Travel Nursing Documentation : Compliance and Credentialing
Travel Nursing Documentation
As soon as a travel nurse accepts a travel nursing job offer, the travel nursing company will initiate the credentialing and compliance process if they haven’t already. Credentialing and compliance is one of the biggest burdens that companies and their travelers have to contend with. In this blog post, we’ll provide some background and offer some recommendations to ensure your documentation is acceptable.
Background on travel nursing documentation
When I first started as a healthcare recruiter in 2006, it was standard to provide the hospital with nothing more than copies of licenses, certifications, basic medical records, and a unit test. Now, every hospital seems to have its own packet of hospital specific documentation, testing, and orientation information that must be completed prior to starting an assignment.
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There are some hospitals that require completion of on-line orientation modules that can take up to 12 hours to complete!! It’s almost as if they’re having the travelers complete the same process that a newly hired permanent employee is required to complete.
Additionally, hospitals have become extremely nit-picky with the documents they’re willing to accept. They’ll decline documents that aren’t properly signed or those that aren’t in the exact required format. To compound the problem, the facilities often want candidates to start within one to two weeks of receiving the offer, leaving very little time to comply. This can result in delays, and often times, assignment cancellations.
Due to the urgency surrounding the compliance process, companies will take an aggressive approach to ensure completion. It’s typical for the company to immediately email a list of required documents requesting that the traveler send them copies of everything they have. I can’t stress enough how important it is to immediately send them copies of everything you have on hand. I can’t even count the number of times I witnessed contract delays and cancellations as a result of missing documents. Don’t wait to get everything together; it’s better to send documents piecemeal if you have to. This is because you won’t know for certain if the documents you have are going to meet the hospital’s requirements.
If the documents don’t meet the hospital’s requirements, then the travel nurse and the company must work together to ensure that documents meeting the hospital’s requirements are obtained in time to meet the hospital’s deadline. Many of the required documents take time to be received, and the timeframes are often times out of the nurse’s and the company’s control. Therefore, addressing these issues immediately is crucial. For example, MMR results and drug screen results are contingent on labs and can often be delayed. Knowing this, agencies typically make these items a priority over other items that are under their control. For example, nurse testing is a lower priority than getting an MMR titer administered.
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Different companies have different policies for obtaining all of the required compliance documents. I believe that most companies offer to pay for anything a traveler needs in terms of medical documents like MMRs, PPDs, Physical Exams, and Drug Screens. I believe they almost always pay for facility specific items too, such as Respirator Mask Fit Tests. Many companies also claim ownership of the items they pay for which means they may not provide copies of these documents to the travel nurse free of charge. They have several concerns that lead to this policy including the possibility that the documents may be used to land a job elsewhere.
That said, it’s important to remember that HIPPA regulations require medical providers to provide patients with records at a nominal cost. Therefore, you can always get a copy of the results from the provider if the agency is unwilling to share them with you. It’s a good idea to always request the results when you’re in the process of obtaining the service in question.
Recommendations for Travel Nursing Documentation
All things considered, it behooves you to diligently maintain a compliance file to ensure that you minimize the time you spend on compliance documentation and that you’re not caught off guard. In order to accomplish this, you should maintain an electronic and hard (paper) file of your licenses, certifications, and medical records.
When it comes to licenses and certifications, I recommend making a copy of all licenses and certifications, FRONT and BACK. Be sure they are all signed in the designated signature space. The best thing to do is to scan the fronts and backs of all licenses and certifications to PDF and save the PDF files somewhere safe. Chances are that your home printer has this functionality built in. If not, you can go to a Fed/EX-Kinkos or other copy shop to get it done. You can ask the service folks at the copy shop for help if you’re not sure how to do this.
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You should include your Drivers License (and/or Passport), Social Security Card, and ALL of your health care related licenses and certifications, including CEU certificates. You never know when some facility may require something obscure. It’s best to have copies of everything ready to go, in order to save yourself time and trouble later.
While we’re on the subject of copies, I should point out that it’s best to maintain copies of all your documents in PDF format. There are many reasons for this. First, PDF is a format that is widely accepted. Second, it results in a smaller file size than image files like JPG, which is what many people use. Third, PDF is printer friendly. The files are typically formatted by default to print out on one page of standard printer paper. This formatting ensure that the documents are usable by the company and they’re not constantly asking you for different copies because the ones you’ve provided aren’t working.
Every commercial printing shop should provide you with the capability to get your documents in to PDF format. In addition, the vast majority of personal home printers have built in capability to scan to PDF. You can also download freeware (free software) that allows you to print to PDF, scan to PDF, and convert other file types to PDF. Simply conduct a web search for “print to PDF freeware” or “scan to PDF freeware.”
When it comes to medical records, you should maintain a file of records that will pass the most stringent standards. Here is a list of examples:
MMR and VZ:
For these, 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 present. A simple statement of “Positive” or “Negative” is not good enough as it will not be accepted by most hospitals. 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”. Hand written titer reports are rarely accepted, 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 hospitals are going to require records of 2 immunization dates. Many facilities also require the immunizations to have been completed within a certain timeframe prior to your starting the job. However, just know that hospitals’ willingness to accept immunization records is diminishing.
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TB:
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. It’s a good idea to get these done whenever you can. However, be sure that the report you receive shows the date given, the date read, the reading (positive/negative), and the induration. Even when the reading is negative, the induration should be recorded as 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, the vast majority will accept x-rays within five years of the start date. Facilities are very particular about the wording that is provided 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:
Physical exams are typically required within 1 year of your job’s start date. Some facilities have specific wording they want to see on the physical exam. This is typically not a problem as your company will often provide you or the clinic with a form that has all of the required verbiage. However, it’s important to remember to have the clinic, or doctor, stamp the document with their office stamp. Many facilities will not accept the physical exam without the official office stamp.
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There are many other medical documents and various other documents that are standard requirements. Travel nurses should try to get copies of everything they can. When you are sent to a clinic, ask the clinic’s staff for copies of everything. They will often provide them to you. If you can’t get copies from the clinic, then ask your company for copies. You should also attempt to get copies of all the exams and other paperwork you complete for jobs. Despite the fact that many companies will decline your request for compliance documents, it doesn’t hurt to ask.
You stand to save a ton of time and frustration by maintaining a full set of compliance documents. For example, it’s true that your company will send you in for drug screens regularly for new jobs, and when doing so, they can schedule the rest of the required exams and screenings. However, trust me when I say, if you rely on this approach for every job, it’s inevitable that at some point you will be sent to multiple clinics, multiple times, for the same assignment because something got botched, or one clinic didn’t provide the type of service needed. This will cost you valuable time at a time when you also have to get all of that facility specific paperwork done too. Even worse, you may fall victim to a lab that delays reporting to the point that your assignment gets cancelled because the facility didn’t receive the report in time.
Moreover, maintaining a comprehensive set of documents helps travel nurses remain mobile, allowing them to easily switch companies should the right opportunity present itself. By taking the small, easy steps necessary to maintain a great file of documents, you can save themselves a ton of time and trouble in the future, and ensure that they’re able to land the highest paying jobs and their most desired jobs when it’s crunch time.
