Travel Nursing at HCA Hospitals

The Hospital Corporation of America (HCA) is the largest for-profit hospital operator in the United States. HCA boasts a whopping 162 hospitals and generates over $33 billion in annual revenue. HCA is also one of the biggest users of travel nurses in the nation. In this blog post, we’ll provide some detailed information about travel nursing with HCA so that you will know what to expect.

Are HCA hospitals good for travel nurses?

Of course, the first question that every nurse considering a travel nursing job with HCA wants answered is whether or not HCA is a good place for travel nurses. Are HCA hospitals “travel nurse friendly?” Unfortunately, this question is too general to provide an all encompassing answer.

HCA hospitals are stretched across the country. And while it’s true that corporations tend to have an overall culture, the culture within each hospital is largely influenced by the people who work there. Therefore, you will find differences between hospitals, between units in the same hospital, and even between shifts on the same unit.

However, this doesn’t mean that you will be unable to obtain any idea about the hospital’s working conditions prior to accepting an assignment. Many nurses turn to social media groups and message boards in an effort to lock down an answer. Be careful with this approach. Like everyone else, nurses have differing opinions on what constitutes a good work environment. When using this approach, be sure to ask for specifics and do not rely on vague, uninformative answers.

Checking hospital rating services is another potential avenue that nurses can explore when attempting to determine whether or not an HCA hospital is traveler friendly. Again, please be careful with this approach. Standard hospital rating services are largely devoted permanent employees. The experience can vary greatly between permanent employees and travel employees.

Meanwhile, even the most active hospital rating services dedicated to travel nurses have very few ratings, so their validity is questionable at best. For example, Travel Nursing Central has been collecting hospital ratings since 2005 and the hospital with the most ratings only has 11 ratings. The vast majority of hospitals on the site have less than 2 ratings. It may be best to utilize all the methods listed above to piece together a picture of what it might be like to work a travel nursing contract at the HCA hospital in question.

Having placed nearly 40 travelers at HCA facilities throughout the country, I can offer the following anecdotal observations. Most of the nurses I worked with had no complaints about the HCA facilities they worked with. For example, I placed an ICU nurse at Bayshore Medical Center in Houston, Texas. She absolutely loved it. She commented glowingly about the orientation and how she was made to feel a part of the team from day one. She accepted an extension and was hoping to get hired permanently.

In another case, I placed a PACU RN at the Woman’s Hospital of Texas. He loved it and returned for several contracts over the years. I also had a positive experience with an L&D nurse who loved her contracts at Rose Medical Center in Denver, CO.

On the flip side, I worked with several nurses who had less than desirable experiences with HCA facilities. I placed a Med/Surg nurse at Sunrise Hospital and Medical Center in Las Vegas, Nevada. She complained of receiving a less than adequate orientation and being overwhelmed with the work load. She left the contract and went on to accept and successfully complete several assignments with me at various other hospitals.

I also placed three ICU nurses together at Regional Medical Center Bayonet Point in Hudson, Florida. All of them complained about orientation and caseload. One of them cancelled their contract early. The second completed their contract but wasn’t happy about it. She went on to accept several contracts with me and enjoyed every one. The third completed the contract and accepted an extension because she liked the area so much.

What are the most common complaints travel nurses have about HCA?

My experience and research indicate that there are some common complaints that travelers have about HCA hospitals. First, HCA uses Meditech which tends to be unpopular among nurses. It’s often described as clunky and anything but user-friendly. The learning curve can be steep and travelers have a short period of time to get up and running. There was talk of HCA piloting Epic. However, I have yet to hear that they are making a transition.

Additionally, travelers express concern about the workload at HCA hospitals. This also appears to be a common complaint among permanent employees of HCA hospitals. In fact, this New York Times article explains that HCA’s move to a flexible staffing system had several interviewed nurses complaining about inadequate staffing levels throughout the hospitals.

Many travelers and permanent HCA employees also cite old equipment as a major concern. I’ve also seen complaints about supply rationing. This link has complaints about both! At the same time, you’ll also see some positive comments on the same page.

Do you care if it’s an HCA Facility?

It’s important to note that many nurses go unaware that the facility they’re considering is an HCA facility. It’s not like Kaiser, where every Kaiser hospital includes “Kaiser” in it’s name. HCA facilities have names that leave them undistinguished from HCA.

Moreover, recruiters may not inform their candidates that the facility in question is an HCA. Sometimes this is an honest oversight. For example, the recruiter may not know that it’s an HCA facility or may not realize that it maybe important to the nurse. In other cases, the recruiter may shy away from telling the nurse for fear the nurse might decline the assignment simply because they’ve heard negative things about HCA.

Therefore, if it’s important for you to find out, then be sure to ask your recruiter if the facility in question is an HCA facility. You can also check the HCA website to see if the hospital in question is on their list.

