HarryHK

Traveler.

What questions provoked this response? You may well have been asking questions with proprietary answers that no agency is comfortable answering. Questions like how many travelers do you have, what is your bill rate, how many assignments terminate, and so on.

What I posted was in the context of contracting to acute care hospitals. In most states, there is no regulation of such agencies or insurance requirements. Home health is outside my area of expertise, and I understand that in most states the industry is heavily regulated. That said, there are always ways around regulation. For example, the woman you took the class with may have been running a simple referral business, with fees charged to the client or the worker. There would be a direct "contract" between the healthcare worker and the client, so no regulation or insurance requirements for the third party. In other words, she was not actually an employer. It is also common for per diem agencies to use nurses on a subcontract basis, and provide no benefits, and may require that you carry your own workers comp and liability insurance. Thus, no payroll, and a large percentage of their costs are shifted to the worker. In the case of per diem workers at acute care hospitals, it is up to the individual facility if this practice is allowed. For home health, I think it depends on the state regulation. Hope this helps. Not a very fast response!

1. If you are working away temporarily from your permanent home, the expenses incurred such as housing are tax deductible. Alternatively, if the agency provides either housing or a stipend in lieu of, that is a tax free benefit - no receipts required. 2. Sign up with several agencies to gauge fair market prices. Yes, with most agencies you can negotiate. The larger agencies tend to be harder to negotiate with. 3. Your agencies will guide you through the whole process. Find agencies with a Google search, or journal ads. 4. Some agencies have better insurance than others, you will have to inquire. Generally your permanent employer will have superior insurance. If that is important to you, you can continue it for up to 18 months per COBRA regulations. You can also purchase your own private insurance through companies like Blue Cross Blue Shield, there are major advantages to doing so if you are relatively healthy. 5. No, the bill rate from the hospital is fixed. However, some hospitals may require ACLS, so having certifications may open up additional assignments to you. It is worth your while to call a couple of agencies and you will start to get a feel for travel nursing. If possible, do not give them your contact information or resume until you are ready to go AND they have a suitable assignment with acceptable compensation.

No matter how you slice it, agencies make a gross profit margin of between 20 to 30 percent of the bill rate after all direct nurse expenses have been paid (the definition of gross profit margin). This is AFTER paying all those additional expenses you are referring to. It is difficult to lose on a direct contract. Now if you want to talk about the time spent in looking for and arranging housing and benefits, you've got a point about the benefits of an agency doing this for you. And withholding taxes, paying their overhead (recruiter commissions, owners, rent, utilities), and marketing, yes, that comes out of the 20 to 30 percent gross profit margin. For those willing to do the extra work and who have the inclination and the skills, direct contracting is a no lose situation, it is not possible to make less money. It is more about considering basic aptitude than worrying about losing money. About the only real money issue for independents is the delay between invoicing and getting paid (usually 4 to 6 weeks), and the upfront money for housing. But every traveler has a cash cushion if they are wise to cover the unexpected. Travelers who are not good money managers should certainly not start their own business, and some would say not even travel!

Thanks, I guess. Not sure what your point was other than projecting your own animosity at innocent nurses who are in no way responsible for your budgetary problems and citing "facts" with no evidence. So if I helped you realize that, you are welcome. I might point out that healthcare costs and outcomes is an interesting topic and we could have had an interesting discussion on that. Certainly the numbers and quality of nurses impacts both costs and outcomes and an open discussion with both management and worker perspective would have been productive for both parties. The high road is always better.

Gee Karen, we seem to be responding to your own animosity for nurses and lack of citations for your "facts". We've cited a reputable study as well as pointing out well known demographic factors. Until you substantiate your claims, ad hominem attacks are a poor substitute for a reasoned argument. OK, a poor substitute even with evidence to support your position.

fizz2Nurse is completely correct in all her posts with tax rules. To add to her excellent posts about some specific statements like the ones above: Assuming the traveler is working away from a legitimate tax home and follows the rules, none of the above is a factor in initiating an IRS audit, or needed for defense in an audit. It is true that for very high wage earners (or more often, high passive incomes), a large shift in taxable earnings is a factor in closer examination of taxes. For ordinary earners such as nurses this is not true. There is no expectation of some threshold of earnings that must be maintained. My own taxable wages swing $50,000 from year to year (a very large shift indeed on a percentage base) and I've never been audited. Some think that making to little in hourly wages is a red flag. The IRS has no idea and no way to know how much you make per hour. They receive quarterly reports on total taxable wages, not wages broken down per hour or per week. Saving receipts for expenses that you have been reimbursed for (such as lodging and M&IE) is completely unnecessary. The IRS doesn't require it, nor do they have any information about your reimbursements as it is not reported to them. Only income is reported to the IRS, not reimbursements. Working 50 miles away from home is not a factor of a determination of a legitimate tax home. This is an urban legend among travelers that arises from two sources. One is the IRS rules on moving expenses which requires a 50 mile distance to be deductible (travelers do not move). The other is from agency based internal rules about whether reimbursements to travelers will be taxed or not. All companies are required to have minimum policies in place to determine if a traveler is eligible (by agency rules) to receive reimbursements tax free. 50 miles is a common determinant (although not the only one). An agency is not the tax police, they only have to show a reasonable effort to protect themselves. How they determine internal rules or actually pay the traveler has nothing to do with whether a traveler is actually eligible for tax free reimbursements. This is a very important distinction that many travelers are confused about and their recruiter assists in this misinformation. The recruiter knows what the agency policy is but is not a trained tax professional.

