What is the most important thing you need to work in the United States?
The answer: a preliminary visa document
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, a Youtube, and this website for tons of resources and support.
What is a preliminary visa document?
A preliminary visa document is a piece of paper, often emailed (which is a recent development) or hardcopy/mailed to you that you present to the border (ie. to Homeland Security). Then the piece of paper magically gets turned into a TN visa. This visa is a nonimmigrant (ie. does not lead to permanent residency or citizenship in the U.S.) visa that permits qualified Canadian and Mexican citizens to seek temporary entry into the United States to work at a professional level, under the North American Free Trade Agreement (NAFTA) in areas the United States government has deemed shortage occupations (e.g. Registered Nurses). Currently, LPNs and NPs are not listed as shortage occupations and thus do not qualify for a TN visa and must seek alternate work visa options.
The purpose of a preliminary visa document process is to determine if you meet the basic immigration and education requirements to qualify per U.S. federal screening for a U.S. work visa (e.g. TN, EB3, H1B, etc.). These include basic things such as criminal record checks, education breakdowns (course-by-course), and verifications from any jurisdictions nurses are licensed to show they are practicing as nurses in good standing -- Wherever in the world they are from.
There are currently two organizations who can verify nurses with a document that meets the criteria for Homeland Security. They are:
CGFNS (provides VisaScreen) & Josef Silny (provides VISA4NURSES)
Both programs verify your education and practice credentials to certify you can work in the United States in the occupation you claim to be (ie. a Registered Nurse).
This is hands down the most complicated and lengthy process -- starting out as a new Canadian-to-U.S. travel nurse and getting your preliminary visa document (either a VisaScreen or a VISA4NURSES).
The preliminary visa document is not optional; it is compulsory, mandatory, required, and so on and so forth. And you cannot work (practically in any capacity) in the United States without it!
In order to work legally in a country that is not your own, typically around the world, you need a work visa of some sort. And you will need the VisaScreen or VISA4NURSES every time you change jobs. The certificate must be included with every visa petition you file at the border.
You cannot just waltz into the United States and expect them to let you work there when you aren’t even a U.S. citizen.
Even if everywhere in the world is short on nurses, this is the process to being able to work legally in the United States. And this process applies to everyone... Social workers, IT professionals, etc. However, only occupations where they have deemed there to be a shortage can qualify for the TN visa. There are other visas, but they are much harder to get and can often take years. And certainly, Canada isn’t all too welcoming of foreign nurses either -- Often requiring them to take additional schooling and courses before allowing them to practice. Comparatively, the United States makes it much easier for us nurses to work there than we let foreign-trained nurses work here in Canada!
And that is the gentle reminder, we may be super tight with our southern neighbours, but we are not Americans and are not at all entitled in any way to work there. They have their own educational, practice, etc. requirements they have set for all foreign-born nurses and we need to respect that. It is often annoying and a nuisance, but if you want to work there, you will need to follow their process.
Who Should Apply for a Preliminary Visa Document?
Registered Nurses (and all other kinds of nurses such as LPNs and NPs who plan to get another type of visa than the TN)
You expect to get a U.S. employer (e.g. hospital or agency) to write you a job offer letter (TN) or sponsor you (for another visa such as the EB3 or H1B)
You are a graduate of an accredited Bachelor of nursing degree (or BSN) program
Have an active license as a Registered Nurse in another country
Have a minimum of 1.5 years of nursing experience
Can demonstrate English language proficiency
MISTAKE #2: Appl
Required Documents
Secondary school information (high school diploma) unless it has been more than 10 years since you graduated from high school*
Nursing license(s), both current and past nursing registration(s) in all jurisdictions*
NCLEX or CGFNS Qualifying Exam (CGFNS only)
Nursing diploma/degree*
*CGFNS requires theoretical instruction and clinical practice in medical and surgical, maternal/infant nursing care, pediatrics and psychiatric/mental health nursing
*Silny requires theoretical instruction and clinical practice in medical, surgical, obstetric, pediatric, psychiatric/mental health, and geriatric
Profession education Information (e.g. Bachelor of Nursing degree), transcripts, course description/break-down (typically included in a Verification form)*
English test (TOEFL or Academic IELTS)
*Exempted, an applicant must meet both of the following two criteria:
- Entry-level professional education must have occurred in the United Kingdom, Australia, Canada (except Quebec), New Zealand, Ireland or the United States; AND
- English must have been the language of instruction, including the language of the textbooks.
