The Basics About Direct Relationships Between Travel Nursing Companies and Hospitals

As we’ve mentioned previously, there are 3 general types of contractual relationships that travel nursing companies can have with healthcare employers. Travel nurses can navigate the system more efficiently and with greater confidence when they have a solid understanding of these relationships. So, in this article, we’ll drill down on “direct relationships”.

What is a Direct Relationship in Travel Nursing?

Direct Relationships are the traditional/original type of relationship in healthcare staffing. A Direct Relationship is when the travel nursing company has a contract directly with the hospital to provide staffing services.

Typically, this means that communication between the two parties is direct, without any intermediaries. Hospitals typically have designated contact-people for the agencies to communicate with. These contacts typically work in the hospital’s staffing office or staffing unit.

Establishing Direct Relationships

Ultimately, it’s the hospital’s decision to decide what types of relationships they engage in. However, it’s important to note that Managed Service Provider (MSP) contacts, which are a different type of contractual agreement, are typically exclusive. This means that a hospital that has an MSP agreement cannot sign any direct agreements.

In any case, different hospitals manage their direct relationships in different ways. And how the hospital manages their direct relationships can have an impact on the agreements themselves.

For example, some hospitals might have a master agreement that any travel nursing company they work with must sign. In this case, every company will have the same exact agreement with the hospital.

Some hospitals might make certain aspects of the agreement negotiable. For example, the hospital might solicit proposals from staffing agencies for bill rates. In this case, different travel nursing companies might propose different bill rates. The general agreement is the same, but the bill rates would vary from company to company.

Some hospitals might just leave the entire contract up to each individual company. In this case, the contracts could vary significantly from company to company. This type of arrangement is quite rare these days because it makes it difficult for the hospital to keep track of all the variations.

Number of Agencies

There are some hospitals that work directly with over 100 different agencies. However, others are able to have their needs met by far fewer agencies and may work with less than 10.

Typically, hospitals that engage in direct relationships will work with a fairly large number of agencies. That said, it depends on how much the hospital utilizes travelers and how difficult it is for the hospital to fill their openings.

One of the knocks on direct relationships is that they’re cumbersome and inefficient. Essentially, processes can become haphazard when one hundred or more agencies are engaged with one client without a central clearing system or single source of truth.

How Communication works with Travel Nursing Direct Relationships

Communication is one of the main problems in this regard. Job order management is one example of this.

With direct relationships, the hospital typically communicates their job openings using some combination of a spreadsheet and emails. For example, the hospital might maintain a spreadsheet with their open jobs which they then email to their partners.

Unfortunately, partners can miss emails or email clients might rout emails to the junk folder. As a result, agencies might continue to submit candidates for jobs that are closed or call on the staffing office for updates unnecessarily.

Similar issues happen with credentialing documents, onboarding instructions, interview scheduling, reporting instructions and other issues.

Vendor Neutrality with Travel Nursing Direct Relationships

Vendor Neutrality and Preferential Treatment are also challenging issues for hospitals with direct relationships to manage. Vendor neutrality policies seek to ensure that the hospital treats all vendors (agencies) equally.  The idea is that this ensures the system prioritizes the hospital’s need to quickly fill jobs with the best candidates over favoring select agencies for some reason or another.

Typically, when vendor neutrality policies are in place, the hospital’s staffing office representatives will receive requests for travel nurses, otherwise known as job orders or job requisitions, from Unit Managers, Chief Nursing Officers, or someone in the finance department who has approved the order. In any case, the intent is for the hospital to notify all of the agencies that have a contract with the hospital at the same time. This ensures that no agencies gain a first mover advantage.

Agencies will then survey their available travelers and reply with the submission profiles of candidates who are interested and available. The staffing office would then review the profiles and forward those that meet the requirements. This person will review the submission profile and decide whether or not to contact the travel nurse for an interview.

In some cases, vendor neutrality rules go so far as to prohibit agencies from identifying themselves on their submission profiles. This way, the system seeks to keep agency identity secret so the hospital’s team focuses on finding the best candidate.

