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Travel Nursing

What you need to know before packing your bag

Day in, day out, you go to the same place, see the same people, and do the same old job. If variety is the spice of life, most of us would be tasteless. Who doesn't sometimes wish they were "jetting off" to unknown lands, to meet new people and have new adventures?

Such is the appeal of the travel nursing (TN) industry. Visit any TN web site and you'll see photos of amazing lakes nestled below mountains, or cityscapes with fantastic architecture. "I worked at the National Heart Hospital in London for about a year," noted Faith Gouge, MSN, CPNP, CRNA, a former travel nurse who now works as a nurse anesthetist at Anesthesia Services, P.A., in New Castle, Del. "That was a rare assignment. Not many people get to live in another country just for the experience."

During her 13 years as a travel nurse, Epstein LaRue, RN, author of the book, Highway Hypodermics: Travel Nursing 2015, has worked in Arizona, California, Oklahoma, Mississippi, Iowa, Florida, Tennessee, Washington, Oregon, South Carolina, and Texas. Currently, she's traveling all over California as a house supervisor and assistant clinical manager for Kaiser Permanente. "I love that I can go to Disneyland, play golf in Palm Springs, go wine tasting or hang out at the beach all day."

Others attest it isn't where they're working, it's what they're doing that keeps them interested. "To be on staff at a hospital would seem stagnant to me," remarked Bridget Irving, MSN, RN, who, as a travel nurse with White Glove Placement Inc. in Brooklyn, N.Y., has recently worked at two different level I trauma teaching hospitals. "There's such a wide range of options in nursing. New specialties equal new challenges, which motivate you to learn more and stay on top of your game. TN has definitely made me more marketable in this field."

Add to this the general "buzz" that travel nurses are raking in money --- some claim to make between $90 to $150 an hour --- and even the least adventurous person will start packing a bag. But is there any truth to the claims that TN pays way better than a steady nursing job? Is TN currently on an upswing? What do you need to know before you start filling your suitcase?

A Sizzling Hot Market
"A recent report in U.S. News & World Reports called this 'the hottest market for travel nursing in 20 years,' " said Kyle Schmidt, author of the book, The Truth About Travel Nursing. Schmidt has also worked as a healthcare recruitment manager. "The demand for travel nurses has been growing since 2012, and hit its current peak in the middle of 2014."

What is fueling demand? Since 2010, as many as 16.4 million previously uninsured people have gained coverage under the Affordable Care Act. In addition, employment is up, so more people are taking advantage of their new benefits.

Bringing Home Better Bacon?
In this type of "hot" market, travel nurses can indeed earn more than nurses who hold down a regular job --- especially those who work in the OR, ED, ICU, PICU, NICU, labor and delivery, or telemetry. Consider this quote, taken off a TN site: "Factor in the top salaries, 401(k), insurance, bonuses, free housing, travel allowance, free continuing education units (CEUs) --- and travel RNs can make up to $100,000 annually."

But Schmidt cautioned this statement is both specious and ambiguous. The amount each traveler stands to make depends on a litany of factors.

"Including benefits like 401(k) and health insurance ... makes TN packages appear higher-paying relative to pay packages for permanent positions," Schmidt remarked. "When a full-time, permanent employee says, 'I make $60,000 a year,' he probably has a health insurance package, but he's not including it in his statement. If he did, he'd say 'My entire compensation package is worth $75,000, and my take-home pay is $60,000.'"

Complex Pay Structures
But what about free housing? Isn't rent everybody's largest bill? While it's true TN companies offer all kinds of tax-free reimbursements, in order to qualify for them, individuals must maintain a "tax home." Annually, travel nurses need to meet two out of the following three requirements of the IRS' three-factor threshold test:

1. pay duplicate expenses at your tax home (rent and associated utility bills);

2. maintain all of your personal business in your tax home state (receiving mail, registering your car, having a bank account, buying car insurance, etc.); and

3. perform a portion of your business within the vicinity of the declared tax home and use the declared tax home for lodging purposes while performing business there.

"Nurses typically do either do 1 & 2, or 2 & 3," Schmidt informed. "If it's the latter, you better be sure you can guarantee a lot of hours for yourself back home, as this scenario requires the individual to work more hours at home than they do in any one travel location. It's difficult to manage. Clearly, 'free housing' does come at a price."

Looking at Benefits
There are other factors to consider, as well. TN contracts rarely offer employees paid vacation or sick time. Most TN agencies offer 401(k) plans, but there is a good chance you won't be keeping any of the agency's "match" money --- in most cases, you're only fully vested after one year on the job. Most TN agencies do pay for travel expenses, but it's a set amount, determined up front (say, $700). The first half is reimbursed on the first paycheck; the last half, on the last paycheck. Can you really drive from Maine to Oregon for $350, or will you spend more? Often, nurses rack up substantial out-of-pocket expenses just getting to work.

TN packages also include a relatively low taxable hourly rate (with tax-free reimbursements balancing out the package). You might have a pay package worth $50 per hour, but only $20/hour is taxable --- therefore, the amount of money getting diverted to your social security, unemployment, worker's compensation, and disability benefits is much lower than that of a full-time employee.

SEE ALSO: Studies Show Positives of Travel Nursing

Contract Cancellation
Contract cancellation is another problem faced by travel nurses. "If a hospital decides the travel nurse isn't a good fit, she's gone," LaRue commented. "Likewise, if one piece of paperwork isn't completed correctly, they'll push your start date back two weeks. So you're in a strange city but your job hasn't begun --- that's personally expensive."

Schmidt has heard worse. "I know nurses who have signed contracts and spent a week driving to a destination only to be told when they arrive, 'You're no longer needed; we cancelled your contract,'" Schmidt reported. "You just added two weeks or more of 'down time' to your work year. There is no safety net in these situations."

A Unique Experience
Despite these cautions, suppose you're still longing for the excitement of TN. What type of person does best as a travel nurse? "Adaptability and flexibility are crucial. You have to be able to function without a lot of support," LaRue noted. "You also need to be able to protest if a hospital is trying to place you in a department where you don't feel competent."

"It can be tough always being the new person on the block," Gouge commented. "Every place does things differently. You are always trying to prove yourself."

Despite the drawbacks, most travel nurses wouldn't have it any other way. "It's such a joy when it all works out," Irving remarked. "It's interesting to experience different work environments and diverse practices. I love that I've made so many new friends --- far more than I would have if I stayed at one job."

Anne Collins is on staff at ADVANCE. Contact: acollins@advanceweb.com


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