Want to Be a Travel Nurse?

Travel nursing has become more popular since the COVID-19 pandemic. A variety of factors can be attributed to this shift, particularly the crisis pay we were seeing for an extended time. A lot that came with the initial waves of COVID is slowing down and becoming normalized, including pay for travel nurses. Unfortunately, the healthcare crises of short staffing, more patients, and a backed-up healthcare system continue. Increased demand for staff at the bedside is causing nurses to burn out faster than ever. One way many nurses can find balance is through the ability to have more control over their schedule and time off. No need to ask a manager for time off or for vacation. Both parties, the RN and the hospital, agree to a contract, abide by that for 13 weeks, and move on, or more should an extension be in favor of both. Many factors in healthcare today make it very tempting to dive into the travel nursing world, but before you get going, there are factors you need to consider before diving in.

Read this article to ....

• Identify if you have what it takes to be a travel nurse.
• Gain valuable insight into the travel nurse world before you even start.
• Receive outlined action steps to get you started.

Action Step: 1 & 2

Choose Travel Nurse Agency

Once you decide travel nursing is for you, it's time to choose an agency. Sounds easy enough until you nosedive into the abundance of information provided on the topic. That rabbit hole naturally leads you to evaluate other travelers' feedback, and boy, they can make things even more confusing. While getting feedback from other professionals in our field is most often beneficial, sometimes obtaining opinions online doesn't provide one with valuable information.

There will always be one or two unhappy customers, so don't eliminate every company that has a few negative reviews, but never choose a company with a ton of terrible reviews. Feedback from someone who has been traveling for more than a year, preferably more than 2 years, is most ideal.

You need to pick which agency will best serve your needs. I have personally only worked with Medical Solutions, Cross Country, & Nomad, but I have applied and had access to Accountable, Trusted, and various other agencies. Yes, this is market shopping, but it is the name of the game in the travel industry. Different companies offer different packages and have relations with different facilities, so it's in your best interest to assess all options available.

Most travel nurse agencies will require you to work with a recruiter. Working with a recruiter has a lot of great benefits; these benefits include making first-time traveling a breeze by guiding you through the entire process. Good recruiters will listen to your travel nurse's desires, work with you to obtain those desires, and guide you on steps that need to be taken. The biggest challenge in this is finding and connecting with a good recruiter; if you don't feel a connection or that your recruiter isn't a good fit, you are not tied to them indefinitely. My first recruiter was an absolute dream; she could not have been better at her job. My second recruiter was completely the opposite; I gave him multiple opportunities to redeem himself after communicating with him directly about why I was dissatisfied. Once he proved that he was not going to be able to meet my needs or standards, I requested that he direct me to his manager; she heard me out, then acted as my recruiter until she got me linked up with a new recruiter, who was much better. Although recruiters come with some of their own faults, they are truly beyond helpful when it comes to travel nursing.

Want to cut out the middleman? Jump over to Nomad who is a recruiter-free agency. Unlike agencies with recruiters, Nomad and Trusted have you complete your application yourself, no recruiter involved. This means you get access to all the jobs available, the pay breakdown, and their requirements. Another bonus, once your profile is updated, the system also lets you know if you are missing any requirements for each open position. You get to evaluate the rates before ever talking to anyone and you get to apply for a job before you talk to anyone; it's amazing. Once you apply and get hired, the navigators jump into the picture. Essentially the navigators facilitate the onboarding process, requesting and submitting all the onboarding documents to get you going. There is a lot less hand-holding with companies like Nomad and Trusted; this can be a positive or negative depending on your situation or personality.

When I first started, I chose 3 companies to onboard with and chose my assignment based on pay, location, and a great recruiter. Later I was onboarded with Nomad so I could land an assignment with a friend. It is best to do your own homework regarding a travel nurse agency, research the companies, then pick your top 3. Once you have narrowed it down to 3 agencies, get your profile set up with each of them.

