Travel Nursing Tips: Agencies, Recruiters and Pay Packages Explained

Agencies & Recruiters: How it works

Healthcare facilities nationwide are short-staffed. One effort to reduce un-safe staffing is to fill employment needs with temporary contract workers–travel nurses. Facilities post their employment needs and staffing agencies fill those needs with healthcare providers with the appropriate degree, licensing, training, experience and skill level. Healthcare facilities will pay the agency an hourly rate for the nurse and then the agency will pay the travel nurse an hourly taxable rate and provide a tax-free stipend. Travel nurses work for the staffing agencies and are only temporary or contract workers for the hospital.

When you inquire with an agency they will assign you a recruiter. Recruiters work for the agencies. They recruit nurses, doctors, respiratory therapists and other healthcare providers to help fill the healthcare facilities’ needs. Recruiters are the ones you will directly communicate with in order to find and secure travel contracts, discuss pay packages and arrange your credentialing in order to begin your contract. Some healthcare systems have created their own agencies and so, it’s possible recruiters are affiliated with the hospital or hospital system they are offering you (they should disclose this). 

Agencies will pay for the travelers’ onboarding (background check, drug testing, credentialing), offer medical benefits, and provide support. The recruiters will work with traveler to find a job that meets their needs. There are hundreds of travel nursing agencies and even more recruiters. Making sure you have an honest recruiter and good agency is the of utmost importance.

If you are looking for agency/recruiter recommendations please leave a comment below so I can provide you my up-to-date best choices.

Pay Packages Explained

The agencies will all take a percentage of the money the hospital pays for the traveler, this is how the agencies make money. The is the way this business works. Hospitals who are in need of staff will post contracts using an online platform. The hospital will post these jobs with an hourly or cumulative bill rate, the agencies will then create a pay-package for the nurse. This pay package is broken down into a weekly gross rate, broken down to hourly taxable rate and a non-taxable weekly stipend.

Agencies (unless owned by the respective hospital enterprise) do not work for the hospitals. Agencies use a vendor management system to view available jobs and details they then calculate a ‘pay package’ and send this to interested travelers. This is a package they come up with after they’ve taken the agency’s percentage.
Keep in mind this percentage cut can be anywhere from 15% to 60% of the original bill rate.

What does a pay package look like?

What is a bill rate?
The bill rate is the dollar amount the hospital is paying hourly for the healthcare provider. So if the hospital is paying $100/hour, some companies will offer you $40 while others will offer you $85. For the same exact position, from the exact same hospital, that is giving both companies the exact same bill rate. Like I said, this is business. My opinion is that you should always work with more than 1 agency so compare rates on similar/same contracts.

Some agencies will reimburse you for travel expenses, some will even book and pay for your flights. Some will reimburse you for continuing education costs (ie: ACLS/BLS), licensing costs and similar expenses of that nature. I’ve even had agencies reimburse me for the cost of state licensure application even though I did it before I worked for them. So, be sure to keep your receipts. Unfortunately not all agencies will not reimburse you for these things because some agencies take only 15-20% of the bill rate versus 50%. A $100 reimbursement isn’t a big deal if your weekly pay rate is $100 higher but you are working for an agency that doesn’t reimburse these costs.

Can I negotiate the pay?
I always recommend you try. Why not ask for more money? The worst they could say is no and they cannot say yes if you don’t ask. Sometimes it is possible for the recruiter to increase your pay package, but other times it is not reasonable (they gotta make their money too). This is why, in my experience, I have found it’s important to utilize multiple agencies to verify that you are getting a rate that is equitable to other agencies. Because it really sucks when you start a job only to find other travelers are getting $500-1000 more weekly than you (trust me it happened to me).

An easy way to get an increase in the pay package is if you decline health/medical benefits (you can obtain private insurance). And don’t forget to ask for an increase if/when you decide to extend your contract.

Tax-free Stipends

As a travel nurse you might be eligible to receive non-taxable income also known as a tax-free stipend. These stipends are your reimbursements for travel, housing, and meals. And are one of the many benefits of travel nursing.

In order to be eligible for these stipends you must be duplicating your expenses. In other words, paying rent in 2 places. If you take a contract that is close to your home and you doesn’t require you obtain housing, you would not duplicating expenses and would not be eligible for stipends. The general rule is that your contract must be 50 miles away from your tax home address.

