Hello everyone and welcome to another episode of the Truth About Travel Nursing Podcast. My name is Kyle Schmidt and I’m your host. Thank you so much for joining me for episode 26 of the podcast. In this episode, we’re going to discuss a host of issues that become pertinent once you start your travel nursing assignment. So we’ll be discussing what to expect, how to prepare, actions that you can take to ensure a smooth assignment, some of the problems that can occur and tips for dealing with them. [Please note that this is a transcript of a podcast episode. As such, grammar and spelling are not optimized for written content.]
I want to point out that there is actually a lot of prep-work that can be done to ensure a smooth assignment. So, throughout this podcast, we’ll be pointing out issues that you can get a head start on before the assignment begins. And remember, we always have everything on the show notes page, so you can visit that page instead of writing things down throughout the podcast.
Okay, so the first thing to consider is how the assignment will begin. In the vast majority of cases, the assignment begins as soon as you step foot in the facility. I know what you’re thinking right now, “That’s obvious, Kyle, you idiot.” However, there are certain cases when you’ll actually need to be present somewhere before you actually visit the facility. And this wrinkle tends to throw many travelers as well as newer recruiters for a loop.
You see, certain assignments will have what is commonly referred to as a “pre-onboarding”. This is almost always the case when you have a contract at a Kaiser hospital in California. It also happens quite often with HCA hospitals. Remember, HCA is the Hospital Corporation of America; it’s the biggest for-profit hospital company in the country. And Kaiser California is huge as well, so these pre-onboarding classes actually happen quite a bit.
One wrinkle that they can cause pertains to your start date. When you interview for the job, you’ll agree on a start date with the facility. Your contract will almost certainly include that same start date. However, when one of these pre-onboarding sessions is required, they’re separate from the start date, so you’ll actually have to be in the area sooner than the start date of the assignment might indicate.
So, it’s actually pretty important to know if there will be a pre-onboarding required. You need to plan in advance to know whether or not you’ll be able to make it in time for the pre-onboarding. For example, let’s say that you agree to a start of Monday, September 23rd because you’re not able to make it to the assignment location until Friday, September 20th. Well, if there isn’t a pre-onboarding scheduled on Friday, Saturday or Sunday, then you could be out of luck.
Sometimes, this oversight can result in a traveler getting pushed back a week, or even have the contract cancelled in the worst cases. Ultimately, the oversight would be the agency’s fault. I mean, at the end of the day, they’re the ones who are supposed to properly train their recruiters to watch out for these issues.
Either way, this is one of those things that it’s always a good idea to ask your recruiter about before interviewing. That way, you’ll know during the interview so that you can make sure you agree to a start date that works for you.
And the reason this is an issue for the recruiter and the agency, as opposed to the hospital, is that these pre-onboarding sessions usually aren’t conducted by the hospital. A pre-onboarding is usually conducted by the hospital’s Managed Service Provider. For Kaiser in California, this is American Mobile as of 2015. For HCA, this is Parallon, which is a staffing company that is a subsidiary of HCA.
These pre-onboarding sessions are typically located at one of the Managed Service Provider’s local offices in the vicinity of the hospital you’ll be working with. However, sometimes they can be in the next city over so you should plan ahead for that. The sessions typically take 3 to 6 hours and you’re typically paid for the time.
However, when it comes to pay for this time, don’t be surprised if you’re paid at a lower rate and maybe even not at all. Remember, employers can require a certain amount of paperwork to be completed without paying their employees for the time. So whether or not you’re paid for this time may depend on whether or not your agency is able to bill for the time and what the agency’s policy is for paying out this type of non-billable time.
Alright, so what can you actually expect at one of these pre-onboarding sessions. Well, a lot of paperwork. In fact, you may even have to complete some paperwork that you’ve already completed with your agency; you’ll just be completing the paperwork for the Managed Service Provider. It’s almost as if these Managed Service Providers are preparing to work for them instead of your agency. And this is a huge point of contention when it comes to managed service providers in general.
We discussed the debate over managed service providers at length in episode 15 of the podcast. Remember Managed Service Providers are Staffing Agencies that have an exclusive contract to staff at a hospital and then they enlist the help of other agencies to get all the positions filled. This creates a potential conflict interest, right? I mean the Managed Service Provider would love to have their competitors’ travelers come work for them.
