Why Do Travel Nurses Hate PBDS Testing So Much?

There is much talk about PBDS testing in the Travel Nurse circles. Those not familiar with the testing and perhaps even some recruiters wonder what the big deal is about this testing as a condition of employment.  Here is a list of some of the issues with this testing:

1) It is subjective based on the scoring person's opinion. 4 docs could answer the question 4 different ways and each be right.

2) The test requires nurses to diagnose patients. That is practicing medicine without a license. Diagnosing is what docs get paid for, not nurses so testing on this is irrelevant to the skills of a nurse.

3) Testing is not given until AFTER arrival in the new assignment city - which means either the Agency or the Traveler are already hooked into a 13 housing arrangement and travel expenses. Hospitals pay no penalty for sending a traveler home if they fail, yet the entire financial burden is on either the traveler or on the Agency.

4) While the test is easy enough, travelers don't get paid for their time to take the test and a few hours is involved to take it.

5) Nurses are all strictly licensed and are tired of proving and re-proving that they are nurses every 13 weeks when they already hold the hard-to-get RN license or CCRN standardized credintialing exam certification.  


6) PBDS testing was developed as a tool for hospitals when orientating their permanent staff. It was not designed as a pass/fail test. It was designed to identify weaknesses and strength so that an orientation can help develop the employee and help determine the department to work in that is best suited to their skills. Using this test to determine the qualification of Travel Nurses is considered abusing this test by the company who created it.


Have you been burned by this test in the past? All it takes is one time before a nurse loses time and money before they no longer will interview for facilities that require it.


Fortunately, I've been hearing lately that there are agencies that have severed ties with client hospitals that use PBDS testing for travelers. One such company is Total Med, Inc.  They, too, realized that the testing was not good for business and/or for the traveler! Common sense prevails!


For those nurses new to the Travel Nursing industry, be sure to ASK your recruiter directly before interviewing if PBDS testing is required.  Also, during your interview with the facility Nurse Manager, ask if the testing is part of employment for a traveler just to be sure.  Lastly, when you do accept an assignment, be sure to have NO PBDS testing as a term of your contract. Otherwise, a facility can spring it on you upon arrival and then you are stuck with all the associated costs of you fail the test.

Bottom line, Travel Nurses should reject PBDS testing!

Cooking In a Hotel Bathroom

While this may not sound very attractive, let's face it, Road Warriors get tired of eating out every night and who can afford it?  Sometimes it is just comforting to eat at your temporary home - the hotel room.  I've discovered that not only can it be done, but it can be done well.

For our recent assignment we were two hours away from our tax home, so the best solution for housing while on this assignment was to stay at a Country Inn and Suites with a negotiated rate with one of the managers there.  We stayed at this hotel three nights per week for 13 weeks.

Funding Future Vacations 
While it isn't completely awesome to stay in a hotel for an entire assignment in a room with no kitchen, it IS helpful to pile up the reward points to that they can be used to get us free rooms for our days off in the future.  We certainly did a nice job with that on this assignment.

To maximize our rewards here we applied for and were approved for the hotel branded credit card.  This gave us immediate Gold Status that earned us an extra 30% bonus points per stay in addition to the 20 points per $1 stayed with their Loyalty program. The branded card gave us another 10 points per dollar.  Further, we signed up for a promotion which tripled our rewards during the promotional time period.  Over 13 weeks we amassed somewhere in the ballpark of 250,000 reward points with Club Carlson. Since one of the other perks of having their credit card is a free night with a 2 night room reward, for us, that is like having 500,000 reward points to use!  We planning on using them this year in NYC and in Puerto Rico for free!

Cooking Without a Kitchen
Free hotel room upgrades was also a motivation for bothering with all of this.  While we stayed at The Country Inn and Suites, we were given a suite each time we checked in even though our negotiated rate was, basically, the same low rate we found on Priceline but we were then able to collect rewards.

The suite we lived in had a microwave and a partially working refrigerator, so it was my job to create a portable kitchen for us to take with us each week. A bigger room also had a couch and an endtable, which then became our diningroom during our stays. 

