Pre-employment physicals: Who pays?

NedRN · Oct 20, 2018

Travel nursing is unlike any staff job you've ever held. There is a bill rate involved and if you don't work, the agency doesn't get paid and neither do you. Very different than a hospital employer who can predict revenue and profits. No matter the "benefit" paid to or on behalf of a traveler, it is coming out of your pay from the hours you work. It is all the same compensation pie split up differently. In that regard, it doesn't matter if the agency pays or you pay, it is coming out of your check. As will your housing, per diem, and travel pay. And licensure.

Generally, an agency large enough to "front" your physical (some do) is one that pays less than other agencies - have to to cover those physical costs for nurses that may not pass them, or end up doing an assignment with them.

Here is another inside tip, some agencies may require a physical prior to submitting you to a hospital with an assignment, but it is not necessary and many agencies don't require it. Interview and land the assignment, yes, you will need all your health stuff, physical, vaccinations, TB status, background check, et cetera.

There are some benefits to getting the physical yourself. You own it! If the agency pays for it, they likely will not give you a copy (yes, I know you have the right to it but the agency doesn't have to give it to you). The reason is that you can take it to another agency, benefiting them, not the agency that paid for it. You get a copy from paying for it yourself (you have health insurance right?), now you can much more easily and quickly change agencies, a big benefit to you. This also limits your xray exposure as you may have to do it again with another agency (up to three times a year) if you don't hold the documentation.

On the topic of TB positive, you have a better alternative than annual xrays. A simple blood draw for Quantiferon is more sensitive and less invasive. I worked in England and took BCG. Stopped taking xrays after this test was developed and it is now acceptable at any employee health department in the country.

Argo · Oct 20, 2018

I usually pay for nothing, or the least I can, and get a copy of everything right at the time of service. I have never had a PA or MD(their cna) turn me down for the copies. This includes all physicals, labs, tb quant, mask fit, drug tests.... they email the labs to me from lab corp and the local clinics.

All that being said, notice I say usually. Occasionally I have paid and been reimbursed later.

RN/WI, ADN, BSN, MSN, RN, APRN · Oct 20, 2018

Agencies pays for physicals, lab tests, immunization you may need. Agency also reimbursed for any license, acls, bls, you may need. If yours isn't, find another one! With acls bls and licenses, I have paid and been reimbursed with receipt.

alfa-sierra, BSN, RN · Oct 21, 2018

Thanks for the feedbackâ˜º

alfa-sierra, BSN, RN · Oct 21, 2018

Thanks for your reply. Once or twice I did a physical on my dime. It was however rejected by a new employer. because they wanted the results on the company stationary and format. But they paid for the new physical of course.

As for the Quantiferon blood test, yes it is more accurate and objective than the skin tests. But if you are a PPD converter you will also show a positive. Quantiferon and still need a chest XR to rule out TB.

The advantage of the Quantiferon (cost not withstanding) for PPD converters is that they don't have to endure another painful skin reaction.

NedRN · Oct 21, 2018

I'v not been required to get an CXR with quantiferon. About 14 years and upteem hospitals.

alfa-sierra, BSN, RN · Oct 21, 2018

I'v not been required to get an CXR with quantiferon. About 14 years and upteem hospitals.

What if the Quantiferon is positive? Does it differentiate between active TB and non-active? Thanks.

NedRN · Oct 21, 2018

Great question. Don't know. But I do know that it differentiates better between active and non-active TB far better than the binary answer of PPD. Not much that an xray can show other than granuloma nodules (I have them). The gray haired advice is to do prophylaxis if your xray shows nodules (I declined some 18 years ago at the TB clinic at Hopkins preemployment for a travel assignment). Active disease is identified by a symptom check done along with quantiferon - nodules without symptoms (something like 30% of all CXRs) present no public health risk.

RN/WI, ADN, BSN, MSN, RN, APRN · Oct 21, 2018

One place that I worked, they did the quantiferon TB blood test. Well, first of all I was pretty sure the idiots did it wrong because I have never had it show positive prior. But of course who knows. It does not differentiate between latent and active TB I found. Next they said I needed a CXR, that was found to be unremarkable- nothing there. Next they say, we need to have a PPD skin test to rule this out. It was all done backwards. The skin test showed no reaction- but whatever .then the idiots wanted another quanriferon drawn. I declined. This was a perm job I took and it was terrible . They kept me for 6 months and didn't pay me my last pay check either. I guess I should have had a clue that there was something wrong with them at the beginning with the TB test. I had been a traveler so I knew better than this.

RN/WI, ADN, BSN, MSN, RN, APRN · Oct 21, 2018

No , the blood test will not differentiate between active and latent Tb. Only a CXR confirms this with sputum culture, if I remember right.

TriciaJ, RN · Oct 21, 2018

Thanks for your reply. Once or twice I did a physical on my dime. It was however rejected by a new employer. because they wanted the results on the company stationary and format. But they paid for the new physical of course.
As for the Quantiferon blood test, yes it is more accurate and objective than the skin tests. But if you are a PPD converter you will also show a positive. Quantiferon and still need a chest XR to rule out TB.
The advantage of the Quantiferon (cost not withstanding) for PPD converters is that they don't have to endure another painful skin reaction.

That isn't true. A negative Quantiferon negates a positive PPD. If you have a positive Quantiferon, then you do need a chest x-ray to rule out active TB.