And when it comes to these pre-onboarding sessions, the Maanaged Service Providers will literally tell the travelers that they can get PRN shifts for them if they want to work extra. So, in a sense, the Managed Service Providers are in fact trying to get their competitors’ travelers to work for them.
Okay, so one of the main things to watch out for with pre-onboarding sessions is exams. You may be required to take tests. Sometimes these tests are pass/fail and if you fail, then you get sent home; you’re contract is cancelled. I’m not aware that this ever happens with Kaiser, but it can possibly happen with Parallon. In the past, the administered a PBDS exam to travelers and cancelled the contracts of travelers that failed the exams. I’ve heard that they don’t do this anymore, but I can’t be certain because I haven’t seen anything official from them. So, be on the lookout for that. Ask in advance if this will be the case so you aren’t caught off guard.
Finally, you may be required to present your official documentation, things like your licenses, certifications, and clinical records might be required. So, be sure to bring them along.
Okay, so the next part of the process to be concerned about is orientation. There are tons of things to consider when it comes to orientation. We’re going to start with something that routinely gets overlooked by both travelers and agencies until it’s too late, and that’s the number of hours you’re scheduled to work during orientation.
It’s really common for hospitals to work their travelers for fewer hours during orientation than they’re contract to work. For example, you might be scheduled to work 36 hours per week, but during orientation, the hospital only works you 24 or 32 hours. So, what happens? Do you get paid for 36 or for what you actually worked?
Well, it depends on your agency. Some agencies have iron clad guaranteed hours policies and they pay you for your contracted hours. Other agencies have guaranteed hours policies that match the policy they have with the hospital in the contract between the hospital and the agency. So, if that policy allows the hospital to cancel the traveler for a certain number of hours per contact, then the agency may only pay for the hours worked.
So, if this is important to you, then you really need to look into this in advance. Basically, you should address this specific question with your recruiter. What if the hospital shorts me hours during the orientation week? Be sure you get a clear answer. “That never happens” is not a clear answer…what if it does? Get the answer. This really is an issue that agencies need to do a better job at managing. They need to educate their hospitals on the importance of getting all hours scheduled and they need to have solid contingency plans for when they don’t.
Okay, so another issue that many travelers are rightly concerned about is level of detail their orientation will entail. How comprehensive will the orientation be? What will be covered? Will it be enough to ensure that you can do your job with confidence?
The answer to these questions is going to vary tremendously from facility to facility. Some facilities will put their travelers through the same exact orientation that their perm staff goes through. Of course, that will be highly detailed, but you might have to sit through a bunch of stuff that doesn’t even apply to you like benefits information and how the 401k savings plan works.
That said, I’d say that one common scenario for traveler orientation is to get 4 days of classroom orientation. These are usually 8 hour shifts, so you’ll get a total of 32 hours that week. The first two shifts will cover general stuff about the hospital, perhaps a repeat of various paperwork requirements like the HIPPA exam and infection control information.
On the 3rd and 4th days, you’ll receive instruction on how to use some of the equipment like beds and lifts, IV pumps, and other things. You will also most likely be given instruction on the computer charting system which is very important. Which reminds me, you definitely want to make sure that your computer access information is working before you step foot on the unit. If you have any problems with this that aren’t confident the hospital is handling, then contact your recruiter for assistance.
Your recruiter may not always be the quickest solution, but sometimes they are the only solution. For example, when I was working at my old agency, I used to see travelers on the Travel Nursing Forum on Delphi Forums saying that were having serious problems getting their computer access codes at HCA facilities they were working at.
Well, that’s because agencies are supposed to be getting those from Parallon. The problem is that Parallon had a reputation of not sending them to the agency unless the agency requested them from specific people in the Parallon organization. And they weren’t upfront about it so agencies didn’t even know to ask. I mean, you’d think that someone over there would let you know, but no. I’m sure that this has been fixed since then, but the important thing to remember is that you should let your recruiter know when things like this are happening.
Okay, so after that week of classroom instruction, you might be given some time with a preceptor which will serve as a unit orientation. This can be for part of your first shift or your entire first shift, maybe even into your second shift. They should show you where everything is located on the unit, provide you with all the door codes you’ll need, teach you the protocols and show you how to get a hold of staff members including the doctors. After that, you’re on your own.
Now, I know a lot of travelers are out there saying, “What are you talking about?! I’ve never been given that kind of orientation?” And that’s because there are a lot of hospitals that offer much less. Many hospitals provide 1 day of classroom instruction, then 4 hours on the floor with a preceptor before they pat you on the back and tell you to go for it.
