Travel nurses are consistently bombarded with paperwork and testing for each new travel nursing job they accept. It’s not uncommon for travel nurses to spend 6 to 12 hours completing paperwork and taking tests prior to even starting the assignment and that’s not counting the various physical exams that must routinely be taken. In many cases, agencies do not pay for the time spent completing these tasks. This leaves many travel nurses feeling like they’re getting ripped off and wondering how this is possible.
Should Travel Nurses Feel Short-Changed When They’re Not Paid for Testing and Paperwork?
It’s understandable that travel nurses feel short-changed when they don’t get paid for the time it takes to complete paperwork and tests. After all, the documentation is required. Moreover, it can take a significant amount of time to complete in many cases.
For example, when American Mobile took over as the Managed Service Provider for Kaiser Permanente, it became a requirement that travel nurses complete a set of 4 “HealthConnect” online training modules when starting a new contract with Kaiser. By Kaiser’s own admission, these modules could take up to 12 hours to complete. That’s a full shift! While it didn’t take most nurses that long to complete the modules, they most certainly spent more than 12 hours between them and completing the rest of the agency’s paperwork.
So, should travel nurses feel ripped-off for this? It depends. First, it’s important to recognize that there are two distinct sets of paperwork that travelers are typically requested to complete. One set of paperwork is needed by the agency. This includes things like an I-9, W-4, Unit Exam, the “Core Mandatory” or “Core Measures” exams among other things. This paperwork must always be completed.
The second set of paperwork is required by the hospital. It might duplicate the Unit Exam and the Core Exams completed with the agency. And it sometimes includes lengthy training modules that are specific to the hospital like the Kaiser description above. Simply put, the hospital’s paperwork can be very lengthy and time-consuming. Fortunately, it’s not always required to be completed before starting the assignment. Many hospitals make it part of their orientation process.
Why is this distinction important? Well, travel nursing pay packages are based on billing the hospital and agencies are never able to bill hospitals for the time it takes to complete the agency’s paperwork. Additionally, hospitals often don’t allow agencies to bill for the time it takes to complete the hospital’s required paperwork.
In fact, the vast majority of agency/hospital contracts also include a clause for non-billable orientation hours. This means that in addition to their inability to bill for the pre-assignment paperwork and testing, agencies are also unable to bill for the first few hours that a travel nurse is actually working the assignment. Non-billable orientation hours can be anywhere from 4 hours to 12 hours (sometimes more!) depending on the hospital.
However, on rare occasions, agencies are able to bill for the hospital’s required paperwork. This is important because if the agency is able to bill the hospital for the hours, but isn’t paying for the hours, then travelers would indeed be getting short-changed.
But, when agencies aren’t able to bill for the time, then the overall travel nursing pay package would be reduced in some other area by an equal amount if the agency pays for the hours it takes to complete the modules. Therefore, it would ultimately be a wash. But why is this the case?
In order to account for the non-billable orientation hours, agencies typically add them as a “burden” into their pay rate calculation programs. “Burden” is a fancy name for cost. For example, if a hospital has 8 hours of non-billable orientation and a bill rate of $60 per hour, then the agency might add a $480 burden into their pay rate calculations. As a result, the amount of money available in the pay package pie is reduced by $480.
Agencies could do the same thing with the time required for testing and paperwork. In this case, they could estimate the number of hours required to complete the testing and paperwork, and add their estimation as a burden in their rate calculations. So, why don’t they do that?
Why Don’t Travel Nursing Agencies Pay for Testing and Paperwork?
There are three reasons that agencies might be reluctant to add paperwork and testing as a burden in their rate calculations. First, if agencies offered to pay for this time, then they’d also ideally want to obtain a time report to account for the hours paid. This would create some problems for the agency. It will take some travelers longer than others to complete the paperwork. This will make it difficult for the agency to budget. Moreover, the paperwork will need to completed without supervision. Therefore, the agency will have to rely on the honor system for the reported hours. No employer likes to do that.
Second, agencies that pay for the time and account for it in their burdens might appear as though they are paying less than agencies who are not. Travel compensation packages are a tough sell. Most travelers focus on the rate. They want a clear and concise explanation of their pay. So if an agency is paying $1 less per hour than its competitors, then it’s tough for them to explain that this difference is due to the fact that they pay for testing and paperwork while their competitors don’t.
Finally, agencies are often blindsided by the excessive hospital requirements. Again, not every hospital requires such documentation prior to starting. And agencies are always working with new hospitals, especially small to mid-sized agencies. So, they don’t have prior experience and hospitals certainly aren’t upfront about these policies.
Meanwhile, travel nursing compensation packages are almost always negotiated prior to interviewing which means agencies don’t find out about the requirements until after compensation has been discussed. This means the compensation package would need to be renegotiated or the agency would have to lose money. It’s a tough spot for them.
Aren’t Travel Nursing Companies Required to Pay for Testing and Paperwork?
Of course, many travel nurses wonder how agencies can get away with not paying them for the hours they spend completing the paperwork required for each assignment. I’ve seen several people cite an article from the United States Department of Labor – Wage and Hour Division when arguing the case that agencies are required to pay for the testing and paperwork. Specifically, there is a section that states:
Lectures, Meetings and Training Programs: Attendance at lectures, meetings, training programs and similar activities need not be counted as working time only if four criteria are met, namely: it is outside normal hours, it is voluntary, not job related, and no other work is concurrently performed.
This would certainly make it appear as though the hours are required to be paid. However, I contacted the Wage and Hour Division and was informed that agencies may not be required to pay for the time spent completing paperwork and testing. First, they said that the statement above assumes that the travel nurse is in the employ of the agency at the time of the testing and paperwork. They stated that employers can make testing and paperwork required as a condition of employment. This is why most agency contracts stipulate that the contract is valid only if all the testing and paperwork is completed in due time prior to the contract starting. So, agencies may use these arguments to defend their position.
Of course, the rules may vary by state and there maybe other issues at play that we’re not covering here. On the bright side, agencies have been pushing back on hospitals over their paperwork and testing requirements. In fact, Kaiser now allows agencies to bill for time spent completing their massive online modules, albeit a relatively low bill rate.
As always, please feel free to share your questions, comments and experiences in the comments section below!