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Travel Industry Overview

Temporary staffing of hospitals has been going on for over thirty years. Travel contracts originally came about to meet seasonal shortages.  Areas with temporary increases in population, such as Florida in the wintertime, need to supplement their core full time staff. This was a very efficient way to meet a hospital’s needs for several busy months a year. Staffing of regional shortages followed. And today there is a shortage of nurses as well as many other healthcare specialists almost everywhere in the United States.  This represents a loss of revenue, and/or over-stressed permanent staff. Many facilities across the country are meeting these short term needs with contract help, generally at a higher cost than permanent staff. While this national nursing shortage is predicted to expand, few shortages last forever. But in the meantime, contract travelers are paid well and also enjoy certain tax advantages.

There will always be a need for travelers, even if the national shortage is reduced. There will still be seasonal needs, and many regions of the country will always have temporary needs.

 

Agencies

Agencies act as the interface between a traveler and the facility. They enter contracts with the facility which makes them a contractor. They bill the hospital (or another vendor) for the contracted rates, and pay the traveler as an agency employee.  Historically, they also find and provide housing for their travelers and reimburse certain other costs such as travel and license costs. 

Some agencies act as “prime vendors” which means the hospital has an exclusive or semi-exclusive contract with that agency to provide all of their travel contracts. Some of these agencies are owned by the hospital chain or are a hospital association. If these prime vendors cannot meet the facility’s needs, they will subcontract with other agencies.

Much of this process is opaque to the traveler. They are an employee of the agency and not privy to facility contract details. Yet these hidden contracts can and do affect the traveler’s own contract and terms. For example, if there are more agencies between you and the facility, with each one taking a cut of the action, this will affect the traveler's pay. 
 

Travelers 

This is the term commonly used for the end provider of services on short term contracts, whether it is a registered nurse, or other healthcare provider such as respiratory therapist, and even in non direct care occupations such as a purchaser or manager. Most travelers are employed by acute care facilities, but there are some other choices.  For nurses, psychiatric, long term, and dialysis care are often provided outside the acute care setting and travel contracts are commonly available.

A traveler differs from a per diem or local agency nurse by virtue of a contract. Travelers are contract employees. These contracts are typically 13 weeks in length, with shift work of 36, 40, or sometime 48 hours a week. Many of our expenses are paid, unlike permanent or per diem employees. These expenses can include housing, travel, license, and certain other costs. We may have an allowance for meals, parking, even car rental. It is common to include health insurance as well.  Agencies offer health insurance policies  of varying quality and cost.  Many agencies have 401(k) retirement plans. 
 

General Details 

The basics of getting a travel contract is finding a travel company, finding an assignment that you would like to do, and filling out massive amounts of paperwork. The paperwork generally includes an agency application (some will accept an application you completed for another agency), a work history, a skills list, two or more professional references, and documentation of any licenses and certifications you may hold. This is usually enough to get an interview with the hospital. 

After a successful interview and verbal agreement to contract details between the agency and yourself, even more paperwork will be needed. If you require a license in the assignment state, this will have to be arranged before your assignment commences.  That state may have some specific CEU requirements before licensure. You will probably have to do some mandatory testing with the agency, such as OSHA, HIPAA, fire and safety, and age related competencies. 

You will need an up to date (within one year) physical, with vaccination history (and immune status titers often required now). TB testing needs to be at least current within one year, with some facilities wanting it current within three months. Some require the two step PPD, and if positive, a current chest xray. You will also be required to submit to a urine drug test. 

You will be required to complete the usual employment paperwork, I-9 (immigration status), W-2 (tax status for withholding), a voided check and form for direct deposit of your pay, insurance paperwork, and perhaps a few other things. Of course there will be a contract to sign. This may happen well before the other paperwork, but will be contingent on everything else being completed. 

This whole process can be done in under two weeks, but is more commonly four weeks or more. Often the biggest sticking point may be getting a state license in hand. In some states, this will take over four weeks. Sometimes there is a delay because the hospital only has one or two start dates per month to accept new travelers. This is because they will want you to go through their scheduled general hospital orientation before starting/orienting on your specific unit/area.

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