Mergers & Acquisitions: How Agency Consolidation Will Affect Travelers
Global mergers and acquisitions reached a new milestone–2017 marked the third year that more than 50,000 deals were made, according to a report in Harvard Business Review, and the healthcare staffing industry was no exception. This trend is expected to continue through 2018, and the industry has already seen its first acquisition. Medical Solutions, one of the top staffing firms in the U.S. in terms of market share, announced the acquisition of PPR on Feb. 9. PPR provides travel nurse staffing and interim leadership for acute and post-acute markets. As part of the transaction, PPR will continue to operate as its own brand and will keep its offices in both Jacksonville and Tampa, Fla., according to a press release announcing the deal. For travelers, staffing industry mergers mean fewer choices As with any industry, consolidation means fewer choices, and that’s the case here. As these staffing companies merge and are acquired, the nurses that use them are faced with fewer and fewer options, said StaffDNA vice president Stephen Gillem. That could negatively affect pay rates and quality of service these agencies provide. The loss of choice could feel especially felt by a specific group of nurses, those who are labeled “Do not hire.” With fewer agencies representing more hospitals, if a nurse is marked “do not hire” by an agency it becomes harder for that nurse to find a new position just by moving to a new agency. Mergers and acquisition as growth strategy The Medial Solutions/PPR acquisition is somewhat surprising, Gillem said, because PPR, just last year, was one of the companies doing the acquiring when it bought 360 Healthcare Staffing. PPR wasn’t the only company to make major moves in past few years. Cross Country Healthcare acquired Advantage RN for $88 million, Travel Nurse Across America acquired Trinity Healthcare Staffing Group in January 2017, and Advanced Travel Nursing acquired both Rise Medical Staffing and IPI Travel Nursing in 2016. Gillem expects these medium to large players to continue consolidating with competing firms because it’s an easy way to spur company growth over organic methods, he said. “It can be hard if you’re a smaller company to compete now on the healthcare traveler national stage if you don’t have that reach,” Gillem said. “You’ve got to have the money for marketing, website optimization, and a robust back office for items like compliance.”
First-time Travel Nurse? Don’t Delay Compliance
You’ve graduated school. You’ve earned your license. You’ve worked a couple years in a permanent position. You’re ready to transition to travel nursing. Time to find an agency. Time to find a recruiter. Time to find a job. And it’s time to start collecting your compliance documents. Really? Before you have a job? Yes. Really, especially if you’re a first-time traveler. Tackling compliance early can ease headaches later There are a couple of reasons to start now. First, you’re going to have a lot to gather, and it’s going to take a little bit of time. You are going to need to provide documents that you haven’t had to access since you started working at your permanent job. You are either going to need to locate copies of things like college transcripts and shot records or you’re going to have to request those documents and wait to receive them. And other aspects of compliance–things like background checks and drug screenings–could take extra time to complete depending on how in-depth the hiring facility or VMS requires them to be. So don’t wait to begin the process of gathering documents. It’s about controlling the things you can control. You can make sure you have all of your documents together. You can make sure you’ve submitted background paperwork promptly. You can make sure you’ve scheduled a time to complete vaccinations or blood draws for screenings. How long it takes to complete those background checks or drug screenings is out of your hands, but you don’t want to be the reason things get held up. Compliance documents to collect So what do you need to have copies of? It will vary by assignment, but you can start here. A copy of your nursing license A copy of your diploma or a transcript that shows you earned your degree A copy of your annual physical Shot records showing you’ve had your: Annual tuberculosis skin test MMR vaccines (2) or positive titer Varicella vaccines (2) or positive titer Hepatitis B vaccines (3) or positive titer Tetanus, Diphtheria, Pertussis (Tdap) vaccine — within 10 years Seasonal flu vaccine (issued between October 1 and March 31) Copies of any certifications you’ve earned Copies of identifications (driver’s license, passport, Social Security card) A voided check to set up direct deposit with your bank Organizing your compliance documents And where should you keep these compliance documents? There are online tools, like cloud storage sites, that you can use. But maybe the simplest option and one that doesn’t require you to remember passwords or worry about a site’s security being compromised is a dedicated flash drive where you keep electronic versions of everything. Take it with you when you go to the doctor for a physical or to receive vaccinations, and they should be able to put a copy of any documentation onto the drive for you. Now, these won’t likely be all the documents you’ll need to be compliant at every hospital. Each facility and each VMS has its own requirements. If you do have these documents, it’ll cut down some of the hustle you have to do before a new assignment.