Travel nursing agencies that work with HCA

If you decide that you want to be submitted for an assignment with an HCA facility, then it’s important to know that Parallon is the Managed Service Provider (MSP) for HCA. It’s also important to know that Parallon is a subsidiary of HCA. Up until 2011, All About Staffing  was the MSP for HCA. They were also owned by HCA and were merged with several other HCA units into Parallon.

As the MSP for HCA, Parallon has an exclusive contract to meet all of HCA’s staffing needs. However, Parallon works with a large number of healthcare staffing agencies to assist them with this endeavor. These staffing agencies are called sub-vendors.

This relationship has several implications. First, it’s important to know that Parallon has first crack at filling all HCA jobs. If they are unable to fill jobs in a timely fashion on their own, then they’ll release them to their sub-vendors.

Parallon works with a very large number of sub-vendors. Therefore, the market for HCA jobs that are released to sub-vendors is highly competitive. It’s not uncommon for jobs to be closed for new candidates within 1 hour of the job being released to sub-vendors. I recall one instance in which a Parallon Account Manager released a list of nearly 100 job openings and closed them for new candidates the following day stating that he had received over 900 profiles.

It stands to reason that you will maximize your exposure to HCA jobs and increase your chances of consideration by using Parallon. However, it’s difficult to tell how much effort Parallon puts in to filling HCA’s job openings on their own. Our cumulative agency ratings for 2014 reveal only 9 ratings across the three most popular agency rating services. This could be an indication that Parallon doesn’t really staff that many travelers.

This could be a result of the fact that Parallon focuses almost exclusively on HCA job orders. However, they still have over 700 jobs, 987 per diem jobs, and 156 permanent jobs posted on their website as of the writing of this blog post. Additionally, their website indicates that they have over 20 recruiters, which would make them a fairly decent sized agency.

Parallon is rated a little less than average by travelers. Our cumulative rating score has them at 67.78 on a 100 point scale. By contrast, American Mobile comes in with a paltry score of 44.07. However, Parallon only received 9 rankings, so it’s difficult to tell if their rating is truly reflective of their service. Finally, I’ve seen several complaints that Parallon doesn’t stand up for healthcare professionals when disputes arise between the HCA hospital and the healthcare professional. The indication is that Parallon is biased as a subsidiary of the hospital.

Again, you’re not required to work with Parallon to land HCA jobs. And rest assured that the most revered agencies in the business are able to land HCA jobs for you.

What’s the Pay for HCA travel nursing jobs?

Parallon advertises that they “offer the best pay rates and packages in the industry.” However, almost every agency advertises that. The truth is that the pay rates for HCA facilities vary greatly across the country.

My former recruitment experience was with a Parallon sub-vendor. Unlike some MSPs, Parallon doesn’t charge their sub-vendors a billing fee for doing business with them. Instead, Parallon’s sub-vendor bill rates already have the cost of doing business with Parallon subtracted out.

I’m explaining this because this approach to sub-vendor fees makes it difficult for sub-vendors to know what the true bill rate is. For example, American Mobile charges its sub-vendors  a fee equal to 2% of the bill rate for the job in question. As a result, sub-vendors can see the actual bill rate that Kaiser pays American Mobile. Knowing the actual bill rate allows the sub-vendors to have an idea of how much American Mobile is able to pay their own employees. This isn’t the case with Parallon.

That said, Parallon breaks sub-vendor bill rates into regions and there are a very large number of regions. In some of the regions, the bill rates for sub-vendors seemed quite low. In those regions, it was fairly consistent for me to hear Parallon nurses express that they were making about $2 more per hour than what I was able to offer. In other regions, it seemed as though my rates as a sub-vendor were equal or better than what Parallon was offering.

I found that HCA bill rates were very good in Northern and Southern California where they were among the highest, if not the highest in the regions. The bill rates were solid in San Antonio, Houston and Colorado. They were fairly low in Dallas and Austin. And they seemed horrendously low in most parts of Florida. Again, these observations are all relative to bill rates for other facilities in the area.

Again this is from a sub-vendor’s perspective. I regularly heard from nurses who explained that pay rates through Parallon were the best they could find in Florida. So it’s possible that Parallon charged a larger fee to sub-vendors on their Florida bill rates than they did for other regions throughout the country.

It’s important to remember this when comparing pay packages with other nurses. For example, you may find yourself comparing pay packages with a Parallon employee while working an HCA contract through a sub-vendor. If the Parallon employee expresses that they’re making more money than you, it’s not necessarily an indication that your agency is ripping you off. Your agency most likely has a lower bill rate.

