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Travel nursing nuts and bolts

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By: David Morrison, RN

Know what to expect to ensure a good experience.  

No doubt about it. The past 2-plus years have been tough for nursing. With a global pandemic, nurses have been placed on the front lines in the fight to return to normalcy, if that’s even possible. It might be easy to declare critical care nurses at the forefront, but I believe all nurses have experienced practice changes. And for some, COVID-19 has led them to leave the profession altogether.

Before the pandemic, experts made many projections about nursing shortages. Since the start of the pandemic, those projections have increased and the time frame has escalated rapidly. A major healthcare system in the state where I work has an estimated deficit of over 1,000 nurses. For those of us who remain active in the profession, many believe the pandemic sheds light on the value nurses bring to the healthcare system. Many who feel their value isn’t recognized as a staff nurse are turning to travel nursing.

If you’ve been a nurse for more than a minute, you’ve heard of travel nursing, and if you work in a facility that’s ever experienced a staffing shortage, you’ve likely worked alongside a travel nurse (traveler). However, you may not know much about how you become a traveler. This article will answer some of your questions.

What’s a travel nurse?

Simply put, travel nurses are temporary help. I’ve compared them to the staff big retail stores hire at Christmas to help with increased customer traffic. But instead of a seasonal need, staffing shortages occur year-round. With COVID-19, the shortages far exceed the available travel nurses, which has dramatically increased what was always a rather good compensation package.

How do I get started?

Start by considering what you want to get out of travel nursing and which type of travel nurse you’ll be. Are you a location traveler (you’ll choose assignments based on locations you want to visit) or a compensation traveler (you’re looking for high-paying positions that will help you achieve financial security, pay down student loans, or purchase a home), or do you fall somewhere in between?

Most nurses join a travel company that arranges contracts for them. Type “travel nursing companies” into any search engine and you’ll find over a hundred companies. Travel forums such as Pan Travelers (pantravelers.org) or the Delphi forum for traveling nurses and therapists (delphiforums.com) can help you narrow your choices. You might also consider talking to a travel nurse and asking them for a referral.

How do I articulate what I want?

Talk to the company or recruiter about your preferences and goals. The travel recruiter is your advocate and should work to find you a position where you’ll succeed. But you need to give them some insight into your practice to find a facility with a good fit. For instance, if you’ve only ever worked at small rural hospitals, a large university teaching hospital might be overwhelming.

Let the recruiter know where in the country you’d like to explore positions. You also can list states or regions in order of preference. For example, Florida as a first choice, California as a second, and Arizona as a third. Provide specifics: “I want to make no less than X amount an hour,” or say, “Find me the highest paying job on the east coast.” Broader requests will result in more options, but being specific will help your recruiter center in on the best fit.

You’ll also need to comply with all the licensing, company paperwork, and skills checklists that will be sent to potential employers. Don’t embellish when it comes to your skills and comfort level with equipment or procedures. Promote your strengths, but don’t misrepresent your abilities. If we weren’t in a pandemic, you might be able to learn some new skills on your assignment. But with the current state of healthcare, you’ll be expected to hit the ground running and require little, if any, assistance in getting your feet under you.

Travel nursing has always required at least of year of current experience in the specialty in which you wish to travel. So if you moved from telemetry to critical care 4 months ago, you might not be able to secure a travel position in critical care. However, due to the extreme needs right now, a more dangerous prospect is that you might indeed be able to secure a position in a specialty with less experience than normally required. In this instance, you must evaluate the risk to your license should something happen. Employers will be happy they filled the position, but they won’t always ensure that you’re safe to practice in their environment. Only you can be responsible for guarding your nursing license.

What happens at the offer stage?

When your recruiter has leads, they’ll share them with you. If, for example, you expressed interest in positions in Florida that pay no less than $20 per hour, the recruiter may come to you with offers that include a $25 per hour position in a Miami teaching hospital, a $23 per hour position in a small facility in Delray Beach, and a $25 per hour position in a large Ft. Lauderdale level 1 trauma center. If none of them sounds appealing, you can ask the recruiter to keep looking. Or you can choose to interview with one or all of them. You have no commitment at this point and no obligation to accept any of the offers. The commitment comes when you find an assignment you like, interview for it, receive an offer, and sign a contract.

Interviews 

Your first contact with a potential employer may be a telephone interview with the unit manager. Take this time to get a sense of the unit. Don’t assume that because it’s a telemetry unit and you’ve worked on telemetry units for 5 years that it will be a smooth transition. Perhaps this unit is taking some overflow patients with COVID-19 who are on BiPap or high-flow oxygen. Or maybe they have some stable patients with COVID-19 who are on ventilators. Get a sense of what you’ll be walking into, and assess whether your skill set meets patient needs.

