rates for lodging, meals, and incidental expenses for different locations within the United States. These rates are updated annually and are based on the average daily rate for lodging and the average cost of meals and incidental expenses in each location.

For Nurses, this stipend may cover expenses such as travel, lodging and meals.

For lodging, Nurses can usually choose between:

  • Booking their own travel and lodging arrangements
  • Using pre-approved lodging options provided by the agency or employer.

If the Nurse chooses to book their own lodging and the cost is lower than the stipend, the agency will still pay the stipend amount in full, and the Nurse can pocket the rest.

Same goes for the meals and food cost, the employer pays the Nurse a fixed amount, how she spends it is up to her.

It is important to note that travel stipends are typically not taxable, as they are considered reimbursement for expenses incurred while on assignment.

If you choose to book your own accommodations, you can use this list of resources to find housing:

  • (Local city name) Housing groups on Facebook
  • (Local city name) Travel Nurse housing groups on Facebook
  • Craigslist
  • Apartments.com
  • Abodo.com
  • ForRent.com
  • Hotpads.com
  • Renthop.com
  • Furnishedfinder.com
  • Bungalow.com
  • Vrbo.com
  • Airbnb.com

It can also be good to look for extended-stay hotels in the area to see how they compare, depending on the city.

Bonus Guide 7:
Nurses coming from Quebec
  1. NCLEX
  2. English proficiency exam
  3. Translation of official documents
  4. Credential Evaluation Services

  1. National Council Licensure Examination (NCLEX-RN)

In every American state and Canadian province, except Quebec, the NCLEX is the licensing exam required to become a Registered Nurse. The exam is developed and administered by the National Council of State Boards of Nursing (NCSBN) and is designed to test the knowledge, skills and abilities that are essential for safe and effective nursing practice.

Before you can take the exam, you will need to apply for a state license and to obtain an ATT (Authorization to Test) from the Board of Nursing. The cost for writing the exam is $200 USD.

Registering for the NCLEX-RN: You will need to register on the NCSBN website. You'll be asked to enter the code of your nursing program. You will notice that Quebec is not part of the province's list. Use the general program code for Canada which is CA99F00000.

  1. English proficiency exam

If your nursing education was taught in French, you will need to pass an English proficiency exam to demonstrate your English level is sufficient to work in the US. The only schools generally exempted from this requirement are: McGill University, Dawson College, Vanier College, John Abbott College, and Heritage College.

There are two exam options, the Test Of English as a Foreign Language (TOEFL) or the International English Language Testing System (IELTS). Each state has their own requirements regarding passing scores (see our guide about the specific states for more information) but the baseline is around 83 for the TOFEL. We recommend doing the TOEFL over the IELTS, as some state Boards of nursing don’t accept the IELTS.

States that only accept the TOEFL: California, Hawaii, Georgia, Kansas, Maine, Nevada, Ohio

  1. Translation of official documents

You will need to have your transcripts, diplomas and certificates translated from French to English before sending them to the Board of nursing for evaluation. Be aware that some Boards only accept translation by translators certified by the American Translation Association (ATA). This can get pretty pricey.

Here is the contact information for the cheapest ATA certified translator we found:

Rachel Pierce:

  1. Credential Evaluation Services

All documents you will need to provide your CES must be first translated to English, unless you plan to use the translation service offered by the CES (see the post about CES for the costs of those services).

Bonus Guide 8:
Tax-home and Visa situations

Tax-home options available for Canadian Nurses on a TN visa in the USA:

  • Work one or two 13-weeks contracts per year and maintain your tax home in Canada. This option allows you to avoid being subject to US taxes on your income earned in the USA provided that you meet the requirements of the Canada-US tax treaty (this can be advantageous from a tax rate standpoint depending on the province where your residence is and the state you are working in). It also means that you can maintain your Canadian car insurance and provincial health insurance while you are working in the USA.
  • Travel for 3 years in the USA and maintain a tax home in Canada. This would give you the same taxes-related advantages mentioned in Option 1, but you wouldn’t be able to keep your Canadian car insurance nor provincial healthcare benefits.  In order to maintain your tax home in Canada, you must return to Canada for approximately 30 days a year.
  • Residency in the USA as a Canadian Nurse: This option involves establishing residency in the USA and abandoning your tax home in Canada. This means that you would be subject to US taxes on your worldwide income, including income earned in Canada. However, if you spend the majority of your time in the USA, you may be able to claim the foreign earned income exclusion, which allows you to exclude up to a certain amount of foreign earned income from your US taxes.


