Read the general professional work overview
Hypothetical example: Annick is a Canadian citizen working shifts as a registered nurse at a long-term-care residence, commuting from Saint-Lucien. A staffing agency has offered her a contract at an American hospital and has told her the paperwork is straightforward because nursing is on the list. It is on the list, and the profession’s own rule sends her to a state licensing board, while separate federal law sends her to a credentialing organization. Neither of those documents is produced by the agency, and neither can be arranged at the border.
The profession’s entry points straight at a state board
Registered Nurse appears in Appendix 2, and the entry is satisfied by a state or provincial licence or by a licenciatura degree. Read carefully, that means the qualifying document for someone intending to nurse in a particular American state is a licence issued by that state, and a Quebec licence does not transfer on its own. Boards differ in what they require of a foreign-educated applicant: an evaluation of the nursing programme, an examination, a language assessment, or a temporary permit while an application is pending. The time this takes is the real constraint on the plan, and it is the first thing to start rather than the last.
Federal law asks health-care workers for a further certificate
Beyond the state licence, federal law requires certain health-care occupations, registered nursing among them, to present a certification from an authorized credentialing organization confirming education, licensure, training and English-language proficiency. It is a separate document with its own process, its own fee and its own timetable, and it is not waived because the applicant is Canadian or because the employer is in a hurry. Presenting an offer letter and a Quebec licence without it is the most common reason a nurse who is entirely qualified is turned away. Ordering it early costs little; discovering it late costs the start date.
When an agency sits between the nurse and the hospital
Agency placements raise a question the offer letter should answer explicitly: who employs Annick, and who directs her work. Self-employment in the United States is not permitted in this category, so an arrangement in which she invoices the hospital through a company of her own is outside it. Where the agency is the employer, its letter should say so, name the facility, describe the nursing duties and give the period, salary and supervisor. Where the hospital is the employer and the agency merely introduced them, the hospital writes the letter. A document that leaves the relationship ambiguous will be read as ambiguous.
What else is on your mind?
Is a matching job title enough for TN?Can years of experience replace a degree for TN?Can my own U.S. company employ me under TN?Can my spouse work if I hold TN status?Editorial source review: 2026-09-07. General preparation guidance, not an individual assessment.