Inquire about patient ratios and the availability of personal protective equipment (PPE). You’ll also want to check the Centers for Disease Control and Prevention web site to find out if your assignment is in a current hotspot. Keep in mind that a location with low numbers can change within a matter of days.

You’ll also want to ask about vaccination requirements. The overall answer seems to be yes. Travelers currently on the road are finding their contracts canceled if they don’t comply with a facility’s mandated vaccinations. If you don’t want to be vaccinated, you may have a hard time finding a travel position.

Contracts 

When you sign a contract, be sure you understand all the terms. You’d be surprised how many questions I’ve received that could be answered just by reading the contract. You’re bound by the contract. It protects you and the travel company. This isn’t a staff position where you can call in sick. And you can’t simply not show up. These actions have consequences based on the terms of the contract.

Pay rate 

Be sure you fully understand your pay rate. You may be making $2,000 per week, but that could include everything—your hourly pay, housing, stipend, insurance benefits. Make sure you understand your compensation and how it’s itemized. (See What are the tax implications?)

What are the tax implications?

What-are-the-tax-implications

Before embarking on your first travel assignment, be sure you understand the tax implications of this work. For the most part, you can deduct (or receive tax free) any expenses you duplicate while on the road, but this is based on having a tax home. As defined by the Internal Revenue Service (IRS), your tax home is the entire city or general area where your main place of business or work is located.

I recommend meeting with a tax professional for guidance. My book on travel nursing includes a chapter on taxes and was vetted by Joseph Smith, the founder of TravelTax (traveltax.com) and an enrolled agent with the IRS. I consider his website’s FAQ page (traveltax.com/consult-and-documentation/) required reading for any nurse thinking about becoming a traveler.

Where will I live?

Once you’ve accepted a suitable travel assignment, the preparations begin. You can work with your agency to find housing, or you can arrange it on your own. For first-time travelers, I recommend working with your agency. After you get the hang of travel nursing, you can take your housing stipend and arrange your own accommodations. Of course, you can always take the stipend right from the start if you have friends or a relative you can stay with during your assignment.

How will I get to my assignment?

You’ll need to decide if you want to drive or fly to your destination. I always liked having my own transportation, and in some locations you’ll need a car to get you to and from work. Explore all your options for getting around before you decide. Some places will have adequate mass transit, and I’ve even worked in locations (San Francisco comes to mind) where I walked to work each day.

What happens when I get to my assignment?

When you arrive to your assignment, expect to jump through a few more hoops. Most hospitals require an orientation, and some require additional testing to confirm competency. If information about additional testing is available, discuss it with your recruiter before signing the contract. Some facilities cancel contracts if tests aren’t passed, adding stress to the beginning of your assignment. If you find test-taking especially anxiety inducing and you have a choice between two assignments (one that requires testing and one that doesn’t), having this information may help you make your final decision.

Before arriving at your location, find out what color scrubs you should have. In addition, bring extra PPE (especially N95 masks) in case the hospital encounters supply issues.

How do I fit in on the unit?

Some travelers face challenges fitting in on a unit. You may encounter nurses who assume you’re making a lot more than they are. Focus on why you’re there: to help the staff provide safe patient care. Don’t attempt to change unit processes. That will only create friction. If the practices are safe, adhere to the unit’s policies and procedures

Many units (like just about all work environments) have cliques and you’ll be dealing with different types of personalities, all of which may be under tremendous stress. You’ll need to prove yourself before you’re fully accepted. Create a good reputation for yourself by going out of your way to be helpful.

Pandemic nursing can’t be done solo, so you need to be accepted as a member of the team. The unit may be similar to others you’ve worked on before or it might be completely different. Nursing requires teamwork, so resolve any personality clashes quickly. Be friendly and helpful and the rest should fall into place.

Reap the rewards

Many nurses find traveling to be a rewarding career path that provides setting and patient diversity, an opportunity to meet and work with people from around the country, as well as a salary that helps them build financial security. However, all nurses continue to experience high levels of stress due to staff shortages and the ongoing pandemic. As a traveler, you might also experience tension related to fitting into a new unit. Find time to tend to your own health and wellness. Maintain a healthy diet, stay active, and speak up if you feel overwhelmed or have symptoms of burnout (loss of motivation, negative outlook, decreased satisfaction).

David Morrison has been a travel nurse for over two decades and is the author of Travel Nurses Bible, available in the Kindle store on Amazon. He can be reached for travel recruiter referrals at david@travelnursesbible.com

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