TTATN 019: Travel Nursing In California

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In this episode, we’re going to take an in-depth look at travel nursing in California. Our goal with this episode is to provide you with actionable information that will you get the most out of your time in the Golden State. We’re going to cover to provide tons of useful details on topics including the licensing process, the major hospital systems in the state, the various regions in the state, and much more. [Please note that this is a transcript of a podcast episode. As such, grammar and spelling are not optimized for written content.]

Demand For Travel Nursing In California

So you may be wondering why we’d devote an entire podcast episode to California. After all, it’s just one of the 50 states in the country. The reason is that California is massive and it’s a huge user of travel healthcare professionals. Nearly 12% of the nation’s population lives in California. Moreover, California has fewer nurses per capita relative to many other states in the nation.

Now, I’m not sure if you’re aware, but the federal government’s most recent projections on the nursing career concluded that there would be a surplus of over 300,000 registered nurses by the year 2025. This hasn’t gotten a lot of press because there aren’t a lot of people who have an interest in talking about nursing surpluses. I mean, nursing schools, professional organizations and staffing companies all have an interest in talking about the nursing shortage, but nobody really has an interest in talking about the projected nursing surplus. We’ll link to an article on that report in the show notes. Anyway, the point is that this most recent report projects that there will still be a nursing shortage in the state of California in 2025 despite there being a national surplus.

So California is among the most popular destinations for travel nurses due in large part to the fact that there is so much demand for travelers in the state. This is why we always recommend that travelers maintain their California license. Outside of obtaining a compact nursing license, the California nursing license may give you the biggest bang for your buck in terms of opening the door to the largest number of travel nursing jobs. It can be big help in ensuring that you stay continuously employed as a travel nurse because it opens the door to so many opportunities.

How To Get Your California RN License For Travel Nursing

So, getting your California license is what we’re going to discuss first. Now, like all state licenses, it’s best to obtain your California RN license in advance. Again, the vast majority of hospitals won’t consider candidates unless they’re already licensed in the state.

There are some states that have walk-through licensing processes that allow nurses to get their license in a day. And in these states, there are some hospitals that will accept profiles for candidates that aren’t licensed…but California is not one of the states. It used to be, but it isn’t anymore. Nurses used to be able to show up in person that California Board of Registered Nursing and get their temporary license on the spot assuming they had the required paperwork in order. And it was almost a guarantee that you’d get the license because they did very little in the way of background checks or checking for action against a license in other states.

A few years back, there was a big expose that uncovered a number of nurses, as well as other licensed medical professionals, who had some serious background issues but were practicing in the state and it was taking the BRN ages to address the issues. So they tightened everything up.

Things were still running relatively smoothly when that happened. Sure, you couldn’t get your license in a day, but the process was still fairly quick.

Then, several different state licensing bodies and various state organizations, including the BRN, adopted a new electronic processing system called Breeze. There were tons of problems integrating the system and getting up and running and this resulted in huge delays in the licensing process.

Now, this happened close to two years ago in 2013. But there are still reports of delays. However, the State says licenses are being processed within the maximum timeframe of 90 days. And that’s probably the problem, 90 days is quite a long time. Either way, it’s important for travelers to know that there are two basic approaches to obtaining a California RN license by endorsement and we’re going to take a very brief look at those two approaches.

The first approach is to apply by mail and the second approach is to apply in person. Despite the fact that California is not a walk-through state, you’ll still obtain your license much more quickly if you can apply in person. Now, no matter whether you apply in person or by mail, you’re going to need the following items:

• A completed Application for Licensure by Endorsement
• 2 passport photos
• License verification: For vast majority of states, this is done through Nursys, which is an electronic verification system. This is the best case scenario.
• Nursing School Transcripts.
• Finger prints.

Fingerprinting for California RN License

Now, if you choose to do everything via mail, then the instructions on the board of nursing website tell you to order your fingerprint cards from them, in which case you have to wait for the fingerprint cards to arrive. The reason they do this is because they print some required information out on the cards. But some of our BluePipes members have told us that you can use any fingerprint card you want, you just have to be sure to include this information, we’ll link to a blog post that has all the details you’ll need. Again, getting the card from the board is the safest bet, but some people are saying that it takes them forever to send the cards out, so this is an alternative.

You’ll need to take the cards into a fingerprinting service like a police station or some other location that offers these services. Be sure to let the ink dry before doing anything with the cards because smudges can prevent the prints from being read which will delay the process significantly. You’ll need to have the prints redone.

