Maybe you just signed your first travel nursing contract or maybe you’re still exploring options before you apply for your first contract. If you’re wondering what you can do in advance to make the onboarding process easier, keep reading. Once you’re a few contracts in, this will all be easy.

            Before you get to the facility for any in-person orientation and before you complete any online modules, you’ll have to complete some health requirements. These can include vaccines, immunizations, tuberculosis (TB) screening, medical clearance for respirator use, color vision screening, or drug testing. This article discusses only vaccination and TB screening requirements.

Getting Started With Immunization and Testing Requirements:

Getting a Head Start

            Your agency will make arrangements for you to complete the health requirements at an occupational health clinic in your area. Having your records organized in advance can save you some trouble and potentially avoid the need to repeat labs and vaccines that you may have already received. Are you one of the nurses who listened to the advice to save all your records when you were in college, or are you like many nurses who request their records again every time they need them? If you need to look for your immunization records, here are some places where you might get started:

• Your current employer: This may be the most up-to-date and complete record, but if you don’t have any concrete plans yet, you may not want your employer to know that you’re looking for a new job.
• School records: If you graduated from college recently, your school may be able to help since you had to meet the immunization requirements for healthcare workers before you started any clinical.
• Your primary care provider: Depending on your age and your state’s immunization registry, your PCP may have all your immunization records since childhood, only recent adult records, or none at all.

            Keep in mind that obtaining an old record does not mean that you will meet current requirements, even if you were up to date with the requirements of your current job when you started. Requirements change, and you may have met the state requirements when you started your job, but changes do not always require that current employees meet the same requirements as new employees. Working in a different state may also mean more requirements.

What’s Required?

            Requirements vary from state to state and between facilities so your agency will need to provide a list of requirements from the facility you are headed to. Requirements and recommendations are based on the recommendations of federal agencies. You can expect to see a recommendation or requirement related to each of these diseases:

• Tetanus, diphtheria, and pertussis (Tdap)
• Measles, mumps, and rubella (MMR)
• Varicella (chicken pox)
• Hepatitis B
• Influenza
• COVID-19
• Tuberculosis (TB) 

            The Centers for Disease Control and Prevention (CDC) recommends these vaccines for healthcare workers: Tdap, MMR, varicella, and hepatitis B.¹ For hepatitis B, employers are required to offer the vaccine to healthcare workers who have no evidence of immunity and are at risk of exposure to blood or body fluids.² Influenza and COVID-19 vaccination are quality measures so facilities will strongly encourage if not require vaccination.^{3,4 The CDC provides many recommendations about preventing the spread of TB in healthcare facilities, including a recommendation for baseline TB screening for any healthcare workers new to a facility.5}

            State departments of health use these recommendations and regulations to create state-specific immunization and testing requirements for healthcare workers. What is accepted in place of vaccines (a documented history of disease, laboratory evidence of immunity, or declination of vaccines) may vary from state to state, so you can expect that some of the testing and vaccines you receive at your pre-employment appointment may seem like they must be above and beyond any requirements. You’d probably prefer to do labs to test for immunity to varicella rather than get called back because the facility didn’t accept your documented history of chicken pox.   

Preparing for Next Time

            As a travel nurse, you expect and welcome frequent job changes. Maybe your next contract will be through the same agency, or maybe a different agency will have something better to offer. Thinking ahead to future contracts can only make it easier on you next time. If you receive any vaccines or TB screening at your pre-employment appointment, ask about how you can request those records. Yes, your agency will receive the records and forward everything to your facility, but what if you find a different agency for your next contract?

Or you decide to apply to graduate school next year and need to provide your immunization record before you can start clinicals. In that situation, you wouldn’t have your employer footing the bill if you need to repeat anything because you don’t have the records.

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References

• 1.         Centers for Disease Control and Prevention. Epidemiology and Prevention of Vaccine-Preventable Diseases. 14th Edition. Public Health Foundation; 2021. https://www.cdc.gov/pinkbook/hcp/table-of-contents/index.html
• 2.         Occupational Safety and Health Administration. Occupational Safety and Health Standards: Bloodborne Pathogens. Vol 1910.1030.; 2019. https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.1030
• 3.         Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases. The National Healthcare Safety Network (NHSN) Manual: Healthcare Personnel Safety Component Protocol, Healthcare Personnel Vaccination Module: Influenza Vaccination Summary.; 2022. https://www.cdc.gov/nhsn/pdfs/hps-manual/vaccination/hps-flu-vaccine-protocol-508.pdf
• 4.         Centers for Disease Control and Prevention, National Healthcare Safety Network. FAQs on reporting COVID-19 vaccination data – June 2024. Published June 2024. https://www.cdc.gov/nhsn/hps/weekly-covid-vac/faqs.html#Data-Reporting:-Requirements
• 5.         Centers for Disease Control and Prevention. Guidelines for Preventing the Transmission of Mycobacterium Tuberculosis in Health-Care Settings, 2005.; 2005. https://www.cdc.gov/mmwr/pdf/rr/rr5417.pdf