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Travel Nursing: a Guide

Travel nurses make the most money and have the most fun. That’s the perception as of recently. Nursing shortages and travel nursing has been all over the news since COVID first hit. But the staffing crisis has been around long before 2020. Travel nurses have filled the void for decades, but until recently, this wasn’t widely spoken about outside hospital walls.

With the sudden spike in publicity, social media groups for travel nurses have been exploding with questions for new nurses anxious to start their careers as travelers.

Photo by Jakayla Toney on Unsplash

The responses from long-time travelers were initially helpful, but these questions kept pouring in. Soon, people were getting into arguments and snapping at each other. The term “nurses eat their young” was in full force.

The answer, time and time again, is the same: YES! You need at least one year of experience in order to be a travel nurse. Honestly, even a year is probably not enough. Do not put yourself, your license, or your patients at risk by trying to travel before you’re experienced enough.

I think it’s important to understand exactly what to expect as a travel nurse. I’ve organized the cycle of travel nursing in what I’ve come to call the six A’s: Applying, Accepting, Arranging, Arriving, Actually working, and Applying (again).

Note: This article turned out to be much longer than I was anticipating. There’s a ton of useful information in here, so if you’re serious about becoming a travel nurse, take the time to actually read this thing!

1. Applying

This is a very detailed step because it is so important. If you don’t take your time here, it can really hurt you later. This is the planning stage.

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There are many staffing agencies, and a lot of them are owned by the same parent company. Most travelers start by contacting one of the major ones (you know, the ones that come up first on Google: Aya, Fastaff, AMN, etc.). They’ll have you fill out a profile and send them all your licenses and certifications. It’s common for travel nurses to work with multiple agencies at the same time. As your journey continues, you’ll come across other agencies.

Staying agile and organized is key. Use a service like Documenti (https://documenti.me) to keep your certifications and credentials organized and up to date. You can securely share these documents with recruiters, too. (Full disclosure: Documenti is my creation. I hand-coded every single line of code used to develop that site! Give it a try — it’s completely free!)

Personally, I like one agency a lot. I can give you my recruiter’s information if you’d like (fill out this form). Yes, I’ll get a referral bonus for sending you her way, but I wouldn’t recommend someone I didn’t completely trust.

There are no hard feelings about working with multiple agencies — this is a business. You need them and they need you. It’s their job to provide you with a good deal. Honesty is important here; always make sure to tell your recruiter if you’re working with other agencies. You need them to find you good jobs, so if you burn your bridges with them, it can cause you problems later.

You need to be very clear as to what you’re looking for. There are thousands of available positions, so you want your recruiter to only send you the ones you’re likely to accept. Tell them what cities or states you’re interested in. Tell them if you have preferences (days vs. nights, 36 hours only or if you’re flexible to do 48 hours, etc.).

The recruiters and staffing agencies have no control over your schedule. Scheduling is done by the hospital. Some experienced travelers include specific schedule requirements in their contracts (like “every other weekend” or “block scheduling”). This may work out if you have a lot of options and experience, but as a new traveler, I would not recommend being seen as “picky.” That’s just my opinion though.

You can and should, however, include any requested time off (RTO) that you need. If you need a specific weekend off, for example, this can be included in your contract by your recruiter. I never include more than two date ranges of RTO in my contract, and I make it clear that I am completely flexible with my schedule during the rest of the contract. Remember, these facilities are looking for someone who can come in and help, not someone who needs a lot of special attention.

After you get your profile and preferences set, your recruiter will start contacting you frequently with positions which match your preferences. Not all job postings are perfect. Take your time to search through them to find one that you really like.

You can read Google reviews of the hospital to help evaluate your choices, but keep in mind who writes these reviews. I don’t give these much weight because typically only angry people write hospital reviews.

I also recently discovered a review site for travel nurses. It’s pretty new, so not all facilities have reviews yet. Either way, I’d check it out: scrubstr.com.

When I am presented with an offer, there are two things I do. First, I see if the pay package is acceptable. Then, I do a quick search into the housing market.

Photo by Alexander Schimmeck on Unsplash

Your recruiter should show you the weekly pay package. This is very important to understand. If your new contract is more than 50 miles from your home, you should qualify for tax-free stipends. The IRS allows this income to be tax-free because you’re already paying living expenses at home. They allow for you to save on the cost of living while you’re traveling.

