Travel Nursing Companies – Their relationships with hospitals matter, Part 1

It’s useful for travel nurses to be informed about hospital-agency relationships. Remember, a travel nursing company can only work with a hospital if it has a contract to do so. These contracts exist under several different arrangements. Each arrangement results in different outcomes for the hospital, the agency, and the travel nurse. There are essentially two relationship categories, Direct Relationships and Vendor Management Service relationships.

What is a Direct Relationship?

A Direct Relationship exists when the company has a contract directly with the hospital to provide staffing services and communication between the two parties is direct, without any intermediaries. Direct Relationships are the traditional/original type of relationship in healthcare staffing.

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Typically, hospitals that engage in direct relationships will work with a fairly large number of agencies depending on how much they utilize travelers and how difficult it is for the hospital to get their openings filled. 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. Hospitals typically have designated contact-people for their contracted agencies to communicate with. These contacts are typically staffing office representatives.

Are travel nursing agency direct relationships vendor neutral?

Hospitals may or may not have policies in place that govern how their representatives engage with agencies to handle the talent acquisition process. Those that do have policies in place are seeking to achieve what is commonly referred to as “vendor neutrality.” Vendor neutrality policies seek to ensure that all vendors (agencies) are treated equally in an effort to ensure that the hospital gets the best candidates as opposed to candidates only from favored agencies.

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Typically, when vendor neutrality policies are in place, the hospital’s staffing office representatives will receive requests for travel nurses, otherwise known as orders or requisitions, from Unit Managers, Chief Nursing Officers, or someone in the finance department who has approved the order. The orders should then be released to all of the agencies that have a contract with the hospital. To accomplish this, the hospital typically sends out a mass email with the necessary details to all of the contracted agencies.

Typically, agencies receive only the most basic information such as License, Specialty, Shift, Start Date, and Contract Length. Specific details about the unit or qualifications sought will sometimes be included as well. So the agency may receive an email from Hospital X that says, “RN, PICU, 7p-7a, 4/18 Start, 13 weeks.”

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Agencies will then survey their available travelers and reply with the submission profiles of any interested candidates. These submission profiles will be reviewed by the staffing office to ensure that the basic requirements are included. If the staffing office deems that all the basic requirements are met, then the submission profile will be forwarded to the Unit Manager, or someone designated in the unit, who will review the submission profile and decide whether or not to contact the travel nurse for an interview.

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 any candidates they might have. It also ensures that the hospital receives the largest possible selection of travel nurses, thereby increasing 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 vendor neutrality policies are disobeyed.

Cronyism and travel nursing direct relationships

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, 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 may be able to bypass the staffing office and learn of open jobs from the Unit Manager before the staffing office is made aware.

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I’ve experienced such cases even when the facility has vendor neutrality policies in place. For example, one facility I worked with had a very stringent vendor neutrality policy that went so far as to require that the submission profiles sent by agencies include 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, and was forwarding all of that agency’s submission profiles to the hiring managers first, before sending any others. 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.

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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, and the couple was forced to go with the other agency to ensure that they were able to lock down 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, it’s possible that landing a job will be quite competitive. The open jobs will be released to many agencies, and the facility may immediately receive a large number of submission profiles. I’ve seen open jobs filled 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. However, this is just the name of the game in today’s market.

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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 there will be fewer candidates to compete against. 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 preferred agencies.

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We’ll discuss the Vendor Management Service relationship in the second part of this 3 part series. We’ll discuss when and how to put your knowledge of hospital-agency relationships to use in the third part of this 3 part series.

Please share your thoughts and experiences on this topic!