Read the general professional work overview
Hypothetical example: Fumiko is a Canadian citizen and a registered nurse at a long-term-care home in Minden Hills, recruited by a hospital system that operates facilities in three states. Registered Nurse appears in USMCA Appendix 2 and its rule is met by a state or provincial licence, so her Ontario registration answers the profession question. The recruiter has been vague about which facility she will be assigned to, and that vagueness is the problem, because the licence that matters is the one issued where she will actually work.
The profession's rule and the practising licence point at different jurisdictions
Appendix 2 sets the credential rule for Registered Nurse as a state or provincial licence, and a valid Ontario registration meets it. Practising, however, requires authorization from the board of the state where the patients are, and that authorization is separate, chargeable and subject to its own processing time. Some states participate in arrangements that recognize a licence held in another participating state, which is relevant only once Fumiko holds one. Until the hospital names a facility, nobody can start the right application. The first task is therefore commercial rather than legal: get the assignment fixed in writing, then open the file with that state's board.
Health-care occupations carry a certification requirement that is easy to miss
Immigration law requires certain foreign health-care workers, registered nurses among them, to present a certificate covering education, licensure, training and English-language proficiency before being admitted to perform work in the occupation. It is issued by an approved credentialling organization and takes weeks rather than days, because it depends on verifications sent directly by schools and regulators. It is separate from the state licence and from the employer's letter, and an application that is otherwise complete can stall on it. Confirm the current requirement and the approved issuers from the official sources, and start the verification requests early, since the delay usually sits with the institutions rather than the applicant.
What the employer's letter must say once the facility is known
The letter should identify the hospital entity that will employ her, name the profession in the words Appendix 2 uses, and state the facility and the state where she will be based. It should describe the nursing work concretely, give the salary, the supervisor and the period requested, and confirm that she will be an employee rather than engaged through her own company, since self-employment in the United States is outside this category. Where the system intends to rotate her between facilities in different states, that has to be disclosed and thought through, because each state's licensing authority governs its own hospitals and a rotation can require more than one licence.
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.