Blacklisting: The dirty side of travel nursing

It happens frequently. A staff nurse is taking a leave of absence or leaves for another job. Or your patient census suddenly spikes. Whatever the reason, you need supplemental staffing until your staff nurse returns or you can hire and train a new nurse.

So you sign a 13-week contract with your company’s staffing agency. Then, six or seven weeks into the contract, your situation stabilizes and you realize you only need a travel nurse for eight weeks. Or maybe you do need a travel nurse, but the one who was sent is not a good fit for your clinic and you don’t want to keep the nurse any longer than necessary.

Whatever the reason, you want to break the contract early. However, if you do so, you will probably have to pay an early cancellation fee.

Some staffing agency contracts have a clause which states that a contract can be broken early, without penalty, if there is a breach of the client’s policies and procedures or there is a clinical breach which is grounds for immediate termination.

What do you do? This is the sticky part.

The nurse is often terminated by being blacklisted, all too often company-wide, so a clinic can save a cancellation fee. The only casualty here is the travel nurse. The reputations of travel nurses who have been blacklisted have been defamed unnecessarily.

Wrong place at the wrong time

Blacklisting, called by several acronyms—DNR (Do Not Return), DNS (Do Not Send), DNU (Do Not Use) to name a few—is an effort to justify terminating a nurse early, and is devastating for a nurse. In an article for WorkingNurse.com, Genevieve M. Clavreul, RN, PHD, writes that the threat of being blacklisted and labeled a DNS is feared by nurses because the criteria is often applied inconsistently, and can be used as a petty and punitive tool. Clavreul further points out that blacklisting is often used as a subjective tool rather than an objective one.

If a nurse has been on a prior assignment without incident or the current assignment for several weeks without incident, a staffing agency usually knows a clinic wants to terminate a contract without penalty when complaints start to surface, sometimes completely ridiculous ones. This is especially true when there is no documentation to support the complaints. A documentation narrative with dates, times and names of witnesses, if any, or irrefutable evidence—computer login records, time clock in/clock out records, station or patient assignments with HIPAA information redacted to name a few—is always necessary. Staffing agencies and dialysis companies are co-employers of each travel nurse, so both companies are vulnerable for wrongful termination lawsuits.

In addition, unless there is an egregious professional infraction (drinking on the job, illegal drug use, etc.) or a serious clinical infraction, no travel nurse should be blacklisted company-wide based on one manager’s allegations, especially without documentation. Too many good nurses who have successfully completed assignments or have been extended in assignments for months, have been blacklisted without recourse based on the opinion of one manager.

If a manager has a legitimate professional complaint, the protocol should be to inform the staffing agency for the opportunity to counsel and coach the travel nurse. If a travel nurse has worked in several different locations for the same company, sometimes, what is acceptable in one clinic is not in another.

If you have a documented clinical complaint, notify the travel nurse’s staffing agency immediately. They will usually offer to work through the issue with you or replace the nurse. If the clinical complaint is egregious, the staffing agency most probably won’t want to continue employing this person.

Ways to end a contract early

If you want to end a contract early, try doing it without blacklisting a travel nurse. Here are some suggestions for a more humane way to address the early termination of a contract.

Ask for a shorter contract up front. The industry standard is 13 weeks, which is largely based on, believe it or not, housing contracts. It is hard to find suitable housing for less than three months at reasonable rates for travel nurse assignments. If you only need eight weeks, talk to your agency. Most will try to work with you.

Make sure a travel nurse understands your expectations. This is usually accomplished during orientation. Unfortunately, this important protocol is sometimes omitted because by the time a clinic seeks out a travel nurse, they are in some level of crisis.

Be willing to pay for hard costs. If you signed a 13-week contract, but now you don’t need a travel nurse that long, speak to your agency. Most reputable agencies will understand and only ask for hard costs for contracts they can’t terminate early.

Move the travel nurse. If your company has another clinic in the area that can use the help, ask the staffing agency if you can move the nurse for the balance of the contract. If it’s within 50 miles of the current location, this would probably be a viable solution.

In general, companies should develop guidelines and metrics to establish what is acceptable criteria to blacklist a travel nurse company-wide. A good agency partner will send you an experienced travel nurse who is able to hit the ground running. They are usually pleasant and patient oriented. Most are not interested in fixing clinic issues although they are capable of doing so.

Summary

With the dearth of dialysis travel nurses, you can’t afford to blacklist one unless it is for a legitimate egregious clinical or professional reason affecting patient care. In a case like that, most reputable staffing agencies would not want to employ the travel nurse either. -by Francyne N. Rosentstock

Sources

Clavreul G. From the floor, do not send: The nursing blacklist. WorkingNurse.com. Accessed on March 10, 2016.