Contract assignment“The manager stated that I would have up to 5 patients on the floor, but every night I find myself taking up to 7.  Yesterday they floated me to the post parteum floor and I had six couplets.  I feel like my license is in danger.”

If you have been a travel nurse for any length of time, the chances of hearing similar words are highly likely.  Unfortunately, it is a fact that hospitals too often float nurses to areas which they aren’t competent to work in or keep on admitting patients no matter how many a nurse already has.  This has been going on for years and chances are, this behavior will last for years.  The only sure fire way to get away from being overloaded with patients is to work in California, but still in California you can be floated to an area which you are not competent to work in.  What is a travel nurse suppose to do to protect herself?

  1.  Always discuss patient ratio’s in your interview with the manager.  How many patients do you truly think that you can handle?  California’s ratios are great, but I found that not too many managers will accept those stipulations.  I have always had better success adding one more.  So for telemetry at night, an acceptable nurse to patient ratio would be no more than 5 patients, step-down would be no more than 4 at night, and ICU really needs to stay at only 2 patients at night. 
  2. Always discuss with the manager where you will be expected to float to.  Several hospital systems hire ICU nurses and then place them all over the hospital, while at a larger hospital system, you will only float in the different ICUs (MICU, SICU, CVICU).  As a telemetry nurse, where are you able to float?  Unless you have OB/PP/LDRP experience, I would suggest NOT floating to those area’s.  OR is another area that you really can’t adapt to with a short orientation.
  3. Talk to your recruiter after your interview and inform him/her what you discussed with the manager.  Also inform the recruiter that you feel very unsafe floating to OB and OR (whatever suits you personally) and that you would like a paragraph in your contract that states that you will NOT be required to float to those floors.  This paragraph should read something like, “Working conditions are to include floating only to area’s of competence.  The hospital agrees to NOT float this traveler to OB, OR, and the ER (or to float to only, whichever is shorter) to take patients.”
  4. Talk to your recruiter also about any stipulations that regarding the number of patient’s that you will accept at a time.  Again, add a paragraph that states, “Working conditions include:  taking care of no more than six patients on a medical floor.” 
  5. You also need to realize at this time, that there is not only a contract between you and the agency, but the agency has a contract with the hospital.  It will be the responsibility of the recruiter to get these conditions of employment confirmed with the hospital.  These things must be added to confirmation that the agency sends to the facility.  According to Crystal Lovato, a senior recruiter at Expedient Medstaff, “A company can only promise and put into writing what the hospital will put into writing on a confirmation. Though some managers will include a patient ratio on the confirmation most unfortunately will not.”
  6. You must realize the agency side of these stipulations.  Again, Crystal informs us, “The issue that can and likely will come up is that many managers will not put ratios into writing nor are they even permitted to because this is not something they can have complete control of at all times….  To note, it is the hospital/manager that would need to give this guarantee in writing, not the agency. If given by the manager/hospital then the agency can and will be happy to add it to the nurse contract. However, we absolutely cannot nor ever should promise and guarantee something in writing that the hospital has not given us. By insisting that it be in writing, the traveler is then limiting themselves to the very few hospitals/managers that will put this into writing. The traveler will very likely find themselves going extended periods of time without a contract while seeking an offer from a facility/manager that will offer this. To note, anyone who wishes this info to be put into a contract should advise their recruiter/agency before submitting. The recruiter/agency would then be able to work with the traveler in focusing on the hospitals/managers that they feel would be more likely to give such a guarantee….”

If your current agency won’t even entertain the idea of putting these protections in your contract, then you can find another agency that will add these stipulations.  Also keep in mind that the travel company can not “make” a hospital/manager put what they said in the interview in writing.  This doesn’t mean the agency is bad or uncooperative, it just means that for some reason, they can not confirm this in the hospital confirmation.