Welcome to all Nurse Travelers

 
 
I have been an RN Traveler for over 6 years and in fact I still am.  I also have worked for a short time for Pulse Healthcare staffing as an Independent recruiter as well as for Health One Staffing, However those recruiting relationships have ended.. I do however have a fairly good knowledge of a large group of the travel companies both from my own contacts with them as well as documented issues others have had over time. I am happy to share that knowledge with you and hope that it benefits you.
  
Lets start with some honest upfront facts and a market appraisal. All the travel companies charge about the same amount to a hospital to provide travelers to them. There are of course regional differences in what the market is willing to pay. Even within a region there are wide variances in what their billing rates are. In Los Angeles for example the rates vary from $50/hr to 68/hr, Naturally you will not get the same rate offered to you for both the high and low ends of that scale. California in fact has rates up to about $75/hr with the highest in Sacramento and San Francisco and not far behind is Bakersfield in the high $60's/hr. In some other parts of the country rates go down as low as $42/hr. Some groups of hospitals are much lower than others i.e. Tenant, HCA and Kaiser. Some state hospital associations have started offering travel companies the ability to bid on the entire states business, Arizona being one of them. Travel nursing is NOT in a slump. There are literally hundreds of assignments available at all times. Many of the same assignments are available at lots of agencies, only a few hospitals have a single vendor for their traveler needs. HCA being one with All about Staffing, Kaiser another with Nursefinders, although this is not total exclusive as the HCA one is, there are other smaller regional hospital groups that have reduced traveler costs by doing this too. Many other agencies will recruit for these hospitals by subcontracting with those travel companies with the exclusive contract. Guess what that's two companies making money off of you! Much better to cut out the middle man.

Benefits are never free, no matter what you are told. Health Insurance costs from $150 per month and upwards depending on what state your working in, as well as your age and whether you smoke. Of course that's just for you, dependants are always at the nurses expense. Mine cost well over $400 in the San Francisco area and that was a preferred HMO with Dental, Vision and Chiropractic coverage and I was 53 at the time. Usually this cost is buried, but be well assured you have paid for it.

Housing: The costs for this obviously differ depending what part of the country you are in, along with, Is it corporate or just furnished? Were you provided with utilities? did that include a local telephone and your basic cable? these costs once again are passed onto you. I will totally agree that its nice not to have to worry about deposits and finding a short term lease etc, but don't ever think you didn't pay for the service. Stipends are nice, but are they worth what the housing costs would be. I rarely see a company offer a stipend that would cover what they would pay for a corporate apartment. Travel money again not free comes from your salary. Rental cars, Airfares ..... same thing. 

Everything is based on the hours you will work on a contract! 13 weeks of three 12 hour shifts is 468 hours. Therefore Health Insurance costs about $1 - $3/hr. A rental car about $4-5/hr for a basic car, Your housing about $10-14/hr, travel reimbursement at 300 each way is $1.28/hr, Flights to and from an assignment are calculated the same way as are any other benefits.
 
Travel companies are mandated by their clients the Hospitals to carry Workers Compensation and Malpractice on their employees, they also are legally responsible to pay the employer portions of your taxes. These burdens, as they are known, come from that hourly rate they charge a hospital. Of course they then have their own overheads, Office space, computers, Long distance telephone calls, employees  to be paid, taxes etc, Naturally this too comes in part from the hourly rates they charge. What is left over after all of this.... Your hourly rate and benefits and the companies (profit) gross margin, which varies from company to company. It can be as low as 8% and as high as 22%. Rollovers from other companies (staying at the same hospital but working for a new agency) and contract extensions will sometimes be a cause to reduce margins, which could mean more money in your pocket. Ask for a payraise for a renewal of contract. $1 or 2/hr is a reasonable thing to ask for!
 
Tax advantage programs: What are they?
 

The federal government will allow a businessman that travels, and that includes you, to deduct from his taxes for the costs of working away from home. Now right there is a very important point. You must have a home somewhere that you are supporting that is not within reasonable travel distance to your place of work, I have seen 50-75-100 miles mentioned in a variety of places. One tax accountant has told me that it must be a different metropolitan area to qualify. The reality is do u have a home somewhere that you are not living in while you are working elsewhere. Many report their mothers homes, or their children's homes, others their own homes. As long as you have an address somewhere else that seems to be all that is needed for most of the travel companies. But for the IRS you must maintain a home, keep your drivers license and car licensed there, be registered to vote there and maintain bank accounts and community relationships.

You are entitled to claim for a Maximum lodging amount if you are not being provided with an apartment. You are also entitled to a Meals and Incidentals allowance for each day you are away from your tax home even if you cannot get the lodging allowance.  However be aware many companies do not offer these per diems, or only offer a small portion of what you are entitled to.

These allowance amounts can be seen on: This federal government website and they vary by state and town, just pick the one for the area you are taking an assignment at. Be aware if you are audited by the IRS you may end up paying taxes on these amounts if you cannot prove you paid rent or a mortgage at that address listed as permanent home you gave the agency and if you can prove you gave someone rent they must be declaring it as income.

