A nursing offer letter is a legal document. Most nurses sign it within 48 hours of receiving it without reading every clause. That's how hospitals end up paying back bonuses they spent, stuck in units they hate, or blocked from working locally after they leave. Here are the 10 clauses you need to check before you sign anything — the same 10 we screen for in the free Contract Red Flag Audit.
1. Non-Compete Clause
Restricts where you can work after leaving. Watch for radius (anything over 25 miles is aggressive), duration (over 12 months is aggressive), and whether it applies to "all healthcare entities" or just direct competitors. Many states now limit or prohibit these entirely.
2. Sign-On Bonus Clawback Terms
Almost all sign-on bonuses require repayment if you leave early. The red flag is when repayment is calculated on the gross amount (before taxes), meaning you pay back more than you received. Always negotiate net repayment.
3. At-Will vs. For-Cause Termination
At-will means the hospital can terminate you for any reason, any time. For new grads in orientation, this is especially dangerous — if you're let go before completing orientation, you may owe back your sign-on bonus with nothing to show for it.
4. Floating Clause
Does the contract specify what units you can be floated to? A float clause without limits means you can be sent to any unit, including those outside your training or comfort level. Push for "float to similar acuity units only" in writing.
5. Mandatory Overtime Language
Check whether overtime is voluntary or mandatory. Some contracts include language requiring you to stay for additional shifts during "critical staffing situations" — undefined and unlimited. Get mandatory overtime policies in writing and negotiate caps.
6. Shift Differential Rate
Is the shift differential locked into the contract, or just referenced as "current policy"? "Current policy" means they can change it anytime without your consent. Get the exact dollar amount or percentage per hour written into your offer.
7. PTO Accrual and Carryover Cap
How much PTO do you accrue, and is there a cap on carryover? Some hospitals implement "use it or lose it" policies that forfeit unused PTO at year-end. Others cap accrual, meaning you stop earning PTO once you hit the maximum.
8. On-Call Requirements
Is on-call paid? At what rate? Some contracts bury mandatory on-call shifts into the job description with no additional compensation or only a nominal standby rate. If you're in a specialty like OR or Labor & Delivery, this is critical to negotiate upfront.
9. Arbitration Agreement
An arbitration clause waives your right to sue the employer in court. Instead, disputes go to a private arbitrator — often favorable to the employer, more expensive to pursue, and without a jury. Ask that it be removed, or at minimum ensure you can still file complaints with state nursing boards.
10. Unit or Schedule Guarantee
Were you told you'd be on the night shift ICU? Get it in writing. Verbal promises about unit, shift, and schedule aren't enforceable. If it's not in the contract or a written addendum, it doesn't exist.
Run your offer letter through our free Contract Red Flag Audit tool — it walks you through all 10 of these clauses with Yes/No/Red Flag responses and generates a personalized risk score.
If you find red flags, the Free Contract Audit Kit gives you the exact email language to push back on each one.