Travel Nursing CE Course

language. Be sure to do research before committing to anything or signing any contracts. Speak with co-workers or friends who may have experience in similar roles, read about the agency, and speak with a recruiter. In addition, choosing the right agency is critical. Healthcare facilities work closely with travel nurse staffing agencies; however, of the approximately 340 nurse staffing agencies in the US, only 110 are certified by The Joint Commission (TJC). Although they are not required to work with a certified agency, most Magnet hospitals and larger academic medical centers only work with these certified agencies (RegisteredNursing.org, 2022; TravelNursing.com, n.d.; TravelNursing.org, 2021d). 

Nurses must understand the difference between an agency nurse and a travel nurse. An agency nurse may only work 1-2 days in each assignment and is typically assigned locally with minimal or no advance notice. In contrast, a travel nurse may work anywhere for weeks to months. Therefore, travel nursing involves a more extended time commitment, travel, and flexibility (RegisteredNursing.org, 2022; TravelNursing.org, 2021d). Nurses considering travel nursing should consider whether these characteristics fit their personality and circumstances:  

• enjoying new locations and organizations 

• enjoying the freedom to choose when, where, and for how long to work 

• flexibility with scheduling 

• thriving when being challenged, as learning a new organizational system can be challenging 

• appreciating learning new things 

• having a supportive family and friends (RegisteredNursing.org, 2022) 

Travel Nursing Pay and Benefit Considerations 

Pay and benefits are significant considerations in travel nursing. Understanding bonuses, incentives, travel expenses, stipends, reimbursements, health insurance, and retirement options is essential before making a decision, signing a contract, or accepting a travel position. Nurses also should consider taxes when accepting a travel assignment, as they may need to pay income taxes in the work state. In addition to base salary and primary benefits (e.g., health insurance, 401k), nurses should obtain clarification regarding any potential: 

• travel expenses, including relocation costs 

• living expenses 

• meal allowances 

• reimbursements 

• uniform stipend 

• supplies required and any associated stipend 

Agencies may offer these stipends for costs associated with certain aspects of the job upfront at a set rate, and at times nurses may be allowed to keep any leftover money. In contrast, other agencies may expect nurses to pay for particular things out-of-pocket or submit receipts for reimbursement. Bonuses and incentives are further details nurses should consider when determining whether to work for a specific agency or take an assignment before signing the contract. Sometimes, the agency offers these bonuses, while the hospitals may offer additional contract completion or sign-on bonuses. Agencies may also offer bonuses when extending contracts or working extra hours (RegisteredNurse.org, 2022; TravelNursing.org, 2021c). 

Travel nurses are paid differently from staff nurses because they receive a taxed hourly base rate and additional payments (i.e., stipends) that are non-taxed. The base pay rate is often lower, and the stipends cover expenses and are non-taxable. These benefits are attractive for those considering travel nursing because they can usually make more money than staff nurses. For example, in 2018, the average nurse's salary was $71,730, while the average travel nurse's salary was $88,400. In addition, to the average wage, travel nurses can earn an additional $20,000 to $30,000 in non-taxable stipends. These figures were much higher in 2020 and 2021 when the COVID-19 pandemic staffing crisis increased the need for travel nurses. For nurses considering traveling internationally, the salary is usually lower than in the US (RegisteredNurse.org, 2022; TravelNursing.org, 2021c). Travel nurses looking to make additional compensation can consider utilizing these strategies: 

• get additional training or certification for an in-demand specialty  

• sign-up for rapid response postings that require fast turnarounds to begin working 

• work in less popular areas 

• work in a strike zone (TravelNursing.org, 2021c) 

Travel Nursing Contract Considerations 

Understanding all the contract details, stipulations, and expectations is essential for working as a successful travel nurse. Travel nurses need to review required shifts, hours worked, how the agency bills (bill rates), taxes, reimbursements, licensing/credentialing costs, liability/malpractice insurance, training/orientation, overtime, payroll, calling off, and guaranteed hours. Each nurse must understand what shifts they will be expected to work, the number of hours per week, whether the agency competitively bills facilities according to demand, and any incentives for working overtime. Nurses should also consider the possibility of being mandated or forced to work overtime if a staff shortage happens. Some agencies will pay hourly for orientation and training, while others may factor this into the nurse's pay later. Nurses must also know how often payroll is processed and how they may be taxed depending on their workplace location. Licensing, credentialing, and other employment requirements are also essential to consider, as if these requirements are not met, a nurse may not be able to work (Hansen & Tuttas, 2022; TravelNursing.org, 2021b).  

