The Power Structure of Travel Nursing…and how to partner to get free of it.

In one of the more frustrating aspects of travel, true power exists solely in the hands of the facility or hospital group that hires on a travel nurse.  Yes, said traveler is technically an employee of the agency that they work for but the contracted employment takes place at the facility and usually at their discretion.

Let’s first take a look at how the contracts are set up.

As we mentioned previously, in order for an agency to receive job vacancies to fill, there must first be a contract set up with that facility or hospital group.  Those contracts are a painstaking process to iron out as both agencies and facilities have their own versions of contracts they would like signed.  Occasionally, there can be negotiations to reconcile the two versions but in the big business of healthcare, the more powerful party dictates the terms and that is usually not the agency.

For example, if the agency wants guaranteed hours and the facility or hospital group says no, the option is either to not offer it to the nurse or for the agency to agree to pay the nurse out of pocket based on the whims of the scheduler or supervisor.  As some hospital staff are told to cut travelers first to save on expenses (that traveler nurses are actually cheaper notwithstanding), this can be an exorbitant financial burden on the agency to agree to pay for it without being able to bill for it.  This is not a sound financial decision for a fiscally responsible agency to make.  It is in fact more honest, for the traveler to know up front that the facility does not guarantee hours and allow the nurse to decide for herself if the contract is risky or not.  This also drives home the importance of asking about low-census scenarios (or the possibility of overtime) during the interview.

The contract between the facility (or hospital group) and the agency covers their interactions and does not involve the travel nurse.  When the travel nurse agrees to accept a position, the contract to be signed is between the nurse and the agency and covers assignment details and expectation of conduct.  The agency is bound to follow the guidelines set out by the master contract they have signed with the facility and the traveler, via verbal agreement or by signing, is agreeing to comply with the facility’s terms and conditions.

This gets trickier when assignments come with facility-specific parameters, such as bonuses and fees.  If a facility offers a bonus (usually in the form of a completion bonus), an agency can sometimes not even be aware of the existence of the bonus until it’s paid or if they are, not know if the facility will consider their own criteria met for qualification.  For example, some facilities have offered completion bonuses based on not missing a shift, rather than being based on total contract hours worked.  This means that if your contract has you working 3 shifts a week and you miss a shift, they can refuse to pay the bonus, even if you made up your hours because there was a missed shift at all.  It’s devious but it does happen on occasion.  Also, those bonuses do not usually include taxes so the take home amount could make you feel cheated if you were aware of the bonus at all.

Fees are also an issue.  Some facilities will fine the agency when a contract is cancelled without due notice.  As some facilities were having many travelers change their minds, they implemented the fine against the agency knowing that the agencies would work hard to ensure the travelers followed through with their commitments.  These fees can range anywhere from $500 to $5000 and can sometimes be disputed, compromised upon or even waived under the right circumstances.  This is why it is imperative to be fully communicating with your recruiter.  For an active contract that needs to be terminated early, facilities will usually waive fees if 2 weeks notice can be given and if the agency can find a replacement nurse within that 2-week timeframe.  For a contract that hasn’t started yet, the facility can require up to 2-weeks notice or they will apply a fee.

What if you haven’t signed the contract yet, you ask?  It doesn’t matter to the facility; in their mind, you verbally committed and they will try to hold you to it.  What happens if you refuse to accept responsibility for the fine?  A few things: 1) The facility can “blacklist” you from any and all hospitals in their group, preventing you from working there ever again in any capacity 2) the facility can cancel their contract with the agency and blacklist them from any working relationship in the future or give them the silent treatment by simply not releasing needs to the agency at all.  Much like the TSA’s No-Fly list, there is no official way to determine if you have been blacklisted and no official channels to get removed from that list.

It’s important to realize that in travel nursing, you are partnering with your agency to show a unified front against the Big Brother mentality of the hospital groups.  With billions of dollars and entire battalions of lawyers at their disposal, these groups know full well they can do whatever they want because nurses and agencies have the most to lose.  Remember when Apple decided to get rid of the headphone jacks on the iPhone, requiring everyone in the universe to buy adapters or new headphones?  They knew it was unpopular but they didn’t care because they are Apple, and are big enough not to need to care.  The same thing applies here; facility groups are united against you (and agencies) and they don’t mind applying fees and litigating into submission anyone who stands in their way.

If you ever find yourself thinking that there aren’t enough jobs out there, consider that this is the result of both nurses and agencies refusing to comply with facility groups many unreasonable requirements.  Playing by a groups rules, within reason, is the best course of action to allow for a variety of job opportunities at a variety of locations.  Not every worst-case scenario will manifest and if one should happen to occur, please speak with your agency representatives to find a workable solution to the issue.  For everyone to have beneficial experiences in travel, nurses and agencies need to remember that they are on the same side and communicate with each other to build that unified front and find the right solutions for everyone involved.  As Mr. Miyagi would say, “if do right, no can defense”.