Travel Nursing Jobs: Midwest States To Consider
Part of the appeal of a travel nurse career is the adventure–the opportunity to discover places you’ve never been before. But those places aren’t just on the coast or in the mountains. There are literally travel nursing jobs everywhere, and America is a big place. We want to take a look at some of those markets that you may have missed in your last job search. We start in the Midwest. Illinois travel nursing jobs Where are the jobs: All over, and more are being added every day. What specialties are these hospitals looking for: Any and all, the jobs are plentiful How quick are the hospitals hiring: Almost immediately. Most interviews are being done the same day resumes are submitted. How easy is it to get a state license: This is where it can get tricky in Illinois. It takes between four and six weeks for a state license to be issued, so accepting your first Illinois assignment takes a bit of preparation. Where many get hung up is submitting an incomplete file. When the state receives an incomplete file, it uses the U.S Postal Service to notify the nurse and requests missing documents be sent back to the state in the same way. That creates a nearly two week delay. Then once the state receives the documents, the four- to six-week clock starts over. So, if you aren’t careful, getting an Illinois nursing license can become a months long process. One way around this, if you’re applying from a neighboring state, is to go to either Chicago or Springfield to the state nursing board’s offices with your full file and ask for a review before you submit your application for a license. It will still take up to six weeks to get the license, but you avoid those delays caused by missing documents. Indiana travel nursing jobs Where in the state are the jobs: Obviously, there are jobs in Indianapolis, but there are also several opportunities in Fort Wayne and Evansville. What specialties are these hospitals looking for: Right now there seems to be a growing number of Med Surg/TELE positions as well as ICU How quick are the hospitals to hire: The answer here obviously depends on the facility, but some hospitals are interviewing the same day candidates are submitted. How easy is it to get a state license: Indiana is not a member of the Enhanced Nursing Licensure Compact, so before accepting a placement there you’ll need a temporary license. Indiana isn’t a walk-through state either, so make sure you leave two to four weeks for the state to issue your license once it’s received all of the required documentation. The license is valid for 90 days. Here are the documents you’ll need to provide: Completed application — notarization is required for a temporary license A 2 ½ X 3 ½ Photo signed on front Proof of current active license Verification of original state license Verification of ALL licenses held, current or expired Completed fingerprint card, not complete prior to sending in the application Missouri travel nursing jobs Where are the jobs: Sedalia, Springfield, St. Louis and surrounding cities What specialties are these hospitals looking for: Med Surg & TELE RN’s are the biggest needs at this time. How quick are the hospitals to hire: Interview typically happen within 48 hours How easy is it to get a state license: Missouri is a compact state, so if you already have a multistate license then you are cleared to work. If you don’t have a multistate license, Missouri is a walk-through state. Go to the board of nursing in Jefferson City and you can leave with an active Missouri temporary license. When you go, you’ll need a completed application, a copy of your current active state license, and proof of your fingerprint registration.
Nursing Licensure Compact Update: More Questions, More Answers
After we posted our story about how new enhanced Nursing Licensure Compact states are handling the transition process, we got some specific questions from readers about the topic. Last week, we answered the first one about whether some Florida hospitals are still requiring single state licenses despite being a eNLC state, and today we’ve got another question from a Florida-native nurse. Q: “I have Florida, North Carolina, and Massachusetts licenses. My home state is Florida. Do I still have to renew my North Carolina single state license even though it lapsed? ” — Stephanie M. A: That’s a good question, Stephanie. Whether or not to renew a license depends on your home state. Nurses who received their primary license in a non-eNLC state are still required to obtain single state licenses as usual, according to the National Council of State Nursing Boards. This rule was carried over from the old NLC. Luckily, since your home state is in Florida, you don’t have to renew your single state in North Carolina as long as you meet the qualifications for a multistate license. In fact, North Carolina wouldn’t be allowed to give you a single state license if you already have a multi-state, under Section 401 of the official eNLC rules. For reference, here are the new uniform requirements to qualify for a multistate license: Meets the requirements for licensure in the home state (state of residency) Has graduated from a board-approved education program; or has graduated from an international education program approved by the authorized accrediting body in the applicable country and verified by an independent credentials review agency Has passed an English proficiency examination (applies to graduates of an international education program not taught in English or if English is not the individual’s native language) Has passed an NCLEX-RN or NCLEX-PN examination or predecessor exam Is eligible for or holds an active, unencumbered license (i.e., without active discipline) Has submitted to state and federal fingerprint-based criminal background checks Has no state or federal felony convictions Has no misdemeanor convictions related to the practice of nursing (determined on a case-by-case basis) Is not currently a participant in an alternative program Is required to self-disclose current participation in an alternative program Has a valid United States Social Security number. Keep in mind that every state will most likely have a fee to upgrade your single state license to a multi-state. Florida charges a one-time fee of $100. If you don’t qualify for a multi-state license, don’t fret–you may still be eligible for that state’s single state license requirements. Got another enhanced Nursing Licensure Compact question, or just a question about traveling? Check out our eNLC coverage for more info, or send us an email with your question. Want to share a great story or industry news tip? Reach out to us today.