Oddly enough, many travelers prefer this, which is why many hospitals are totally cool with offering such a streamlined orientation. That said, it’s important to speak up if you’re overwhelmed or scared. Orientation should be viewed as a time to ask questions and get the information you need to your job safely and confidently.
It’s a great idea to bring along a card to write everything down on, from access codes to notes about various procedures and where to find things. A huge part of stress is related to trying to juggle too many things in your mind at once. Writing things down in a safe place that you know will always be on you will help clear your mind so you can focus on the tasks at hand. When you need a specific detail, look at your notecard and you’re good to go.
Okay, another thing to remember about orientation is that your recruiter and agency may not know what to expect. This may be the first time they’ve placed a traveler at the hospital you’re going to. Or, the hospital may use a Vendor Management Service that inhibits the agency from contacting the hospital. That doesn’t mean you shouldn’t attempt to get the help or information you need from your agency, it just means that they might not always be able to help immediately.
Along the same lines, you may find that the orientation differs from what was described during the interview for the assignment. This happens quite often, not because they’re lying to you, but because the unit manager was unaware that orientations were different for travelers than perm staff or something changed since the last time the unit had a traveler. The point is, be prepared for random outcomes.
Okay, so that at least gives you a general idea of what to expect out of orientation, or what not to expect for that matter, I guess. So, let’s move on to discuss some other important assignment related issues. Getting paid for example, that’s pretty important.
When it comes to getting paid as a traveler, I think the most important thing to remember is there is a middle man between you and your paycheck. In this case, the middle man is the hospital. Technically, you work for the agency; the agency pays you. But the hospital plays a role in that process. You see, you’re actually working your hours at the hospital, but hours need to be reported to the agency in order for the agency to pay you.
There are many different ways that this can happen. For example, some hospitals require their travelers to keep a paper time card and have a unit manager or some staffing office representative sign off on it each week. Then, the traveler can fax or email the timecard to their agency so the agency can pay the traveler and use the timecard as an invoice to bill the hospital.
Other hospitals have a Kronos time keeping system, so your time is tracked electronically by the hospital’s system. The hospital will then send the agency a report with the hours. And there are several other methods that hospitals might require for time reporting. The important thing for travelers is to find out what the process is and adhere to it in order to get paid on time and correctly.
And I think that you should actually take it a step further. You should always keep your own physical copy of your time card regardless of what the hospital’s method is. For example, if they have an electronic system, then you should still keep a paper record of your time. And you should do so on your agency’s official timecard. Every agency has their own time card. It’s always best to get a copy and keep your time on it for your own records.
Then, get in the habit of emailing of faxing a copy of your own time card records to your agency on a weekly basis. This should be done early in the week or as soon as you have worked your final shift for the week.
This way, the agency can match what you send them to what they receive from the hospital. It will also prompt the agency to know that you worked and to be on the lookout for a time report from the hospital. If they don’t get one in time, they can call the hospital with a record of proof.
It’s amazing how often hospitals are late in sending time cards to agencies. And time cards can be incorrect too. And it’s amazing how often the errors are in the hospital’s favor.
So again, it’s important to find out how the time reporting is handled at the hospital and then keep your own records.
Okay, let’s move on to discuss how travelers are received by the facility in general. I mean, do you receive a warm welcome or are you treated like a threat to everyone’s job a scapegoat for all the bad patients. Of course, this varies greatly from facility to facility.
Some hospitals welcome travelers as part of the family. They’re absolutely amazing with their travelers. Other hospitals have an openly stated policy that travelers get the worst patient assignments because they’re there to provide relief. And the staff members at some hospitals are anti-traveler because they believe that travelers depress wages and working conditions. We saw an image of a poster in a Kaiser hospital that read, “Kaiser! Hire Local Staff RNs Now! No More Travelers!” It was posted by National Nurses United and The California Nurses Association.
However, I think that for the most part, facilities are pretty good about how they treat their travelers. Otherwise, travelers wouldn’t be having such a great time being travelers.
But what do you when there are problems? And what kind of problems can come up? Let’s talk about that next.
One of the most common problems that travelers encounter, and it’s usually newer travelers that experience this, is getting overwhelmed. It’s a new computer system and a whole new set of processes and procedures. It can understandably get overwhelming. The most common advice that I see from experienced travelers is to give it a week or two to let yourself get in the swing of things. More often than not, you’ll get the hang of things.