My portable kitchen was created in the form of a clear tub storage tub.  In it, after trial and error, I stocked it with the following:

• 4 Bobby Flay plastic plates that were colorful (color adds something to food, especially in the hotel room)
• Silverware from home 
• Good knives including chopping, steak, and paring
• Spices - I tend to get carried away with this, but packed lots of them!
• Spatula and a wooden spoon
• Toaster oven - sometimes I rotated out the toaster oven and subbed in an electric skillet or a quesadilla maker.
• 2 Potholders and a mitt
• 3 Dishcloths, 3 dishrags
• 1 small bottle of dishsoap from the dollar store
• Corkscrew/bottle opener
• Wine Saver pump and rubber stops
• Battery operated lights for the table
• 2 colorful placemats
• 2 wine glasses
• 1 French White baking dish with glass cover
• 2 square rubbermaid dishes, 2 small square rubbermaids
• 1 can of Pam spray
• 1 small bottle of Olive Oil 
• Tinfoil 
• a pastry brush
• A small bottle of Mr. Clean

The tub was lightweight even when fully packed, pictured below, and it stored nicely in the closet of our room out of the way. We carried the entire "kitchen" into our room all in one neat, medium sized package. The electric appliance was set up on a hard surface.  Sometimes I used a table in the room, and other times I moved the coffee maker out of the way and used that surface for cooking instead.

One of the meal I experimented with successfully was one of my husband's favorite comfort foods, Chicken Reganotti (oregano chicken, it's Greek).  After much researching online and then experimenting for myself, I discovered that while French White cookware is not rated for toaster ovens, they perform just fine even being so close to the heating source. 

Planning the Meal
About two hours before I picked my husband up from work I headed to the grocery store. Back in the room I placed the chicken and potatoes in the cookware without a cover, and set aside.

Preheat toaster oven to 450 degrees.

Next, for dessert, the other comfort food is Strawberry Shortcake. I bought one packet of Bisquick, mixed with water and dropped onto toaster oven metal sheet. I baked for 10 minutes or until biscuits browned around the edges.  I removed the biscuits onto tinfoil to cool. Despite what nay-sayers blog about elsewhere, I find this cheap toaster oven to bake just fine!

Next, I reset the toaster  to "Bake" with a temperature of 375 degrees, but the chicken and potatoes in, and let it cook for 1.5 hours.  

Chicken Reganotti Recipe
Any cut of bone-in chicken with skin (I prefer thighs for their cost and their size)
Peeled potatoes
Baste chicken and potatoes with olive oil
Pour or squeeze lemon juice over everything - I use a lot - about 1/2 cup
Season to taste with oregano - I use a lot of it - about 2 tablespoons
A pinch of sea salt over the top

Just before leaving the house to pick up the husband from work, I turned off the toaster oven and unplugged it.







As soon as we return to the hotel room, I turned on the oven again, but this time for only about 5 minutes on broil just to be certain that all the food served will be hot.  Delicious, just like it is at home.

Another meal in the room I made was Quesadillas.

This time I visited the salad bar at the grocery store. When I returned to the room I cut everything into smaller pieces.  The electric quesadilla maker made this a quick meal with easy cleanup.  Even adding protein to this meal is easy as some salad bars ofter mock-crab, ham, or seasoned chicken.

I added sour cream, fresh salsa, and medium sized flour tortillas to round out the selection.

Cleanup
Finally, there is no escaping the after-cooking cleanup.

Before I started cooking I tackled the bathroom.  In this particular room the counterspace was very limited.  So, I moved toiletries, towels, makeup, and anything else to one side of the countertop.  On the other side, I designated it as the kitchen for cleanup and cleaned the countertop and wall with Mr. Clean (yes, I'm funny that way).  Next, I laid down a fresh kitchen towel.  After the meal I washed the dishes in the sink and promptly dried them with a clean dishtowel, then stored them back in the storage tub.  I think used the pants hangers in the closet with clips on them to hang the towels to air-dry over the bathtub.  Complete!  While living in a hotel room isn't a fantasy situation, at least one doesn't have to be cut-off from home cooking!  

Here are other ideas for cooking in a hotel room:
Using tinfoil pans from the Dollar Tree to cook chicken.  

Use tinfoil to bake cut-up potatoes, much like you would do on a grill.  I use plain yogurt with seasonings to make a zesty compliment for chicken and potatoes.

My Exploring Dover Delaware Blog

So here we are in our newest assignment finding ourselves in Dover Delaware.  With all of my searching online I am finding very little information by way of personal blogs about the area so it looks like I will be taking my own discoveries and experiences and posting them for others to benefit from.

Historic Dover, at least at first blush, appears to be a great, little, All-American city.  Great location, easy to navigate, historic, terrific seafood access, close to beaches, close to huge metro areas, and the cost of living is manageable. With a population around 37,000 the city is compact and quick to navigate. We found an apartment two miles from the hospital and it takes us about six minutes to make the trip.

