I've got to put in my 2 cents here. The issue of being paid for hours worked lies between the employer and the employee- specifically, the agency and the agency nurse. What can and can not be billed for is an issue between the agency and hospital, not the nurse. If a nurse notates the hours that he/she works and is not compensated by the agency, that is a violation of federal law and the agency can be audited and fined- and the nurse WILL receive adequate compensation (payment in full) as a result of the audit. Any subsequent violations on behalf of the agency can result in further financial, punitive action or worse. "If you don't get the signatures to approve the lunch not worked, we can not bill the hospital" is not a replacement for the law. That being said, this is what I suggest:
Agency work involves self marketing of skills and teamwork. Do not make this billing issue between the agency and the hospital something that negatively reflects upon you. For a 12 hour shift with no lunch and a hospital that refuses to sign for the time you worked, simply notate the times you actually worked (12.5 hours) and leave it at that. If the authorizing hospital employee is not happy with this, simply write on your time slip- bill only 12 hours and tell her/him your agency will take care of it. Keep your reputation free from harm and smile during the entire interaction. Now, your agency MUST pay you. They do have the right to also counsel you to take your breaks and subsequently fire if they wish, but if they do you are working for the wrong agency anyway.
Can you blame the hospital for wanting a 30 minute discount when they are getting stiffed with 31% profit margins? There is a reason why the top stock on Wall Street is healthcare agency work- and not not necessarily an ethical reason (those are our tax dollars too that are being shoveled out to keep not-for-profit hospitals afloat). Unfortunately, the agencies that run huge profit margins are the most inflexible in these situations. Their corporate affiliation holds them to a certain (rather large) profit expectation. My agency routinely pays for time the hospital considers "off the clock" for billing purposes. There is something to be said about volume business, partnership, and satisfied customers. This is an issue between you and your agency- don't let them make it out to be the hospital. Take charge of the situation and inform your staffer how it will be handled.
Feel free to contact me if your agency won't honor the time you put in- I'll even give you the number of the federal authority you can contact for the backpay!