What is a tax home?
The IRS defines your tax home as the “entire city or general area” of your workplace. 
You must meet one of two criteria to prove you have a taxable home to the IRS.

1. Be able to prove you visited your primary residence at least once in the year, and are also able to prove that you have financially maintained that residence
2. Prove that the area in which your primary residence is located, is also the same area in which you earned the most income last year

Since travel nurses normally don’t earn the majority of their income in the location of their permanent residence, they would choose option one.

You can check the per diem stipend rates for each part of the country on gsa.gov (click on Per Diem lookup).
This tool will show you the daily expected dollar (maximum) amount for lodging, meals and incidentals based on the city/state and month/year.

Unfortunately not all agencies calculate the stipends correctly which could become an issue if you get audited by the IRS.
So, it’s important to see and to understand your pay package breakdown.

This site is also helpful if you want to get an idea of how much you should be getting in stipends for a specific city.

Good Recruiters Matter

I have had recruiters who made my assignment 10X better and I’ve also worked with recruiters who made my experience 10X worse. Recruiters do not work for you and you do not work for them. You should not be afraid to tell a recruiter no thank you or that you would like to work with a different recruiter or another agency. You should feel confident using multiple recruiters and never feel bad about doing what is best for you.

I have had many travelers tell me “but I like my recruiter” when they discover they are making less money than other travelers for the same exact position. I like my recruiters and I have developed personal friendships with a few of them, but at the end of the day this is business and if my recruiter isn’t maximizing my pay the way another agency can or finding me the right contracts, I will find a new recruiter.

“I am dating multiple recruiters, but I can only sleep with one at a time”

-Christa RN

Is it OK to work with more than one recruiter at a time?

Yes, it is advisable.
I like to make light of it by telling them “I am dating multiple recruiters, but I can only sleep with one at a time”. They understand, and they enjoy the honesty and lightheartedness. You won’t be the first person to tell them this, they know travelers are usually working with more than one recruiter. You’re not doing anything wrong by utilizing all your available resources, in fact this is the only way to ensure you are getting a fair rate that competes with the rest of the market.
Also want to mention, if you like the agency but just aren’t getting along with your recruiter you can request a new recruiter.

Recruiters can sometimes be pushy with jobs, even when they know it isn’t what you are looking for. Be wary of these recruiters, they are often encouraging you to go to certain facilities because they’re desperate or stand to earn bonus pay.

Recruiters are only human

While we should be able to trust all recruiters, they are human and they have money to make in this business too. So just be sure you are always looking out for your best interest, since you cannot guarantee that recruiters are.

Also, do not feel pressured into setting up a profile just because you saw one contract you were interested in. Like I said 2-4 is plenty, you don’t want to waste time setting up a bunch of profiles with different agencies you will likely never use. I will simply tell the recruiters that I do not wish to set up a profile unless they have a job posting that I am seriously interested in applying for now.

Submitting to the same job twice does not increase your odds of getting the job–don’t do it

It is OK to work with multiple recruiters it is NOT OK to submit to the same job/hospital with 2 different agencies. This is can cause confusion on the facility’s end and they might just toss both of your applications away.

I have had a few incidents where a recruiter submits me for a job that I did not approve of. So now when I am speaking with a recruiter I always notify them that I am working with other recruiters to job search and that I state that I need to “provide verbal approval before any job applications are submitted“. By being specific I am eliminating the chance for error with that one recruiter who will be pushy and say “but you are the perfect fit for this position” and submit me without my knowledge.

Recruiters are your point-person

With that being said, having a good recruiter can sometimes make all of the difference. Especially recruiters who have worked with certain facilities for many years, they are more familiar with the inner workings of the hospitals and they can be immensely helpful if you have any issues during your assignment. Your recruiter is pretty much your go-to person when it comes to anything and everything regarding your contract. You want to notify them right away if you have any issues while on contract, anything from emergencies. injuries, staff conflict to conversations with the manager, etc. They will be your advocate if anything happens so it’s important you keep them in the loop. Sometimes you will barely speak with your recruiter throughout your contract, this isn’t necessarily bad if things are running smoothly.

I am frequently asked which agency or which recruiter I use.
And my answer is almost always different. I have used a different agency for almost every contract. Why? Because I go with the agency/recruiter that best meets my needs for that specific contract. I have used the same agency/recruiters again, but maybe not consecutively.

If you are interested in my agency/recruiter recommendations
please leave a comment below so I can provide you my up-to-date best choices.