It is clear that you have a narrow management perspective and to imply that you are preparing a foundation for a new generation of nursing professionals is wrong. You are actually preparing a new generation of workers to exploit. I would suggest to you that rather than denigrate travelers for being overpaid, you should consider the reality that you are underpaying your own staff nurses. If you paid appropriately, you would not be understaffed . And from a national perspective, there would not be a nursing shortage if all nurses were paid what they are worth. Despite being a manager, you are not understanding the basic economic principles of supply and demand, only the constraints of your own corporate pocketbook. You might look to the California example. Not only do they have mandated staffing ratios, but pay far above the national average. In fact staff pay routinely is so far higher than travelers that travelers become staff there. And the use of travelers in California has dropped precipitously in lockstep with the rise in pay over the last couple of years.

As the general contractor, you will be required to show proof of general liability, you may in turn pass this liability down to your contractors and require that they obtain insurance contractually and show proof to you. You are not responsible for workers comp on your contractors. However, the facility may demand such proof by you or your contractors. Ultimately, you have little control over the contractor filing a WC claim against you or the hospital by attempting to show that they are an employee, not an IC. Good contracts and handling of work relationships are key to protecting yourself. A good text to read if this is of concern by you is: HIRING INDEPENDENT CONTRACTORS: The Employer's Legal Guide, Attorney Stephen Fishman, AUG 2000 NOLO $29.95 304 pages

My knowledge base is limited to traveling. That is something that can be done to employ one's self with practically no funds or licenses. A local staffing agency is a very different beast. Yes, you will need significant funds and/or a way to finance your payroll, set up an office, purchase needed utilities and licenses, and promote your business. Good luck with that! It is certainly not low hanging fruit but if you know the industry well and have many contacts with local nurses and facilities, then that is the kind of business you should take a stab at. Do do lots of research before you start, check out your competitors and what you can do better, and of course other market conditions, particularly availability of staff and needs of facilities.

Only a person MOVING to the state. Not business travelers.

I would never put the name of an agency on your resume. They cannot provide a good reference and even have some incentive to give a bad reference. It is the hospital that is providing you with a workplace and supervision and a reference/evaluation as needed (you should be maintaining your own professional portfolio - get your own written references for best control over your career). Your goal should be to have a one page resume, particularly for agency or travel assignments. No one cares to look through a five page resume, they are hiring a warm body and just need to ascertain minimum skills and experience. Be ruthless and expunge all irrelevant information, even education if you have a long work history. Add stuff if you have a short work history to flesh out the page. Format it so a quick glance will allow the reader to get a snapshot of your professional life. In this regard, the hospital names you have worked at will be a key clue for the manager. Resumes are very individualized and often have to be because of unique experiences. As such, there are many ways to format information. I'm a fan of one hospital, one line with start and stop dates. I have 12 years of travel on a one page resume and still have room for education. That cannot work that way for per diem though. In your case, I would say per diem, general area (Los Angeles), date range worked, and the specialties worked. That may take up two lines. Then a list of all hospitals worked, in this format you can list more than one on one line. There are a dozen resume books just for nursing, and innumerable ones for resumes. If you go to Google images and search for nursing resumes, you will come up with many samples (mostly inappropriate in my opinion as they are designed for permanent staff positions). Pantravelers.org has samples specific to travel which may get you a better idea. Look under Resources>Download for them (I believe a free registration is required).

Ignore the cops. If they issue a ticket, take it to the courthouse along with a copy of your contract. You should be able to get it settled without an actual court date. It is not in the best interests of the State to incur the costs of a formal court appearance for something that will be thrown out on the basis of your evidence. Ignore also the threats that you will have to return in three months. You do not. You can present evidence by mail. In addition, if you are out of state, that is more evidence in your favor, and they cannot touch you out of state unless you return. California has every right to defend tax and fee collection and as noted, a number of California residents register their cars in Nevada or Oregon to avoid the high costs of car ownership and insurance in California. California is the most aggressive state I know of in this regard, even to posting an 800 number to call on billboards to report out of state cars in your neighborhood. The rules are clear, but the bottom tier person, the cop, may not understand them. California also has a much misunderstood rule on a presumption of residency if you spend 9 months in California. This is also not relevant for travelers, but you do often have to fight this presumption.

Agencies do not charge 70 to 100 dollars an hour. The norm is more like 50 to 62 an hour depending on location and specialty. But why would you want to undercut your competition? Get what you are worth! I have always been the highest paid traveler at every hospital I go to. The reason is that I do not have the limitations of regular agencies, I can negotiate just for myself as I am not trying to compete with other agencies to provide many nurses. And they cannot obtain my services from any other agency. This allows me much more flexibility to structure my contract to meet the hospital needs. If your skills are valuable and you are a consummate professional, you are a valuable commodity, not the warm body of the usual agency placement.