Passport-style photograph
*These documents must be in English and any translation to English must be done by the educational institution(s). If the educational institution(s) is unable to provide an English translation, then CGFNS/Josef Silny can translate documents for an additional fee. Josef Silny require documents in their original language AND translated (or will translate for a fee)
*All documents must be sent direct from the institution to CGFNS/Josef Silny.
Which Provider should I use?
Good question!
I will breakdown the differences between the two providers, CGFNS (VisaScreen) and Josef Silny (VISA4NURSES) and then you can decide for yourself.
CGFNS VisaScreen
CGFNS International is an immigration neutral nonprofit organization that assesses and validates the academic and professional credentials for foreign education healthcare professionals (e.g. Registered Nurse) who wish to live and work in the U.S.
As of May 16th, 2024
Cost: $740 USD / $1006 CAD
Application Length of Time to Complete: 1 year (if it expires, you can renew it at a reduced fee of $250 USD)
Estimated Processing Time: 2-6+ months (as long as applicant is prompt with submitting documents and it depends on if your university and college of nursing take their sweet time). Bear in mind, it is not unusual to take 1-2 months to process a single document with CGFNS
Expedited & Is It Worth It? +$650 USD, ready in 10 business days once all documents are in. Consensus among most nurses is that it isn’t worth it to expedite. Nurses report it seems like many get it even 24 hours later without expediting and others report expediting and saying it was a complete waste of money. Expedite and time and normal time seem to be the same.
Translation Services: $85 USD per page
Other Fees: CGFNS will report on 2 schools, 2 jurisdictions and a secondary education. Additional licenses and schools will cost more per entry ($125 USD)
Expiration? Renewed every 5 years (reduced fee $475 USD) (documents kept on file for 5 years)
States Covered: All*
*CGFNS also has a NY thing where they forward all your documents to the NY BON which could be cheaper.
Other:
CGFNS may send documents by mail or digitally.
CGFNS will not return calls to a long distance number
With CGFNS, once you pay, there is a dashboard of things you need to submit and documents to forward to your university and college of nursing
Josef Silny VISA4NURSES
At Josef Silny, they assist international students, U.S. citizens, and permanent residents educated abroad in foreign credential evaluation and translation to determine the foreign education equivalency in the United States (including the VISA4NURSES).
As of May 16th, 2024
Cost: $585 USD (including international shipping) / $795 CAD
Application Length of Time to Complete: 1 year
Estimated Processing Time: 1-4 months (as long as applicant is prompt with submitting documents and it depends on if your university and college of nursing take their sweet time). Silny is quite fast compared to CGFNS.
Expedited & Is It Worth It? +$100 USD, ready in 10 business days once all documents are in. Consensus among most nurses is that it isn’t worth it to expedite. Nurses report it seems like many get it even 24 hours later without expediting and others report expediting and saying it was a complete waste of money. Expedite and time and normal time seem to be the same.
Translation Services: $100-300 USD total
Other Fees: Unknown.
Expiration? 5 years. No discount/reduced fee for renewals. Documents kept on file for 1 year only (and then destroyed).
States Covered: 26 States: 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
Silny is not accepted in all states for educational eval (if states that require a Educational Evaluation (often called a CES). You may want CGFNS if the state you want to apply to won’t accept an educational evaluations from Silny. Note, some states aren’t listed (e.g. MA or NY) but don’t even require a educational evaluation in the first place.
Other:
Silny may send documents by mail or digitally
IMPORTANT NOTE ON TIME & MONEY
Time
Before you begin, it is important to note that the process of becoming a travel nurse in the U.S. takes approx. 6-8 months from start (paying for CGFNS/Silny) to your first day of orientation on your first U.S. contract.
Money
It is not a cheap process to become eligible to work in the U.S. You should anticipate spending about 2-3.5k CAD for everything. These fees include your preliminary visa document, costs to submit documents, gas/flights, background checks, the TN visa fee at the border, etc.
I know many of you will be floored at the price. Don’t let that scare you too much, because some agencies reimburse the VS/V4N (e.g. TNAA). They may not offer it up front because it is so expensive; so, make sure you ask your recruiter!
