Travel Nursing CE Course

2.0 ANCC Contact Hours AACN Category A

Syllabus

Objectives

  1. Identify the qualities and characteristics of a successful travel nurse.
  2. Be able to identify the importance of understanding the contract and obligations of a nurse prior to signing a contract or agreeing to an assignment.
  3. Explore and discuss what the nurse should consider prior to committing to a travel job.
  4. Identify and understand legal expectations related to travel nursing, and nursing scope of practice in other states.
  5. Explore the importance of attendance and identify appropriate actions to take when calling in sick.
  6. Identify factors that may negatively impact the travel assignment such as work relationships, communication, and personality conflicts. 
  7. Understand, define, and identify the difference between guaranteed hours and non-guaranteed hours.
  8. Explore the two primary types of housing options for travel nurses.

Background

Travel nursing can be a gratifying career; however, nursing professionals must understand the expectations and commitment that is involved in travel work. The demand for travel nurses is expected to increase by 19% before the year 2022 (United States Bureau of Labor, 2019). There is a wide variety of opportunities in multiple specialties and disciplines, allowing nurses to travel almost anywhere within the United States and internationally as well. Nurses should remember that although it is an exciting and wonderful opportunity, they still have responsibilities and essential aspects of the job they must consider. As more opportunities arise from different companies, employers, and organizations, nurses must understand the expectations, contracts, and considerations involved. Nurses considering a travel nursing job must understand the stipulations, contracts, legal obligations, calling in sick, attendance, personality conflicts, scheduling, housing, benefits, and policies that are unique to this specialty. It is also important that travel nurses understand policies regarding hour guarantees, pay, overtime, and any stipulations that may impact their contracts. It is a rewarding career and an excellent opportunity, but it also entails a lot of responsibility and dedication. Due to the nursing shortage in the U.S., there is no limit on the possible opportunities currently available for nurses looking to go into travel work.

Travel Nurse Considerations and Characteristics

 Nursing assistants, licensed practical nurses (LPNs), and registered nurses (RNs) can all do travel work. Advance practice nurses and nurse practitioners can also pick up travel assignments and contracts. According to Wood (2015), the demand for travel nurses and other healthcare professionals will only increase due to the nursing shortage and aging population. Generally, one year of experience is required, but most agencies prefer at least two years, and if working in a particular specialty, often additional bedside experience is required especially in areas like labor and delivery, pediatrics, or behavioral health. Experience can be important to many agencies and hospitals as the nurse must have knowledge regarding nursing practice, that particular patient population, and be prepared when going to new facilities, which depending upon the facility may have limited resources available to help orient or train the travel nurse.

Important aspects a nurse should consider when deciding upon a travel job is pay, location, and contract specifics such as duration of the assignment, hours/shifts, housing, relocation assistance, benefits, stipulations, and requirements. Be sure to research before committing to anything or signing any contracts. It is advisable to speak with co-workers or friends who may have experience as a travel nurse, read about the company, and speak with a recruiter (Moore, 2013). Shaffer (2014) states that it is imperative that nurses understand the difference between an agency nurse and a travel nurse. An agency nurse may only work one or two days in each assignment and is typically assigned locally with minimal or no advance notice, while a travel nurse may work anywhere for a period of weeks to months. Travel nursing involves a longer time commitment, travel, and flexibility (Shaffer, 2014).

Travel Nursing Pay and Benefit Considerations

Pay and benefits are significant considerations as it pertains to travel nursing. It is essential to understand bonuses, incentives, travel expenses, stipends, reimbursements, health insurance, and retirement options prior to making a decision, signing a contract, or accepting a travel position. It is also crucial for the nurse to consider taxes when accepting a travel assignment as they may need to pay income taxes in the state where the assignment is located (Faller, Gates, Georges, & Connelly, 2012). In addition to base salary and primary benefits (health insurance, 401k, etc.), the nurse should obtain clarification regarding any potential:

  • Travel expenses, including relocation costs,
  • Living expenses,
  • Meal allowances,
  • Reimbursements, 
  • Uniform stipend, 
  • Supplies required, and any associated stipend.

Companies may offer these stipends for costs associated with certain aspects of the job upfront at a set rate, and at times the nurses may be allowed to keep any leftover money, while others may expect their nurses to pay for particular things out-of-pocket or submit receipts for reimbursement after the fact. Bonuses and incentives are other details nurses should consider when determining whether or not to work for a particular company or take an assignment before signing the contract. Sometimes the agency or company offers these bonuses themselves, while other times the hospitals may offer additional completion or sign-on bonuses. Agencies and companies may also offer bonuses when extending contracts or for working additional hours. 

