MEDICAL RESTRAINTS

How health care companies use debt to trap nurses on the job

- Mark Betancourt

AFTER GRADUATING from a Denver nursing school in 2016, Neil Rudis knew the real training wouldn't start until his first job-ideally in acute care at a Level 1 trauma center treating the sickest and most injured patients. So he was excited to sign on at the neurological intensive care unit at University of Colorado Hospital, the flagship facility of one of the state's largest and richest health care employers. His contract included a catch that's become common for new nurses: If he quit or was fired before a year on the job, Rudis would have to repay UCHealth up to $7,500 for training, with any debt accruing 12 percent annual interest. The arrangement is called a Training Repayment Agreement-critics add the word "Provision" to round out the acronym.

Rudis focused on what he thought he'd learn, and not the position the deal would put him in. "I definitely want to go into a TRAP," Rudis remembers thinking. "I've heard such good things." But within months, his excitement turned to anxiety, as he came to worry that the ICU was short-staffed. Nurses assigned to instruct him kept getting pulled away, leaving him alone with patients before he felt ready. "I'd come out of the room trying to find somebody," he recalls, "and there's no one available." The hospital ended his training a month early so he'd be freer to work and help fill its staffing gap. When supervisors asked Rudis to teach the hospital's new nursing recruits, he told the trainees he was still learning, and they'd have to figure things out together.