Next, you’ll need to contact every college that you took nursing courses at, or any courses that counted toward your nursing degree, and have them send official copies of your transcripts to the board. The instructions for this are on the endorsement application.

Next, you need to initiate the license verification process. Hopefully, your state verifies with Nursesys. If not, you need to look into how the verification is done through your particular state. With nursesys everything is done electronically so there is little room for error.

Finally, you’ll fill out the application, take care of your passport photos and send everything off in the mail. Now, the problem is that the California board will need to send your fingerprint cards to the federal government for processing. This takes a ton of time.

Many people wonder if they can speed the process up by applying for a temporary nursing license. The problem is that the temporary license will not be issued until your fingerprint results are back. The temporary license really saves you the time of having the board wait for and process your college transcripts. But with all of the delays the board is currently experiencing, it’s often likely that your transcripts will be received and processed before your old fashioned fingerprint cards are.

And that’s where showing up in person can save you all the processing time. You see, if you show up in person, then you can use livescan to do your fingerprints. From what I’ve heard, some states will let you do livescan fingerprints from another state, but California does not, at least as of now. You must do livescan fingerprints in the state.

So the point of doing it this way is that results come back immediately. So you can take care of all your documentation beforehand, visit the board of nursing and pick up a livescan card, then there is a livescan service right near the board of nursing so you can get that taken care of and then return to the board’s office and turn everything else in and you should get your temporary license within a week or two. At that point, you’ll just be waiting for your college transcripts to come through and get processed in order to receive your permanent license.

As I mentioned before, we’ll link to a detailed blog post in the show notes for this episode that includes all of this information so you don’t need to write it down now. Also it’s important to note that there are many agencies out there right now that offering assistance and deals to help you get your nursing license. I know that Valley Healthcare Staffing which is based in Sacramento, CA where the board is located, was offering an amazing concierge service where they would walk you through the process, pick you up from the airport and drive you everywhere you needed to go to get your license taken care of. There are others out there as well. Again, we’ll provide links in the show notes.

Travel Nursing and the Hospital Systems in California

Okay, so in addition to obtaining your license, it’s a good idea to have an understanding of the major hospital systems that operate in California. The biggest hospital system in California is Kaiser. They operate at least 38 hospitals in the state. And they use a lot of travel nurses.

Travel Nursing With Kaiser In California

Now, you’ll hear a lot of people say that they hate Kaiser hospitals and they’ll strongly recommend that travelers never work there. It’s important to know that there are a lot of people who work at Kaisers and love them. I personally lost many travelers to permanent jobs at Kaiser because they liked them so much.

When it comes to this issue, it’s important to remember that whether or not a hospital is good to work at, goes all the way down to the unit level. So I’m sure that there are some units at some Kaiser hospitals that are wonderful and others that are terrible.  The point is that I don’t think it’s a good idea to just avoid all Kaiser hospitals. Give them a shot and see how it goes or try to find information on the particular hospital and unit you’re considering.

With that in mind, as we’ve discussed before, American Mobile is currently the managed service provider for all Kaiser hospitals. This means they have first crack at filling the open travel nursing jobs. If they’e not able to fill those jobs within a certain amount of time, then they release them to their sub vendors which are companies that contract with American Mobile to staff at Kaiser. Therefore, all agencies that staff at Kaiser must go through American Mobile.

When your profile is submitted for a Kaiser assignment, what typically happens is that you’ll first receive a call from an American Mobile representative who will ask some standard questions and verify some information on profile. For example, they might ask if you have ever participated in a code blue and if you’re proficient with IVs. They might also review any requested time off that you have during the assignment and various other details. If everything is good at that point, they’ll most likely schedule a time with you for the actual interview.

In the past, the interview was with a registered nurse that worked with American mobile. I think their title was clinical liaison or something like that. They would go off an interview template and basically ask the same questions all the time. Now, I believe that they do electronic interviews. There is a portion that’s on the computer and a portion that is recorded over the phone. The results get sent to the unit manager or hiring manager and they make a decision on whether or not to bring you on.

Travel Nursing With Sutter In California

Okay, so Sutter is another big hospital system in California that uses a lot of travelers. Many Sutter hospitals work through a Vendor Manager called RightSourcing. This is a vendor neutral service so they aren’t engaged in staffing directly. Instead, they manage all the agencies for the hospital. I believe that some Sutter hospitals have different arrangements to handle their travel staffing so this will be a mixed bag. Pretty much all of Sutter’s hospitals are in Northern California.

