Tips for Travel Nurse Documentation, Compliance and Credentialing

The compliance and credentialing process is one of the biggest burdens that travel nurses have to contend with when landing a new travel nursing job. In this article, we’ll explain why this process has become so burdensome and provide tips and tools to help travel nurses navigate it with confidence.

Why Credentialing is Important for Travel Nurses

Simply put, travel nurses can not start working a travel assignment until the hospital agrees that their credentialing process is complete. I’ve seen hospitals push start-dates back by weeks due to incomplete credentialing. And I’ve seen hospitals cancel travel nursing contracts altogether in cases where agencies or travelers failed to complete the hospital’s credentialing requirements by the hospital’s deadline.

This is why some travel nursing agencies push for you to get your entire profile complete before they even submit your profile to a hospital. Essentially, they want to know everything they’ll need to obtain so they can plan and set expectations accordingly.

Now, credentialing used to be much simpler. However, things have changed dramatically over the years.

Why The Credentialing Process for Travel Nurses is so Complicated

When I first started as a travel nurse recruiter in 2006, we had to provide facilities with nothing more than copies of the nurse’s licenses, certifications, basic medical records and a unit test. Every now and then, the nurse would have to complete some training and/or testing that the facility provided.

Now, every facility seems to have its own packet of facility specific documentation, testing, and orientation information that the agency and travel nurse must complete prior to start. In fact, some facilities require completion of on-line orientation modules that can take travel nurses up to 12 hours to complete!! It’s almost as if they’re having the travel nurse complete the same process as a newly hired registered nurse.

Additionally, hospitals have become extremely nit-picky with their requirements for specific documents. For example, hospitals might decline documents if document signatures don’t match the hospital’s formatting requirements.

Similarly, hospitals now often accept only one specific type of clinical documentation when any number of options would otherwise suffice. For example, a hospital might require a QuantiFERON-TB Gold+ test and not accept standard tuberculin skin testing for latent tuberculosis.

To compound the problem, the facilities often want travelers to start within one to two weeks of receiving the offer, leaving very little time to comply. Moreover, travel nurses switch facilities often due to the short term nature of contract work. Therefore, they go through this process quite frequently.

The Role of Relationships

Finally, the relationships between travel nursing agencies and hospitals can also add complexity to the credentialing process. In the past, agencies commonly had direct relationships with the hospitals they staffed. Now, it’s much more common for an intermediary to stand between the two. Unfortunately, this can result in communication breakdowns and delays that negatively impact the credentialing process.

Also in the past, agencies commonly worked with a smaller number of hospitals relative to the number of travelers that the agencies had on contract. Now, even really small agencies can have access to thousands of hospitals.

As a result, many agencies have limited to no experience placing candidates at most of the hospitals they work with. Therefore, they might be flying blind when it comes to credentialing for a particular hospital which can cause delays.

How Travel Nursing Agencies Handle the Credentialing Process

It’s important for travel nurses to know that different travel nursing agencies might handle the credentialing process in different ways. For example, some agencies might have you work directly with a dedicated credentialing specialist. Other agencies might have you work only with your recruiter to complete credentialing.

In any case, the credentialing process should start promptly after you’ve received a job offer and signed a contract. You’ll find that some companies are highly organized, while others are not. You’ll find that some companies will help you by providing checklists, making appointments, finding services and even paying for things related to credentialing. Other companies might not provide these services.

Please remember that you’re not necessarily receiving less money from a company if they don’t pay for credentialing. They could be giving you more money somewhere else in the contract.

While many of credentialing’s potential pitfalls are outside the nurse’s control, there are several actions that nurses can take in order to ensure a smooth compliance and onboarding experience. One of those actions is maintaining a great set of personal compliance documents.

General Tips for Travel Nursing Documentation

Different documents have their own set of rules and nuances. However, here are some general tips that apply to all documents.

In general, you want to make sure you have both electronic copies and hard (paper) copies, or the original copies, of all your documents. Agencies and hospitals will accept the electronic copies during the credentialing process and they’re obviously easier to send and manage. However, many hospitals will require you to present the hard copies during orientation.

If possible, I recommend making PDF copies of everything. It’s not the end of the world if you don’t, but PDF is the document type most organizations prefer. This is because the file sizes are typically smaller and the resulting documents are more printer friendly than images like JPEG or PNG. You can use phone apps like Camscanner to make PDF creation easy.

I recommend making front and back electronic copies of every single document, no matter what it is. Yes, even blank back pages. I know it sounds crazy, but some hospitals require it.

I recommend that you demand every healthcare provider to provide you with copies of any and  all medical records and test results. I say this because many travel nursing agencies will withhold the documentation they pay for and they are legally allowed to do so. However, HIPPA requires health providers to provide you with copies no matter who pays for the test or exam.

Be sure that you sign every document that has a place for a signature. This goes for licenses and certifications like your RN license or your BLS card.