Action Step: 3, 4 & 5

Search & Apply

Once your employee profile, and resume, are set up with your choice agencies, it is time to start looking for your first travel nurse job! If working with a recruiting agency, be forward with them that you are working with multiple agencies and tell them that you don't want them to submit any applications without your approval. This will avoid any issues of being double-submitted. If the recruiter has an issue with it, find a new one.

Action Step: 6, 7 & 8

Contract Agreement

If you chose a recruiting agency, there is a chance you will do a phone interview before you are hired. If you went with a navigating company, there is typically no phone interview. After you apply and get the job, it's time to review and sign the contract.

This tends to be the most stressful part for me. Not because the contract is complex or difficult to understand but because some deep-rooted subconscious fear makes me feel that I am overlooking something every time, even after multiple contracts.  To ease this worry, I have come up with a system that has served me very well, and recommend you use it as well.

• Take 24-48 hours to read and re-read the contract. 
• Have someone trusted read over it.  
• Pay special attention to the following components of the contract. 
  • Unit 
  • Shift
  • Hours/week
  • Hourly rate
  • Stipend rate
  • Contract length
  • Holiday pay
  • OT Pay
  • Schedule requirements (Holidays? Weekends? Rotating?)
  • Float requirements 
  • Cancellation fees (in case of emergency)

If any of these are not correct in any way, do not sign until the issue is resolved. When it comes to floating, it's not an unwillingness to float, but to ensure there is an understanding I am contracted to my home unit and not as a float nurse.

It is very important to understand the pay breakdown before signing your contract (see Pay breakdown below).

Once you sign the contract, you are officially committed.

Action Step: 6, 7 & 12

Pay Rate Breakdown

When looking at pay rates it's best to know and understand the breakdown.  The blended rate is the total weekly rate the company is offering for the contract. The blended rate is made up of the weekly meal stipend, weekly housing stipend, and weekly pay.

The stipend rate is not taxed. This rate will fluctuate from one contract to another because it is based on cost of living in the area you will be staying at while on contract.  You are receiving the stipend money because your tax home is essentially too far to commute to and from work, so you are supplemented for the need to obtain housing and buy food in the area you will be working. This mileage is not clearly defined, but all three companies I have worked with required you to be 50+ miles from your tax home to receive the stipend untaxed.

Your weekly pay will be taxed. This is the total of your hourly rate for the week, the hours in this sum are based on your contracted hours.

Duplicating expenses is a commonly used term in the travel nurse world. This is paying for two homes, one of which is purely for work, so you aren't taxed on that portion of your income.

It is best to consult an accountant for any tax questions or concerns. They are truly worth every penny.

Action Step: 9

Budget

Because life happens and there can be unforeseeable events, it is wise to have some backup money saved before taking off, although this is not necessary. As a nurse, you will be able to obtain another job no matter what, but imagine traveling to a new place, spending all the money you have, to find out there was a family emergency, or maybe the hospital canceled the contract. I recommend having a backup budget, but it would be a lie if I said I did this every time I left for a travel nurse contract. It just never hurts to be prepared for emergencies.

Action Step: 9 & 10

Travel Expenses

Travel expenses sound lavish, but at the end of the day, it's usually just a flat rate based on gas and miles from your tax home to the assignment. This gets paid out once for traveling to the assignment and a second time for traveling back home. No more, no less. The company is not going to pay for your hotels or food along the route. The agencies I have worked with were not open to negotiating travel expenses, but perhaps I am a poor negotiator. Regardless, you will end up spending more on your travels than what the company covers.

Before the tax law changed, I wrote off all expenses; since 2017, the cost vs benefit of itemizing all travel expenses not paid for is not worth it. That doesn't mean there aren't any perks when it comes to traveling because there are some amazing deals for travel nurses. Make sure to ask whichever company you contracted with for any discount codes. Also, ask rental car companies and hotels for any healthcare provider discounts; there are more out there than you are aware.

