Healthcare staffing firms push to have temporary nurses recognized as employees
The firms claim that under the Fair Labor Standards Act, temporary nurses don't actually meet the criteria for contract workers.
Photo: Maskot/Getty Images
A group of 30 healthcare staffing firms has jointly penned a letter to the U.S. Department of Labor asking for guidance on the latter's classification of temporary nurses as independent contractors – saying this in fact violates the Fair Labor Standards Act, and carries "significant risks."
The staffing firms contend that such temporary nurses should be considered employees. Four healthcare staffing firms – IntelyCare, Gale Healthcare Solutions, ShiftMed and connectRN – signed off on the letter, which was endorsed by 26 more firms, including AMN Healthcare and OneStaff Medical.
All of the firms either signing or endorsing the letter employ nursing staff as W-2 employees, meaning formally employed. Not all staffing firms do, however. According to the letter, many organizations with similar staffing models classify nurses and CNAs as independent contractors, which the coalition describes as "taking advantage" of a market that was experiencing unprecedented demand and increasing labor shortfalls during the COVID-19 pandemic.
"As a result, although the nature of temporary nursing work has not changed, we believe that a significant number of nurses and CNAs are improperly classified as independent contractors due to the number of agencies that have chosen to operate under that model," the firms wrote.
WHAT'S THE IMPACT?
The firms claim that under the Fair Labor Standards Act, temporary nurses don't actually meet the criteria for contract workers.
"Temporary nursing staff in post-acute facilities do not have the necessary opportunity for profit and loss to classify them as independent contractors," the letter states. "Workers may be classified as independent contractors if they can exercise their managerial skills to obtain greater profits. On the other hand, a lack of exposure to potential losses is a strong indicator that workers are employees."
The coalition contends that contractor status is a dangerous misclassification in this case. The danger for nurses, the firms said, is that independent contractors are denied certain benefits ranging from overtime pay and unemployment to health insurance and workers' compensation.
Meanwhile, this can have a downstream effect on patients, they said, since temporary nursing staff members interact with vulnerable populations daily and generally require a higher level of training and oversight to ensure the integrity of certain care standards.
Facilities, meanwhile, may face increased co-employment risks, misclassification claims and audits over factors such as unpaid overtime and workers' compensation liability.
The firms also claim that facilities heavily reliant on independent contractors face higher risk of substandard care, potentially leading to malpractice claims stemming from an inherent lack of clinical and professional oversight.
The coalition is seeking guidance and opinion from the DOL, emphasizing the worker shortages that have made temporary nurses more prevalent in the industry.
THE LARGER TREND
Staffing issues and an ongoing nursing shortage continue to cause challenges for the nation's nursing workforce. A full 91% of respondents to a March nurse.org survey believe the nursing shortage is getting worse and that burnout, poor working conditions and inadequate pay are the primary causes.
Meanwhile, 79% said their units are inadequately staffed, while 71% said improving staffing ratios would have the greatest impact on the nursing shortage. And of course, nurses want better pay. Fifty-five percent saw a pay increase during the last year, but 75% still feel underpaid and 52% believe their hospital does not pay nurses with similar experience equally.
Twitter: @JELagasse
Email the writer: Jeff.Lagasse@himssmedia.com
