Traveling Through an Agency Vs Direct Hospital

[NurseN26]

Hi my fellow nurses!

So, lets jump right to it!

I am a new travel nurse, looking to take an assignment down south. I started working with AMN sister company Onward, but I have been having such a struggle with pay rates! Every hospital is paying so low for nurses its pretty terrible. I've come to realize that the hospitals aren't really paying low, its the nurse who is getting the pay cut. I feel as though one the agency takes their huge cut, the nurse is left with peanuts!

So, I have done my research. I have notice MANY MANY MANY hospitals having their own SEASONAL traveling contracts directly through their hospital. Many of them are paying between $50-60/hr with a housing stipend of an additional $1,000-1300. That is good money for the south.

I feel if I go directly through the hospital, I will be treated better, have a better orientation, and not have to go through the 'middle-man" which is so frustrating. The only PRO with working with an agency is travel and licensure reimbursement, but to me that is not enough because plane tickets are so low depending when you purchase it, and spending $150-200 out of pocket for your RN license is not bad since you will have it for life (good investment).

Everytime I speak to my recruiter she just talks so fast, and sounds like a used car salesman, and the money is so low. I'm talking $30-40 emergency room nurse speciality low.

What do you guys think? Has anybody gone through a traveling contract directly with a hospital, or do you prefer using an agency?

[NedRN]

Lot of questions here. For starters, your relationship with your recruiter is absolutely key to your success traveling. You do not have a good fit, nor have you done adequate shopping. Call a bunch of agencies, and pick five of them who have recruiters you can communicate with and explain so you can understand. Without that, you have nothing.

Pay is relative to what you make as staff. Most travelers come from the South and are delighted with pay rates that many travelers sneer at. Travel does pay well, but if you are only talking to one agency, you have no idea of what you are worth in a particular market. Again, call a bunch of agencies.

I must be behind the escalating pay rates, or you are L&D. I've not heard of seasonal hospital travelers making that much (do tell us who, and what your specialty is). But if they really are paying that much, you can make close to that as an agency traveler too.

Yes, the hourly rate for seasonal travelers can be higher than most agencies offer. There are some small catches (or differences anyway) to working for regular agencies. Hospital invariably tax your housing as ordinary income. If you are traveling away from a tax home, you can deduct the duplicated cost of housing plus per diem (meals and incidentals or M&IE in IRS lingo) but thresholds mean that you are unlikely to even come close to the way agencies pay travelers on those benefits. So the difference is less than it might appear.

Also, hospitals will only withhold taxes for their state. You will still have to pay taxes in your home state. That is true regardless, but many agencies will withhold taxes appropriately for both your home state and work state so you don't owe money at the end of the year.

You may be treated differently as a seasonal traveler rather than as an agency traveler, but I doubt that is common. Certainly a returning seasonal traveler is generally welcomed back, but I've had that same experience as a traveler. Every assignment is different, and the only real way to find out how you are treated is to go there and work.

You are right that licensure costs are relatively trivial for most states so that is not much of a factor. Just so you know, not all agencies will reimburse you, and almost none for the full costs. Full costs include background check, and license verifications, which can get expensive and slow things down when you collect a few licenses that require verification by snail mail rather than online via Nursys.

So I'm suggesting signing up with multiple agencies here (after proper screening - if they don't share information before making you sign up, forget them!) and I know that is a big hassle. But after you do this, you are ready to go anywhere with relatively little work. You will soon boil down your favorite agencies to just a couple of favored ones you know treat you right (usually money is secondary to that) and get you good assignments. In contrast, signing up for seasonal is only good at one hospital (or sometimes a chain like Banner in Arizona) instead of thousands. I wouldn't go seasonal for just a couple dollars.

In the old days (I started traveling in 1995), sometimes you were an employee of the hospital with the agency providing housing and benefits. I swore after I did that that I'd never do it again. I can't remember all the reasons, but going through the employee crap for the hospital was not good and it cost me some agency benefits. This is analogous to working seasonal direct for a hospital I think. So I wouldn't do it without a large financial incentive. Personally, I've worked in Florida and it is not great. So even a great financial incentive wouldn't do it for me. I can vacation in Florida handily and work somewhere else, usually for much better money, where the work is good.