There are a few quirks about this city, as there is with every city.  The state of Deleware is serviced by volunteers for their fire departments instead of paid crew. 
According to Delaware law, volunteers are not permitted to have, mount, or use sirens on their vehicles when in pursuit of a fire; therefore, each time a firecall is made the tornado air-raid sirens across the city go off. These sirens go off frequently and at all times of the day or night and it is unnerving at first.   It took us several days to finally ask someone about the frequent sirens.  When staying in a hotel on the south end of town we didn't hear the sirens, but when we moved into our apartment on the far west side of downtown we heard them five times within the first 24 hours of settling in!  Crazy stuff!  With all of the technology today at our fingertips... like cellphones for calling and texting, it is annoying that air-raid sirens are used day and knight to wake up everyone in the city for each fire call.  

Next up, stop lights here do not appear to be timed or at least timed well.  I find myself sitting at a red light with no other cars in sight for what feels like five minutes for each light.  Because the city is so old, blocks are short and stoplights are plentiful. What should take 3 minutes to navigate takes more like 9 minutes. I can be stopped at a light with no other car in sight while I wait for 3 minutes per light for the signal to turn green. 

The city of Dover is the state capital.  Government seems to be the biggest employer here. Therefore, there is a high unemployment rate particularly for the black and minority population.  Unfortunately, developers here have become predatory here, meaning, that the large historic homes which populate the downtown area have been run down, foreclosed up, then snapped up by developers turned slum-lords.  Large sections of the downtown are now home to the unemployed and the under employed poor of Dover. Crime is higher than the national average and the downtown business area has died because of it.  20% of the population in Dover earns $20,000 or less per year for a family of four.  That is quite a bit higher than the national average.  With that population living downtown there is plenty of room for trouble in the business district. Less pedestrian traffic, less investment, and less money coming into businesses has cause the downtown Loockerman Street to have a 30% storefront vacancy rate.  As of 2014 the State is attempting to pour business development funds into the downtown, but quite frankly, until the jobs develop (better paying that minimum wage) the business revenue cannot return. Those with the higher earning wages that the State jobs provide have built in suburbs. The three thriving businesses here that we have seen so far are:  The Dollar Tree/Dollar Gerneral/Family Dollar - those are on every corner!  Liquor stores are a booming business - there are more liquor stores here than there are even in Wisconsin. That is quite remarkable.  Bail/Bonds also seems to be big business are there are several business on State Street and Governors offering 24/7 services.

Since we have lived here, which is only for one month so far, the Restaurant Association credit card processing site has been hacked and our credit card info has been stolen and fraudulent charges have been made, and I have personally been approached by a thirty-something man in the grocery store at 1:00pm in the afternoon offering to sell me his food stamps in exchange for cash.  While the history of the city is terrific here, opportunity lacks and, unfortunately, this city of Dover has left the impression of being seedy.

Another fact with this city, Dover has a very high sex offender rate compared to the national average.  Some critics suggest it is because there isn't much to do here.  Liquor stores are on every corner in Dover.  I wonder if that is a contributing factor.  Liquor seems to be the big business here as those parking lots are always full while restaurant parking lots seem mostly empty.  

There is a stretch of the DuPont Highway just south of the Dover Downs Hotel and Casino that is a restaurant waste-land.  This is the busiest stretch of roadway real-estate in the city yet there are at least five restaurants in a row that sit empty and abandoned with no other businesses in between. 

Now for more of the positives. The surrounding area is quite scenic with vast amounts of waterfront reserved for wildlife.  Pickering Beach is the home of the largest population in the United States for breeding horseshoe crabs.  At high tide you can easily see the strange, prehistoric creatures on the beach by the thousands. Some grow to be a couple of feet long!

Customer service here provided by the young generation actually seems better, more sincere, than in other parts across the US. When these people thank you, they actually mean it, not just repeat some mantra.

Having unpacked and catching our breath we had a little time to explore the area.  One of the big attractions here is the big casino, Dover Downs.  Not only is it a sizable, luxurious casino, but it also sports one of the fastest NASCAR circle tracks in the United States.  I hear that they host one event a year on the track.  For another part of the season the stands are filled with harness racing enthusiasts.  While we arrived too late in the season to catch a horserace, the pictures look pretty amazing of the grounds.  More on that later as we discover it for ourselves.

Dover sits in perfect proximity to the Rehoboth Beach entertainment district, Wilmington's attractions, Philadelphia, Washington DC, Baltimore, and New York City.  All of this to see and do close enough for just a day trip.  

While we certainly don't want to stay in Dover, we are enjoying being here as we get to see the Eastern Seaboard up close and personal.