Travel nurses must also understand and abide by all the policies and procedures of the hospital or facility where they work, just as regular employees do. In addition, when traveling and working at different facilities or hospitals, nurses must recognize that the agency has a contract with the facility. Each travel nurse represents the agency and must make every effort to follow policies within their assigned organization (Hansen & Tuttas, 2022; TravelNursing.org, 2021b).  

Choosing the right travel nurse agency is critical when embarking on this new nursing endeavor. Unfortunately, not all travel agencies are the same, and each nurse needs to pick the agency that is the best fit for them. Before signing a contract, talking with more than one agency Talking with more than one agency before signing a contract can help nurses ensure the best selection. Some questions to consider when selecting a travel nurse agency include (National Association of Travel Healthcare Organizations [NATHO], n.d.): 

• Is the agency certified by TJC? 

• Does the agency provide professional liability and worker's compensation insurance for the nurses they place? 

• Does the agency have a good reputation? 

• Does the agency offer comprehensive services for onboarding (i.e., housing arrangements, credentialing, benefits)? 

• Is the agency a member of the NATHO? NATHO has a set of service standards to protect nurses hired by member agencies. 

Personality and Communication Conflicts in the Workplace 

If a travel nurse has an issue with another employee at their contracted facility, they must follow their facility's policies and those of the travel agency or agency. Travel nurses should make every effort to work through conflicts appropriately and professionally. As contracted employees, travel nurses must remember they are guests in the facility. They represent the agency and should be professional and respectful of the facility to promote the best patient care and staff experiences. If another employee is violating facility policy or putting the safety of patients or others at risk, or if a travel nurse feels that they are being bullied or harassed (sexually or otherwise), then they should notify both their immediate supervisor at their assigned location and their recruiter or agency supervisor as soon as possible (Rosenstock, 2016; Travel Nurse Source, 2019).  

If an issue arises regarding a personality conflict, communication breakdown, or harassment experience when working for a facility, travel nurses must follow not only their agency policy but also the facility’s requirements.  Travel nurses must make every effort to work with immediate supervisors and administrators when handling conflict or when problems arise before going to another superior, whenever possible and appropriate. Furthermore, nursing staff should follow the chain of command when reporting issues within the workplace or when they cannot resolve an issue with their immediate manager or supervisor. Failing to work with immediate supervisors and follow the chain of command within the workplace could create hostility and have unintended consequences (Rosenstock, 2016; Travel Nurse Source, 2019). 

Within travel nursing, there is a phenomenon known as blacklisting. Being blacklisted is synonymous with being labeled as Do Not Send (DNS), Do Not Use (DNU), or Do Not Call (DNC). Blacklisting began to protect travel nursing agencies and hospitals from incompetent nurses. Reasons for being considered incompetent include not following hospital or agency policies and procedures or causing patient safety concerns (i.e., serious medication errors). Nurses can also be blacklisted for breaking a contract, demonstrating frequent tardiness or absences, or having conflicts with hospital staff. Blacklisting can extend to the agency, hospital, or hospital systems. Some bans are temporary, while others may be permanent. Travel nurses should know their agency’s policies and procedures and follow them when working in different hospitals. This is the best way to prevent becoming blacklisted in travel nursing (Travel Nurse Source, 2019).  