Travel Nurse Agency: 3 Signs It’s Time to Find A New One
When you started traveling, you may have had a great relationship with the people at your travel nurse agency. But like all relationships, things can change. The people you enjoy working with move on. Shifting business goals can mean that focuses switch, and things just aren’t what they used to be. Whatever the reason, that relationship that you once had is different now. It’s just not working for you, and you’re thinking about making a switch. Before you make any agency change, you may want to consider switching recruiters, especially if you’re with an agency that generally has a good reputation. But if you’re seeing any of these signs, a recruiter change may not be enough. It could be time to break up with your agency. Your travel nurse agency’s response time is more than 24 hours. How quickly does your agency respond to issues? What about submittals? How quickly can they find answers for you? If you contact your agency and someone there doesn’t respond to you on the same day–extenuating circumstances excluded–then they are taking too long. Keep in mind that you have the power to create urgency. If you call and leave a message that tells your recruiter your question isn’t critical and that they can get back to you at their convenience, then that “same day” timing may slip some. But no agency should leave you hanging, and if yours does then it’s time to find a new one. The recruiters aren’t nurse-centered. Who is your recruiter most concerned about, you or the agency? If your recruiter continually pushes you toward jobs that you don’t want in locations you have no interest on shifts that don’t match your needs, then they likely aren’t worried as much about you being happy as they are about lining their agency’s pockets. The control over what job you take should always be in your hands. Your recruiter should be listening to what you want and tailoring a plan around that. He should know your goals and help you meet them. You feel like you aren’t getting the whole story. Transparency is the hallmark of a good agency/traveler relationship, and if you feel at all like your travel nurse agency is keeping things from you then it’s time to start shopping for a new one. How do you know if you aren’t getting the whole story? Look for indirect answers to direct questions. That’s usually a good sign. If they hem and haw when you ask about pay for a potential contract, they aren’t being transparent. Same is true about jobs. Sometimes, jobs just aren’t available that meet your criteria. A good recruiter and a good agency are going to tell you that.
New Travel Nurse: Four Things To Remember On Your First Assignment
As a new travel nurse, you’re getting ready to head out on your first assignment. You’re excited, maybe a little bit nervous. You’re thinking about the new adventure, about living in a new place and meeting new people. What you probably aren’t thinking about is the nursing. That, you know. In the hospital and with patients is where you’re comfortable. But travel nursing is a bit different than staff nursing, and recruiters say there are four things you need to remember once you get to the hospital to make your first assignment a success. You are not a staff nurse. This can be tough to remember when you are coming from a permanent position, but when you are on a travel assignment you’re there to do a job. You won’t get the choice shifts. You won’t get the best days off. You are there to fill the gaps in staffing. Unfortunately, those gaps usually occur at night and on the weekend. It’s the trade off you make for the adventure and pay that comes with being a travel nurse. You aren’t there to be an agent of change. Think of yourself as a guest in someone else’s home. If they take their shoes off at the front door you do too. You may think it’s odd. You may disagree with the reasons they do it, but you do it anyway. It’s their house. Travel nursing is the same way. Every facility has its way of doing things. You may not understand them. There may be other or better ways to do those things, but it’s not your place to lead the charge in changing practices. Sure, you can make polite suggestions, but, at the end of the day, it’s their house. You play by their rules. Orientation won’t teach you everything you need to know. You hear that you’re going to have an orientation and probably assume that when you’re done you’ll be fully equipped to get to work. Chances are, you won’t be. Orientation is more focused on policies and procedures–what’s the dress code, how do you clock in and out, etc.–and not about actually doing your job. Be prepared to ask where certain equipment is kept and how certain emergencies are handled, since you may start your first shift without knowing. Temporary work comes with a certain amount of uncertainty, and that’s OK. If you’re someone who finds comfort in knowing what’s around the corner, even if the corner is months away, getting used to the uncertainty of travel nursing can take some adjustment. You may not know where your next assignment will be until a couple of weeks ahead of time. The secret here is to trust your relationship with your recruiter. If you’ve been clear with your recruiter about the kind of assignments you want then they can be working to find that next assignment for you while you are wrapping up your current one. They are the certainty when you travel. The places you go and the people you work with will change, but having a recruiter who you trust can make that uncertainty exciting rather than nerve wracking.