This scenario represents the way things should work with a direct relationship model when the hospital has vendor neutrality policies in place. It ensures that all agencies who are contracted with the facility receive a fair shot at submitting candidates. It also ensures that the hospital receives the largest possible selection of travel nurses. This increases the chances that the hospital receives more highly qualified candidates from which to select. Despite these advantages, some hospitals choose not to institute vendor neutrality policies and sometimes their team members disobey the rules.

Preferred Vendors with Travel Nursing Direct Relationships

In some cases, hospitals that maintain direct relationships engage in preferential treatment of their list of vendors. Sometimes, a hospital’s preferential treatment policies support the hospital’s interests. Other times, the preferential treatment is detrimental to the hospital’s interests.

For example, let’s say a hospital’s suppliers have negotiated different bill rates. The hospital might release jobs in stages beginning with their lowest-priced suppliers first. This way, they try to fill their openings at the best price.

Or, let’s say a hospital has 100 suppliers, but only 15 of them deliver 90% of the travel nurses the hospital ends up working with. The hospital might release job openings to those 15 companies first in an effort to minimize the noise and increase efficiency.

Similarly, let’s say a set of suppliers routinely delivers low quality candidates or fails at the credentialing process. The hospital might choose to demote these suppliers and favor using others instead.

Cronyism

In it’s worst form, preferential treatment is essentially cronyism. Sometimes, the staffing office representatives play favorites or enter into side agreements with agencies.

For example, the hospital’s staffing office representative responsible for handling the jobs may develop a strong relationship with particular agencies. Or worse, they might accept gifts or kickbacks from agencies in exchange for favorable treatment. Other times, agency representatives will somehow develop close personal relationships with Unit Managers, or other individuals who can trump the staffing office. In this case, the agency representative might learn of open jobs before the staffing office does.

I’ve even experienced such cases when the facility has vendor neutrality policies in place. For example, one facility I worked with had a very stringent vendor neutrality policy. It went so far as to require that submission profiles made absolutely no mention of the agency, whether in writing or logo form. They were aiming to ensure that people at the facility would not even know where the profile was from. The only person who could possibly know was the staffing office representative who originally received the profile, and that’s where the breakdown originated.

It became well known that the representative developed a very close relationship with a single agency. They were forwarding all of that agency’s submission profiles to the hiring managers first. This ultimately resulted in one, pretty small agency having 18 to 20 travel nurses at the facility at one time.

In another instance, a county hospital I worked with had strict vendor neutrality policies, which most municipal facilities do. I was working with a travel nursing couple, he an OR nurse and she a Cath Lab nurse. They were also working with another agency, and we both submitted him to an open OR job at the county facility. He interviewed, was offered the job, and selected to work through us. We were told there were no Cath Lab openings, nor would there be any time soon.

Then, the other agency called the couple and told them they had secured her a position in the Cath Lab, and could land both jobs if they both agreed to work with the other agency. We called our contact in the staffing office who knew nothing of the Cath Lab job. The other agency had clearly bypassed the staffing office, perhaps directly to the hiring manager. They essentially forced the couple to go with the other agency to ensure they were able to secure contracts at the same hospital.

Considerations for Travel Nurses

What does this all mean for the travel nurse? Well, there are a few important things to take away from all of this. First, if the hospital works with many agencies and things are working like they should, then it’s likely that landing a job will be quite competitive. The hospital will release the job to many agencies and they may immediately receive a large number of submission profiles. I’ve seen open jobs fill in less than an hour. I’ve also seen emails from hospital staff indicating that they had received 50 or more submission profiles in less than hour.

Second, if the hospital engages in direct relationships with relatively few agencies, then you’ll stand a much better chance at getting an interview. The hospital will still receive many candidates, but you’ll be competing against fewer candidates. Additionally, there is a good chance that the few agencies who are working with the hospital have developed a strong working relationship with the key players at the hospital. This will result in the agency having more information about the hospital, the unit, and the travel nursing job overall.

Finally, if the hospital is working with many agencies, but is giving preferential treatment to a few agencies, you’ll have a difficult time navigating the system unless you happen to be working with an agency that is receiving preferential treatment. If you’re working with an agency that is not receiving preferential treatment, you’ll have a very difficult time landing a job at that hospital. Your agency may not even receive word that an opening exists, and even if they do, your submission profile may be passed over in favor of others from the hospital’s preferred agencies.