Hour Guarantees 

Understanding hour guarantees is essential for nursing professionals, as contracts and assignments may get canceled or changed depending on the policy and facility. Guarantees can differ, as some hospitals can cancel a contract until a certain point, but others cannot cancel at all, directly impacting travel nurses. If no guaranteed hours are defined within the contract, a nurse could lose hours or pay if a hospital cancels the contract. For example, a hospital may have a nurse contracted to work 40 hours a week and then decide to cancel two shifts. If the contract does not guarantee 40 hours per week, the nurse will only be paid for the 24 hours they worked with no additional pay. Many contracts guarantee minimum hours for the travel nursing staff to work. Otherwise, the nurse must be paid the difference between their actual hours worked and the hour guarantee; however, not all agencies or agencies do this. The nurse must be aware of hour guarantees and contract details when signing. Hospitals and facilities may cancel shifts or even contracts based on staffing levels, patient census, or acuity, leaving nurses with no hours or pay. Often, agencies and agencies that offer guaranteed hours will have lower pay (hourly or salary) than agencies that do not offer guaranteed hours. This difference is crucial, and nurses must understand this portion of the contract when deciding whether to sign. Travel nurses must understand their contracts and thoroughly review the details, stipulations, and expectations regarding their employment before accepting the position (Faller et al., 2018; Travel Nurse Source, n.d.). 

Laws and Scope of Practice Considerations 

Nurses should understand the laws and nursing scope of practice when working in other states or countries. If the nurse fails to do so, they could face penalties/fines, restrictions on their license, and even risk losing their nursing license. In addition to understanding their scope of practice, nurses must also understand local laws, regulations, and applicable rules when crossing state lines or entering another country. Nurses who travel must understand cell phone, seatbelt, car insurance, parking, and licensing laws within the state or country in which they travel to avoid consequences such as tickets, fines, or even jail time (Travel Nurse Source, n.d.). 

Some states require nurses to apply for a separate license, which includes fulfilling all the requirements for state licensure before being able to work within that state. Many states are now members of the enhanced Nurse Licensure Compact (eNLC), allowing nurses to apply for a multistate license to operate outside their home state. According to the National Council of State Boards of Nursing (NCSBN, n.d.), the 35 compact states include Alabama, Arizona, Arkansas, Colorado, Delaware, Florida, Georgia, Idaho, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Mississippi, Missouri, Montana, Nebraska, New Hampshire, New Jersey, New Mexico, North Carolina, North Dakota, Oklahoma, Ohio, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, West Virginia, Wisconsin, and Wyoming. Rhode Island was a member of the original NLC but has not yet joined the enhanced version. Massachusetts, Pennsylvania (recently passed and awaiting an implementation date), New York, Minnesota, Washington, Alaska, Illinois, and Michigan currently have pending legislation regarding membership in the eNLC. In addition, West Virginia and Louisiana have extended their eNLC status to LPNs and RNs. Nurses must research and identify which states require them to apply for a separate license and which do not. In addition, they must know the requirements and scope of practice in each state or country in which they work. The NCSBN website has the most up-to-date resource regarding the status of the eNLC in each state (NCSBN, n.d.). 

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 to work in a particular place; however, it is imperative to understand all expectations regarding assignments. Assignments can range from a few weeks to a few months, with many assignments being 13 weeks in length but could be as brief as 2 weeks. 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 must complete the contract as outlined. Leaving an assignment before completion could result in losing bonuses, incentives, overtime pay, and even being blacklisted. If a location is not as expected, the travel nurse should notify their recruiter or manager, communicate their concerns, and make every effort to complete the assignment and fulfill their contractual requirements. Not doing so can adversely impact the nurse’s employment and pay. However, it can also negatively impact the organization’s reputation and lead to losing future opportunities with that facility (Rosenstock, 2016; Travel Nurse Source, n.d.). 

Attendance 

Nurses must make every effort to fulfill all obligations regarding their schedule. Travel nurses are often assigned to fill positions due to staffing deficiencies, so they must be reliable and punctual. 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 have unreliable staff. Therefore, travel nurses must work their shifts as scheduled and make every effort to demonstrate good attendance, be on time, and understand the policies and expectations regarding attendance within their agency (Travel Nurse Source, n.d.).  