Travelers should also be aware that specialty unit bill rates, like ICU, tend to be about $3-$5 per hour higher than standard unit bill rates, like Med/Surg. Additionally, overtime and holiday bill rates tend to be about $7 to $1o per hour higher than the regular bill rate. Finally, HCA hospitals will sometimes offer completion bonuses of between $2000 and $5000. On the rare occasion that bonuses are offered, they are typically for hard to fill specialties like CVOR and L&D.

Qualifications for travel nursing at HCA facilities

HCA has some fairly stringent qualifications by industry standards. They typically require a minimum of 2 to 3 years of recent experience in the specialty applied for. They have a stated policy requiring all travel nurses to have an ACLS certification. This includes specialties that don’t routinely require this certification. It’s fairly rare for them to overlook or bend on this requirement. Some HCA hospitals also require Stroke and Trauma certifications for applicable specialties.

HCA frequently requires Meditech experience. This is probably because they know that the learning curve for Meditech can be steep. Moreover, they often require that travelers have experience working in HCA facilities.

Contracts and per diem for travel nurses with HCA

HCA engages in traditional travel contracts. They commonly have 13 week contracts for 36 hours per week. They also have 8 week contracts on occasion.

However, HCA also engages in a lot of per diem and “local” contracts as well. So you may find Parallon and many sub-vendors offering “Hybrid” contracts. With hybrid contracts, the nurse must make themselves available to work a particualr number of days per week, usually 5, and the agency will guarantee 36 hours per week. As soon as the nurse reaches 36 hours they are not obligated to remain available for the remaining days. It’s a hybrid between travel and PRN.

With all of this variability, you should be extra mindful of asking about what you’re signing up for. Travel contracts, hybrid contracts and local contracts all have different aspects from bill rates to guaranteed hours clauses. So it’s especially important to ask about the guaranteed hours clause that Parallon has with your particular contract.

Travel nurse submission process with HCA

Unlike many MSPs, Parallon does not conduct their interviews in-house. Instead, the profile is sent directly to the Unit Manager responsible for the job requisition. In the vast majority of cases, the travel nurse will have an interview directly with the unit manager. This is the best case scenario for travel nursing interviews because it gives travel nurses the opportunity to get all of their interview questions answered.

There are a couple more things to note about the HCA submission process. First, if you’re getting submitted by a sub-vendor, it maybe highly competitive and you may wind up waiting quite some time for an interview or to hear that the assignment has been filled by another candidate.

Second, you should NEVER contact an HCA hospital directly, even if your recruiter tells you to. Parallon and HCA have a strict policy prohibiting travel healthcare candidates from contacting the hospitals directly. Often times, rookie travel healthcare recruiters are unaware of this policy and tell their candidates to call the hospital directly. This will definitely result in your profile being pulled from consideration and could result in your agency losing their sub-vending contract with Parallon.

Onboarding for travel nursing jobs with HCA

If you decide to take an assignment with an HCA hospital, then there are few things you should know about the onboarding process. First, the onboarding process can be unstable. That is, sometimes it goes smoothly and sometimes it’s a train wreck.

Many sub-vendor agencies complain that Parallon doesn’t use a Vendor Management System (VMS). They cite this as resulting in poor communication between the agency and Parallon as to a candidate’s progress through the onboarding process.

For example, VMS’s allow agencies to upload the candidate’s required documents and receive updates through the system as to whether or not the documents are acceptable. They also get notifications from the system on missing documents. With Parallon, the documents are emailed or faxed and there is no way for the agency to track the documents. Instead they must wait for email communication from Parallon.

Agencies cite many other examples of poor communication between themselves and Parallon that result in a shaky onboarding process. It’s important to understand this so you don’t end up blaming your agency for the potential poor service during onboarding at an HCA facility.

Thankfully, HCAs tend not to have overly burdensome onboarding paperwork requirements. However, some HCAs require a PBDS exam prior to starting a assignment. Some HCAs will cancel the contract if the PBDS exam is “failed”. We’ve discussed the issues to consider with PBDS exams in a previous blog post, so we won’t rehash them here. However, it’s extremely important for all nurses to ask the facilities they interview with if such tests are administered!

Travelers will typically be required to visit the local Parallon staffing office prior to starting their assignment. There you’ll fill out some standard paperwork. It’s also a good idea to bring your licenses, certifications and medical documentation just in case. Different local offices handle this meeting in different ways. Some require travelers to come in on the Saturday before their start date. Others have the traveler come in on Monday or Tuesday of their first week.

Finally, it’s important to request your computer access code from your recruiter prior to starting your contract. Neither the hospital or the local staffing office has the ability to set this up, so it must be obtained from your agency’s Parallon contacts. At least this is how it worked in the past and I assume it still does. Many recruiters are unaware that they must request this from Parallon and sometimes it slips through the cracks.

We hope you find this information helpful. And as always, your feedback, questions and comments are welcome in the comments section below!