The COVID-19 pandemic has exasperated ongoing challenges with bedside nurse staffing. As a result, many organizations are struggling to fill their job openings, leading to a boom in the use of travel nurses. This article provides an overview of what nurses need to know; how to get started, be successful when on assignment, and help protect themselves from legal liability.
The COVID-19 pandemic has exasperated ongoing challenges with bedside nurse staffing, with some nurses temporarily furloughed and others choosing to leave the profession, retire early, or switch jobs. As a result, many organizations are struggling to fill their job openings, leading to a boom in the use of travel nurses. Furthermore, the long-term outlook for travel nurses appears healthy, as more Baby Boomer nurses continue to retire, putting additional strain on the workforce. In fact, the U.S. Bureau of Labor Statistics predicts a 9 percent job growth for RNs from 2020 to 2030.
The generous pay for travel nurses is certainly a lure, although drawbacks such as loneliness and resentment from staff nurses who may not be paid as well exist. Here is what you need to know before packing your bags to take a travel nurse job, including how to get started, be successful when on assignment, and help protect yourself from legal liability.
Travel nurses work on temporary assignments that usually last for 13 weeks but can assignment lengths can vary. Rather than being employed directly by an organization, travel nurses typically work for a company that specializes in supplying staff to organizations in need. Most jobs are located in hospitals, although other settings, such as home care, long-term care, and outpatient clinics, are also available.
A higher paycheck is the most cited benefit of travel nursing, particularly now, as pay has increased dramatically due to factors related to the pandemic. But there are other benefits to consider as well. As a travel nurse, you can explore many areas of the country and forge new friendships. Working in multiple organizations can help you identify best practices that you can apply going forward in your career and help you explore different career options. You’ll also often find excellent opportunities to build your skills, which makes you more marketable. Another benefit is that the higher pay may allow you to take several weeks off between assignments.
On the other hand, it can be lonely working in a strange city with people you don’t know. Getting to know a new facility can feel intimidating, particularly during your first few assignments. And although in general, your colleagues will welcome your help, some may resent that you may be earning much more than they are for doing the same work, especially when they are already stressed from the demands of the job.
Focusing on the positives and engaging in self-care practices can help you surmount difficult situations and manage your own stress caused by the pandemic and other challenges. You’ll need to make an effort to reach out to others, and you can use video communication platforms such as Zoom or FaceTime to check in with your support system back at home.
You should have at least a year’s experience as a nurse before traveling since you will be expected to have the expertise required to practice independently. You’ll also need to have a license in the state where you’ll be practicing, and some jobs require specialty certification.
When selecting a travel company, don’t simply look at the salary. Check for benefits such as medical and dental insurance and reimbursement for travel to your assignment. Many companies will help you with finding housing, and continuing education and tuition reimbursement may be offered. Some companies even have retirement plans. If you work with any travel nurses, ask them about their experiences with the company that employees them. You can also check reviews on Google or Glassdoor.
It’s also a good idea to ask how the company typically handles guaranteed hours with an organization because this varies. In some cases, there are no guaranteed hours. If census unexpectedly drops and you aren’t needed, you will not be paid. In other situations, you may need to float to another unit to obtain your guaranteed hours.
You’ll be asked to create a job profile with the company and complete some paperwork before you are assigned a recruiter and start your job search. Most travel companies require a background check, drug testing, physical examination, a current negative TB skin test, and various immunizations such as Hepatitis B. Proof of vaccination against COVID-19 is also likely. You’ll probably be asked to complete a skills checklist that potential employers can review.
Ultimately, you will sign a contract with the company. Review this document carefully before signing, paying particular attention to what your compensation does and does not include (for example, housing). Keep in mind that your contract is with the travel company, not the organization you are assigned to.
The interview with the manager of the facility where you will be working will likely be by telephone or video platform. As with any interview, the manager will ask about your expertise and they will be looking to determine if you are a good fit for the organization. And as with any interview, this also is your time to ask questions, such as nurse to patient ratios, floating policy, how scheduling is done, and specifics about the types of patients you will be caring for. Other good questions include who provides any required scrubs, and parking availability.
Once the organization agrees to your assignment, the travel company will send a confirmation notice that includes items such as start and end date, assigned unit, and the number of shifts per week.
Starting the assignment
The organization you will be working for will usually ask you to complete a test to verify your expertise in areas such as arrhythmia detection and drug administration. Even though this is a temporary assignment, you’ll still complete an orientation, although it will be shorter than if you were a permanent employee. Travel nurse Gloria Gillman writes that in her experience orientation typically involves shadowing a nurse for 2 days before functioning independently. She advises nurses to walk the unit several times to become familiar with the layout. In addition, flexibility and friendliness are keys to establishing productive relationships and promoting a good experience.
