Hey everyone! Welcome to The Truth About Travel Nursing Podcast. This is Kyle Schmidt. I’m your host and I want to thank you so much for joining us for episode 33 of the podcast. In this episode, we’re going to discuss 10 of the most common myths and fibs about travel nursing. We’ve touched on a few of these throughout previous episodes, but my hope is that exposing these myths and fibs in great detail will help us gain a better understanding why they exist, what to watch out for and ultimately help us approach travel nursing with greater confidence so that we can get more out of our travel experience. [Please note that this is a transcript of a podcast episode. As such, grammar and spelling are not optimized for written content.]
California’s Paid Sick Leave Law and Travel Nursing
Now, before we start, I want to try something new on the podcast. I thought it would be a good idea to open the shows with a quick mention of some news and current events that are pertinent to the travel healthcare industry. I’m hoping that this will add an extra dynamic to the podcast that will be beneficial to you.
Essentially, up to this point, we’ve covered information that would commonly be referred to as “Evergreen”. In other words, we’re talking about things that are pretty much always going to be relevant barring any groundbreaking changes in the industry. But meanwhile, in the real world, there are things happening in the industry in real time that could be very beneficial for you to know about or that you might simply be interested in hearing about.
So, we’re going to do our best to share some of these things with you. Now, we won’t be going into great detail with these issues like we do with the general subject matter of the podcasts. However, we’ll provide links when possible in the show notes of each episode so that you can do some further research if you’d like. Moreover, if you have a news story that you think is pertinent to travel nursing, then please email it over to us so that we can review and share with everyone else. Ad, you know, remember that travel healthcare is a pretty small industry, so there may not always be news or current events to share. But again, when there is, I think you’ll find it both helpful and/or interesting.
So, for today’s news, I wanted to quickly mention California’s new Paid Sick Leave Law. It’s actually a little bit old as far as a news story goes, but many travelers and agencies are unaware of it. Essentially, the state of California enacted a Paid Sick Leave Law that requires employers to provide paid sick leave to nearly all employees. And yes, travel healthcare professionals qualify as a covered class of employee.
Let me be clear, this means that employers are required to provide paid sick leave to travel healthcare professionals. Of course, only the hours that you work in California will qualify. In other words, if you’re on contract and working in Wisconsin, then this law does not apply. Again, it applies only to the hours you’re working in California.
Also, it doesn’t matter where the agency is located. If they are staffing in California, then they are required to abide by the rules of the law.
Now, I think we could devote an entire episode to this topic and answering all the questions involved. But like I said, the news segment will be quick. We just want to make you aware of what’s going on. And in this case, we’ve published a detailed article on BluePipes Blog on this topic. So, we’ll link to it in the show notes. I encourage you to give it a look if you’re interested in the details.
Is There a 50 Mile Rule For Tax-Free Reimbursements in Travel Nursing?
Okay, so let’s jump into these myths and fibs about travel nursing. The first myth we’re going to cover is commonly referred to as the 50 Mile Rule. We’ve discussed it very briefly on previous episodes in which we simply stated that there is no such rule.
But basically, this myth claims that travel healthcare professionals can qualify to receive the tax-free reimbursements offered by travel healthcare companies simply by living 50 miles or more from the place that they’ll be contracted to work. Now, we went into great detail about what it takes to qualify for tax-free reimbursements in episode 18. We also have a whole section on BluePipes Blog devoted to the subject. We’ll link to both of those in the show notes.
For our discussion here, we’re just going to say that the most basic rule for qualifying for tax-free reimbursements as stated in IRS publication 463 is that you can accept them if, “you need to sleep or rest to meet the demands of your work while away from home.” Also, it’s important to note that you have to actually incur an expense to get reimbursed. There is no scenario under which you can commute to and from your home to a job and receive tax-free reimbursements.
Okay, so let’s take a look at why this myth exists and some of the supporting arguments that are provided by those who espouse it. First, there are many hospitals that have their own internal rules for who can be considered a traveler at the hospital. For example, the hospital might have a rule that says that travel nurses must have an address that is at least 50 or 75 miles from the hospital. So, some agencies and recruiters might be confusing such rules to mean that the hospital must be instituting them because of the tax-free reimbursements.
