HCA Ends TRAPs Forcing Nurses To Repay Training Costs

4 Min Read Published May 19, 2023
HCA Ends TRAPs Forcing Nurses To Repay Training Costs

Source: NBC News

Imagine receiving a $10,000 bill for your employer’s hospital orientation. Unfortunately, several nurses have faced this reality after resigning from their inpatient jobs due to poor working conditions, such as understaffing. 

NBC News recently investigated nursing contracts from HCA Healthcare, the nation’s largest for-profit hospital chain, which required nurses to pay back the cost of training if they left their jobs before a two-year contract term. 

The organization announced last week that it will no longer include these provisions in its contracts. 

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HCA Healthcare Criticized For TRAPs

On May 9, NBC Nightly News reported that HCA required nurses to sign two-year agreements that would put them thousands of dollars in debt for resigning early. 

HCA is not the only health institution that employs this type of contract clause. Incidentally, nurses have taken to TikTok and social media to expose hospitals that charge nurses for quitting early. 

However, HCA’s use of payback provisions is noteworthy because HCA has recently been criticized for understaffing and bad working conditions. 

One union study found the hospital network’s staffing levels were below average compared to other hospitals in 19 of the 20 states where it provided care in 2020.

HCA employs 284,000 people in 182 hospitals and 125 surgery centers across the US and the UK.

Are Repayment Clauses “Indentured Servitude?”

According to NBC News, National Nurses United (NNU) surveyed over 1,700 nurses and found that hospitals used these contracts to staff the worst shifts with the sickest patients.

“We see these contracts as a form of indentured servitude,” said Brynne O’Neal, a lawyer and policy specialist at NNU, the largest nurses union in the country. “It’s requiring people to work out a term based on debt.”

According to the Student Borrower Protection Center, these Training Repayment Agreement Provisions, known as “TRAPs,” are the latest way employers use contract provisions to trap workers into jobs with poor working conditions. 

Bree Fellows, RN, a Labor and Delivery nurse in Utah, spoke out in the NBC report about her experience in an HCA TRAP. She said that she was bound to a two-year contract but had to resign in her sixth month of pregnancy because her facility wouldn’t move her to the day shift. 

Soon after, she received a letter demanding her to pay back a $10,000 bonus plus almost $6,000 in “training costs.” Bree and her husband obtained a new credit card to pay a $14,000 settlement to the hospital. 

Source: NBC News

Investigators reviewed over a dozen nursing contracts and spoke with healthcare professionals about repayment. They discovered that the practice had become increasingly prevalent, with some hospitals demanding nurses to pay back as much as $15,000 for training if they quit or were fired before their contracts expired.

According to NNU, 55% of new nurses who participated in a training or residency program said they would have to repay employers for orientation and training as part of a contract if they departed or were dismissed early. 

How HCA and Hospitals Justify Repayment

Employers who support these payback contracts claim that they protect their investments in nursing education and offset the costs associated with high turnover rates. 

“Given our substantial investment in this professional development program, we ask participants to commit to staying with us for a certain period after completing the training,” said a spokesperson for HCA. “During their commitment, nurses are eligible for promotion and have the flexibility to pursue opportunities at any of our more than 2,300 sites of care across the country.” 

The HCA representative said that their training programs were developed by nurse educators as “an important investment in our colleagues and demonstrate our commitment to the nursing profession.” 

Other hospitals that use repayment contracts hope to encourage commitment and discourage frequent job changes by instituting a financial deterrent.

Nurse Unions Respond to Repayment

On the other hand, critics are concerned about the strain on nurses. The financial obligations connected with repayment conditions can be significant. Furthermore, they potentially compound the financial difficulties that many nurses already face, such as student loan debt and a reduced starting income. 

According to opponents, such contracts limit nurses’ professional alternatives and create a sense of entrapment and exploitation. “With debt hanging over their head, a nurse has a much harder time speaking out,” O’Neal explained. 

Repayment programs can have far-reaching consequences for the nursing profession and the healthcare system. Potential implications include:

  • Increased job dissatisfaction.

  • Poorer morale.

  • Burnout.

  • Higher turnover rates.

  • A worsening of the present nurse shortage.

“These contracts are bad for nurses, and they’re bad for patients,” said O’Neal.

HCA Announces End to Repayment 

In a statement to NBC News, HCA said it has decided to stop using repayment terms in its nursing contracts. “Despite our substantial investment in the training and professional development of new graduate nurses, we recently made the decision to no longer require a work commitment.”

However, it declined to comment on the enforcement of already signed contracts and reimbursement for nurses who have paid. 

The Federal Trade Commission (FTC) recently proposed a rule that would ban employers from using TRAPs to charge departing employees with unreasonable training costs. The rule was open to comment until April 19th, and the FTC is currently reviewing the findings.

Sarah Falcone
Sarah Falcone
Nurse.org Contributor

Sarah S. Falcone, BSN, RN, is a nurse and health content writer in Fort Worth, TX. She has worked in various settings, including Med-Surg and L&D, but home health has her heart. Sarah is a passionate advocate for moving advanced levels of care to the home, where her clients can safely receive medical treatments they need, with greater satisfaction and comfort. She focuses on patient experience, outcomes, and advancing clinical models using innovative technology to serve patients better. Sarah draws from 15 years of practicing patient care and nursing leadership, to share her own nursing experiences and expertise online. Connect with her on LinkedIn!

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