Remember, you qualify for tax-free stipends because you’re duplicating your expenses. This means that you still must pay for living expenses at home! If you aren’t paying rent at home, you aren’t duplicating your expenses, and therefore don’t qualify for these tax-free stipends. The IRS could audit you and make you pay back taxes if you took tax-free money when you weren’t allowed to. (Talk to a CPA for details, I’m not an accountant. I’m just giving you a brief intro to how this all works. There are other tax implications on how to maintain your “tax home” and how often you have to come home. I recommend Travel Tax for more information.)

Anyway, the pay package! When you look at a pay package, it should have two categories: tax-free stipends (meals and incidentals (M&I) and housing) and per-hour rates (regular and overtime). Don’t just look at the Gross Pay, look at each category.

The first thing you’ll notice is that your hourly pay rate probably looks low. That’s ok. Your hourly rate is taxed. Generally, it doesn’t matter if your hourly rate is lower than you expected, so long as your tax-free stipends are maxed out. If you go to the GSA website (https://www.gsa.gov/travel/plan-book/per-diem-rates), you can find the maximum daily per diem rates available for a specific area. Your weekly stipends should match these rates exactly. If they don’t, you should ask your recruiter to maximize your stipends. This is pretty standard.

Next, look at your overtime rate. Remember that the reason your hourly rate can be lower is because you’re making a lot of tax-free money in the form of stipends. The stipends do not increase if you work additional hours, however, so your overtime rate needs to be high, or else it isn’t worth working overtime.

Let me explain it visually because this can get confusing. I made an example using the actual 2021 GSA maximum per diem rates for Atlanta, GA.

If the overtime rate is calculated at the traditional time-and-half (Column C), you would make an extra $320 ($27/hr) for the extra shift. However, if the overtime rate is appropriate (Column D), you’ll earn $720 ($60/hr) for the 4th shift.

So, if you plan on working overtime, remember that from hour 36 through 40, you’re only making your low hourly rate. Overtime doesn’t start until after 40 hours (for most states), so your OT rate needs to be high.

One last piece of advice regarding pay: don’t spend too much time worrying about what other travelers are making. Don’t concern yourself with how much the hospital is paying your agency (the “bill rate”) or how much your agency is making off of you. Of course, you don’t want to be taken advantage of, that’s not what I’m saying. Just make sure you’re happy with your pay and leave it at that. Your agency serves a valuable purpose, and they need to get paid, too. Everyone has a place in this industry. Look out for yourself, but don’t drive yourself crazy, either.

Ok, so, once you find an acceptable pay package, do a quick preliminary search of the housing market. You need to make sure that there are places to live (that you can afford) which are available during the contract. I like using Airbnb because it’s easy. I also use Furnished Finder, which is a site specifically for travel nurses to find housing, although it’s a little harder to work with.

Photo by Yaopey Yong on Unsplash

Some travelers recommend that you book a hotel for the first week of the contract to “get a feel for the area.” Once you’re there, you can decide where to get a long-term place to live. I’ve never done this though, as I’m paranoid that there won’t be a place for me to stay once I’m there.

Either way, do not book a place to stay yet! This is just a preliminary search to make sure you like the available options.

When you find a location and pay package you like, have your recruiter submit you for the job. I do not recommend submitting for more than one job at a time.

You need to become an expert in doing this preliminary evaluation. These contracts come and go quickly. When you’re presented with a potential contract, you need to be able to evaluate the pay package and housing situation within an hour. If you want to be submitted for a good position, you’re in the running with other nurses, too. The quicker you get submitted, the better chance you have to be selected.

Once you’re submitted, wait for the facility to accept or decline you for the position. In my experience, this is a pretty fast process, and I usually hear back from a facility within a day or two. The facility may call you for a phone interview, but they don’t always do this.

I know, such a long first step. It’s all so important, though! Hopefully I’ve done a decent job explaining this to you so that it makes sense.

2. Accepting

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If they accept you, congratulations! Confirm with your recruiter that you accept the offer. If you’re working with other agencies, it is courteous to reach out to your other recruiters to tell them that you have accepted a position. This saves them time and effort. They should appreciate the honesty. I always make sure to tell them the contract’s end date, so they can begin looking for my next contract at around that time. This is what I call “snoozing” recruiters. They won’t work to find you jobs until that time. Again, this is a business. If you’re up front about working with other agencies from the start, this conversation shouldn’t be weird.