But, for starters, hospitals don’t set tax laws, the IRS does. And more importantly, hospitals maintain these rules for an entirely different set of reasons. For example, the hospital figures that anyone within 50 miles of the hospital should be signing on as a per diem nurse, not a traveler. And they do that because per diem rates are lower than travel rates. Or the hospital may figure that the person should just apply for a full time job instead of working as a traveler. Basically, there are number of reasons that hospitals have for maintaining these rules and none of them have to do with tax issues because the hospital has no involvement with the tax issues anyway.
Okay, so another potential reason that this myth exists is that there are certain states that have a 50 mile rule for their state legislators to qualify to receive the tax –free reimbursements paid by the state. I mean, you know, the state capital might be really far away from the state legislator’s home, so they could qualify for tax-free reimbursements while in the capital on business. But the bottom line here is that these are just state rules for paying these things out and in this sense the state is acting as an employer. At the end of the day, it’s the federal government who has the final say in this.
Now, the third reason is quite similar. You see, some agencies have their own rules as far as distance from the job is concerned when it comes to paying out the reimbursements. Agencies do this because the IRS requires employers to exhibit some level of due diligence when paying out tax-free reimbursements. In other words, the employer isn’t supposed to be paying out tax-free reimbursements if they know for sure that the individual doesn’t qualify for them.
And employers are supposed to maintain a set of internal policies designed to ensure that they’re making sure their employees qualify. This is why most agencies will have their travelers sign a document attesting to the fact that the traveler qualifies to receive the stipends. But here again, these are rules established by the employer. They mean nothing to the IRS.
Now, the next reason that this myth exists is a little tricky. You see, the IRS does have a rule that in order to deduct the costs associated with moving your residence, the commute from your current address to your new job must be more than 50 miles greater than the commute from your current address to your old job. The problem is that you’re not moving when you’re a travel nurse and we’re not talking about deducting moving expenses on your tax records. Instead, you’re traveling away from your tax home for work and you’re going to be receiving tax-free reimbursements for things like lodging and meal expenses. So, this rule doesn’t apply here.
Okay, the last reason for the 50 mile myth that we’re going to discuss is a duplicitous one. Simply put, some recruiters toss it out there as a way to get travelers to accept an assignment that’s close to their home. For example, let’s say a recruiter places a job ad on a site like indeed.com. Then, a candidate who’s not really interested in travel assignments but who lives fairly close by responds to the ad. The recruiter might just tell them it’s totally cool for them to take the assignment and the tax-free money, just to convince them to take the assignment.
Of course, you might be wondering why the recruiter would do this. Why wouldn’t they just offer to pay the candidate all taxable? Well, if you recall from episode 4, this could get the agency in trouble for wage recharacterization. Remember, it’s not okay for an agency to offer one base for travel healthcare and then increase that base by the amount of the stipend money for a local candidate on the same exact job. That’s an indication that the agency is recharacterizing wages, which is not cool for the IRS. This is why many agencies will not offer all w2 wages; they don’t want to get mixed up with all of this.
How Long Can You Stay In One Location As A Travel Nurse?
Okay, so that’s the logic behind the 50 mile myth. Hopefully, this helps you approach any such claim with the information you’ll need to confidently confront the issue. So, let’s move on to the second myth we’re going to discuss here and that’s the myth that you can work at home for a week or two every year in order to continue to receive tax free money in the same area.
Here again, we discussed this one briefly in episode 18, but we’re going to go into a little more detail here. And think it’s important to do so because I actually came across a post in a forum on travel nursing in which the poster cited our podcast when talking about this topic, but there was some confusion on the issue. So, let’s take a look at an example.
Let’s say your tax home, a tax home where you are paying duplicate expenses, is in Columbia, South Carolina. And let’s say you take a 13 week assignment in Los Angeles, California and end up extending 2 more times. So, essentially, you’re in LA for 9 months. Now let’s say that you return home for 3 or 4 weeks during the holidays and while you’re there you pick up some per diem shifts at the local hospital.
Now, after that 3 or 4 week period, you return to Los Angeles for another contract and keep extending or finding new contracts in the Los Angeles area for the next 6 to 9 months. If you do this, your tax home is going to shift to Los Angeles. Remember, your tax home is first and foremost the place where you conduct your income deriving business. So, your tax home and your family home can be two different things and in this particular case they would be.