Travel Nursing With Dignity Health In California

Another hospital system that uses a lot of travelers is called Dignity Health. They operate hospitals all throughout the state. To the best of my knowledge, different Dignity hospitals get there staffing needs met in different ways.

Travel Nursing Game Plan for Hospitals in California

Why is any of this important to know? Well, if you’ll remember from episode 6, one of the recommendations we gave for finding and evaluating travel nursing companies was to make sure that you were finding companies that worked in your desired locations. It’s also a good idea to make sure that you have all the hospitals covered in any given area that you want to work in. This way, you can maximize your exposure to the job market in a given area. So you can ask the agencies you talk to which of these hospitals they have contracts with.

You can also ask them to give you pay quotes for jobs at Kaiser hospitals or Sutter hospitals if they have contracts with those hospitals. This way, you can shop around for the best rates at these hospitals. In the end, you’ll be able to find a combinations of agencies that get you access to all the hospitals in a given area at the best rates.

Okay, so there are a few other hospital systems for us to discuss, but those are the big ones and you get the general idea. So let’s discuss the various different regions of California and what they have to offer. And throughout this conversation, we’ll discuss some of the other hospital systems to look out for.

The 5 Different Regions in California That Travel Nurses Should Know About

Now, most people talk about or focus on the difference between Northern and Southern California and it’s true that the rates in northern California tend to be higher than they are in southern California.  For example, the Kaiser hospitals in northern California have a higher rate than those in southern California. And this is the same for many, if not all, hospital organizations that operate in the state of California. However, there’s much more to consider when it comes .

Travel Nursing in Southern California

I like to break the state down into 5 regions. First, you have southern California, which is basically the Los Angeles area down to the border which means it includes San Diego. Now, in this area, I think it’s fair to say that they have a less difficult time attracting travel nurses and nurses in general to work there. It’s got the year round great weather and great beaches. Hollywood and that all that stuff going for it. It’s just a very attractive place to live.

It’s also on the expensive side to live down there. California is expensive in general, but Los Angeles and San Diego are above average cost wise. Now, there are a lot of Kaiser hospitals in Southern California. There are a few Dignity Hospitals down there too. There are a couple of HCA hospitals too. And when I was recruiting, the HCA hospitals in Southern California had great bill rates. They were much higher than a lot of the other hospitals in the area.

Other than that, there are tons of stand-alone hospitals in southern California. There are university hospitals, various private hospitals and so on. I can tell you that Cedars Sinai, which sort of considered the hospital of the stars and is a really highly rated hospital for both workers and quality of care, isn’t it funny how those two things go hand in hand most of the time, treat your workers right and get great results…you’d think someone would pick up on that…anyway, Cross Country has the exclusive contract with them and my experience was that they rarely had to release orders to sub vendors because they never had a problem filling them. That said, the job market is really tight right now, so that may have changed.

Travel Nursing in Coastal California

Okay, so the second region I like to use is what I call the coastal region. I consider this to be everything from Santa Barbara in the south to Santa Cruz in the north. These are the big cities that anchor the region. They’re actually fairly small cities, but they’re big for the region.

Santa Barbara is a beautiful area. It’s sort of a college town area, there’s a small suburb of Santa Barbara called Isla Vista which is where UC Santa Barbara is located. It’s also a vacation and retirement spot for Los Angeles area. That’s where Michael Jackson’s home was and there are lot of famous stars with homes and property in that area; very beautiful area with a lot of wineries popping up.

The main hospital system there is called Cottage health. They have 3 or four hospitals in the area. When I was in recruiting, they were all going through a vendor neutral service call ComForce. So, nothing special here, you’d just have to track down agencies that have the contracts there and there are a lot of agencies that do.

There are several other communities going up the coast including Santa Maria, San Luis Obispo, Paso Robles and these are all really nice communities. And then you get to a fairly large desolate area on the coast which is taken up by Los Padres National Forrest. But above that there is Monterey and Santa Cruz, both of which are really pretty areas on the Coast.

Now, the rates in these areas might sound somewhat appealing when they get quoted to you if you’re coming from a state like Mississippi or somewhere in the south where nurses get paid a little lower than the average, but these areas can be quite expensive and it can be somewhat difficult to find housing if you’re picky about your accommodations. That said, there are sometimes some really good rates if there are rapid response or crisis rate assignments…but for the most part, these tend to be destination assignments as opposed to money assignments.

Finally, there are a lot of Dignity health hospitals along from Santa Maria through Santa Cruz. So that’s good to know when doing your research.