You will need to be licensed in the state where you’ll be practicing. This is easier if your “home” state is part of the Nurse Licensure Compact, which allows any nurse who resides in a participating state to practice nursing in another member state. The National Council of State Boards of Nursing has a map of contract states. If your state isn’t part of the compact, you’ll need to apply for a license; but your travel company can usually help with this.
Be sure your professional liability insurance is current and notify the provider of your change in practice setting. This is a good time to ensure that you also have coverage for State Board of Nursing actions taken against your license. Some nurses assume that they are adequately covered under the staffing agency’s insurance, but employer-provided coverage typically does not apply to State Board of Nursing investigations. In addition, employer-provided coverage insures you only while you are employed and on the job, which could leave you vulnerable in situations such as during per diem or volunteer work and when you are between jobs.
| Reducing travel nurse liability
| Here are a few steps you can take to help reduce the potential for liability related to working as a travel nurse:
- Be sure your license is recognized in the state where you are practicing.
- Understand the state’s Nurse Practice Act.
- Review the State Board of Nursing’s website for practice information.
- Ensure you have professional liability insurance that includes license protection coverage.
- Follow the organization’s policies and procedures.
- Speak up if do not feel you are qualified for the task or assignment.
While on assignment, you’ll need to adhere to the laws and regulations in the state where you are practicing. Pay particular attention to the state’s Nurse Practice Act, since the nursing scope of practice can vary by state or territory. You’ll also want to visit the State Board of Nursing’s website, which typically contains good information related to expectations related to practice.
Follow the policies and procedures of the organization. Failure to do so leaves you open to litigation should patient harm occur. In addition, remember that your supervisor and colleagues will not be as familiar with your expertise as would be the case with a permanent job. If you’re given a task or assignment that you don’t feel qualified for, speak up. Describe what it is about the task or assignment you don’t feel equipped to handle, the reason for your feelings, and the training or accommodation you would need to be more confident and better prepared.
Some travel nurses who receive a stipend for housing or meals decide to live more cheaply and retain what is not used. Doing so, however, can create tax problems. To avoid these problems, you should keep receipts for items such as housing and uniform expenses, and you also need to understand where your tax “home” is. A tax home is the main place you work, not where you live, and, of course, that usually changes more than once during the year for travel nurses. The tax home can default to the place of residence, if a person meets certain criteria, such as incurring significant expenses for maintaining their primary residence (such as a mortgage) that are duplicated when on assignment (such as paying rent) A detailed explanation is beyond the scope of this article, but you can learn more via these explainers from American Nurse Today or Trusted Health. There are also resources for filing your taxes available via the IRS website, as well as for finding a licensed tax professional to help you go over the specifics of your situation.
A new world
Travel nursing can open a new world of opportunity for those who are flexible and confident in their skills. By understanding expectations and taking steps to protect yourself against liability, you can enjoy multiple rewarding experiences and grow as a nurse.
Gillam G. Travel nurse essentials. Am Nurse J. 2021. https://www.myamericannurse.com/travel-nursing-essentials/
Gray, S. Understanding taxes as a travel nurse. Am Nurse Today. 2020. https://www.myamericannurse.com/understanding-taxes-as-a-travel-nurse/
IRS. Tax Information for Individuals. 2022. https://www.irs.gov/individuals
Morrison D. The adventure of travel nursing. Am Nurse Today. 2018. https://americannursetoday.mydigitalpublication.com/articles/the-adventure-of-travel-nursing
NSO. When to refuse a nursing assignment. 2017. https://www.nso.com/Learning/Artifacts/Articles/when-to-refuse-an-assignment
Schmidt K. The ultimate travel nursing contract checklist. BluePipes. n.d. https://blog.bluepipes.com/ultimate-travel-nursing-contract-checklist/
U.S. Bureau of Labor Statistics. Occupational Outlook Handbook: Registered Nurses. 2021. https://www.bls.gov/ooh/healthcare/registered-nurses.htm
Disclaimer: The information offered within this article reflects general principles only and does not constitute legal advice by Nurses Service Organization (NSO) or establish appropriate or acceptable standards of professional conduct. Readers should consult with an attorney if they have specific concerns. Neither Affinity Insurance Services, Inc. nor NSO assumes any liability for how this information is applied in practice or for the accuracy of this information.
This risk management information was provided by Nurses Service Organization (NSO), the nation's largest provider of nurses’ professional liability insurance coverage for over 550,000 nurses since 1976. The individual professional liability insurance policy administered through NSO is underwritten by American Casualty Company of Reading, Pennsylvania, a CNA company. Reproduction without permission of the publisher is prohibited. For questions, send an e-mail to firstname.lastname@example.org or call 1-800-247-1500. www.nso.com.