Travel Nursing Contract Considerations

Understanding all the details of the contract, stipulations, and expectations is essential when it comes to working as a successful travel nurse. Domrose (2015) outlined how important it is that travel nurses review data regarding shifts, hours worked, how the agency bills (bill rates), taxes, reimbursements, licensing/credentialing costs, liability/malpractice insurance, training/orientation, overtime, payroll, calling off, and of course guaranteed hours. The nurse must understand what shifts they will be expected to work, the number of hours per week, if the agency competitively bills facilities according to demand, and any incentives for working overtime. Nurses should also consider things like being mandated or forced to work overtime if a staff shortage were to occur for any reason. Some companies will pay hourly for orientation and training, while others may not, yet factor this into the pay the nurse is receiving later. Nurses must also know how often payroll is processed and how they might be taxed depending upon the location in which they are working. Licensing, credentialing, and other employment requirements are also essential for the nurse to understand, as often if these requirements are not met the nurse may not be able to work (Domrose, 2015). 

Travel nurses must be aware of the facility or hospital policy in which they are working in addition to their agency policy. They must understand and abide by all of the rules and regulations of the hospital or facility in which they work just as the regular employees do within that organization (Elrod, 2010). When traveling and working at different facilities or hospitals, the nurse must recognize that the agency has a contract with the facility, and they represent that company so they must make every effort to follow policies within that particular organization. 

Personality and Communication Conflicts within the Workplace

    If the travel nurse has an issue with another employee within the hospital in which they are contracted, they must follow not only the facility policy but the agency policy as well. Travel nurses should make every effort to appropriately and professionally work through conflicts themselves whenever possible. Travel nurses must remember that they are guests and are contracted through their agency. They represent the agency and should be professional and respectful of the facility in which they work, so as not to potentially put the contract with that facility at risk. If another employee is violating facility policy or putting the safety of patients or others at risk or the travel nurse feels that they are being bullied or harassed (sexually or otherwise), then the travel nurse should notify their immediate supervisor at their assigned location as soon as possible as well as their recruiter or supervisor within their agency (Domrose, 2015). If an issue arises regarding a personality conflict, communication breakdown, or harassment in the workplace when working for a facility, the travel nurse must not only follow the agency policy but the facility’s as well. Travel nurses must also be prepared and able to handle conflicts with nurse managers or supervisors should problems arise. Issues regarding sexual, physical, or emotional harassment must be reported to the appropriate supervisors as well as the agency. According to Rosenstock (2016), nurses must make every effort to work with immediate supervisors and administrators prior to going to another superior, whenever possible and when appropriate. It is also important that nursing staff follow the chain of command when reporting issues within the workplace or when unable to resolve an issue with their immediate manager or supervisor. Failing to work with immediate supervisors and follow protocols within the workplace could create hostility, unintended consequences, and if the immediate supervisor is not given the chance simple problems that could normally be fixed easily could cost more time and efforts to resolve.

Hour Guarantees and Non-guarantees

Hour guarantees are also essential for nursing professionals to understand as contracts and assignments may get canceled or changed depending upon the policy and facility in which they are working. Guarantees can differ, as some hospitals have the option to cancel a contract up until a certain point, and some cannot cancel at all, which directly impacts the travel nurse. If there are no guaranteed hours defined within the contract, the nurse could potentially lose out on hours/pay if a hospital cancels the contract. For instance, a hospital may have a nurse contracted to work 40 hours in one week and then decide to cancel two shifts. If the contract does not guarantee 40 hours/week, the nurse will only be paid for the 24 hours they worked and will not receive the additional pay. Many contracts guarantee a minimum number of hours for the nursing staff to work. Otherwise, the nurse has to be paid in addition to their actual hours; however, not all companies or agencies do this. The nurse must be aware of hour guarantees and the verbiage of the contract when signing. Hospitals and facilities may cancel shifts or even the entire contract depending upon staffing supply or patient census and acuity, which may leave the nurse with no hours and no pay. Many times, agencies and companies that offer guaranteed hours will have lower pay (hourly or salary) when compared to companies that do not offer guaranteed hours. This is an important consideration, and the nurse must understand this portion of the contract when deciding whether or not to sign the contract (Faller, Dent, & Gogek, 2018). Nurses need to understand the contract and fully review all of the details, stipulations, and all expectations regarding their employment before accepting the position.