So, what people typically want to know is exactly how much time they can work in any one metropolitan area. And that’s the key here…it goes my metropolitan area, not by state. So, San Diego and Los Angeles are different areas. So, how long can you work in one metropolitan area before your tax home shifts there? The bottom line is that there is no steadfast written rule from the IRS on this issue. However, based on court rulings, there are some general rules of thumb.
Now, for starters, it depends on whether or not you’re paying legitimate duplicate expenses back at your tax home in the form of rent, a mortgage, bills, etc. If you are, then one general rule of thumb is that you shouldn’t work in any one metropolitan area for more than 12 months in a rolling 24 month period. So, you can’t just go back and work in the same city as a traveler for years on end by simply taking short breaks in between. Your tax home will shift there.
Now, if you don’t pay duplicate expenses on year a round basis, then the amount of time you can stay in any one location is going to depend largely on the amount of time that you stay, work and pay taxes at your declared tax home. In this case, the common example is that you might return to one metropolitan area, like Tampa, Florida for example, on an annual basis to work seasonal contracts with the hospitals there. You make that your tax home and while you’re there, you pay full taxes on your income. You maintain all your personal business there as well. Your mailing address, your vehicle registration, doctors, voting registration, etc. are all kept there. Now, if you do that, you can take travel assignments and the tax-free reimbursements, but you can’t work in any one location for longer than you work at your declared tax home in Tampa, Florida. So, you’d actually have to move around quite a bit. So, you probably wouldn’t be able to take contract extensions unless they were really short.
Low Taxable Rate For Travel Nurses?
Okay, so the third myth we’re going to discuss is another tax related issue. The myth is that it’s okay for travel healthcare professionals to receive a really low taxable wage in order to “maximize the tax advantage”. Now, this is actually one that I think we’ve discussed in pretty good detail on previous episodes. So we’re not going to really go into all the nuances here.
Simply put, when an employer is paying tax-free reimbursements, they’re required to pay a taxable wage that is in line with what the professional in question might reasonably expect to make in the regular employment market. And here again, there are no steadfast guidelines. And remember, it will be different for Registered Nurses than it is for OR Techs or LPNs for that matter.
That said, you’ll find a lot of information out there indicating that anywhere from $18 to $22 per hour is the minimum taxable wage that should be received by Registered Nurses. And remember, your taxable wage is just one part of your travel healthcare compensation package. So, while that figure sounds low, the pay packages almost always make up for it and then some with the tax-free reimbursements.
Also, it’s important to note that the most common way for you as a traveler to get audited for this is if your agency gets audited. Everyone that worked for the agency will get caught up in the dragnet. That said, it’s also possible to get audited on an individual level as well. So, don’t go for this. The benefits simply aren’t worth it.
Does The Joint Commission Certify Travel Nursing Paperwork?
Now, the fourth myth we’re going to discuss is that The Joint Commission, or TJC, which is the acronym, certifies documentation, or provides approval for documentation. Just in case you’re not aware, TJC is a non-profit accreditation organization focused on healthcare organizations. Essentially, they certify that healthcare organizations are meeting minimum standards through a licensing process.
Again, the idea that TJC certifies paperwork is a myth. TJC does not certify or approve documentation. So, let’s take a look at some background about exactly what we’re talking about here.
As you know, there is a ton of paperwork and documentation that needs to be completed when you work with a new agency. And in most cases these days, there is also a lot of paperwork that needs to be completed when you start with a new hospital. Now, agencies typically have you complete the standard set of documentation that has become pretty commonplace throughout the industry. This includes a skills checklist, some basic background questions, a skills assessment test for the specialty you’re working, and a set of training modules and exams commonly referred to as Core Measures. The Core Measures encompass a wide range of topics from fire safety to national patient safety goals and a lot of other stuff. Now, most of this paperwork is required on some level by TJC. So, you have to do it.
However, TJC does not certify certain providers of content, or exams. They simply require that healthcare organizations provide training on these subject areas and test for competency. Healthcare organizations must have a reasonable expectation that the training and testing meets TJC guidelines. So, it’s actually possible for organizations to develop their own documentation, but they typically use outsourced providers because it’s more cost effective.
