Are You Ready? Do You have what it Takes to be a U.S. travel Nurse?
You will need to meet certain prerequisites, do your research, and be organized before taking on this challenge.
Before You Begin
The very first thing you should do is join the community of other Canadian to U.S. nurses. We have a Facebook group, Instagram, and this website for tons of resources and support.
Next...
Requirements & Things to Do
Aside from setting yourself up for success by doing the research, the following are just a few requirements to travel nurse to the United States. The goal of these things is to increase your chances of landing a travel nurse contract, especially the higher paying contracts!
Become a Registered Nurse
Get your bachelors of nursing & (preferably) NCLEX
Unfortunately, the U.S. has a list of shortage occupations and the only nursing-related job listed is for Registered Nurses. This means, LPNS, RPNs, RPNs (psychiatric), and NPs are not eligible.
There are some LPNs and other types who have gotten travel nursing contracts and a TN visa. However, this is typically because the border guard processing their entry probably did not know/care about the difference between an RN and LPN. But if you attempt this, spend all the time and money to secure a job, state license, VisaScreen/Visa4Nurses, and get to the border and the border guard DOES know the difference, you’ll be sent home and your file will show you were declined for a TN visa and the reason why so it isn’t like you can just ‘try another border crossing’. It will show you were denied due to not being on the NAFTA shortage occupation list. Some NPs have had unique job titles such as ‘Advanced Practice Nurse’ and their RN and have been approved but this is still incredibly risky as the job itself is not an RN job. I want to go on record that I do not recommend leaving these things to chance.
Ideally, if you have graduated after 2015, you’ll have your NCLEX. However, many from Quebec and those who have graduated earlier will not have the NCLEX. This is not a requirement prior to travel nursing. Here is how it will go... You will need to apply for your VisaScreen or Visa4Nurses and a state license. It is during the process for your STATE LICENSE that once they receive your education and approve it, then they will typically issue an ATT or ‘Authorization to Test’ and then you can book your NCLEX at a nearby location. Make sure you study lots beforehand!
Also, we have an NCLEX chat in our Facebook group to support any questions regarding the NCLEX!
Gain Experience
At least 1-2 years of RN experience, preferably in acute care
When getting this experience, the best advice I can give is to try and work in a larger hospital with more learning opportunities. This way you’ll gain more experience in record time. Once you can handle the sickest patients on your unit all by yourself -- You will know you are ready to be a travel nurse.
I cannot emphasize this enough; as a travel nurse, you are hired to fill a desperate need. Facilities expect you to be ‘good to go’ and ‘ready to hit the ground running’ with minimal orientation. Please keep this in mind, they are paying a lot of money because they expect a competent nurse to arrive who just needs a bit of orientation and then will get to work. If you show up and aren’t fully competent, not only would the hospital not be too impressed, but you may find your contract cancelled.
As such, you must get your learning, competency, and confidence built up BEFORE you try to travel nurse. You need a strong foundation to be able to handle anything you come across on contracts. This is NOT the time or place to learn a new specialty. If you are lucky, you might get a little extra training, but that can not be expected. For example, I learned shoulder replacement and spinal fusion surgeries on one assignment. Another assignment, I was doing a lot of cosmetic plastic surgery that we wouldn’t really perform in hospitals in Canada (e.g. rhinoplasties, breast augmentations, BBLS, lipo, etc.).
Often times travel nurses will be given 1-2 shifts to a week of orientation. And often times they is not much extra time even if you need to learn a whole new computer charting system - Adaptability and flexibility is key! You may or may not have supportive coworkers. So, you need to be strong all on your own. You might be working with new equipment, new charting systems, different policies, etc. Likewise, recruiters and mistakes can happen so do make sure if you accept a job, it is within your scope of practice. For example, if you’ve always worked in pediatrics and a recruiter tries to get you a job with adults or you get to your assignment and they try to float you to adults, you need to refuse in the interests of patient safety. Patient lives and your license are on the line.