I highly recommend enjoying your travels from one location to the next; part of the travel nursing excitement is getting to see new places! Take a few extra days or weeks, get a nice hotel, take your time, and take in the beauty this country has to offer!

Action Step: 11

Housing for 13 Weeks or Less 

Obtaining housing for 3 months is easier than it sounds. There are a lot of resources available to travel nurses; you just need to watch out for scams.

Good places to look for housing for travel nursing are extended stay hotels, Airbnb, furnished finder, social media travel groups like gypsy nurse on facebook, and my least favorite, craigslist.

Get to the area you will be temporarily working at least one, preferably two weeks ahead of time. This provides you with time and space to get settled. You can finish up any onboarding documents while exploring the new area you will be residing temporarily. Most importantly, you will assess areas for housing; go see potential housing, and meet your potential landlords. This is the best way to prevent any scams. Obviously, things like Airbnb or an extended stay hotel have more safeguards, but if you see an affordable, nice, well-located place on craigslist or networking on social media, my pro-tip is to meet the landlord/property agent, see the home, then sign a lease agreement before providing them with any deposit. One of the nicest places I stayed was found on craigslist. At another place I stayed, the landlord wanted everything in cash; you bet she signed a dated receipt that rent was paid each month. You are a nurse and have great critical thinking; use that skill when finding housing.

Action Step: 12 & 13

Benefits

Like any other full-time job, when you are on a contract, and you have medical and dental insurance and the ability to sign up for a retirement plan.

When it comes to insurance, if you plan on taking more than one month off between a contract, it is important to consider getting health insurance through something like cobra. Age and health may be a huge factor in this, and as nurses, we know that accidents don't wait for when we have insurance. Although it would be dishonest of me to say that I never let my insurance gap. To my knowledge, there are only a handful of states in the US that charge a penalty for not having insurance, and this is no longer a requirement at the federal level. If you are unsure how your state handles a gap in insurance, this is another great question for your accountant.

You will also want to plan for retirement; none of this is investment advice, just what I have learned through experience, and what I do. Earlier in my career, I just signed up for whatever retirement plan my company offered, started small, and bumped it 1% higher each year, including with each travel company I work. When I am taking time off, my attempt is to save enough to continue investing in myself, although this takes some research and time to find an investment plan that is best for you. If you don't want to spend your time thinking about financial investments, it could be beneficial to hire a financial advisor to guide you.

Once you have found a job, signed a contract, get to your temporary home, and find a place to live, it's time to get to work. When working as a travel nurse, there are traits and qualities that will make this job go smoother. Below we will discuss these traits.

Action Step: 14

Experience & Competence

Competence comes with experience; experience comes with time. It is best to obtain at least two years' experience in the specialty you will work as a travel nurse.  Once you start working you are given minimal orientation, then you hit the ground running. Some hospitals will provide you with a week's worth of orientation, others may only provide you with a shift worth of orientation. The hospital and nursing agency are paying for your expertise, the ability to easily transition into a new hospital, it is impossible to do this without foundation or experience.

It takes time to see and work with a variety of patients, to become truly efficient in nursing it is best to stick with one hospital and stay in one unit for at least one, preferably two years. It takes time to learn how to be a nurse, but it also takes time to learn and understand policies, procedures, where to find them, where the supply closet is, what's the code to the supply closet, what number to dial or who to call in what situation, not to mention all the people -- nurses, doctors, respiratory therapists, physical therapists, nursing assistants. Having a set routine and way to do things for a period longer than 13 weeks allows you to learn and understand why things are done, what to expect in situations, what to ask for in critical situations, and so much more. Obtaining experience is so you can function efficiently and confidently as a travel RN.