However, it’s best to be careful with this approach. I mean, you have to use your own professional judgment to determine whether or not things are so bad that patient safety is in jeopardy. And if you feel it is, then I always think it’s best to talk with your recruiter first. The agency may have a really good relationship with the hospital and they may be able to offer some useful insight or assistance.
Another common problem is when hospitals don’t uphold their end of the agreement. And this statement really covers a lot of different possibilities. For starters, they may not be abiding by the agreements that you made with the nurse manager during your interview. Maybe they aren’t honoring your agreed upon time off, or they are floating you when they agreed you wouldn’t float, or something like that.
Circumstances like this are why we always recommend that you make sure these agreements make their way on to the confirmation that the agency sends to the hospital when you agree to accept the contract. This is the agreement that hospital agrees to when they accept the contract. It helps both you and your agency hold the hospital accountable. Remember, the contract you receive is the contract between you and thee agency. We discussed this in detail in episode 11 of the podcast.
Of course, there are also potential problems that aren’t related to your agreements with the hospital. For example, you might run into problems with particular staff members. I once had a traveler working at a hospital in the Los Angeles who was getting constantly harassed by a staff nurse because the traveler was picking up a lot of extra shifts. The staff nurse thought those shifts should be going to staff members. Of course, they were first offered to staff members who weren’t interested, and then the shifts were then offered to the travelers, so the harassment was misguided.
Again, just as we discussed previously, I think it’s best to discuss these issues with your recruiter first. Often times, your recruiter will recommend that you deal with these issues directly at the source. But it’s always best to let them in on the situation first.
Okay, so all of this information that I’ve just covered comes from my own knowledge. And I don’t think that my knowledge as a former recruiter and staffing manger is ideal for giving you the full picture of what to expect while you’re working an assignment. Sure, I know a lot more than the next guy, but I’m always the first to say that travelers know best when it comes to the issues that pertain directly to the job itself. I think that highly experienced recruiters and staffing managers are the best resources for discussing the business aspect of the industry. But they’ve never actually worked an assignment, so they don’t really know what it’s like to be in those situations. They’re also not nurses.
Why am I saying this? Well, I highly recommend looking in to some of the blogs and resources available that have been produced by travelers themselves, especially for a topic like this. I’ve mentioned before that Highway Hypodermics is my personal favorite for this. The book is great. I just pulled my old copy out to take a quick look at it and it’s all dog eared and highlighted up. The book was an invaluable resource for me when I was getting started back in 2006.
The Highway Hypodermics website has some great information on it as well. There are 2 articles that relate to the topic we’re discussing that I think are well worth the read. The first is an article titled Surviving Your Assignment. In it she provides eight tips for surviving an assignment and she should know. I’ve spoken with her and she has survived some of the most notorious hospitals for travel nurses, I mean, some of the most difficult places to work.
One of her tips is to spend more time with patients in order to stay out of the politics and away from negative people in the unit. She also recommends keeping a smile on your face and staying positive as a way to ensure that your patients don’t get the impression that something is wrong and to get your day started on the right foot.
The other article I recommend as far as this topic is concerned is titled “Disposable Travel Nurse”. In the article, she provides 8 tips to avoid being disposable. For example, use extra caution when wasting medications and make sure someone actually sees you waste the narcotic. She also recommends that travelers always ask about hospital policy if you have any doubt what it is. She says ignorance is no excuse and simply because they do something one way at your old hospital doesn’t mean that’s the way it’s done at your current hospital.
These really are great articles on this topic and we’ll link them on the show notes page, so check them out there.
Okay, so that’s a really good place wrap up this episode. We’ve covered a lot of different issues and tips that become pertinent once you actually start your travel nursing assignment. I hope that the information we covered will help make your assignments run smoother and be more enjoyable.
As always, we’ll have links to everything we discussed in the episode along with the transcript of the show up on the show note page. The link is blog.bluepipes.com/episode26. You can also leave any questions or comments there and I’ll gladly address them. While you’re there, be sure to join BluePipes and take advantage of all the networking and career management tools designed to help simplify your travel nursing career and your healthcare career in general!
If you’ve been enjoying this podcast, then I would greatly appreciate it if you would provide us with a review on whatever platform you’re listening through. Whether it’s iTunes or stitcher, it really goes a long way toward helping us move up in the rankings so we can get this information out to more travelers and keep the show going.
Again, thanks so much for listening and until next time, have a safe and prosperous travel healthcare adventure.
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