You should not expect a ton of details about the position until closer to the start date (one or two weeks before). Eventually, you should expect to be told what color scrubs to wear or other uniform requirements. You may have to take some tests, assessments, or other education. You may have to take a drug test or get a physical.

You should get paid for your time spent completing any job requirements; ask your recruiter for details. You should also receive “first day” instructions that tell you where to be and when. Don’t worry if these details are slow to arrive. However, if you haven’t received them at least a week before your start date, make sure to ask your recruiter.

Never reach out directly to the hospital before you start working. Your point of contact at this point is your recruiter.

3. Arranging

Now that you have a confirmed position, you need to find a place to stay. Go back to Airbnb or Furnished Finder. Google the city and the area. Find a neighborhood that you like and book a place to live. Don’t forget to make travel arrangements.

Helpful hints: ask about parking, WiFi, laundry, and pets (if you have one). Make sure it’s furnished with pots and pans, plates and forks, etc. I’ve seen some places that look good, but don’t have a stove or a TV, for example. Make sure to spend some time finding a place to live.

If you can, message the landlord to ask to speak on the phone or have a video tour. You’re booking their place for potentially 13 weeks; you want to make sure it’s a good fit for both you and them.

I mentioned this in Step 1, but I’ll say it again here: some travelers recommend booking a hotel for the first week and waiting to make a long-term arrangement until you’re physically there. Some people like being able to “get the feel” for a city, and this would prevent you from accidentally booking a place in the “wrong” neighborhood.

Also, a topic not spoken about much, is that your start date can be “pushed back” by the facility if they run into credentialling issues. The hospital can also cancel your contract at any time for any reason. While I’ve never had this happen, I’ve heard horror stories. Making sure you book only refundable options for the first week is a good strategy to mitigate these risks. However, by doing this, you run the risk of not being able to find an available long-term place once you’re there.

You can check out travel nursing social media pages or a city’s Reddit page if you want to ask questions about a specific city or hospital.

When deciding what to bring with you, remember that you have to pack and unpack multiple times, so pack lightly. Bring your clothes for work and a few changes of clothes for day-off activities. Plan ahead for changes in weather and seasons.

4. Arriving

My fiancé and I are both travel nurses. We usually make sure to arrive at least a few days before the contract starts. We like being able unpack and arrange the place, go to the grocery store, and figure out our routine and plan our route to work before having to rush to orientation. Plus, it’s nice to be able to explore the city you just moved to!

Photo by HiveBoxx on Unsplash

5. Actually Working

Your first day(s) are usually filled with some generic hospital orientation. Expect topics on HIPAA, using a fire extinguisher, and a glucometer. Don’t be annoyed, they’re likely federally-mandated to provide you this information. Remember, you’re being paid a lot to sit there.

Once you get your badge and computer access, you should get at least some orientation time on the floor. Don’t expect much. Nursing is nursing; you should know how to do patient care. You’re going to get a crash course on their flow and how things work at their specific facility. The most important things to know are their communication technology (Vocera, Ascom phones, radios, etc.) and their charting system.

This is why it is so important to have a really good foundation of patient care. You are expected to be an expert in your field. You are expected to receive minimal orientation and direction and are expected to function (at least) equally to their full-time staff.

Don’t let this scare you; if you have the experience, you can do it. On my first three days on a new contract, I think “oh s**t, what am I doing?? This place is crazy!” But after three days on my own, I feel at home. You start making friends, you start fitting in, and you realize that this really isn’t so different than what you’re used to.

Photo by Rusty Watson on Unsplash

Some things to remember: for most things, your point of contact is now your manager or director. You should get their phone numbers and email addresses. Also, make sure you know how to call the unit, and it’s a good idea to get the phone numbers of some charge nurses (once you get to know which ones you can trust 🤣).

Your recruiter should be available to you if you need something regarding your contract, but they can’t do much about your actual job. If something happens while you’re working (you get injured, you have a major conflict or get in trouble, etc.), you should tell your recruiter, but only after you follow the facility’s policy. Remember, you’re functioning as basically an employee of the hospital, so they expect you to follow their rules. But you’re not actually their employee — you’re an employee of the staffing agency. You need to follow the guidelines of both organizations.