Another issue can be the recency of your experience. I see this with international nurses who have come to Canada but Canada didn’t approve their education but the United States will. The issue is while they have been waiting for Canadian citizenship, they haven’t been working as a nurse. By the time they get their Canadian citizenship, it may have been years since they last practiced as a nurse. It is really important to have RECENT experience in your specialty (within about the last 6 months). This can be a big issue for travel nurses if they only work once a year and do not keep a per diem/casual job in Canada. Aim to work at least a few shifts a month or at least 2 travel contracts per year.
There are alternatives such as waiting to get those 2 years of experience, choosing to relocate, or finding a new grad residency program. These will not pay as much as travel nursing and come with some commitments.
Personally, I started travel nursing to the United States after being an OR nurse for about 5 years. At a minimum, I recommend starting the process around 1.5 years. Ideally, your documents and everything should be ready around the same time you reach the 2 year mark. And I have heard of nurses with only 1.5 years in their specialty struggling to get a placement and having to settle for less money.
Build Your Skills/Specialty
Build your skills and get certifications
Whether you are a new nurse or new to a specialty, try and start taking the most difficult patient assignments to build up your skill set. If you can take further certifications, do get those (e.g. ICU). This will not only better equip you for your specialty, but will help boost your resume. Even being able to help other units and diversifying your specialty could be a big help! The more skills you have, the more marketable you are to facilities. The more areas you can work in, the more of an asset you will be!
If you want to specialize in some of the most in demand and highest paying specialties, the top five areas are:
Cath Lab, OR, ICU, Med-Surg/Tele, and ER
These specialties can often alternate and shift depending on demand. Obviously during covid, we saw ICU nurses take front and centre stage as the most in demand nurses. And as we know, there will be more pandemics to come (roughly every couple of years we get new ones -- e.g. SARS, Swine, Ebola, Covid, etc.). Likewise, immediately after covid, OR nurses were crazy in demand after long OR closures. High demand = high pay and low demand = low pay. And the most in demand specialty is always changing, but usually not by too much.
I get new nurses or nursing students who often ask, “What specialty should I go into to make the most travel nursing money?” And it is a bit of a tricky question. The best answer I can give is to choose the specialty YOU enjoy the most. If you are passionate or absolutely love the specialty, that is the best thing in the world -- to love your job. For me personally, I always wanted the OR and working as a travel nurse has allowed me to really, really LOVE it because when I’m on a travel nurse contract, I only like taking 3x12s shifts (three 12 hour shifts per week) so I get 4 days off every week. And when I am not working on a travel nurse contract, I typically work 1-2 days the rest of the year in Canada. And I can happily say, I am not burnt out, I am excited to go to work, and love my specialty/job. I am also lucky to work at two fantastic ORs in Canada with wonderful coworkers at both of my per diem/casual jobs. So, my answer is to pick the specialty you LOVE and if it happens to be one of the in demand areas, awesome. If it isn’t, well, so be it. There may still be contracts out there, even if they don’t pay as well.
Another consideration is that if you choose your specialty based on money, what is most in demand can often change. So you better like what you do!
***Canadian Citizenship
Ensure you have your Canadian citizenship
In order to qualify for a TN visa, you must be a citizen of a NAFTA country (Canada or Mexico). And if you have U.S. citizenship or dual Canadian-U.S. citizenship, you won’t need a visa there at all! But PR status does not count. You must wait until you go from PR to full citizenship to qualify for the TN visa.
Again, not singling anyone out but I want to include a reminder here: We are a foreign country and foreign citizens applying for jobs. We are not entitled to be able to work in the United States whatsoever. I know Canada and the U.S. are tight, but we are still separate counties. I see a lot of nurses who are annoyed they need to get a VisaScreen or Visa4Nurses or who think they can just get a state license and start working in that state.
No. We are Canadian citizens or Permanent Residents (PR). As such, many countries (e.g. the UK) have strict rules for being able to work as a nurse there. We are very lucky that Canada moved over to the NCLEX and most nurses since 2015 don’t need to take another exam. For example, the UK has their own exam so our NCLEX is pretty meaningless to them. Compared to most countries, the United States is actually more efficient and flexible in hiring foreign nurses. Likewise, it is SO much easier for Canadians than say nurses from the Philippines or other countries. So, we really shouldn’t complain.