Rating Hospitals for Traveler Friendliness

Now that we have a few hospitals under our belts we think it's fair to rate them for the experience we had while at each facility.

The grades given are strictly our impression and are a cumulative grade considering the following:

Length of orientation
Quality of orientation and training
Management quality
Facility physical quality
Employee attitude towards travelers
Employee helpfulness
Fairness of floating or assignment workload
Policies
Ease of doing the job efficiently; computers vs paper charting

Novant Healthcare in North Carolina rates a B-.  Orientation was thorough. It's a massive hospital with 950 beds, so it took about 2 shifts just to learn the way from the parking lot to the unit.  Patient charting was done by hand on a six page form - a challenge for any traveler. In 2014 they would begin to convert to EPIC.

Tarzana Medical Center in California. This facility rates a solid C.  No orientation was given as the floor was too busy and short-staffed to afford the time to orientate.  Floating travelers, low census, an unremodeled, small unit, and changed scheduling were common.  I did receive EPIC training while there as a conversion was underway.

Menomonee Falls in Wisconsin rates an A.  Training was excellent, unit was brand new and spacious, the staff was all around helpful, knowledgeable, nurses here were truly patient focused, and patient assignment fair.  They use EPIC.

Amazing Positive Experiences While Travel Nursing!

So far I have written several posts about what to avoid and how to position yourself with Travel Nursing contracts and housing covering the trials and tribulations about the challenges faced with Travel Nursing.  Today I am focusing on the light-hearted and positive experiences we've had that we would have missed out on had we not decided to hit the road as a Travel Nurse.  We have already created life-long memories from the rich experiences we've had!  We have some fun stories to tell as well!

One of the reasons my husband wanted to become a travel nurse, as with many Travel Nurses, is to see the country while getting paid for it.  During our quest, from the beginning, we decided to create a "road" bucket list of experiences we want while exploring this great country.  While we are only in our 10th month on the road, we are happy to report that we have already checked off a bunch of bucket list items and discovered  more that we didn't know we wanted to do!
  

Let's start with a big one!  We took an assignment in Los Angeles for the winter.  Because we were in LA and because we had more daytime to enjoy the city, I ended up on The Tonight Show with Jay Leno!  Yes, you heard right!  One average day we went wandering around Universal Studios with our annual passes.  As we stood to watch a kids show being filmed on the lot we were approached by a guy who was holding spokesperson auditions and asked me to "try out."  Now, I knew from how vague he was that it couldn't have been "real," but we were having a really fun day and opted in.  It turns out that the spokesperson role was being filmed for the Fake Spokesperson segment on The Tonight Show and my audition made the cut.  A couple of weeks after the shoot, our friends back home started flooding our facebook page with comments how they saw us!  It was hilarious!!  In addition to being ON the show, we were given tickets to watch a live taping of it at the studio. Oh, how we miss Jay Leno now that Jimmy Fallon took over! The entire experience was so much fun! 

Chance encounters with other famous faces happened a few times while in Los Angeles as filming is everywhere there, every day.  On a Friday afternoon we had a brief moment to meet and talk to Garth Brooks.  Though I am not a country music fan, after seeing him in person and listening to his interview I'm a fan! He is such a humble guy!

My husband had the opportunity to meet his favorite actors from his teenage years. We went to a book signing on Sunset Boulevard featuring a new book written about an old show.  During the book signing the Producer, Director, and two of the main characters all showed up!  What a cool, cool day for my husband! After the signing was finished, the actors mingled with the crowd. My husband had the opportunity to discuss the show personally with them for quite some time, one-on-one!  Great experiences --- and all because we were brave enough to hit the road and try Travel Nursing!

In his younger years my husband loved to play tennis. He always dreamed of getting to a pro tournament.  While on assignment in Winston-Salem, North Carolina we made that dream come true.  The Winston-Salem Open came to town and we were able to get tickets to see some of the sports top players compete! The husband was in heaven! It had been so rainy all week but on this evening of competition the climate was just right and no rain!  Bucket list item --- checked off and look how happy he is!  

• Other great experiences we checked off the list include; eating dim sum in an authentic Chinese restaurant. We did that in downtown Los Angeles in Chinatown.

• Putting out feet in the sand on Christmas Day. We went to a beach in Malibu to spend part of our Christmas -- sure beats the snow back in Wisconsin!!

• Roadtrip to explore San Diego. What a great city! We'd certainly look for assignments here in the future. There is so much to see and do!