But again, the bottom line is that there is no approval or certification of documentation by TJC. And, you know, this is why you won’t see the big content and exam providers advertise that they’re TJC certified. So, companies like Prophecy and API don’t claim that their documentation and content are TJC approved or certified.
Now it’s also important to note that sometimes there is some overlap in the paperwork between the agency and the hospital. In other words, you may end up completing Core Measure training and exams for the agency and then do it again for the hospital. And there really is no reason for this. And this brings us to the fifth common myth in travel nursing.
Can Travel Nurses Transport Their Paperwork From Agency To Agency?
This myth is that all the documentation you must complete with the agency must completed through the agency. In other words, documentation is not mobile or transportable. Or another way to put it is that an agency can’t accept your documentation from another agency or another source; they need to be the ones who administer the paperwork.
Okay, so this is pretty much not true. At least, it’s not true according to anything that I’m aware of in TJC’s certification manual for healthcare staffing agencies. As long as the agency can demonstrate there is a reasonable belief that the documentation came from a reliable source and meets the criteria, then they can accept the documentation. Now, of course, I welcome anyone to correct me on that with demonstrable proof from the manual or an official statement from TJC, but my understanding from the manual and having conferred with some of the top TJC certification consultants in the healthcare staffing industry indicates that agencies can indeed accept such documentation in lieu of completing the agency’s own paperwork.
So, let’s look at an example. You know, unit exams or specialty competency exams as well as the core measure exams and training are supposed to be administered annually. So, if you were take one with agency A in January, and then move to agency B in May of the same year, then you should be able to transport that documentation. And I mean, especially if the agencies in question used the same testing service. But either way, it should be acceptable.
And you know, as further proof, one of the biggest service providers in this area has a program that enables this process to happen. So, I know that I’ve mentioned Prophecy several times. They’re one of the commonly used testing and training companies in the healthcare staffing industry. Well, they have a program that they conduct in accordance with the website MightyNurse.com.
Essentially, in March of 2013, MightyNurse.com announced that that they were partnering with Prophecy to provide members of the MightyNurse Community with free skills assessment testing. I’m going to read a few quotes from the press release to clarify exactly what’s going on.
“Mighty Nurse has become the first online community to offer free skills assessment testing through a partnership with Prophecy Healthcare, Inc. Members of the Mighty Nurse online community have free access to a skills assessment test once per year. The 54 skills tests cover 20+ nursing specialties including RN, LPN/LVN and CNA. Members can also purchase additional online skills assessment tests for a nominal fee. By completing an online skills test with Mighty Nurse, nurses will own that record for up to one year and can use it with any potential employer.”
Mariah Scott, the COO, at Shiftwise which is the company that owns MightyNurse said the following “This saves time for nurses, and gives them control in managing their careers. We’re proud to be the only nursing community with this offering.”
And Ron Gonzalez, Founder/CEO Prophecy Healthcare, Inc. said “Our partnership with Mighty Nurse provides nurses with an invaluable career resource tool. We hope that the ability to take ownership of their knowledge set and credential management translates into propelling their careers forward in the specialties they wish to pursue.”
So, if these two companies are essentially providing a service that allows nurses to transport their documentation from one employer to another, do you really think that they would do this if it was against TJC policies or regulations? Of course they wouldn’t.
Now, we’ll link to all of this on the show notes page so you can check it out. But, I have to warn you that MightyNurse is owned by Shiftwise and Shiftwise is owned by American Mobile Healthcare. And so there are some lead generator concerns there. In other words, pay close attention as to how the service can use your information before signing up. Also, it appears as though agencies can request a copy of your exams without your consent. I could be wrong about that, but they have a landing page where agencies can request a copy of exams for a price.
Must Travel Nurses Complete All Paperwork Before Talking Details?
Okay, so let’s move on to the sixth myth in travel nursing and this is another paperwork myth. The myth is that an agency must have all the paperwork, tests and all, prior to submitting you for an assignment or even talking about jobs or pay packages with you. Now, some agencies might have their own policy on this, but the myth is that there is some law or regulation that requires them to obtain the paperwork. That’s just nonsense.
I mean, the bottom line is that you don’t need to complete any paperwork to find out what an agency has to offer. You should even be able to get some sample pay quotes. You should only have to fill out paperwork in order to get submitted for an assignment. Or, better yet, as we mentioned on previous episodes, find recruiters that will work with your BluePipes documentation to save you the time and trouble and help you get submitted quicker.