Oh, one last thing — really important — make sure you have no questions about your timesheet. It is 100% your responsibility to make sure you get paid correctly. Some agencies have paper forms you submit by email, some have phone apps where you can submit your hours, and others get your timesheets directly from the department’s manager. Either way, you have to make sure your agency has your timesheet.

Once you’re paid, make sure you check your paystub. We’re all used to just trusting that we were paid correctly, but mistakes happen. It’s easier to correct them in real time than if you discover a problem later. Check your stipends and your hours. Your agency is your point of contact for your pay, not the hospital.

Expectations

Remember, travelers are hired to be dropped in to fill a role.

Calling off work is not generally acceptable as a traveler. Unless you’re actually really sick, you’re expected to show up to all of your shifts. Failure to do so could result in fines from your agency. You can get your contract cancelled for calling off more than a few times. Make sure you check your contract. I’ve heard of travelers being charged thousands of dollars for calling off too much.

Be early. Do your work well. Don’t cause problems. Go home. Get paid. Enjoy life. Don’t make it harder than it has to be.

A general rule of thumb is that travelers are not hired to fix the facility. This is something I struggle with, because, as my fiancé loves to point out, I’m “a David.” (Keep reading my articles. You’ll come to understand what that means.) I just can’t help myself sometimes. 🤷‍♂️

They’re right though; some hospitals just want you to show up and do your job — they don’t always want your input.

Try to avoid discussing your pay. The full-time staff are making less than you to do the same job, and they know it. Bragging about it is just mean.

If someone wants to talk to you personally about becoming a travel nurse themselves, that’s fine, but speak in generalities, not specifics. If they’re serious about traveling, don’t just give out your recruiter’s contact information. Instead, text the person’s info to your recruiter. This way, your recruiter can choose when to call them. Plus, you’ll get a referral bonus! Again, if you want me to refer you to my favorite recruiter, just fill out this form. 👍

Oh, and definitely avoid saying “well, where I’m from, we do it this way.” They hate that. It’s cringeworthy. Every place does things a bit differently. If you’re lucky, you can pick up on new things that work better than you’re used to. Don’t harp on the negatives.

6. Applying (again)

Set a reminder in your phone’s calendar for about 4 weeks before the end of your contract. That’s when you need to start submitting yourself for your next contract. The recruiters you “snoozed” before should start contacting you. If they don’t, reach out to them.

Photo by John Schnobrich on Unsplash

If they still have a need for travel nurses, your current hospital may wish to offer you an extension. If you are interested, this may be a good idea, as you’re already comfortable there. You should ask your recruiter to ask the facility to give you a raise. After all, you’re already trained, you already know their process, and they already like you. You’re worth more money than a random new person. Know your worth and don’t settle for less. If you don’t like the option they give you, you can always move on to somewhere else.

Make sure you update your resume to include your most recent travel assignment and upload the updated resume to Documenti. (Shameless plug, sorry.) On my own resume, I have one section for travel assignments. I only include the name of the hospital, department, and city. As you travel more, this space can get crowded, so find a way that works for you. You just want to show that you have travel experience. You are a more valuable travel nurse after your first assignment, now that you fully understand what it takes to succeed as a travel nurse.

Final Words

When your contract is over, make sure to leave a review of the facility on Scrubstr (www.scrubstr.com). This site is new (I didn’t create it), but I love the idea. If it catches on, it can provide valuable information for the travel nursing community.

You should get the personal email address of your Director and Manager, as well as a few charge nurses. You will likely need references in the future. I don’t ever just rely on their corporate email addresses, in case they switch hospitals.

Words of Wisdom

Ok, I know that was a lot, but I basically explained a whole career path here! To close this article, I have compiled some words of wisdom from the travel nurse community:

If you would like to contribute your story, I’d love to hear from you. Feel free to reach out.

David I. Mancini is a Registered Nurse and a Licensed Paramedic. He’s a tech enthusiast, world traveler, and an eclectic eater. https://davidmancini.xyz

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Do No Harm is a collection of articles written by members of the medical field. Some are written for others in the profession, while others are intended for the general public. No articles are to be interpreted as medical advice; talk to your own doctor.

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David I. Mancini, RN

David I. Mancini is a Registered Nurse and a Licensed Paramedic. He’s a tech enthusiast, world traveler, and an eclectic eater. https://davidmancini.xyz