• Palm Springs - a great, small city place to take in nature and relax on days off. We'll look for work here when we need to slow down a little.  This is the perfect place for it.

• Neither of us had ever been to Wilmington, NC or Charleston, SC before but wanted to go.  We were able to do that while on assignment in North Carolina.  Both are waterfront, historic cities that have a well-developed waterfront area offering great seafood dining options.  We had a blast!

• Outer Banks - we took another roadtrip specifically to enjoy the southern end of The Outer Banks. A really nice, beachside vibe!

• Toured the Biltmore Castle.  Upon arrival we were given a pair of specialty Servants Quarters Tour tickets - a group had a few no-shows and granted the spare tickets to us for free!  Ah-mazing castle!  I kept picturing that this must be the type of place the Downton Abbey crew worked in!

• Experienced the Smoky Mountains.

• Saw the Andy Griffith Museum and the city which inspired Mayberry.

• Wineries!  We love wineries and breweries so we tour them from coast to coast.

• Visited our first Presidential Library - The Reagan.  A traveling exhibit about Spies was an excellent bonus. We boarded Reagan's Air Force Once - it's cool to now say we were on Air Force One!

• We attended our very first Jazz festival and seeing Dave Koz give a live performance as well as Al Jarreau.  Loved it!

• Finding the world's best barbecue (in my humble opinion) in Wichita, Kansas.

• Photographing abandoned buildings, cities, gas stations, and signs along Route 66.

• We stood on the corner in Winslow, Arizona. What a fine sight to see!

• Met some really great people by starting a meetup group in one of our assignment cities - one of whom has become a very good friend.

• There has been so much more to blather on about already, but I'll leave it here as a "to be continued."  

• In summary, while Travel Nursing is hard work, as any nurse will tell you, it is very rewarding and exciting, too!  

We are hoping for the next assignments to be on the Eastern Seaboard to finish out the summer months, then hopefully, off to Honolulu for six months of warm weather bliss again!  We are loving the option to skip our horrible winters back in our tax home!

How to Negotiate A Travel Nurse Contract

 A Travel Nurse lives and dies by the contract negotiated.  It is so important to negotiate the best pay package that you can during for your assignment.  We have read a LOT of articles, blogs, and websites that talk about getting "everything" in writing in your contract but we have found very few specifics for what to ask for.  Since we are still in our first year of Travel Nursing, the lack of info was frustrating for us. 

Here are a few pointers we've learned to get written into the contract BEFORE we start an assignment.  Whatever it is you want or need, HOLD YOUR GROUND. If your recruiter can't or won't give you what you need, then pick another company. There are hundreds to choose from.

1) Plan your vacations and get those dates you want/need written into the contract.
2) Put language in writing that specifies no PBDS testing or Prophecy testing is required by either the Agency OR the Hospital, and if it IS required, that the contract will NOT be cancelled if you fail.  It is appalling that you move to a new location and commit to an apartment LEASE only to have a Performance Based Development System test sprung on you that hinges on whether or not you start working.  That is unacceptable.  You commit to a contract and so should they.
3) Instead of asking for completion bonuses or sign-on bonuses, negotiate a higher taxable hourly rate. This will be significant for take-home pay as nearly 40% of those bonuses go away to taxes withheld when the bonus pays out.  Additionally, completion bonuses can be affected by the facility when they low census (for which you have no control).  Some Agencies WILL penalize you even though it wasn't your fault you didn't get all the hours contracted for (see item #5 for guaranteed hours).
4) Insist that the clause for sick days be deleted or modified.  Some companies will garnish your pay (we've seen up to $19/hr!) if you call in sick!  At LEAST negotiate 2 days of sick time without a wage garnish.  
5) Get "guaranteed hours worked" in your contract.  This means that the facility guarantees you will be scheduled for AND WORK 36 hours after orientation is complete.  We moved across the country and were then repeatedly low censused.  It makes no sense to take an assignment and then be subject to low census repeatedly.  GET THE GUARANTEE.   The caveat to that, of course, is that you must then be prepared to float to other departments.  But work is work!
6) Get a Travel Reimbursement of $300 to $500.  Half pays out when you arrive at the assignment, the rest pays when you travel to either your tax home or next assignment.

7) Get hotel reimbursements in addition to the Travel Reimbursement.  We have gotten up to $200 for hotels to go to an assignment.

8) If a new license is required for a state you accept a contract in, get License Reimbursement written into the contract and get the dollar amount specified.

9) Any certifications required, you get a Certification Reimbursement. 