Are Travel Nurses Required To Float?
Okay, so the seventh myth we’re going to discuss is that travel nurses MUST float. Now, this one is really more of a fib. That’s because there are assignments that require you to be open to floating and there are those that do not. And there are even some scenarios where the hospital will require floating in order to honor the guaranteed hours clause in their contract with the agency and they’ll give you the option to decline floating and thereby take the risk of getting called off.
All that said, I worked with many travelers when I was a recruiter who refused to float. They always asked about it during the interview and simply declined assignments where they were required to float.
However, I do think that it’s fair to say that it will be much easier to land assignments if you are open to floating. And of course, you should only be floated to units where you are qualified. And moreover, hospitals that are floating you to units that you aren’t qualified to work are essentially violating TJC rules. I mean, a big part of TJC is about ensuring that professionals are competent to perform in the settings their put in. So, if you haven’t taken a specialty exam of filled out a skills checklist for a particular unit, then how are they supposed to know that you’re okay to be there. In these cases, your agency really should be going to bat for you because it’s their TJC certification on the line as well.
So again, the bottom line is that floating makes it much easier, but it isn’t required 100% of the time.
Must Travel Nursing Overtime Rates Be Time-and-a-Half?
Alright, myth number eight is that travelers only get paid time and a half of their base taxable rate for the extra hours they work. This simply isn’t true. As we discussed in great detail in episode 4 of the podcast, there are many different ways to pay out extra hours for travel nurses and ultimately, you should be looking to make as much or more than your fully blended contracted rate for the extra hours that you work. We’re not going to go into the details here in this episode, but you can review episode 4 to get all the information you need. For now, just know that there are plenty of companies that will pay you much more than one and a half times your base rate for any extra hours work. And remember, extra hours are any hours that you work in addition to your contracted hours.
The Mythical Travel Nursing Pay Package
Okay, so the ninth myth that we’re going to cover is the, “mythical pay package myth.” I like to call this one the “White Whale Pay Package.” Basically, every so often you’ll see someone talk about a travel nurse or a per diem nurse making exorbitant amounts of money. And I understand that this is possible on a short term basis with strike work. However, when someone says they’re on contract making this much money or they’re making this kind of money over the course of the normal year, then something is definitely mythical.
So, just how much money are we talking about here. Well, let me read a quote from one of the social media groups on travel nursing to illustrate.
“So I just had to get this off of my chest and let someone know. So I’m working in California on a tele unit. Most of the nurses on the unit work per diem and live out of state. I met a nurse from Georgia and the other from Florida. They fly out here for 2-3 weeks at a time just to work. The nurse from Georgia showed me her pay stub and she brought home after taxes $21,000 for 2 weeks. Now she did work 172 hours but dang!!! I almost lost my mind!!! I have never seen a nurses paycheck that big. She said right now she’s over the $200,000 mark for the year. Am I doing this travel nursing wrong?!?!? I just had to share.”
Now, I’m not saying registered nurses never make over $200,000 in a year. They certainly do. In fact, there was a story in 2011 about a California Correctional Registered Nurse who grossed $270,000 for the year. But they did that by working 2,450 overtime hours in addition to their 2000 scheduled hours. That’s a total of 4,450 hours which would come out to an average of $60 per hour.
However, the figures that our story describes are staggeringly different. So, let’s took a look at how different they are. For starters, the claim is that the nurses are working PRN on a Telemetry Unit. So, if they are working PRN, then they do not get paid tax-free reimbursements so all the income is taxable. So, working backwards from the net pay figure to the gross pay figure using a paycheck calculator shows that the gross pay would need to be anywhere from $41,000 to $42,000.
So, let’s put that into perspective. First off, that’s an average of $244 per hour. Remember in our example where the correctional nurse made over $200,000, they did it with an average hourly rate of $60 per hour.
Second, our story is basically claiming that the nurse is making over $20,000 per week. So, if they were to do this for a 48 week period, which is basically one year, then they would make $960,000 for the year. I’m sorry, but I just don’t see that as being a possibility.