VMS: What Is It & How It Affects Your Travel Healthcare Career
Globally, the vendor management services market is valued at $138 billion, according to a report from Staffing Industry Analysts, and that number is growing. That may not mean a lot to you, but it should. Vendor management services are playing an increasingly larger part in where you work and how much you get paid. Solving the vendor management problem Large hospitals can spend in excess of $20 million a year on traveling healthcare workers, almost always working with multiple agencies to fill openings. That leaves administrators at those facilities having to manage multiple relationships and dozens upon dozens of contracts individually. It’s a situation that, for many, became untenable. They looked to technology and services for help and found vendor management systems. These allow the hospitals to have a single point of contact that managed billing, talent sourcing, compliance verification, among other tasks. For the hospitals, it’s great. They solve their vendor management problem. For the traveling healthcare worker and the agencies that staff them, it changes how business is done, but not necessarily for the better. What are vendor management services? Vendor management services is a broad term for a tool or organization that helps a healthcare system manage their relationship with outside services, such as healthcare staffing agencies. The two common types of VMS solutions that are relevant to travel nurses are vendor management systems and managed service providers. A vendor management system is a software tool that allows an organization to self-manage their relationships with outside organizations. So, your recruiter and the hospital both interact with the system; it facilitates communication and automates some aspects of their relationship. A managed service provider (MSP) is an uber staffing agency. VMS software provides the resources for a hospital to manage their own staffing, and an MSP manages all aspects of contingent staffing for the hospital. This may include sourcing, credentialing, hiring, onboarding, timekeeping, and billing. An MSP may draw on the resources of multiple staffing firms to fulfill these needs. How does the VMS market impact you? Each model for managing the relationship between a hospital and an agency can impact the bottom line in different ways. VMS software is a more or less vendor-neutral way for the hospital and the staffing firm to conduct business: it will not prioritize any staffing company over any other. When all staffing agencies are treated the same way, you will have an equal chance of getting a position at a hospital for the same salary, no matter which agency you work with. An MSP, on the other hand, often has exclusivity agreements with the hospitals that they contract with. This is why you can only find positions at certain hospitals through certain staffing agencies. If a hospital has a particularly high need, an MSP will source candidates from other staffing agencies, often keeping the best jobs for their own candidates. Either way, the MSP retains a portion of the total bill rate, resulting in lower take-home pay for you. These MSPs also are forcing staffing agencies to carry more of the burden around liabilities, forcing them to carry higher levels of insurance. Those higher premiums come out of the total bill rate, again, resulting in a lower take home for you. It’s about more than just pay While affecting pay is a big deal, working with a VMS is affecting your career in other ways. Each VMS or MSP has different policies. The pre-employment testing that you have to take isn’t always because the hospital wants you to do it. The VMS that a hospital has contracted with could be the one requiring it. If you’ve had a recruiter who was pestering you for compliance paperwork weeks and weeks ahead of a scheduled start date, that could be because of the VMS as well. Some systems will arbitrarily require paperwork to be submitted and approved by certain dates that can seem a bit arbitrary. The biggest thing travelers should know about VMS solutions is that getting on the wrong side of one can make a traveling career much tougher. That’s because some VMSs will blacklist a travel nurse not just at a hospital, but at any facility or health care system that uses that VMS. So, if you don’t early-terminate a contract properly or you no-show a job, you can potentially make yourself virtually unemployable. That’s why it’s even more critical today to work with your recruiter if you have to terminate early or are having problems at a job that are so severe you’re ready to leave. Portions of this post originally appeared on the blog at Liquid Agents Healthcare. They are being used with permission.