Reminder
Make copies of most documents and bring to the border for applying for TN visa . It’s also good to have them on hand when crossing back and forth too in case you get asked for it.
Here is the list from the border of what they expect:
Pro Tip
Download Rebtel for any calls that aren’t toll-free (if you don’t have free long-distance calling).
Here is a link to sign up which includes $10 free credits.
Step-By-Step to Applying for Your Preliminary Visa Document
Everyone who wants to work in the U.S. must be certified with EITHER CGFNS or Josef Silny. These two are the gatekeepers to ensure your credentials and experience are equivalent to U.S. educated nurses.
APPLICATION SECTION:
Start by creating a free account and apply for the VisaScreen on the CGNFS website HERE. Once you apply and pay for the CGFNS VisaScreen, a dashboard will appear with tasks to fulfill. Alternatively, you could head over to Josef Silny HERE and fill out an VISA4NURSES application and email it to the email they specify.
***Ensure you pay first BEFORE submitting any documents to CGFNS or Josef Silny.
If you don’t have your NCLEX yet, don’t worry. Simply apply for your state license at the same time as you apply for your preliminary visa document (at one of the 18 states that will let you apply without an SSN, see previous articles for more information). Only do this if you are 100% certain you are prepared to write the NCLEX within the 1 year application window for both CGFNS and Silny.
For CGFNS, any messages or updates will be under the ‘Correspondence’ section of the Message Center. Visit this occasionally as this is where they will often send you important messages.
DOCUMENTS SECTION:
Next, when preparing documents to send off to your nursing school and jurisdictions where you are licensed as a nurse, ensure you sign each document and fill out any sections meant for you before you send it to each organization.
High school
You should have a physical copy of your High School Diploma from when you graduated.
If you do not have this document, you must:
Contact your high school and order a copy.
If your school no longer exists, you must contact the School Board for your previous school.
Fill out the form ‘Request for Secondary School Diploma/Examination Certificate’, take and attach a photo of your diploma, and upload it to the CGFNS portal.
The high school diploma is the only document you will upload yourself. All other documents must be sent directly from your nursing university and all provinces where you are (or ever have been) licensed as a nurse.
CGFNS will update the CGFNS Connect Portal when the document is received.
In order to upload documents to the portal, select the “My Messages” option on the top right in your account. Then, select the “Contact Us” option. Select the VisaScreen as your service and ‘Other’ as your subject. Scroll down until you get to the ‘Optional PDF attachment’ section. Your order will be your VisaScreen. Make sure your attachment is under ‘Secondary School Diploma’. Pick the file and click ‘Submit’.
For Silny, high school academic credentials, NCLEX RN Candidate Report and the passport photo I.D. are to be emailed by the applicant to info@jsilny.org
Academic Records
Next, you will need to submit any documentation re. you nursing school. Both CGFNS and Josef Silny will be looking for a course-by-course breakdown. They typically have their own verification form to submit to your nursing school. You will also possibly need the physical copy of your degree so ensure you have it. If you don’t need it at this point, you will for when you cross the border. For getting the verification from your nursing school, you can search your university or college website to see if it is offered there or contact your nursing school’s admin or registrar’s office. Remember to fill in any sections meant for you before sending it to your university/college. Double and triple check!
If you split your education between more than one school, you’ll need each one as an entry and will need a verification sent to all of the schools your attended for your bachelor’s of nursing (or BSN).
Send the verification and order a transcript to be attached to the verification as well. Your nursing school admin or registrar should be able to help organize this.
If college of nursing asks for recipient (for mailing), put CGFNS or Josef Silny. Again, it has to come directly from university/college of nursing to CGFNS/Silny. It cannot be sent to you or from you (as they consider that it could be forged or tampered with).
You also have a section for any certifications (e.g. perioperative diploma, lactation consultant, etc.).
(Provincial) Nursing License(s)
Now, you will need to enter all jurisdictions you are licensed in (including expired ones as there should be a spot to put the dates) on your application to CGFNS or Josef Silny. This can be particularly tricky if you travel nursed in Canada and might have 5+ nursing licenses! Bear in mind, CGFNS charges for each jurisdiction after 2.