10) Any online training that is required prior to arriving for your first day of the assignment you get paid your base rate.  We have spent up to 10 HOURS of unpaid training for one hospital that we never received pay for!!!!  All of that was required before he started the job yet our Agency never disclosed it during contract negotiations and never compensated us.  This training was specific to the hospital about it's policies and procedures.

11) Get the highest taxable rate that makes sense for you.  Many agencies offer a low taxable rate ($10-$18/hr) and then make it up in a glamorous housing stipend.  The Agency is saving a boatload of money by doing this because they don't have to pay out employment taxes and the saved money goes into their own pocket.  Also, they are not paying into your social security account for your future, AND, if you plan to buy anything requiring a loan in the next 2 years, that housing stipend does not factor into your income so you will qualify for a smaller loan.  One more thing to note, the IRS is now getting more aggressive on auditing Agencies who circumvent taxes by paying inappropriately low rates to nurses. BEWARE!

12) Make sure your contract specifies the hours of your shift assignments.  We've seen assignments be for 12 hour night shifts but upon arrival they schedule nurses for days, pm's or eight hour shifts.  That's a no-no!

13) Get your hourly and overtime rates specified.  In California, for example, blended rates are usually quoted by your Agency.  You must be able to see the specific hourly base rate and the specific OT rate so that you can determine if working an extra shift is worth it.  Blended rates hide what you will actually earn.

14) Get a minimum eight hours of in-unit orientation time written into the contract.  We have arrived at assignments where orientation was intended but never happened. Zero!  The unit had a couple of nurses call in sick so we never were even given a tour around the unit, just thrown into the fire on the very first night.  

15) If you take the company housing, specify all the things you require in your apartment, such as  a TV, non-smoking, proximity to the facility, pets allowed, etc.

16) Assignment Extensions:   Nurses who accept a contract extension need a paid visit to their tax home.  Get the length of visit and the cost reimbursements written into the contract.  Agencies typically offer $400-$500 for this, but often Nurses must ASK for it - it is not typically offered without asking for it.

17) A contract extension is really more accurately described as a new contract. Negotiate higher pay for the extension.  The Agency doesn't spend money recruiting or getting a new nurse licensed/certified again, and the hospital isn't paying for more orientation.  Many Agencies will offer completion bonuses to entice you but negotiate higher pay instead.

18) Finally, if a specific uniform is required by the hospital that you must go buy, get that reimbursement written into the contract.  Though Uniforms are tax deductible, I would rather get the reimbursement from the Agency than wait to claim it on my taxes.

These are all things we learned the hard way as we didn't find any specific guides written anywhere as to what to ask for!  

I hope these help you as you negotiate the best deal possible for yourself.  If there is something else that you ask for that isn't listed here, please comment or email me as we'd love to know and share with others!

Frequently Asked Questions of a Travel Nurse

It has now been over nine months since we embarked on this journey of travel nursing. We are finishing a contract and an extension in Southern California and soon headed back to our tax home for the next contract.

We have learned so much that we figured out the hard way. No matter how much reading we did we did not discover details until they blindsided us.  I will answer some of these questions for you know and share our thoughts.  Keep in mind, our experiences, of course, are our own and we can't speak for every travel nurse. We just want to describe our real life challenges as a husband/wife team as travel nurses living and learning in our first year around the country.

Will I get orientation for each new hospital I contract with?  
While this sounds like an obvious answer, the answer is NO.  Although hospitals you contract with WANT to give you 8-12 hours of orientation on your first day on the floor, keep in mind that most hospitals who hire travelers are in somewhat of a state of distress. That is why they are hiring a traveler in the first place.  My husband's first day was to include an orientation, however, 2 union nurses called in sick his first day so he was thrown into the workload with 2 critical care patients WITHOUT ANY orientation whatsoever.  No walkthrough where to locate equipment, no direction as to what policies and procedure are or where to locate them, no computer sign-on, not even a finger-point to where the restroom was located... nothing!  He was NEVER given the orientation, not even after months ticked by.

Long story short, get it written into your contract that an 8 hour orientation on the floor, in the unit, will be given on the first day.  If you don't have this in writing, you are setting yourself up for policy infractions and documentation problems when charting.

Los Angeles sounds fun.  Should I take a contract there? 
Unless you plan to stay for 6 months or more, skip Los Angeles for your job opportunity. Housing is not only highly overinflated, but also not offered for short term stays.  Communes are common with everyone paying a fortune, no privacy, and lots of mental health and/or employment issues is what we found.