Ask a Recruiter: 5 Things a New Travel Nurse Should Know
Talk to most recruiters and they will tell you that the number of travel nurses is growing rapidly. A lot of that growth can be attributed to new nurses trying traveling for the first time. They hear stories of fun adventures or higher pay from a traveler working an assignment at their hospital, they check it out, and they decide to dive in–often with too little education to know what they are actually getting into. We sat down with David McKenzie, a recruiter with LiquidAgents Healthcare. McKenzie has been a recruiter for almost 5 years and is passionate about educating first-time travelers. HCT Today asked him what travelers should know before they hit the road for the first time. Here’s what he told us. The nuts and bolts of the pay package McKenzie says the pay package is the first thing that a first-time traveler should understand. That’s why McKenzie spends time with his new travelers or nurses just exploring traveling and breaks down the different elements of a pay package. The gross pay: The total value of the contract The non-taxed portion of the pay package: These are any stipends or per diems that are included in the package, as long as the nurse meets IRS requirements to receive them. The taxed portion of the pay package: These are the hourly wages, but can also include any stipends and per diems that are taxed because the nurse does not meet requirements to receive them tax free. The take-home: This is what the nurse gets at the end of the day Knowing how their pay breaks down and what they should expect on a paycheck helps the nurse, but it also helps McKenzie avoid panicked phone calls later from nurses who fear they’ve been somehow cheated. The Bucket Theory Many first-time travelers hear stories before they get into traveling about stipends, reimbursements and per diems and get visions in their heads of free money. McKenzie says that it’s not true. Many travelers, especially first-timers, don’t understand that there is essentially one big bucket of money that everything they are going to get paid comes from. That money comes from the hourly rate that the hospital is willing to pay for that traveler. How that money is divided is up to the nurse. So, they are free to ask for things like money for travel, but that doesn’t mean they are getting additional money. It means the pay rate is being lowered to account for the shift of money to cover travel, and the same goes for housing allowances or per diems. Both are money from the same bucket, so you aren’t getting anything additional. You decide whether it’s more important to get the tax-free money or have more in your take-home pay. Sometimes a traveler will be tempted to ask for more money on a contract. There are only two ways that kind of request gets approved. Either the hospital agrees to a rate increase, making the bucket bigger, or the agency wasn’t maxing out what it was able to pay in the first place. The 3 Pillars of Travel Nursing Pay, location and shift. That’s what McKenzie calls the pillars, and he tells first-time travelers that they need to pick one of these as the most important because they can’t all be the priority. As an experienced traveler will tell you, finding all three in a single placement is rare. New travel nurses should decide early whether the right shift is the priority. Or maybe it’s being someplace relatively close to home. Or maybe they’ll sacrifice both of those for a good-sized paycheck. Pick the most important. Be flexible on the others, and the recruiter can likely always find a job. “Having some wiggle room on one of those factors, you can get anything to move,” McKenzie says. Know how far is too far McKenzie says that even when first-time travelers decide that location is one of the pillars where they have some flexibility, it’s important for them to know how far from home is too far. Most traveling contracts are 13 weeks long, which can be a long time to be far from home for many first-timers. For some travelers, that adventure is what draws them to the job. But for many, having the ability to get back home easily, whether it’s for an emergency or just to recharge around familiar faces, is still a comfort, and one that McKenzie says first-timers should consider before taking an assignment. The process for getting hired There’s a bit of time between a new traveler deciding she wants to hit the road and when she starts her first job, and McKenzie said it’s important new travel nurses understand the steps it takes to land that first assignment. It starts with creating a resume that will get them hired, and the next step is to find jobs to submit the traveler to. Then a review by the facility, hopefully an interview, and then an offer. But things don’t end with the acceptance of an offer. Next comes verification of compliance documents, potential drug testing, and possible pre-employment testing. McKenzie says educating the first-time traveler on all those intermittent steps is important because it will ensure they don’t get confused as the process plays out.
