US or Canadian — Can You Tell?

"Every hospital and every travel company competes for these nurses," says Beth Price, recruiter, Richards Healthcare, a travel and therapy management company. "Rightly or wrongly, a Canadian nurse can come to bedside and you can’t tell the difference between a Canadian and US nurse. There is no language barrier. Unfortunately, with nurses from other countries, that perception does exist. No matter how good the training is, the perception is you’re not getting an American nurse."

The training of nurses in the US and Canada is similar, says Francine Dennelo, senior recruitment leader, Cross Country TravCorps.

With no language barriers and similar educations, Canadian nurses are in high demand in the US, Dennelo says. "[Placing Canadian travelers] is something that we’ve been doing as a company for about 12 years and have been increasing business year over year. [Canadian nurses] are great travelers and tend to be very hardworking. They’re more like old-school nurses."

TN Visa Is a Snap

It takes 18 months or more — from the time one applies to work in the US to being able to start work — for travelers from most other parts of the world to be able to join the US workforce, according to Price. "With the TN Visa, you offer them a job, and they can come immediately."

Canadian nurses can apply for the TN Visa because registered nurses are one of the professions classified under the North American Free Trade Agreement (NAFTA) between Canada and the US. The TN Visa is the nurse’s ticket to work in the US, without having to wait for a green card.

Canadian nurses can get visas at the US border, for $50, if they have a letter from a US employer (including a travel company) offering them a job. The nurse will also need documentation, including a transcript, degree, US license, and passport. Though TN Visas are limited to a year, they are renewable in one-year increments.

Travelers who want to stay long-term can apply for green cards, Price says. Companies have various requirements for sponsoring employees for green cards. Registered nurses are lucky when it comes to going through the lengthy green card process. They can skip labor certification, a costly and long process. Sponsoring companies must prove that no Americans are available to fill the position being filed for.

NCLEX Is Required in Most States

According to Dennelo, more and more Canadians are taking the NCLEX right after they take Canada’s national nurses exam. It’s easier, she says, to take the test right after school, while the information is fresh in one’s mind. The nurses who have taken the NCLEX don’t have to worry about it later if they decide to take US travel assignments.

There are states in the US that still recognize the Canadian exam, depending on the year that it was taken. But according to Michael Yao, branch director for travel nurses, Medical Staffing Network, most states are moving toward requiring the NCLEX.

Nevertheless, it’s an option for nurses who don’t want to take the NCLEX to come to the US and work in the handful of states that do not require it, Dennelo says.

Some states also require the Commission for Graduates of Foreign Nursing Schools, Price says. The CGFNS test, used years ago with H1A visas, was reborn with the passage of the Immigration Reform Act in 1996 to verify that any healthcare professional who wanted to immigrate to the US temporarily or permanently had an education equivalent to that in the US. The CGFNS is necessary for foreign nurses to get a green card; travelers who have taken the NCLEX, however, do not have to take the CGFNS to get a TN Visa.

Canadian Nurses Like High Pay, Have to Adjust to US Healthcare System

Richards Healthcare doesn’t specifically advertise to the Canadian nursing market because most nurses in Canada are aware of the advantages of a TN Visa, Price says. Many like the idea of working in the US, where the pay is substantially higher.

In fact, there are lots of people who migrate into Canada in hopes of coming to the US from other countries, and they have to wait first to get their Canadian citizenship, according to Dennelo.

One hurdle for these nurses, according to Price, is getting used to the US health system. "In Canada, healthcare is available for all, and it’s not profit based."

Yao explains that Canadian nurses come from a social medicine background and coming to the US, with its profit motivators and productivity standards, is a philosophical change for them.

While Yao says that nurses should take responsibility to acquaint themselves with the US healthcare system, Dennelo adds that nurses considering traveling to the US on assignment should also lean on their travel companies to get the information they need about acclimating to a new country. Travel companies that merely sponsor a nurse but make it her responsibility to figure out everything are not the best choices for employers, Dennelo says. Rather, the travel company should help the nurse with his immigration, licensing — even applying for a social security number and opening a bank account when the nurse arrives.

Cross Country says that it helps to place Canadian travelers who are new to the US in places that are travel friendly. "We try to find places where we tend to have a lot of Canadian travelers — the states where you don’t have to write the American boards tend to have a lot of Canadians," says Dennelo.

According to Yao, the states bordering Canada tend use Canadian nurses most.

Overall, Canadian nurses will find that the world is their oyster in the nurse-starved US system. Price recommends: "Shop around when choosing a travel company. Remember, you are in the driver’s seat."