Travel Nursing In California’s Central Valley

Okay, so the third region as I see it is the central valley. This includes everything from Bakersfield on the South to Sacramento on the north. Now, the rates in this region tend to be pretty good relative to the cost of living. The central valley is little less expensive to live in. I mean some of the areas are quite a bit less expansive…like Bakersfield, Fresno and Modesto.

Most of the cities in the central valley have a pretty bad wrap. Most of them are rural communities that are somewhat removed from the coast on the west and the mountains on the east. That said, I think they’re fine for an assignment or two. There’s actually a lot of really pretty national forest land to the east. For example, Bakersfield is fairly close to Sequoia National Forest and Modesto and Fresno are pretty close to Yosemite. So if you’re into that then these are good spots. There’s enough to do in these areas to keep you busy.

That said, the majority of the central valley does have a less vibrant economy. It’s also pretty hot in the summers. There’s a lot of air pollution as well. I think Fresno, Bakersfield and Stockton are regularly found the most polluted air list. Anyway, you take the good with the bad and there are actually a lot of travelers that really like these areas, so they’re certainly worth checking out.

Sacramento on the other hand is actually pretty cool. It’s the state capital so there’s all that. It’s got a really good restaurant scene and plenty of nightlife. It’s got a professional basketball team, the kings, and a triple A baseball team, the Rivercats. It’s got a minor league soccer team as well. There’s a lot of outdoor activities and it’s an hour and a half to two hours from Lake Tahoe on the East and San Francisco on the west. It’s also close to Napa and there are a lot of wineries in the area as well.

Anyway, this region has a bunch of Dignity Health hospitals as well as Sutters and Kaisers.

Travel Nursing in The San Francisco Bat Area

Okay, so the fourth region as I see it is the Bay Area. The Bay area is from San Jose on the South to Santa Rosa on the North. And we can also consider the east bay area in this region which includes cities like Walnut Creek and Pleasanton as well as the north bay area which includes cities like Vallejo and Napa. Now, these areas tend to have a really high cost of living. Sometimes, the bill rates are really good, so the pay rates can be really good as well. But sometimes, the bill rates can be mediocre so you have to watch out.

This area includes San Francisco and Silicon Valley as well as Napa Valley, so there is tons of stuff to do there. Some of the more unique things to do there include visiting Google’s corporate headquarters, and going to check out Alcatraz.

This area has tons of Kaiser Hospitals some Sutters, and some Dignity health hospitals. There are also some Tenet health hospitals as well as some pretty prestigious university hospitals like Stanford, and UCSF. There’s a couple of really popular hospitals for travelers in this region as well. Valleycare in Pleasanton and John Muir in Walnut Creek are really popular with travelers.

Travel Nursing in Northern California

Okay, so everything north of this is what I refer to as northern California. Many people don’t realize that there’s nearly 400 miles between Sacramento and the Northern California border. This region is pretty desolate. There’s a lot of farm land and really pretty mountain areas and coastal regions. The areas that use the most travelers up there are Redding which is in the center of the state and Fort Bragg which is on the northern coast.

Fort Bragg is an absolutely beautiful area. There’s a really cool town up there called Mendocino which is right on the coast and it’s where they used to sometimes film the TV show Murder She Wrote. Redding is really close to Lake Shasta which Is a really nice lake for water skiing and other water sports.

Okay, so this is probably a good place to end this episode. We’ve covered the licensing process, a little bit about the hospitals and hospital systems in California, and a little bit about the various regions and what to expect out of them.

Again, we’ll have the transcript of this episode up on the show notes page for you to review. We’ll have tons of useful links there as well, links that will take you to blog posts with even more detailed information. And as always, we welcome your comments and questions about this topic on the show notes page. The show notes for this episode will be at blog.bluepipes.com/episode19. While you’re there, be sure to join BluePipes where you can take advantage of the professional networking and documentation management tools designed to simplify travel nursing for travel nurses.

Also, if you’ve been enjoying this podcast, then we’d greatly appreciate your submitting a review on whatever platform you use to listen on, whether it be stitcher or iTunes or something else, it really goes a long way in helping us get the word out so more travelers can get this information and we can keep the show going.

Thank you so much for listening and until next time, have a safe an prosperous travel healthcare adventure.

Links:

TTATN 006 :Tips for Finding and Evaluating Travel Nursing Companies

Travel Nursing – How to get Your California RN License by Endorsement

Shocking Results From California Nursing License Audit

Travel Nursing In California

5 Things to Know about Temporary Nursing Jobs with the California Department of Corrections

Major Delays for California RN Licenses

Travel Nursing at California Kaiser Hospitals