Laws and Scope of Practice Considerations for Travel Nurses

It is the nurse’s responsibility to understand the laws and nursing scope of practice when working in other states or countries. It is the nurse’s responsibility to understand what they can do legally within their scope and what they cannot do. If the nurse fails to do so, they could face penalties/fines, restrictions on their license, and even be at risk for losing their nursing license. In addition to understanding their scope of practice, nurses must also understand local laws, regulations, and the “rules of the road” when crossing state lines or when entering another country. Nursing staff who travel must understand cell phone, seatbelt, car insurance, parking, and licensing laws within the state or country in which they travel. It is also essential that they are aware of the legal limit laws for driving under the influence (DUI) when traveling. The travel nurse must abide by the laws when traveling in another state or country, or they could suffer consequences such as tickets, fines, or even jail time. It is the nurse’s responsibility to be aware of laws and regulations when traveling to another state or country (Morrison, 2018). 

Some states require nurses to apply for a separate license, which includes fulfilling all of the requirements for licensure within that state, before being able to work within that state. Many states are now members of the enhanced Nurse Licensure Compact (eNLC), which allows nurses to apply for a multistate license to work seamlessly outside of just their home state (Moore, 2015). According to the National Council of State Boards of Nursing (NCSBN, 2019), the 34 compact states include: Arizona, Arkansas, Colorado, Delaware, Florida, Georgia, Idaho, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Mexico, North Carolina, North Dakota, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, West Virginia, Wisconsin, and Wyoming. Alabama and New Jersey have adopted the intention of becoming members of the eNLC (date to be determined) and Indiana plans to enact their membership in January of 2020. Rhode Island was a member of the original NLC but has not yet joined the enhanced version. Massachusetts, Pennsylvania, and Michigan currently have pending legislation regarding membership in the eNLC. West Virginia and Louisiana extended their eNLC status to LPNs as well as RNs.  Nurses must do the research and identify which states require them to apply for a separate license and which do not. They must know the requirements and scope of practice for nurses in each state or country in which they work. The NCSBN website is the best, up-to-date resource regarding the current status of the eNLC in each state (NCSBN, 2019).

Location and Scheduling

Among the many positive aspects of travel nursing is the nurse’s ability to choose their location, facility, and schedule. Travel nurses may have the opportunity to decide whether or not to work in a particular location; however, it is imperative to read the contract before signing and understand all expectations regarding assignments. Travel nurses are generally expected and required to complete assignments once the contract is signed. If a nurse does not like a location or facility, they can attempt to contact their recruiter or manager to request a change; however, if a replacement is not found the travel nurse is required to complete that contract as outlined. Leaving an assignment prior to its completion could potentially result in losing bonuses, incentives, overtime pay previously worked, and even include termination from the position. Nurses should make every effort to complete assignments and fulfill their contractual requirements. Assignments can range from anywhere from a few weeks to a few months, with many assignments being 13 weeks in length. If a location is not as expected, the travel nurse should notify their recruiter or manager and communicate their concerns but make every effort to fulfill their obligations as outlined in the contract. Not doing so can not only adversely impact the nurse’s employment and pay, but it also can negatively impact the organization’s reputation or lead to the loss of future opportunities with that particular facility (Rosenstock, 2016).

Attendance

Nurses must also make every effort to fulfill all obligations regarding their schedule and assigned shifts. Travel nurses are often assigned to fill positions due to deficiencies in staffing within the hospital, so they must be reliable and come to work on time. Agencies often have stricter attendance policies than many hospitals or facilities as their employees are viewed as temporary and replaceable. Competition within the free market allows facilities to cancel contracts and no longer use a particular agency if they prove to be unreliable. It is imperative that travel nurses work their shifts as scheduled as well as make every effort to have good attendance, be on time, and understand the policies/expectations regarding attendance within their agency. 

Certainly, a contagious nurse working with patients when they are ill is not only a risk to the patients and other staff on the unit, but to the nurse themselves. If a travel nurse must miss a shift due to illness, they must notify their agency and the hospital or facility in which they are contracted. Travel nurses are expected to abide by not only the policy of their agency, but also the hospital or facility policy as well. First, the travel nurse needs to notify the hospital immediately to give as much notice as possible. After notifying the hospital, they must notify their agency as soon as they are able per the agency policy. Travel nurses may not be paid for hours missed and could even face penalties for missing shifts, as the agency agreed to staff these hours within the contract. Calling in sick may also affect bonuses, incentives, stipends, or even result in loss of employment if excessive. If a nurse violates policy or calls in sick excessively, they may risk being terminated, and not be eligible for re-hire (Rosenstock, 2016).  Nurses must understand attendance expectations and associated consequences within their contracts before signing or agreeing to anything regarding travel employment. Attendance is an integral part of the travel nurse’s job as facilities and hospitals greatly depend upon nursing staff to fill in when there are shortages, problems with staffing, or when there might be a strike involved. Travel nurses must understand the importance of coming to work consistently when scheduled, and how absences can negatively impact the unit they are working on, the facility, and the agency (Domrose, 2015). 

