“Oh, you’re a travel nurse? What’s that?”

That is typically how people or my patients respond when I first mention I’m a traveling nurse. At least once, I experience the following exchange with one of my patients while on assignment:

“So how long have you worked at XYZ Hospital?”

“To be honest, only a few weeks. I’ve been a nurse much longer than that – don’t worry. I’m actually a traveling nurse, so I’ll only be here a few months. You’re in great hands though because the people here are wonderful.”

From there, it sparks people’s interest. Some claim that they could tell that I “wasn’t from around here” or “[they] couldn’t tell because you blend right in” or “[they] knew it because of your accent” or “Wait, but, you don’t even have a New Jersey accent” or a combination of the above. Eventually, the conversation moves away from me and moves towards what travel nursing entails. Below is typically how I would explain it, with further details.

What is Travel Nursing?

I usually tell them that travel nursing is like the “band-aid” of nurse staffing issues. When a hospital has a problem with fully staffing a unit or units, they often utilize contract workers for temporary positions until they can resolve the shortage. Per Diem (or in-house, as needed) positions won’t entirely be sufficient because many times they aren’t required to work as much as the hospital might need in their particular situation. They also can’t force staff to work overtime to meet their needs. Travelers offer that little time-out to alleviate the pressure. We are nurses that bounce from place to place in order to meet the needs of the facilities and the communities they serve for a period of time.

When Do Facilities Need Travel Nurses?

Most times, there’s no crisis on the horizon. When someone retires or transfers, they have to fill that position of the retiree. If they have trouble doing so, and the unit was already tight, they might go ahead and get some help in the meantime until a qualified candidate comes along. When they find that qualified candidate (full-time), it takes some time to train him/her (up to 6 months). During this orientation period, you generally tie up two nurses, the nurse doing the training and the trainee. Orientation periods for traveling nurses are usually much briefer, and in my experience, last no more than one week. As a result, a traveling nurse carries a smaller opportunity cost than a full-time candidate, resulting in a more reasonable “quick fix” in tight staffing situations.

Other times, these facilities have good staffing, but there has been a sudden rise in a number of patients staying at the hospital. This is most common in the winter months due to the flu and the colder weather making those with respiratory issues more susceptible to becoming sick. These contracts can be a little longer due to the patient surplus, rather than staffing inadequacies. For example, if they hire a full-time candidate for a temporary problem, then the hospital could be wasting time and resources because, at this point, the hospital will be overstaffed once the winter is over.

How Does a Nurse Find the Right Facility?

That’s a great question. The facility has identified that they require a number of nurses to meet their needs. Now they need to find those nurses. This is where staffing agencies come in.

Staffing agencies work as middlemen for both the facility and the nurse. They put nurses who are in need of jobs in front of hospitals in need of nurses. They are very important in this whole process. These agencies do a lot of behind the scenes work. They maintain relationships with facilities and their staffing personnel, ensure credentials are up to date, manage payroll, find viable positions, help with housing (if needed), and many more things. Sometimes, facilities have exclusive relationships with companies called vendors. If the vendors are unable to adequately staff the needs with their own nurses, they will open up the contract to other companies in order to fill the need. The relationships of all the parties in the process are shown below:

Capture 1.PNG

I recommend you find an agency and recruiter you are comfortable with and that meshes well with your values and personality.  It’s not uncommon to work with more than one agency at a time while you’re looking for a job, however. Sometimes the agency you’ve worked with doesn’t have access to the contract that you really want. In those cases, it’s important to have eyes out there looking for potential jobs for you. That’s not to say there’s no loyalty, but this is your livelihood. Some recruiters will try to make you feel bad for working for someone else on a contract, but that’s all the more reason to leave. Nothing in these work relationships should ever be driven by personal reasons. As long as you are transparent with all parties involved and professional, then there should be no reason to worry. Remember: YOU are your greatest asset.

How Does Pay Work?

Remember back to when we discussed that the facilities reach out to these agencies and vendors? They also name what they’re willing to pay in regards to specialty, experience, and availability. When the agencies receive these pay rates, they reach out to their nurses and let them know what these facilities are offering in exchange for their care. If it’s a good fit, then the contract is drafted and signed. When thinking about contracts, it’s important to remember that the Facility/Agency contract and Agency/Nurse contract are different entities. When it comes to pay, the facility pays the agency, then the agency pays the traveler, following a similar pattern to the relationship pictured earlier. However, since these agencies offer their services, there’s obviously a portion that is deducted as a service fee. Some companies structure it in a way that is a percentage of the total contract and others set it up as a flat fee for a contract, regardless the size of the total package.

Some new travelers tend to get upset about these cuts, stating things like “But I’m the one who is making them their money. I’m the one on the unit. I’m the nurse. I should get all of it.” In reality, that’s just being greedy, and without the help of these agencies, we wouldn’t have jobs. Also, think back to the services they provide. They offer a service and deliver their service. As far as I’m concerned, what’s fair is fair. I understand that there are profits that the company must make and goals to meet. As long as I take home my fair share, it’s more than fine with me. I understand that there are many people involved long before I ever step foot in the hospital. Just to name a few, there are recruiters, managers, compliance coordinators, salespersons, and things like rent and utilities. It’s very important to understand that it’s very much a mutual relationship where we both benefit.

From the bit that gets taken out by the agency (and possibly vendor), the rest is for the nurse (and government in taxes). The goal is to have the least amount of taxable income possible so that you can take home as much as possible and pay the least taxes as legally possible. There are a lot of tax implications (and I am not a CPA), but the basic rule of thumb is that you need to have duplicated expenses of living at home and on the road in order to receive tax-free stipends (please see TravelTax.com for more).

To better illustrate, please see the image below:

pie chart

Please keep in mind that this is a VERY rough estimate and that there are many variables, including contract specifics, the business model of agency, presence of vendor, qualification of tax-free stipends, etc.  I promise to go in more depth on the breakdown of pay in later posts.

Key Points

  • Travel Nurses aid in the management of staffing issues in temporary positions
  • The Nurse/Agency relationship is important when landing a contract
  • Facility pays the agency who in turn pays the traveler
Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s