Again, fill out any part of the Verification form meant for you and then send it to your Provincial College of nursing (or any international areas you are licensed too). Most Provincial Colleges of Nursing in Canada have an area or page on their websites to request a verification of registration. For some like the CNO, you just login to your CNO account, click ‘maintain your membership’ and then select ‘request verification of registration or view verification requests’ and click ‘submit new verification request’ and you will be able to upload the CGFNS form right there!
Most Colleges of Nursing in Canada charge a small fee and wait times can vary. I know the CNO took 7 weeks to send my verification for one of my state licenses, but others have gotten it sent within a week. Likewise, most Colleges of Nursing in Canada are used to this process and have emails and ways to get the document where it needs to go. I wouldn’t worry too much about whether they will mail or email it and just check in by calling them for updates frequently.
Some Colleges of Nursing (e.g. B.C.) might not allow you to submit your own verification and might only fill out and use their own version. If this is the case, you should be able to submit it without issue from CGFNS or Josef Silny as it can’t really be helped.
Other:
Photo
While you’re at it, why not submit a passport-style photo if you have one or go get one taken. It isn’t the most pressing thing right now, but if you’ve sent off all your documents, you can get this done while you wait!
To upload on CGFNS, head to your ‘dashboard’ and click the gray square on the left and click ‘upload applicant photo’. Once reviewed by CGFNS and okay’d, the ‘photo’ part of your application section will turn green.
**English Proficiency Exam (if applicable)
If your nursing school was in English including the textbooks, you will likely be exempt. However if you need to take a English exam, it is recommended to pick a more popular one like the IELTS or TOEFL. The reason is that both the state and Visa Screening organization (CGFNS or Silny) will want the test. If you already know which state(s) you are planning to get licensed in, DO check their websites and application process to see what they will require for an English proficiency test. Otherwise, if CGFNS accepts one test and the state doesn’t, you’ll have to take a second English test which could have been avoided if you picked a more universally accepted English proficiency test.
If you require a English proficiency test, these exams are easily a few hundred dollars and results take a couple weeks. Remember, the results should be sent directly to CGFNS.
If you aren’t sure if you will need an English test or not, just keep an eye on your dashboard. Typically, CGFNS will waive the English test once they assess your education. if they haven’t and you took it in English, then you may want to give them a call.
Bear in mind, not every school in Quebec automatically requires an English test. Several nursing schools are exempt. For more on this, there will be an article coming out soon specifically on the subject of English Proficiency Tests. Stay tuned!
Other/Miscellaneous
With CGFNS and the dashboard, your tasks will be highlighted in either green, orange, or red. Check often for updates if you know you’ve sent everything in. Sometimes things can get lost in the mail, etc. To that end, try to ensure absolutely everything has mail tracking on it.
Once all your items are received, reviewed, and assessed to be all good, you will receive your VisaScreen (same for Josef Silny, except you are assigned a person who is typically very responsive).
Back in the day (man I sound old), we had the VisaScreen document mailed to us. Now, I’m hearing that a lot of nurses in our community are just being emailed it with a QR code. So, it appears they have updated their process slightly and may be going digital now! Make sure you print or photocopy a couple copies just in case. You will need to show the border agent when you cross for your TN visa.
Bonus tip
You can apply for a state license at the same time as you apply for your preliminary visa document. In fact, I ENCOURAGE it. This can save months and months of time if you want to travel nurse ASAP!*
*You may want to wait for some states like WA (where the state board of nursing application expires after 30 days) as long as you have your NCLEX already. Otherwise, your NCLEX will hold up the processing for CGFNS/Silny.
Final Note
On a final note, there will be LOADS more to come and I will be expanding on the following in their own articles:
- English Language Proficiency Test
- Educational Evaluations (ie. CES)
- TN Visa
And just to keep in mind, most employers will likely not issue a job offer without at least a VisaScreen/VISA4NURSES. This is true for travel nurse positions especially, but also even relocation agencies who tend to be a bit more hands on.
As always, for a list of our Recommended Recruiters, see this link HERE
And if you are searching for a good relocation agency, I have two that I absolutely love. So many either never replied, didn’t know what they were doing, didn’t have a lot of options, etc. so I have two fantastic ones. Simply contact me below as I haven’t gotten them up on the website just yet!