TN visa renewals: The TN visa is valid for up to 3 years and can be renewed every 3 years. To renew your TN visa, you must continue to meet the eligibility requirements, including having a job offer from a US employer.

Green card sponsorship: If you are interested in staying in the USA permanently, you may be able to apply for a green card if you take on a permanent position within a hospital in the USA. Your employer would need to sponsor your green card application, and there are specific requirements that must be met in order to be eligible.


It is important to note that each of these options has its own advantages and disadvantages, at the end of the day, it depends on what is the best situation for you both long and short term.

Reach out if you want to learn more about the opportunities in the USA.

Bonus Guide 9:
Importing your car

If you are traveling in the states with your Canadian car, there are a few things you need to know. Here’s some information on the different options you have.


Temporary importing:

You can temporarily import your Canadian licensed car to the US for personal use for up to one year at a time without permanently importing it. However, if you decide to keep it in the US for more than a year, you have to complete the permanent import process before the 365 days are up. If you fail to do this, your vehicle would be subject to seizure for non-payment of duty.


Getting started:

Before importing your car to the US, we advise you to read the overview on importing a vehicle to the US from the US Customs and Border Protection (CBP). Depending on your situation, importing your car can be a confusing, time-consuming, and sometimes impossible process, so it’s not for everyone. Please note that regulations can change without notice, and you should always consult the relevant agencies for complete guidelines and up-to-date information. Some procedures may differ depending on which state you reside in, so check state requirements too.


At the border:

If you intend to keep your car in the US beyond a year and convert it to a US registration, declare this to the customs officer at the border when you cross into the US. You will need to provide the officer with your vehicle registration as well as a completed DOT Form HS-7 and EPA Form 3520-1 and any supplemental documentation to prove that your car meets safety and emissions standards.

If everything is in order, you will receive written approval that you have met all the requirements from the customs officer, which you must then take with you to your final destination where you will register your car and convert it to a US registration and ownership. Make sure to ask the customs officer to stamp your passport at the border so you can prove when you entered the US, as this may be helpful later on in the process when you register your vehicle.


Duties:

Automobiles are generally subject to a duty of 2.5% of their current value when they are imported to the United States. However, vehicles manufactured in USMCA countries (U.S., Mexico and Canada) are usually exempt from this duty.


Safety and emissions compliance:

All vehicles imported into the US must comply with US Federal motor vehicle safety standards (FMVSS) set by the US Department of Transportation (DOT) and US emission standards set by the Environmental Protection Agency (EPA).

When bringing your vehicle from Canada into the United States, you will be required to present the following completed compliance forms:

  • DOT Form HS-7
  • EPA Form 3520-1
  • DOT Safety Compliance Requirements


All vehicles less than 25 years old must meet all US FMVSS standards to be imported into the United States. You can determine if your vehicle is compliant by looking for an FMVSS certification label (usually inside the car door or under the hood). If your vehicle has this label, you should have no problem importing it to the US from a safety standards standpoint. However, in many cases, your vehicle only has a label certifying it complies with all Canadian motor vehicle safety standards (CMVSS).


The driver’s license transfer process varies from state-state, check the website of the state’s DMV for more information. Keep in mind that you have a maximum of 6 months to transfer your car insurance to the USA. See section 5 of Guide 11 for more details about your car insurance options in the States.

Hope this helps you on your journey!

Nurse Group


Questions?
Feel free to connect!

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