A contagiously ill nurse working poses a risk to patients and other staff on the unit. If a travel nurse must miss a shift due to illness, they must notify their agency and the hospital to which they are contracted. Travel nurses are expected to abide by the policies of their agency and hospital or facility. First, the travel nurse must give the hospital as much notice as possible. Next, they must notify their agency as soon as possible per the agency policy. Travel nurses may not be paid for missed hours and could even face penalties for missing shifts, as the agency agreed to staff these hours. Calling in sick may also affect bonuses, incentives, and stipends. If nurses violate attendance policies or call in sick excessively, they may risk being terminated and becoming ineligible for rehire. Attendance is integral to travel nursing, as facilities and hospitals greatly depend on nursing staff to address shortages, problems with staffing, or strikes. Travel nurses must understand the importance of coming to work consistently when scheduled and how absences can negatively impact the department they work in, the facility, and the agency (Rosenstock, 2016; Travel Nurse Source, n.d.).  

Housing 

Housing is another factor nursing staff must consider when traveling, as it can significantly impact an assignment. There are certain aspects a nurse must consider when deciding where to stay. Some agencies offer agency-based housing, while others provide a housing stipend or allowance. Certain places might be fully furnished or include amenities, while others provide none. Experienced travel staff may rent or purchase a recreational vehicle (RV) and live in local campsites or RV parks. Nurses should consider assignment length when determining where to stay. For example, a nurse might utilize a hotel or motel during a short-term assignment, whereas a long-term assignment may necessitate renting an apartment or home (Travel Nurse Source, n.d.; TravelNursing.org, 2021a).  

Agency-Based Housing 

Some housing is provided for staff by the agency or agency. The main advantage of this option is that it is the responsibility of the agency to secure the housing and pay the landlord/housing agency. This option is significant for agencies or agencies that do not provide guaranteed hours. If the agency provides housing and a contract is canceled, the nurse has no legal or financial obligations to the landlord/ agency providing the home or unit. In this case, 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, utilities, and cable or internet service. However, there are typically only 2-3 options with agency-based accommodation. Any special requests regarding housing are not guaranteed. Travel nurses will often receive an apartment or home but may be asked or expected to live with a roommate assigned by the agency (Faller et al., 2018; Travel Nurse Source, n.d.; TravelNursing.org, 2021a). 

Stipends 

Some agencies give nurses a housing stipend or allowance for living arrangements when contracted to travel. Stipends may be beneficial for nurses who have guaranteed hours, want to find independent housing, or have specific preferences or specialized needs when looking for a place to stay. Often, if a housing option costs less than the stipend, agencies will allow the nurse to keep any leftover money. However, if hours are not guaranteed, the nurse may have to pay rent or penalty fees to cancel the lease if shifts or an entire contract is canceled. They must also find their housing themselves. Depending on the location, nurses may struggle to find a good place within the budget allotted by the agency or agency. Each nurse is responsible for finding and finalizing arrangements. Nurses need to fully understand and read the lease agreement before signing since it is a legal contract, and it is imperative to see if there is a penalty for canceling the lease. This option may be desirable if the agency provides guaranteed hours or offers nurses a penalty-free contract regarding rental cancelations. However, it is not generally recommended for first-time travel nurses. If utilizing a stipend, each nurse should consider the distance from their facility, rental agreement stipulations, furnishings, amenities, and provided utilities when evaluating places to live (Travel Nurse Source, n.d.; TravelNursing.org, 2021c). 

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. Travel nurses should not get involved in workplace politics or gossip. They 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 organization. Since travel nurses represent the agency, their actions can impact future contracts or opportunities. Therefore, 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 Nurse Source, n.d.). 

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

Special Considerations for Travel Nursing 

Travel nurses should research the facility before beginning a new assignment and try to learn as much as possible about the area before arriving. The nurse should make every effort to consider driving safety and never travel before reviewing the contract. It is best to research routes, traffic patterns, and alternative options to commute to work in the case of inclement weather, heavy traffic, or construction. In addition, nurses should always take safety measures to avoid becoming a target for crime, such as parking in well-lit areas, not carrying lots of cash, and not leaving valuables in plain sight inside their car when parked. Before traveling to the site, it is also imperative to review the contract before each assignment to understand overtime expectations, breaks/lunches, and other pertinent information (Travel Nurse Source, n.d.). 