We took the housing stipend and finding housing in Los Angeles, a very transient town by nature, was nearly IMPOSSIBLE to find housing.  No month-to-month leases or 3 month leases are either 1) offered or 2) if they are, they are not affordable.  That leaves nurses to craigslist.  Nutjobs and depressed or drug-dependent people are offering to gouge you on craigslist. Those are your options.  Extended Stay hotels are $89.99/night, even for 30-days or more. Who can afford $2500 a month or more when housing stipends range from $1700 to $2000 per month?  An Extended Stay rep was even present at the 2013 Travel Nurse Conference held in Las Vegas and admitted that he had not realized that nurses aren't before the conference! Still, nothing has changed and Extended Stay Hotels are simply not an option for long-term contract stays.

The other option is to take the Agency Housing. Other travelers we work with have done so.  The result.... long commutes to work and living with unsavory characters hovering in an extremely overpriced apartment in some cases.  The San Fernando Valley is mostly like a ghetto if you are East of the Hwy 101.  Densely populated with low-income earners, garbage overflowing everywhere, sirens, and plenty of domestic violence can be heard.  Now... the City of Los Angeles actually seems to be better.  The Valley stinks... literally.

There are several other routes for finding your own housing, but each attempt has been met with equal shock and disappointment.  Airbnb we found a place for $54/night that required no security deposit in Woodland Hills. It was a mid-century modern, 3 bedroom home... it looked like a nice, quiet neighborhood.  While we stayed there we learned that the owner rented out her "room" and back yard/pool for live porn film shootings while we were renting. She hid 2 extra roommates, 3 extra cats and a dog from us when we showed up to inspect the place.  Moral of the story... the people on craigslist are preying on Travel Nurses. STAY away.

My pay-package has a low taxable rate and makes up for it with housing stipend and M&I.  Is this legal?
With the economic downturn of 2010, Agencies realized profit losses as the medical/travel nursing work dried up.  Agencies now in are restructuring paypackages for travel nurses with such low taxable rates and paying the rest as housing stipends, which are untaxed. We confirmed this by finding and reading the Corporate Report for one of the industries leaders. Right there in black and white we read how the company is getting more profitable on the backs of the 26,000+ nurses this one company employs.  They specifically list in their own corporate reports to investors that this is solely to lessen the tax burden of the Agency.  The IRS has now caught on to this throughout the industry and have amped up the auditing of the Agencies AND of the employees who work for those Agencies.  It is NOT ok to take ultra-low table income and make up the difference with the stipend. Here are some reasons why.


1) No one wants the IRS auditing them and charging back taxes plus penalties for income that was evading taxes.  This is happening every day!

2) Someday you will want to buy a new car, a home, or some other type of large purchase that you will need a loan for.  Only TAXABLE income qualifies for your loan consideration.  The look-back period of time for a mortgage is 2 years or more, so if you are working for $18/hr taxable now, then in 2 years from now you will only qualify for a small loan instead of reflecting your "real" cashflow income.

3) The less tax you (and your employer) pay, the less money you are contributing to your Social Security Fund.  It is in your best interest to pay your fair share of taxes so that later in life you aren't caught with an under-funded lifetime earning shortage.

4) There are many travel companies out there. The big companies have stock-holders and they are those who first took advantage of this creative paypackage and are the first to get audited.  There are reputable companies out there who are not skirting the law. Choose those when looking who to bet your working future on.

If we forward our mail through the post office will we be covered for the duration of our contract?
Simply put, NO. 
Forwarding through the USPS is 
1) slow.  You will see a 10 day or more delay with receiving your mail.  
2) If you have different last names you must complete multiple change of addresses including a new one for each name.  
3) You can not edit the change of address to be shorter, only longer.   
4) Not all mail transfers.  Our bank checks, our driver's license, car title, and license plate renewals all had a "do not forward" on them and were returned (without telling us) to the DMV and bank.  It was murder getting them to be send to us at our temporary, out-of-state address. The bank checks never did reach us. We had to go to a branch office to get counter checks (for a fee).
5) Most but not all magazines will not forward to new address.
6) In order to transfer from your temporary address BACK to your permanent address, there is a 10 day lag-time for the "verification" to go through at the post office PLUS another 10 days for the mail to forward. This is the post office's way of trying to insure that the credit card used with the permanent address is valid.  

Your best bet for mail during your traveling is: 1) Paperless billing and 2) Forward all mail to a reliable source such as a family member or friend who will mail a pre-paid shipment to you once a week.  This is about the only way to get around the gruesome inconveniences we have found.