Action Step: 14

Confidence & Humility 

With experience comes confidence and humility, which are two very important traits in a travel nurse. Travel nurses must be confident in their ability to perform care, but they must also obtain humility, freedom from pride or arrogance, because not knowing things and asking questions are always going to be a must for a travel nurse. A travel nurse is not going to remember every policy, phone number, or where some supplies may be hiding, so questions must be asked. At an even greater scale, even if you have been a nurse for twenty years, the facility you are going to may do things entirely different.

Perhaps you have managed _X_ a certain way while working at one facility; you may find that when you go to a different facility, there is a whole different set of rules. One hospital I worked at didn't use wrist restraints on any of their intubated patients. Another hospital I worked at titrated a vasopressor by mg/min instead of mcg/kg/min. Some facilities use fitted sheets on every bed no matter what; others will say this is taboo and bad for the patient's skin. It is bad practice to come into new facilities with the mindset you know how to do everything the best way, because the best way at one facility may not be the best way for another. Ultimately is best practice to adapt to your environment and work with the flow of the hospital you are contracted at.

Another important factor to be aware of regarding confidence and competence is knowing your own capabilities. As a traveler, you may find yourself in a situation where you do not have the proper training to care for a patient; it is your responsibility to speak up, "I have never cared for this type of patient; this assignment is not appropriate.” That is okay! It is also okay to be aware that you just need some additional knowledge, "I have cared for this kind of patient before, but we didn't do _X_ at my facility. Can you please show me how to do this the correct way?” What is important in both scenarios is that you understand your competence and advocate for yourself and your patients, do not put either of you in that situation.

The potential for you not to know or understand what or why a facility is doing is 100%; it is simply a matter of how you handle it. With a lack of confidence or humility, it will be difficult to adapt to a new environment every 13 weeks.

Action Step: 14

Resourcefulness & Flexibility 

The above example shows why you may need to have some flexibility in travel nursing, but there is so much more than that. You will be required to float; it's guaranteed at some point while working as a travel nurse. You are also likely to get the "not so appreciated" assignments. Que Bruce Hornsby's "That's just the way it is.” Obviously, hospitals are going to do everything they can to retain the staff they do still have. The hospital's goal is to ensure it has enough nurses and does the best it can at pleasing its staff, not a temporary contracted worker. That must be okay with you. Otherwise, you are going to cause yourself a lot of unnecessary grief and frustration.

With the ability to be flexible at work comes resourcefulness. It is imperative to be resourceful as a travel nurse because you are required to adapt to new environments regularly. Don't know a policy? Find it. Can't find it? Find a staff member who is knowledgeable and show you how to get there. I appreciate all nurses, but I always check the policy for myself because things can vary so much from one facility to another. Also, once you get used to checking the policy, you can typically find the answer to many questions you will have.

I hope this article provided you with valuable insight and information to best prepare you for your first travel assignment. Transitioning from staff to traveler can feel overwhelming due to all of the uncertainty. My goal has been to provide you with all the information you need to get going ... confidently. 

If you didn't like what you had to read, then maybe travel nursing isn't for you. 

If you read through that and feel like, "yes, I can do this,” time to get started!

Utilize this article to guide you through the process of getting started as a travel nurse. Numbered below are the action steps discussed in each section; use this as a step-by-step guide to prepare yourself for travel nursing. Reference the above sections when you need a more detailed explanation of each action step.

Now that you know all that travel nursing entails, time for you to get going on your Travel Nurse adventure!

Action Steps Summarized

1. Choose the top 3 travel nurse agencies.
2. Update professional portfolio/resume with top 3 candidates.
3. Job shop. Find your ideal location & pay rate.
4. Apply to a travel nurse job.
5. You're Hired! 
6. Review every component of the contract. 
7. Understand the pay breakdown.
8. Sign Contract. You are now officially committed.
9. Budget for travel & emergencies. 
10. Make the trip to your temporary home. 
11. Find Housing. 
12. Hire a CSA. 
13. Plan for Insurance & Retirement.
14. Evaluate your ability & needs before making the transition.