4 Traits New Travel Healthcare Professionals Need In A Recruiter
When you’re new to traveling, finding the right agency to work with is critical. But maybe more important is finding the right recruiter. This relationship is critical. If you get it wrong then your travel experience is going to suffer. So what do you want in a recruiter? Here are four things to look for. You want a recruiter who you generally get along with. Of course you do, right? That should go without saying. But too many travelers, especially those who are new, continue relationships with people who they don’t genuinely enjoy working with. Ideally, this will be a years-long relationship. Find someone whom your personality matches with, with whom you share a working style. While getting along is key, remember that doesn’t mean they’ll always tell you what you want to hear. You also want someone who can be direct when needed and deliver bad news quickly, should there be any. You want a recruiter who knows the industry. The truth is that travel healthcare recruiters can get into the industry without a lot of prior knowledge. So pairing an inexperienced recruiter with a first-time traveler can be dangerous. First-time travelers should look for someone who understands the industry and can help them navigate the aspects of it that can be confusing, especially as they get started. You want a travel healthcare recruiter who can not only help you understand the ins and outs of things like housing and pay packages, you also want one who can help you fix problems once you are on the job. He or she should be comfortable being your advocate and addressing problems with the hospital and working toward resolutions. It should be obvious early on that you are working with an experienced recruiter, but if it’s unclear ask how long they’ve been in the business. And if you aren’t comfortable doing that, there are a couple of red flags that you are working with someone who is inexperienced. They aren’t forthcoming with information. Do you get the used car salesman vibe from them? They won’t answer your questions with a straight answer, dancing around your query as long as they can? If so, they likely lack the experience and knowledge to answer your question. They are magically able to meet everything you’re looking for. While perfect placements can exist, an experienced recruiter knows that finding a job that hits the trifecta of location, pay, and shift is unlikely. If you are always being told yes, then you are working with someone who doesn’t understand the industry. You want a recruiter who puts your interest first. A good travel healthcare recruiter is going to put you in a situation that works for you. They will listen to what you want, then find you the closest thing they can to that. If you are looking for A, they won’t push B. A recruiter that puts his or her agenda first is one you want to walk away from. You want a recruiter who is responsive. Technology has made it very easy to communicate, so a recruiter who lets days go by when you are reaching out to them is a recruiter you don’t want to work with. That’s especially true when an issue arises on the job. Your recruiter is your lifeline. You need them to be available, and that means through email, phone or text message. If your travel healthcare recruiter isn’t responding when you reach out, it’s time for a new one.
Cancel Your Travel Contract Without Ruining Your Reputation
Sometimes you need to cancel your travel nurse or allied contract. Maybe an illness forces you to have to leave early. Or a death in the family. Or it could even be that the working conditions have become unbearable, and you aren’t able to finish out your travel contract. It used to be that canceling a travel nurse or allied contract came without much consequence. That’s not the case now. Canceling a contract early can get you blacklisted by hospitals, by hospital systems, and, in some cases, at any hospital that uses a particular vendor management system (VMS). It can ruin your reputation and kill a travel nurse or allied healthcare career. It doesn’t have to. There are things you can do if you think you might need to cancel your contract that can keep you from the “do not hire” list. Lean on your recruiter. Start the process by talking to your recruiter. Have them look at your contract so you understand your options and the potential implications of leaving early. Fines, for instance, that you may be responsible for. They will be able to talk you through the process and help you think through whether or not canceling makes sense. Also, recognize that there may not be anything you or your recruiter can do to avoid a black mark on your record. Sometimes, especially with VMS programs, it’s impossible. And, yes, you can cancel your contract if the facility isn’t living up to the contract it committed to, like floating you to areas where you aren’t competent or moving your shifts. If that’s your situation, this may be when you need to lean on your recruiter most of all. Let them talk to the hospital. Let them start the process for you, initiating the possibility of canceling if problems aren’t resolved. Be communicative. If you know that there’s a possibility you’ll need to cancel, tell people early. Let them know that it’s a possibility, then keep them updated as your situation evolves. If your recruiter knows that you might need to be replaced, they can get to work lining up someone. If your facility knows you might have to leave before the end of your contract, they can have time to make contingency plans. Put in a proper notice. When it becomes clear that you need to leave a contract early, put in a proper notice, whether that’s two weeks or 30 days. Provide a professional statement to anyone who needs one: your supervisor, the head of nursing, human resources. What is required to cancel will be included in your contract. Refer to it. Work every shift to which you’ve committed. Just because you’ve given your notice doesn’t give you the OK to cut out early. Even if everything about your early termination has gone smoothly, skipping out on that last shift can kill any goodwill you might have established.