Journal of Nursing
Uncategorized

Travel Nurse Blacklists

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By Kyle Shmidt

When travel nurses get banned from working with a particular travel nursing employer, it is commonly referred to as blacklisting, blacklisted, or blacklists. However, employers commonly refer to the action as DNU (Do Not Use), DNC (Do Not Call), or DNS (Do Not Send). It’s important for travel nurses to thoroughly understand the issues involved with this action because it can have huge implications for their careers as travel nurses and beyond.

To be clear, there is a difference between a permanent ban and a temporary ban. For example, hospitals will sometimes impose a temporary ban due to a failed examination during orientation. Such a ban is most commonly the result of failing a PBDS or EKG examination. Temporary bans typically last anywhere from 6 months to 1 year. By contrast, DNU’s, which we’ll focus on here, are intended to be permanent.

Who blacklists (DNU’s) travel nurses and what are the implications?

A DNU can be issued by a hospital, a hospital system, or an agency. When it’s issued by a hospital, the traveler will be banned from returning to that particular hospital. When it’s issued by a hospital system, the traveler is banned from working with any hospital within the entire hospital system. And when a DNU is issued by an agency, the traveler is banned from working with that particular agency. Each of these scenarios has different implications.

Getting Blacklisted By Hospitals

Getting DNU’d by one particular hospital is perhaps the least consequential possibility. Again, the ban pertains to only one hospital. Getting DNU’d from an entire hospital system can be more serious depending on the size of the hospital system. For example, getting DNU’d from all Kaiser hospitals removes a large number of hospitals and potential travel nursing jobs in the state of California. Getting banned from all HCA hospitals affects options in multiple states, and dramatically affects options in Texas and Florida. At the other end of the spectrum, getting DNU’d from Cottage Health System means you’ll only be banned from 4 hospitals. However, you wouldn’t be able to work in Santa Barbara, California anymore because they’re pretty much the only hospital that uses travelers in the area.

Getting Blacklisted By Travel Nursing Agencies

The consequences of getting DNU’d by an agency vary by agency. Getting DNU’d from a smaller agency may not have much of an impact on your assignment prospects. There is a very good chance that all of the hospitals the smaller agency works with, also work with other agencies that could therefore get you access to the same assignments.

By contrast, getting DNU’d by one of the larger companies could have a major impact on your travel nursing job prospects. This is because many of the largest agencies act as Managed Service Providers (MSP) for some of the largest hospitals and hospital organizations. For example, getting DNU’d from American Mobile can get you banned from all Kaiser Hospitals as well as all University of Stanford Hospitals and many more.

How is this possible? MSPs act as the single staffing provider for a hospital or an entire hospital system. You may commonly read or hear this referred to as an “exclusive contract.” The MSP uses sub-vendors to help them meet the hospital’s staffing needs when the MSP is unable to achieve fulfillment on its own. However, ALL submissions pass through the MSP and are checked against the MSP’s database. Those who have been DNU’d by the MSP are rejected.

What causes travel nurses to get blacklisted (DNU’d)?

DNU’s happen for any number of reasons. Typically, any disciplinary or clinical issue that maybe grounds for terminating a contract may also result in a DNU. This could include things like attendance issues, medication errors, or consistent insubordination. Also, if a traveler cancels a contract early or fails to show for an assignment they had accepted, then there is a possibility that they may get DNU’d.

It’s important to understand that different employers maintain different criteria for enforcing DNU’s. Moreover, it’s often a subjective decision. Every case is different. For example, I once worked with a nurse who was DNU’d for repeatedly failing to follow timekeeping procedures. Another time, a nurse was DNU’d for a rather severe medication error. Another time a nurse was DNU’d for not properly completing paperwork for a patient that coded during her shift.

What is the process when a travel nurse is blacklisted (DNU’d)?

In most cases, DNU’s are enforced by hospitals or hospital systems. Agencies enforce DNU’s far less. They tend to view their travel nurses as both employees and customers. Therefore, agencies are typically willing to provide a little more leeway. In any case, formal notification of DNU’s should be expected.

DNU’ing is covered by JCAHO rules. In fact, it’s one of the details that JCAHO critiques when they conduct an audit of an agency. Therefore, any JCAHO certified company should have formal processes and procedures for dealing with DNU’s.

The traveler will typically receive a call from their recruiter immediately to inform them that they are not to return to the hospital. They recruiter may have only limited details at that point. In most but not all cases, the hospital will provide the agency with a written report detailing the issues that led to the DNU. It’s fairly common for the agency’s Chief Nursing Officer (CNO) or Clinical Liaison (CL) to contact the nurse, go over the report,and get the nurse’s side of the story. Everything is documented in the agency’s database.

It’s also very common for agency’s to utilize a point system in order to evaluate whether or not the DNU should also be instituted by the agency. The point system typically has guidelines that group various potential issues into categories with escalating point values for more severe issues. The CNO or CL will assign a point total for the issue in question and if/when the a predetermined number of points is reached, the agency will enforce their own DNU. It’s important to note that it’s very rare for the travel nurse to receive a formal written report from the agency or the hospital regarding the DNU.

What can travel nurses do about blacklists (DNU)?

Travelers should always be mindful of the potential to get DNU’d as well as the consequences involved. The possibility of being DNU’d should factor into decisions regarding contract cancellations. For example, you maybe experiencing a very difficult situation with one particular HCA hospital, but you may not want to risk getting DNU’d from the entire organization. When you have family emergencies or illnesses that could potentially force you to cancel a contract, specifically mention to the hospital and your recruiter that you’re concerned about being DNU’d. They are most often very understanding in these cases. If you sign a contract and are considering backing out of it before it starts, consider the DNU as a potential consequence.

If you do get DNU’d, there is very little you can do. Appealing directly to a hospital is very unorthodox and not advised. However, if you are DNU’d from an agency, including a larger agency with MSP contracts, you can certainly attempt to appeal their decision. Contact them and request to speak with supervisors and/or escalate the issue up the chain of command. If all else fails, build up a solid record of travel nursing work history and references elsewhere, and return to them at later date with an appeal to have the DNU lifted. At that point you’ll be able to make a valid case that you’re deserving based on your recent work history.

 

Having a great time as a travel nurse and making good money while doing it can depend a lot on maximizing your opportunities and access to the travel nursing job market. Don’t let DNUs get in your way.



 
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Editor-in Chief:
Kirsten Nicole

Editorial Staff:
Kirsten Nicole
Stan Kenyon
Robyn Bowman
Kimberly McNabb
Lisa Gordon
Stephanie Robinson

Contributors:
Kirsten Nicole
Stan Kenyon
Liz Di Bernardo
Cris Lobato
Elisa Howard
Susan Cramer