Housing

Housing is another factor nursing staff must consider when traveling as it can significantly impact an assignment, and there are certain aspects a nurse must consider when deciding upon where to stay. Some agencies offer agency-based housing while others offer a housing stipend or allowance. Also, some places might be fully furnished or include amenities, while others may offer no furniture or amenities at all. Experienced travel staff may rent or purchase an RV and choose to live in local campsites or RV parks. The nurse should consider assignment length when determining where to stay. For example, during a short-term assignment, a nurse might utilize a hotel or motel, whereas a long-term assignment may necessitate renting an apartment or home. Assignments can be as long as 13 weeks or more and as little as two weeks in length. 

Agency-based Housing

Agency-based housing is housing that is provided for the nursing staff by the agency or company. The main advantage of this option for the nurse is that it is the responsibility of the agency to secure the housing and pay the landlord/company that provides the home or unit. This is especially important when it comes to agencies or companies that do not provide guaranteed hours (Morrison, 2018). If the agency provides the housing, and a contract is canceled, the nurse has no legal or financial obligations to the landlord/company providing the home or unit. It is the agency’s obligation, and the nurse does not have any costs or fees associated with canceling the rental agreement. Additional advantages to agency-based housing are that they typically provide furnished apartments/housing with necessities such as dinnerware, and utilities are included, in addition to potentially cable or internet service as well. However, with agency-based housing, there are typically only two or three options, if the nurses are given any choice at all. Any special requests regarding housing are not guaranteed. Nursing staff will often have their own unit, apartment, or home, but may be asked or expected to live with a roommate who is also doing travel work for the company (Faller et al., 2018).

Stipends

Some agencies opt to give nurses a housing stipend or allowance, which is a set amount of money to find their own living arrangements when contracted to travel. Stipends may be beneficial for nurses who have guaranteed hours, those who would like to find their own housing, or nurses with specific preferences or specialized needs when looking for a place to stay. Often, if the housing costs less than the stipend, agencies will allow the nurse to keep any leftover money. However, if hours are not guaranteed, the nurse may be forced to pay rent or penalty fees to cancel the lease if shifts or an entire contract is canceled. Additionally, they must do the work to find their housing themselves. Depending on the location, it may be challenging to find an acceptable place within the budget allotted by the agency or company. The nurse is responsible for finding and finalizing arrangements and must read all the fine print before signing any rental agreements. Nurses need to full understand and read the lease agreement as it is a legal contract, and it is imperative to see if there is a penalty for canceling the lease. This may be a good option if the agency is providing guaranteed hours or if the nurse is being given a penalty-free contract regarding rental cancelations, but it is not generally recommended for first-time travel nurses (Fraleigh, 2010). If utilizing a stipend, the nurse should consider the distance from the facility, rental agreement stipulations, if furnished or unfurnished, and what amenities/utilities are included when evaluating places to live.

Expectations of a Travel Nurse

    Professionalism and reliability are critical qualities of a travel nurse. Travel nurses must be courteous, open-minded, reliable, and professional when completing travel assignments. Fraleigh (2010) encourages travel nurses not to get involved in workplace politics or gossip and warns against attempting to change facility policies or procedures. Nurses should respect policies within the workplace when traveling and avoid challenging different procedures or methods as they may not fully understand the workflow within that particular organization. It is also important to be professional and polite as travel nurses represent the company, and their actions can impact future contracts or opportunities. Every effort should be made to respect the organization’s practices to facilitate a good working relationship between the facility, the nurse, and the agency (Rosenstock, 2016).

    Travel nurses should maintain a professional appearance when working and follow the uniform guidelines of the facility or hospital in which they are working and the agency if they exist. They should maintain a clean appearance, tie long hair back when appropriate or indicated, cover tattoos, and take out piercings or remove artificial nails when indicated in the facility’s policy. Staff should also avoid heavy perfumes or scented lotions when working. If a smoker, the nurse should be cognizant of the smoking policy within the facility and avoid coming to work smelling like smoke. If the nurse fails to understand and follow the policies, rules, and regulations within an organization, they could face consequences which include written reprimands, suspensions, financial penalties, loss of bonuses, or termination (Rosenstock, 2016). Travel nurses must review and research policies at each facility and how they may impact their employment as each facility is unique.