Never assume that you can obtain a document quickly. You never know how long it will take a lab to return results or how long it might take to even schedule an appointment. I’ve had things like MMR Titers that typically took me 2 to 3 days to obtain take over 10 days to obtain. It’s best to be urgent about all documentation. Take care of it as quickly as you can.

Next, let’s take a look at some tips for each of the various categories of documentation.

Tips for Travel Nursing Licenses and Certifications

Licenses and certifications are potentially the most important documents to have in line. Of course, you absolutely must have a state’s license in order to work in that state. That said, you can potentially land job offers in a state without the specific state’s license. First, you’ll need to have a clean license in some other state. Also, the destination state would need to have an extremely quick license endorsement process in place. Finally, the facility would need to approve of this.

When it comes to certifications, it’s important that you obtain certifications from the most widely recognized certifying body for the certification in question. For example, you should always obtain your BLS, ACLS and related certifications from the American Heart Association. Similarly, you should obtain fetal heart monitoring certifications from AWHONN.

Next, you should be extremely cautious with any certifier who offers a process that seems so easy that it’s too good to be true. I can’t tell you the number of times I ran into problems with certifications that travelers obtained via some obscure online process.

While CEUs are not necessarily licenses or certifications, they sort of fall into this category because you need to meet CEU requirements to maintain your licenses. Therefore, obtain and maintain copies of ALL your CEU completion verification certificates.

Finally, I’m compelled to reiterate that you must maintain copies of both the fronts and backs of all your licenses and certifications.

Tips for Travel Nursing Medical Records

The list of medical records that hospitals may require for travel nurses is quite lengthy. And you never know what new or obscure requirement they’ll come up with next. That said, here is a list of the medical topics hospitals most commonly require documentation for:

• Tuberculosis Screening
• Drug or Alcohol Screening
• Pneumococcal
• Physical Exam
• Vision Testing
• COVID-19
• Respirator Fit Test
• Polio
• Rabies
• Blood Tests
• Meningococcal
• Color Blind Test
• Chest X-Rays
• Influenza
• Hepatitis A
• Hepatitis B
• Hepatitis C
• MMR – Measles Mumps and Rubella
• Tdap – Tetanus, Diptheria, Pertussis
• Varicella

Generally, you should be prepared for some hospitals to maintain very strict expiration dates for medical documents. For example, they may require tuberculin skin tests to have a read date no later than 1 week before your start date.

Here are some tips for specific medical documents.

MMR and Varicella tips for travel nurses

For MMR and Varicella, it’s best to have a titer report. In case you’re not familiar with this, a clinic will draw blood and determine immunity by measuring the level of antibodies in your blood.

It’s important to note that many facilities will not accept a simple statement of “Positive” or “Negative”. Instead, make sure that the report you receive displays the ranges of immunity, and your blood’s level of antibodies, commonly referred to as “lab values”.

It’s also important to note that hospitals rarely accept hand written titer reports. So, be sure the report you receive is typed out on the clinic’s letterhead.

If you MUST get by with immunization records, note that most facilities require records of 2 immunization dates. However, just know that the facilities’ willingness to accept immunization records for travel assignments is diminishing.

TB / PPD tips for travel nurses

It is becoming more and more common for facilities to require copies of 2 PPD tests within the last year of your job’s start date. Therefore, keep copies of every report you receive.

However, be sure that the reports you receive show the following details:

• date of administration
• the date read
• the reading (positive/negative)
• the induration (NOTE: Even when the reading is negative, the document should show that the induration is 0mm)

If you test positive, you’ll need a chest x-ray AND the report that shows you tested positive. The most stringent facilities will require chest x-rays within the last year. However, many facilities will accept x-rays within five years of the start date.

Facilities are very particular about the wording on the Chest x-ray report. You’ll want to be sure that at a minimum the report says, “X-ray reveals no abnormalities in lungs. No sign of communicable disease.”

Physical exam tips for travel nurses

Hospitals commonly require physical exams within 1 year of your job’s start date. And, here again, hospitals can be very particular about the verbiage they require on the physical exam report. This is typically not a problem as your agency will often provide you or the clinic with a form that has all of the required verbiage.

It’s important to remember to have the clinic, or doctor, stamp the physical exam document with the office stamp. Many facilities will not accept the physical exam without the official office stamp.

Organizing and Managing Your Travel Nursing Documents

As you can see, there are a lot of documents that travel nurses must maintain on their own. Keeping track of it all can be challenging. Moreover, travel nurses will routinely need to transmit the documents to agencies and hospitals.

Contracts are often delayed and sometimes cancelled when hospitals don’t receive documents by the deadlines they set. Sometimes, employers will lose documents and request you to send replacements immediately. In the worst cases, the traveler is forced to miss shifts until the documents are received.

To help organize and manage these documents more conveniently and efficiently, BluePipes offers a free document management system. Members can upload their documents and email them from the system to any email address at their convenience. This way, travel nurses can access their documents from anywhere they have an internet connection. Along with the rest of the free services that BluePipes provides, you’ll be able to manage your healthcare career more efficiently and effectively.