Nurses Owe Thousands if They Break TRAP Training Contracts

At least one national nurses’ group, as well as federal agencies and state legislators, are trying to curtail longtime employment practices that require nurses to repay costs of job-mandated training programs if they leave a hospital before their contract ends.

Medscape Medical News recently spoke with several nurses who were forced to repay up to $12,000 when they broke their contracts. The contracts were broken mostly because of the pandemic and staffing shortages.

Last year, Jacqui Rum, RN, accepted a position at an HCA Healthcare hospital in Thousand Oaks, California. She signed a contract that required her to remain at the facility for 2 years or reimburse the hospital for training. Rum told Medscape she quit after a little over a year, citing poor working conditions. Since October, she has received multiple letters from HCA Healthcare demanding that she pay the remaining $2000 that the hospital says she owes for training costs.

“Oftentimes we didn’t have a nurse to relieve us for lunch, so instead of getting a 30-minute lunch, we got 1 extra hour of pay,” Rum said. She believed she was shortchanged on training. “It was 6 weeks of classroom training, which included a lot of information we [had already] learned in nursing school.”

Rum recently sued HCA Healthcare in US District Court for the Central District of California, court records show. The court set a jury trial for October, according to Law360. The health system has halted its use of Training Repayment Agreement Provisions (TRAPS), according to an NBC investigation into the practice.

Harlow Sumerford, HCA director of media relations, told Medscape that TRAPs agreements are not standard across the health system and were only being used in a handful of markets. “Most of our hospitals decided in early 2022 that requiring nurses in our residency program who leave early to pay back associated costs was not a preferred way to recruit or retain nurses, and all of our hospitals ultimately did the same.”

Neil Rudis, RN, also had to repay training costs as part of a TRAPs agreement. As a newly licensed nurse at the start of the pandemic in 2020, he was excited to work at the UC Health University of Colorado Hospital Trauma Center and train in its intensive care unit. But he had to sign a contract that required him to work at the facility for 2 years or pay back $7500 for 6 months of preceptorship training. Rudis signed the contract and upheld it. He doesn’t think the hospital upheld its end of the agreement.

Short staffing in the unit forced the hospital to cut his orientation short by at least 4 weeks, he told Medscape. “I did get phenomenal training…but I was supposed to have a full 6 months of orientation with a preceptor, and that did not happen.”

Rudis left UC Health after his contract ended. The university health system has since stopped using TRAP agreements.

National Groups Investigate

Last year, the Consumer Financial Protection Bureau began to scrutinize agreements in which employees become indebted to their employers, according to a press release.

“The labor market operates at its best when workers are able to move freely within it,” agency director Rohit Chopra said in the release. “Our inquiry is about studying the effects of an emerging form of debt that may have the potential to trap employees in place.”

In response to the federal investigation, National Nurses United (NNU) surveyed nearly 1700 nurses and found that about half said their employers required them to participate in a training or residency program at some point. Of those, 55% said they were required to pay money back for the training.

One third stated that they “felt restrained” from complaining about unsafe or unfair staffing or working conditions, and almost 40% said that they were forced to accept low wages during the contract period.

Hospitals may defend these contracts as an investment in trained nurses and, in return for the training, require nurses to commit to remain with the facility for a certain period, Jonathan F. Harris, an associate professor at Loyola Law School in Los Angeles, told Medscape.

Lately, use of such contracts seems to have increased, especially in business sectors in which there is a high demand for workers, including healthcare, retail, transportation, finance, and technology, he said. They are primarily used to keep workers on the job, he said.

“Sometimes the in-classroom component is learning about hospital policy,” Brynne O’Neal, an NNU lawyer and regulatory policy specialist, told Medscape. Nurses often sign these contracts because they are initially excited by the training being offered. “And with the increasing consolidation of health systems, nurses may have limited options to find a job that doesn’t require [TRAPs] if they are not willing to relocate.”

O’Neal added that nurses who work in understaffed units are often afraid to complain because if they are fired, they would have to repay the debt.

Chris Hicks, senior policy adviser at the Student Borrower Protection Center, told Medscape that TRAPs are considered “shadow” student debt, a nontraditional form of credit to finance higher education and job training.

“Workers are trapped into shadow student debt with promises of on-the-job training, and this ensures that they will face significant financial consequences if they want to find another job,” he said.

What’s Changing?

While TRAPs contracts are still widely used in various employment sectors, there has been a growing trend to curb their use. In 2020, California passed a law requiring acute care hospitals to reimburse employees and job applicants for certain training costs. California state lawmakers also are considering a new law that would prohibit a broader range of employers from imposing any penalty, fee, or cost on an employee or independent contractor for terminating the employment relationship.

New York is considering similar legislation, including a NY Assembly bill and a companion NY Senate bill that would prohibit the use of employment promissory notes.

Despite such efforts, about one third of employees in the private sector are bound by TRAP-like contracts, Hicks said.

In the early days of the pandemic, Colin K., RN ― who requested that his full name be withheld for fear of repercussions ― accepted a nursing position in a hospital emergency department in Fredericksburg, Virginia. The job came with a $15,000 signing bonus, which made the offer very appealing, Colin told Medscape.

He had to stay on the job for 2 years. If he quit or was fired before then, he would have to pay back the amount, prorated for time worked. “It seemed like a good job, and I didn’t see a problem staying for 2 years.”

But working conditions rapidly deteriorated during the pandemic, he said. Equipment and supply shortages along with a lack of training in the treatment of patients with COVID put nurses at risk, and Colin left the job within 6 months. “I didn’t think anything of it, and figured that they had forgotten about it,” he said. “And then I received a letter from a lawyer that I was being sued for about $12,000 — my prorated amount — for breaking the contract.”

Colin worked out a payment plan with the hospital lawyers to pay $1000 a month for 3 months. But the hospital then sent him a subpoena that requested $8000, which he has since paid.

The Federal Trade Commission’s (FTC’s) proposed regulation that would ban employers from imposing noncompete agreements could also include TRAPs, Hicks said. He’s hopeful the FTC will approve the ban and that other states will follow California’s lead in prohibiting the restrictive employment agreements.

Roxanne Nelson is a registered nurse and an award-winning medical writer who has written for many major news outlets and is a regular contributor to Medscape.

For more news, follow Medscape on Facebook, Twitter, Instagram, and YouTube.

Source: Read Full Article