Key Takeaways 

Travel nursing is a growing field that offers many exciting opportunities. However, before committing, nurses must consider contract stipulations such as policies regarding attendance, dress code, hour guarantees, stipends, bonuses, housing costs and arrangements, benefits, pay, and local laws. Nurses are also responsible for knowing the laws and regulations regarding their scope of practice within the state or country they are taking an assignment. When representing their travel agency, nurses must maintain professionalism in the workplace, respect policies and procedures within the facility, and handle personal conflicts by following the proper chain of command. Professional behaviors include being open-minded, demonstrating understanding, and having excellent communication skills when entering a new workplace. Finally, nurses must investigate and understand bill rates, the current market, and factors affecting current travel employment (Faller et al., 2018; Travel Nurse Source, n.d.).  

Before signing a contract, travel nurses are responsible for reviewing and understanding all rules, regulations, and expectations since each assignment is unique, and each agreement may be written differently. Before traveling or accepting a contract, nurses must review the expectations, shift requirements, overtime policies, travel reimbursement practices, and hour guarantees. Once a contract is signed, the nurse may lose compensation or incur financial penalties if they do not meet the requirements or cannot complete the assignment. As a representative of their agency, travel nurses should consider how their behavior, attendance, and professionalism may represent their agency and potentially impact future contracts with certain hospitals or facilities (Rosenstock, 2016; Travel Nurse Source, n.d.). 

 

References 

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. https://www.proquest.com/openview/a1c089d66bb1f8b176a43129f79f0875/1?pq-origsite=gscholar&cbl=30765 

Hansen, A., & Tuttas, C. (2022). Professional choice 2020-2021. Nurse Leader, 20(2), 145-151. https://doi.org/10.1016/j.mnl.2021.12.018 

National Association of Travel Healthcare Organizations. (n.d.). What should I look for in a travel healthcare company? Retrieved May 8, 2022, from https://www.natho.org/Travel-Healthcare-Professional 

National Council of State Boards of Nursing. (n.d.). Nurse licensure compact. Retrieved May 8, 2022, from https://www.ncsbn.org/nurse-licensure-compact.htm 

Odom-Forren, J. (2022). Travel nursing: Price gouging or supply and demand? Journal of PeriAnesthesia Nursing, 37, 153-154. https://doi.org/10.1016/j.jopan.2022.01.013 

RegisteredNursing.org. (2022). What is a travel nurse? https://www.registerednursing.org/specialty/travel-nurse 

Rosenstock, F. N. (2016). Blacklisting: The dirty side of travel nursing. Nephrology News & Issues, 30(5), 20-23. https://pubmed.ncbi.nlm.nih.gov/27386607 

Travel Nurse Source. (n.d.). What is a travel nurse? The exclusive travel nursing guide. Retrieved May 8, 2022, from https://www.travelnursesource.com/what-is-a-travel-nurse 

Travel Nurse Source. (2019). The truth about being blacklisted. https://www.travelnursesource.com/notes/truth-about-being-blacklisted 

TravelNursing.com. (n.d.). What is travel nursing? Retrieved May 8, 2022, from https://www.travelnursing.com/what-is-travel-nursing 

TravelNursing.org. (2021a). How do travel nurses find housing? Agency vs. stipend. https://www.travelnursing.org/housing-for-the-traveling-nurse 

TravelNursing.org. (2021b). How does travel nursing work? Salary and FAQ. https://www.travelnursing.org/frequently-asked-questions 

TravelNursing.org. (2021c). Travel nursing average salary and benefits 2021. https://www.travelnursing.org/salary-and-benefits 

TravelNursing.org. (2021d). What is a travel nurse? https://www.travelnursing.org/what-is-travel-nursing