Welcome to Travel Nurse Pay
Mistakes to Avoid
Additionally, there are some big mistakes many nurses make (don’t worry, you aren’t alone if you’ve made these mistakes).
Here are the big mistakes I want to warn nurses about...
MISTAKE #1: Being disorganized
I see this a lot, so please don’t feel like I am calling anyone out in particular. It is nearly a daily occurrence, where admin open the pending posts for the Facebook group and we get a message like,
“Hi, I’m so and so and a something-something specialty. I’m looking to start travel nursing to the U.S. can anyone help?”
This is totally okay! What I do is tag them on a ‘new members’ post where I have outlined where all the resources can be found (with links to the website, etc.).
But, you need to do your own research and understand. I really try and make it simple and not overwhelming, but I recognize it is A LOT. From work visa stuff, to taxation, to trying to negotiate the best pay... It is a lot to learn. This is why it is so utterly important to USE the resources, network with other Canadian to U.S. travel nurses, and really stay on top of everything by being SUPER organized.
Being disorganized can leave you stranded at the Canadian/U.S. border and unable to cross for a TN visa.
Being disorganized can mean you applied for a state license in a state that requires an SSN so they flat-out won’t give you an active license.
Being disorganized can mean not looking through your contract and negotiating things to ensure you are paid fairly.
And the list goes on!
I am typically doing an article per week to give more information but it is an ongoing effort. For anything that doesn’t have an article, you can DM me directly on Facebook (Kat Ann) or post to the group. If it does exist, I’ll redirect to the article or resource. If it doesn’t exist, I’ll post it and comment as best I can. If I can’t, some other seasoned travel nurses usually can!
MISTAKE #2: Applying to a state license without looking at educational pre-requisites
This is always unfortunate, but many states will want a educational verification and if you are missing clinical or theory in required fields, they will not grant you a state license. Some areas that many states deem mandatory are L&D, pediatrics, and mental health. If you do not have one or more of these, head to the state board of nursing (BON) and find the form that will be submitted to your university and see what fields the form is asking for. If it is asking for L&D clinical and you have never taken it, you might need to apply to another state. Likewise, if you cannot find the form, give the BON a call and ask. Just please, please, don’t spend the money on an application and sending all your documents in only to realize, your university screwed you over by leaving out key nursing clinicals or theory courses. This is a pretty common issue with Ontario nursing schools and some Alberta nursing schools. I emailed the CNO who certifies all Ontario schools and got a lengthy but pretty bland reply. I encourage anyone who is missing areas like L&D, pediatrics, and mental health, contact your university and provincial college of nursing to complain. They don’t care that you aren’t able to work in the States (because they have invested interests in seeing Canadian nurses stay in Canada to work), but the key issue is that you paid for what was supposed to be a COMPREHENSIVE education as a nurse. And regardless, those areas (L&D, pediatrics, and mental health) are essential components of a nurse education and to not include them in the curriculum, or to make students choose between two essential areas of nursing practice should disqualify that nursing school from their certification by the provincial college of nursing and the provincial colleges of nursing should be putting pressure and withholding their approval of these nursing schools that are only offering a program that can create 85% of a nurse (due to missing courses).
MISTAKE #3: Not Having a support system
This is where the community and social media links in the beginning of the article are so huge. We have seen nurses stranded at the border and under review and unable to get a U.S. social security number. Within 24 hours, they have gotten answers from nurses who have been there and done that. The trouble shooting in the group is absolutely invaluable. I like the think the resources are amazing, but it is the trouble shooting that is really reassuring -- That you are really not doing this alone.
MISTAKE #4: Not saving and preparing your finances
Yes, travel nursing is big money. Unfortunately, it also can cost a bit to get going. Many agencies will reimburse some or most of the costs, but initially, it is painfully expensive. This might involve dipping into emergency savings or sticking some of the fees on credit cards. Do ensure you are prepared and have at least one month of money saved. This can be hard, I know. I was delayed 2 weeks and my thankfully my wonderful recruiter offered to set up an advance for me which really saved my bacon! I also kept a per diem/casual job in Canada and was able to quickly pick up a few shifts.