Why do the travel companies want you to take the tax advantage program: Simply put, It reduces their burdens. They pay employer taxes on the amount they pay you per hour including FICA, Workers Comp, Social Security Taxes, Unemployment etc, So if you are getting $xxx/week in M&IE tax free then that has reduced the hourly rate you are given. Same thing if they roll in your housing allowance. The downfalls to this are many. If you are injured at work then the workers comp is based on the taxable hourly rate you are getting. Retirement benefits are also based on your payments. If you want to work overtime you are paid at the lower hourly rate x 1.5 not the true rate. To give a simple example. A nurse might be entitled to a $35/hr salary in Bakersfield, but is offered a MI&E of $43/day x 7 days which is $301/week or $8.36/hr tax free to make the same gross margins the original $35 is reduced to about $25/hr, you the nurse will still be getting about the same net take home pay or maybe a little more but the company has just saved the taxes they have to pay on $10/hr. Plus now when you work OT you will get 37.50/hr instead of 42.50/hr, so now the company makes an extra $5/hr on your OT hours, from your pocket. Some companies will offer up to $1358 a week in tax free money and pay an hourly salary as low as $8-12/hr this would equal about $47-51/hr to work in San Francisco, of course to get this kind of tax free allowance you have to find your own apartment or lodgings.

My recommendation: take the full hourly rate, you are still entitled to the tax free amounts, just let your accountant do the work, after all you're paying him at the end of each year to get you as big a refund as he can. At the same time, the IRS is well aware that nursing pays more than $20 - 30 per hour. If you work for an entire year being paid like this, then they are far more likely to audit you. If a company insists on paying you high per-diems tell them your a resident in the area and therefore not entitled to the tax free money so make a deal that does not include them, or find anoher agency that will give you what you need and want.

Be aware that completing 3 (13 week assignments) assignments at the same facility, or renewing an assignment twice is ok, but the moment you accept the 4th assignment, you become resident in the area and therefore not entitled to tax free benefits, including the apartment you have been provided with at no cost to you. The apartment becomes a taxable benefit and you must pay taxes on the value of the monthly rental, furniture costs and utiities. It is good practice to do no more than 2 - 3 assignments in the same general area. It is usually not acceptable to take assignments just in different parts of the same city, unless its a huge one and travelling from your current apartment location would take 2 hours or more to get to the assignment location. It doesn't matter if you move to be nearer the assignment. The basis that IRS works on is, if you can go home after work then you are not entitled to the per diems. A 12 hour shift and 3-4 hours driving to and from the assignment would generally entitle you to them. Therefore make sure your next assignment is at least that far a drive from your new one.

To maintain your tax home you must visit and work there during each year, or at least be able to show that you applied for positions during the time you were there. You do not have to work in nursing during this time, you might for example be helping your uncle in his business for a month or two. Staying on assignment in Los Angeles (for example) for 2 years even if you worked in two or three hospitals in this time and collecting tax free per diems or getting a free apartment can put you in severe debt to the IRS. Anyone calling IRS to whistle blow on you can collect 50% of your unpaid taxes. Therefore be warned, talk to a qualified Travel Tax consultant, get good advice thruout the year. Maybe even share a copy of your contracts with them for advice before signing them!

Keep records of your mileage. Keep all receipts for travel, cellphones, Long distance calls, rental costs, parking costs, hotels, truck or uhaul expenses, Licenses, Credentialing, drug testing, back ground checks, Union or association dues, Publications and Journals, Malpractice insurance, Liability Insurance, Resume expenses, Copying expenses, Courier costs, fax costs, postage related to work issues, Uniforms, Shoes, Stethascopes, any other work related equipment, Dry cleaning and Alterations, Continuing Education, Seminars, Reference and text books, Epocrates, other medical software needed for work, any healthcare receipts including doctors and Dentist fees, prescriptions, Health Insurance premiums, hospital and clinic fees, eyeglasses & contacts. This list is not fully inclusive if you get a receipt for anything, save it, you never know if its deductible.

I believe the nursetraveler.org website has proved my commitment to the travel nurse industry in the past and will continue to do so. You can visit all the companies on the Travel Nurse companies page with well over 200 companies currently listed there. I try to check each company website monthly to make sure the links work, and that the company is still in business! Things change in this industry all the time. Companies are bought and folded into others, Others disappear and yet others are newly formed all the time. If you are aware of any company not listed on the travel company page please email me their information. Only companies with a WEB presence are included, almost all have this, the few that do not are not included for the simple reason that I have no where to link to! I have not in the past felt it appropriate to have just a telephone number listing. I continue to feel this way! 

Lastly make use of the delphi forums shown on the nursing links page. They can invaluable to you, save you all kinds of hassles, forewarn you of bad companies and hospitals or areas and just generally put you in touch with a huge group of current and past travelers who often will respond to enquires. 

Best wishes and lets talk soon. Please let the companies know you found them thru NurseTraveler.org or if you are asked who referred you, feel free to give my name. By all means email me at anytime. I respond to all of the emails I get each day. I am happy to refer you to well known recruiters and companies that will take your enquiries seriously and attempt to get for you the very best deals they can and in the area you want to travel to. I have created a database of which companies offer assignments in which states. The types ofbenefits they offer etc. Its not 100% subscribed to in any way by the travel companies since many have never responded to my emails asking for this information. I have worked with many nurses by email and telephone trying to get them to the best recruiters and companies and most of whom are still working for the companies I referred them to.
 
Peter Mentz, R.N.
Travel Nurse.