We all know how tight hospitals are when it comes to costs. For this price, this hospital could hire 4 new grad RNs, fully train them, and have them work the entire year, whether they needed them or not, and come away spending less money than they do for the 1 person in this story.
Now, even if we assumed that the people in this story were getting tax-free reimbursements, they would still need to get paid an average of $210 per hour. And of course, if they were getting tax-free reimbursements, then they would be working through an agency, which means the agency would have to get it’s cut. So, the bill rate for the agency would have to in the neighborhood of $250-$270 per hour.
So, any way you cut it, I’m calling shenanigans on this story and others like it. Now, in the show notes, we’ll link to a highly detailed blog post in which we broke down this story so that you can see all the detailed figures if you’re interested.
Will Travel Nursing Agencies Just Offer The Job To Someone Else?
Okay, so the tenth travel nursing myth occurs when a travel nursing agency tells you that they’ll just offer another candidate the job in question if you don’t like what they have to offer. So, first let’s look at a couple of scenarios for this one. I once came across a conversation in one of the forums in which a travel nurse was complaining about the Prophecy’s Core Mandatory training and exams. You know, these exams are really detailed and actually take quite a bit of time to complete. So, the nurse was basically looking for agencies to work with who didn’t use Prophecy as their testing service. And that’s fair enough; it’s understandable.
Of course, all the recruiters who worked for agencies that used Prophecy were up in arms and they tossed out the standard myths and fibs about the paperwork. They said that they used Prophecy because they were certified or approved by TJC for example. And one of them said the following:
“Well I was just making the point that no one will lose. If you opt not to take a job, we will offer it to someone else. We all have options.”
So, for starters, this is a terrible angle to take when you’re providing a service. But that aside, there are several things wrong with this statement. First, agencies don’t offer jobs, hospitals do. Second, agencies are competing with one another to land the same jobs, so there is a very good chance that this particular agency would indeed lose out if a traveler declines to work with them. Third, it’s not as though agencies submit only one candidate per job. In fact, agencies will submit as many qualified and interested candidates ass they have for any given job. Again, it’s the hospital’s job to decide on the best candidate and the more candidates that an agency submits, the greater their chances of landing a job. The point is that the agency is going to submit multiple candidates if they have them. And therein lies the rub. Chances are that the agency won’t actually have any other candidates to submit for the assignment.
Now, this fib often comes up during compensation negotiations. You know, the recruiter might say that they have other candidates willing to accept the job for the rate being offered. The indication being that they won’t submit you if you want more money; they’ll just submit the other candidates. So, just be aware of these issues and don’t let this fib hamper your negotiating approach.
Do Travel Nursing Companies Provide Free Housing and Stuff?
Okay, so the eleventh and final myth that we’re going to discuss on this episode is that travel nursing companies offer free things. You’ve heard this one a thousand times, no doubt. You’ve read it in marketing ads and seen it on job postings. As we covered in great detail in episode 3, nothing is free. Everything has to be accounted for when comparing and evaluating pay packages.
And one of the things that I love about this myth is that you’ll see an agency advertise free housing or free travel expenses on their website. Then, right next to that advertisement will be another advertisement talking about how much travel nursing pay packages are worth, with a calculation that includes the value of the housing and travel expenses. It’s like, what? I thought that was free?
Okay, so that does it for this episode, another long one with tons of information. I hope that hearing about these myths and fibs, the logic behind them and the reasons that they’re actually myths or fibs will help you approach your conversations with recruiters and agencies with more confidence and ultimately get more out of your time as a travel healthcare professional.
As always, we’ll have thee transcript of this episode up on the show notes page. We’ll also have links to all the resources we discussed in this episode. The show notes page can be found at blog.bluepipes.com/episode33. While you’re there, be sure to join BluePipes to take advantage of all the tools and features designed to simplify your travel and healthcare career.
Again, I want to thank you so much for listening to the podcast. If you’ve been enjoying the podcast, then I would greatly appreciate your providing us with a review on whatever platform you’re listening on. Whether it’s itunes or stitcher or some other platform, the reviews really go a long way to help us get the word out and move up in the search rankings so that we can get this information out to more travelers.
And to those of you who have already left a review, thank you so much. It really does mean a lot to me. Thank you so much for taking the time.
Okay, so until the next episode, have a safe and prosperous travel healthcare adventure.