Ready for a Game of Can or Can’t?
Here is how this will work, We’ll ask a common question and say if it is possible to travel nurse (can) or is not possible (can’t).
Travel nurse with spouse/kids?
Absolutely can. Do ensure if a spouse plans to work, they may need their own work visa (the TD visa for dependents is a non-working visa). Likewise, if they work for a company that has any presence at all in the U.S. it may be illegal.
I am a nurse who refuses to ask questions or for help. Can I travel nurse?
Probably not. Travel nurses really need to be able to safely manage their patient assignments, critically think, work as a team, be flexible and adaptable, be independent and knowledgeable, possess the necessary skills for their specialty, and be able to ask for help.
I am a new grad, can I travel nurse?
No, you cannot travel nurse. You would be a major liability. And I could probably put this in a kinder way, but I’m just going to lay it out there, as a new grad, you really don’t know your head from your ass at this point. Sorry for the bluntness! I do love new nurses, but travel nursing is a huge no-no.
I have 1 year of experience, can I travel nurse?
Agencies may take you but most facilities will pass you over. You will easily find yourself submitting for contracts and not getting anything for 6+ months. Facilities will choose RNs with 2+ years before you. I’d recommend at 1 year, start saving up your money for all the costs prior to travel nursing. Then, I’d suggest waiting to do all the paperwork to work as a travel nurse in the States until about 1.5 years as a nurse in one specialty.
I have my PR, can I travel nurse to the States?
No. You must be a full citizen of a NAFTA country to take advantage of the TN visa. You could get another type of work visa but that could take some time.
I work in LTC, Home Care or Admin, can I travel nurse to the States?
Absolutely! Some agencies pay big money for home health. It can sometimes take a bit longer to find LTC contracts and admin positions, but they are out there on a travel nurse basis. I’d maybe suggest getting a couple state licenses to improve your chances of landing a contract.
What do I do? I am in a specialty that is not high in demand (e.g. NICU). Can I still travel nurse to the States?
Yes, you certainly can, but cast a WIDE net. So, I’d suggest getting a few state licenses and be ultra flexible in whatever locations come up!
I am a LPN. Can I travel nurse to the States?
No, LPNs cannot get a TN Visa, but could get other work visas (e.g. HB1). Most other work visas will typically require a commitment of approx. 1-3 years. However, if you get a greencard, then you could take travel LPN contracts though!
I am a recent LPN-RN grad. Does my LPN experience count?
LPN experience often doesn’t count. Facilities often have a lot of applicants and most will have RN experience which would trump LPN experience resulting in losing out on virtually every job you submit to.
Final Note
On a final note, it took me about 3-5 years to feel confident enough to travel nurse. And on my second day of my very first travel nurse assignment in an adult OR, we had an emergency case on a 21-day old baby and no one among the staff had any pediatric training (the two staff members who did these cases were off shift). With my background, I was able to say, “I have peds OR training, I can help.”
Likewise, only you know if you feel ready to travel nurse or not. There are some scenarios you might not be prepared for that are uniquely American.
For example, some ICU nurses have talked about how the patient ratios are much worse in the ICUs there in the States, so that could catch even some wonderful ICU nurses off guard.
But if you get challenging patient assignments and find you are stressed to the max, you simply may not be ready.
We all have nightmare days, but if this is your normal, you may need to keep at it a bit longer as a staff nurse.
Busy is one thing and to be expected, but to be drowning nearly every shift, is not normal.
Another good marker that may indicate you are ready to travel nurse is if you ask yourself, “Do my coworkers and new nurses come to me for help or to ask questions? Do my coworkers and manager see me as a resource on the unit? Does my charge nurse trust me with the most difficult and challenging assignments?”
If the answer is yes to the above, you are clearly able to safely manage the most acute patients on your unit and are absolutely ready to travel nurse!
Otherwise, don’t get discouraged -- Especially nursing students, new grads, PR nurses, etc. because the answer isn’t, “No,” but rather just, “Not yet.”
The more prepared and competent you are, the smoother the process will be -- This will prevent a lot of unnecessary anxiety and make travel nursing to the United States a much more fun, rewarding, and exciting experience!
