The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has recently set new standards for healthcare staffing agencies. The new certification process will mean big changes in the travel nursing field. What does this means for staffing companies? New standards have been placed on the travel staffing companies and on travel nurses.

The staffing companies will have to clearly define the company leadership hierarchy. Administrator and director of nursing services will be first and foremost on the top of the list with the travel nurses at the bottom of the list. Also in the mix will be the accountant, pay roll supervisor, information systems technician, human resources, and a housing supervisor.

This budget will include costs of certifications, cost of management, cost of the nurses, costs of the benefits, and how that amount compares with the accounts receivable through the hospital bill rate. With the implementation of JCAHO certifications, the cost of owning a travel nursing or staffing company just sky rocketed. Most certainly not all staffing companies will be able to survive all these costs; therefore, companies either will have to do more subcontracting through companies which can afford the JCAHO certification or the smaller companies will have to fold.

According to the travel nurses that I have talked to, the majority believe that this will lead to Cross Country Trav Corp, Intelistaf, and AMN becoming the Walmart, Kmart, and Target of travel companies with the smaller companies like Midwest Staffing, Nursing Options, and Big Sky Nursing fighting to keep alive.

Nurses know that they get better service with the smaller companies, but we also know that jobs with these smaller companies are few. A code of ethics? As a nurse, I expect companies to treat me like a name, and not a number.

JCAHO standards also involve continuing education. Continuing education as well as experiences is what makes a good nurse even better. A nurses skills must be kept up to date and new education opportunities taken advantage of in the area of expertise.

When these quality measures become issues, then a staffing company must have an organized approach to improve the nurses’ performance. If required verbal warnings, written warnings, and termination may be inevitable if these opportunities are not taken advantage of. When I asked Reginald Helms of All Health Staffing ( about the quality assurance, he stated, “Frankly, I think that the issue is not with the agency, but with accountability from the hospitals ensuring that any nurse sent by the agency is as stated on paper. In my opinion, agencies as a whole do a pretty good job of getting qualified nurses. If there is a conflict between what is stated on paper and what the nurse’s performance is, the hospital has the responsibility to report it to the staffing agency.”

Another issue addressed by JCAHO is addressing conflicts of interest including contract discrepancies, making your travel assignment your permanent assignment, and other conflicts between the hospital and the nurse. (Nurses, this is why we MUST read our contracts word for word). Conflicts can also occur when a nurse wants to continue on as a permanent staffing member instead of travel. When there are problems with the nurse’s performance, the hospital has a right to terminate that contract, but there is usually a conflict between how much the employee is penalized monetarily for housing and travel. The problems that do occur must be promptly solved. The longer the problems linger, the greater the problem becomes.

The next big issue is that of quality nursing care. Quality must be assured by skills checklists, orientation skills checked off, and standard safety skills. Safety issues are addressed initially with the use of skills checklists, which are completed by the nurse upon application for the position. If a hospital reports that clinically a nurse is not able to perform as stated, then it is the agencies job to work with the nurse to either find different placement or help the nurse to obtain the credentials.

One of the biggest safety issues that are a prominent concern is nurse to patient ratios. It is the travel nurse’s responsibility to assure they are not being put into an unsafe situation, during the interview with the hospital. It is the staffing agencies responsibility to stand behind the nurse with these staffing issues. If the nurse to patient ratio is not as stated in the interview, then the staffing company and nurse need to do some conflict resolvement with the hospitals management team.

Evaluations from supervisors are also an important tool in safety and quality of care. These evaluations are used to determine if the job is really going as well as the travel nurse states it is, or as bad as the nurse states that it is. JCAHO standards also involve continuing education. Continuing education as well as experiences is what makes a good nurse even better. The records of each nurse must be safeguarded. The information must be available to the nurse if needed for other staffing opportunities.

Profiles only need to be submitted on approval of the nurse. What is the future of travel nursing? Staffing agencies will have to be JCAHO certified to place nurses in JCAHO certified hospitals. The cost of this certification will not increase the bill rate to the hospital, yet it will be taken out the nurses pay rate and benefits. Over all travel nurses are quality nurses who have great expectations placed on them. I believe that these regulations were created to assure quality of care that is provided to the hospitals which use travel nurses.

To check out the staffing agencies that are currently certified, please check out the JCAHO website at:

Written by Epstein LaRue, RN, BS, author of “Highway Hypodermics: Your Road Map To Travel Nursing”, “Love At First Type”, and “Crazy Thoughts of Passion.”