What cellphone service is most reliable for someone traveling in the United States?
We found that AT&T was HORRIBLE nearly everywhere we went. Wisconsin, Kansas, Missouri, California, North Carolina, South Caroline, Ohio, Tennessee, Illinois, Texas, Arizona, and everywhere in between, it was terrible coverage.  US Cellular (a midwest predominantly) was best for upper mid-west, but Verizon appears to be winning the National Map for best coverage, least dropped calls, and by far the best data coverage.

Will I work holidays and weekends?
Probably.  Even if it is in a hospital's policy to schedule nurses for every OTHER weekend and every OTHER holiday, often they schedule travelers for each and every weekend and every holiday or holiday-eve.  

If you want or need specific days/holidays/weekends off, specify it in your contract in writing.  While you may get part of a weekend off, the only way to insure it is to ask for it in advance of starting your contract.  In the three contracts my husband has worked so far, the first he was scheduled every-other weekend and the 1 one holiday.  In the second contract (and extension) he worked part of nearly every weekend and he was scheduled to work every holiday day or holiday weekend.

I'm moving my family across the country.  Will I get low censused?  
Low census is very possible irregardless how far you came for the assignment.  While it is true that travelers are brought on because a hospital is short staffed and busy, it is also like any other hospital with natural lull-times in census.  If beds are not filled, then someone goes home.  That's it.  According to each contract we've seen, Agencies agree to allow this.  You will not be compensated if you are low censused.  

In most hospitals they are busy enough over the duration of your contract that you may request additional an additional shift(s) to make up for the lost hours.  It is in your interest to complete the agree hours of your contract, particularly if you have a written completion bonus at the end of your contract.

We recommend getting guaranteed hours written into your contract to avoid missing out on paychecks after you move.


If I extend a contract can I request to go home to visit in between?
Yes. In fact, most agencies provide travel pay specifically for that. Travel pay is only for the travel nurse to go back to the tax-home location though, not any other vacation location.

There are more questions and circumstances that popped up that I will explore here... I will continue this session when I think of the impromptu circumstances that cropped up over the months that weren't covered anywhere else that I read about.

If I travel alone will I meet a lot of other travelers to hang out with?
Some hospitals hire many travelers and others only have you.  If you are a solo female traveler in her 20's, then likely you will make some friends at your hospital.  If you are an older traveler then expect that others in your age group prefer to be left alone and do their own thing.

We have met other travelers and found that our invitations to meet out for a beer, dinner, or a sightseeing expedition are always politely declined. There was a single 20-something female traveler who lived in the same complex who worked the same schedule as my husband and she was not at all interested in spending time with us, even by the pool!  I have concluded that travelers seem to fit into 2 categories; partiers and loners.  We are in the middle and, therefore, appear to be alone there!

The bottom line, being a travel nurse can be lonely so before you embark, be sure you are comfortable sightseeing and dining on your own as you may or may not meet people in the location you are assigned.

Will getting what I want into my contract guarantee that it is honored? 
No.  You must scrutinze your contract before you sign it to insure that what you THINK is in it is actually there.  Secondly, your hospital may overlook the details. For example, if you have a provision for a certain day off, your hospital might schedule you anyway. Be sure to bring it to their attention as soon as your schedule comes out.

Just because you discuss it with your recruiter does not mean it is certainly in the contract. A contract is a stock document that is modified for each assignment. Make sure your requests are in it.


If I take the housing stipend, how can I find out what apartment the Agency uses for housing?  
Ask your recruiter!  Agencies do not mind sharing the information. They prefer for travelers to arrange housing for themselves as the lease and associated expenses (ie. risk) is then on the traveler. Agencies are happy to share the info they have on housing.

What if I fail a Performance Based Developmental System (PBDS) Test that the employer requires?
Avoid these contracts and confirm with your recruiter that this test is not a condition or requirement of employment BEFORE you verbally agree to a contract.  I am of the opinion that nurses are licensed for a reason.  In order to get licensed a nurse must pass a rigorous state test.  Those credentials are in place for a reason.  I feel it is excessive for a hospital to then demand an additional test on the spot, and well after a contract has already been signed and a traveler has spent time and money to get to the location.


If a traveler agrees to one of these tests and moves, then fails a test... tough luck! You are on your own!  If you opted for company housing then YOU must pay your agency back. If you opted for the stipend AND signed a lease, YOU are on the hook for the full financial term of the apartment lease and your agency will NOT typically stand behind you.  


If nurses stick together and demand of their agencies to disallow performance based testing for contracts, then hospitals will be forced to acknowledge and recognize a nurses license as all that is needed to perform the job professionally.