Special Considerations for Travel Nursing

Travel nurses should research the facility before a new assignment and make every effort to learn as much as possible about the area before arriving. The nurse should consider driving and safety and never travel before reviewing the contract (Fraleigh, 2010). Research routes, traffic patterns, and potential alternative options to commute to work in the case of inclement weather, heavy traffic, or construction. Nurses should always take safety measures to avoid becoming a target for crime and utilize methods to help keep themselves safe such as parking in well-lit areas, not carrying lots of cash, and not leaving valuables in plain sight inside the car when parked. It is also imperative to review the contract before each assignment, so the nurse understands expectations regarding overtime expectations, breaks/lunches, and any other information pertinent to that particular assignment before traveling to the site (Domrose, 2015).

Travel Nursing

    Travel nursing is a growing field that offers a wide array of exciting opportunities. However, prior to committing it is vital that nurses consider contract stipulations such as policies regarding attendance, uniforms, hour guarantees, stipends, bonuses, housing costs and arrangements, benefits, pay, laws, and nursing scope of practice. Nurses are responsible for awareness of local laws and regulations regarding their scope of practice within the state or country in which they are working. Nurses need to be fully aware of policies and procedures regarding overtime, pay, benefits, hour guarantees, and stipends. Nurses must maintain professionalism in the workplace, respect policies and procedures within the facility, and be able to handle personal conflicts appropriately and maturely. Nurses must be open-minded, understanding, and have excellent communication skills when entering a new workplace. Staff should understand they are guests within the facility and must exhibit professional behavior within the workplace. According to Faller et al., (2018), nursing staff also need to investigate and understand bill rates, the current market, and factors that might be affecting current travel employment. 

    Travel nurses must review their contracts and completely understand all rules, regulations, and expectations before signing. There are many factors the nurse should consider and research prior to taking on the position and when starting a new assignment. Nurses must remember that each assignment is unique, and each contract may be written differently, so it is their responsibility to understand and read the contract before signing. Once the contract is signed, the nurse may face a loss of pay or financial penalties if they do not meet the requirements or cannot complete the assignment. Prior to traveling or taking on a contract, it is imperative nurses review the expectations, shift requirements, overtime policies, travel reimbursement practices, and the hour guarantees. While travel nursing can be an extremely rewarding career with a wealth of opportunities, travel nurses should understand the importance of their job and their commitment to the company. As a representative of their agency, travel nurses should consider how their behavior, attendance, and professionalism may reflect on their agency and potentially impact contracts with that hospital or facility in the future (Rosenstock, 2016).

References

Bureau of Labor Statistics, U.S. Department of Labor (2019). Occupational outlook handbook: Registered nurses. Retrieved from https://www.bls.gov/ooh/healthcare/registered-nurses.htm#tab-1

Domrose, C. (2015). Travel NURSING. Nurse.Com NurseWeek (West), 28(10), 21. 

Elrod, J. (2010). Considerations for travel nursing: an update. EP Lab Digest, 10(11), 3p. 

Faller, M., Dent, B., & Gogek, J. (2018). The ROI of travel nursing: A full-cost comparison of core staff pay rates to travel nurse bill rates. Nursing Economics, 36(4), 177-181. Retrieved from http://wa.opal-libraries.org/login?url=https://search-proquest-com.wa.opal-libraries.org/docview/2096469984?accountid=37071

Faller, M. S., Gates, M. G., Georges, J. M., & Connelly, C. D. (2012). On the move: Exploring the perceptions of travel nursing. Nursing Management, 43(7), 42–47. doi:10.1097/01.NUMA.0000415492.43449.99

Fraleigh, J. M. (2010). Getting started as an emergency department travel nurse: travelers’ and recruiters’ tips for your first assignment and a successful career. Healthcare Traveler, 18(3), 26–31. 

Moore, A. (2013). Making a decision about travel nursing. NurseZone Newsletter, 1

Moore, A. J. (2015). Crossing state lines as a travel nurse. NurseZone Newsletter, 1

Morrison, D. (2018). Embarking on a travel nurse career: Start by choosing a travel nursing company that meets your needs. American Nurse Today, 13(12), 72–75. 

National Council of State Boards of Nursing. (2019). Nurse Licensure Compact. Retrieved August 23, 2019 from https://www.ncsbn.org/nurse-licensure-compact.htm

Rosenstock, F. N. (2016). Blacklisting: The dirty side of travel nursing. Nephrology News & Issues, 30(5), 20–23. 

Shaffer, F. (2014). The joys of travel nursing. American Nurse Today, 9(5), 56–57. Retrieved from https://www.americannursetoday.com/the-joys-of-travel-nursing/

Wood, D. (2015). Why travel nursing jobs are booming again. NurseZone Newsletter, 12