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advice on first time acute care travel experience please!


I've been working in a SNF/ subacute rehab for 2 years now and landed my first travel nurse agency position at a medsurg tele in a community hospital. yes, community meaning barely any nursing aides and no phlebotomists! only 4 hours of orientation and I was on my own on DAYS! biggest mistake since its so busy. I thought i was very confident with my skills, assessments, labs, etc.

1st day, i had one patient that started on amiodarone drip fixed rate that was already hung, plus x2 IV ABX going on multiple iv sites d/t incompatibility. he had to go down for TEE to check for vegitation ( which I had to look up). 2nd pt went down for an angiogram and I was still getting used to their paper charting and orders since im use to using PCC that I missed having to notify the pt's team when pt arrived back from surgery.

2nd day was a little better in getting orders done and carried. except for no nursing aides and I had two patients total assist and on restraints. still learning their policies and documentation on restraints but I felt i hurt my back providing pt care bc it was so hard to find and extra hand to change pts. especially when an orthopedic surgeon decides to come in at 1830 end of my shift to remove a cast from a RBKA revision and blood soaked everywhere on the bed sheets and I had to change pt and bed all by myself even when I asked the charge nurse for help.

3rd day was the worst! 4 patient load 2 total cares and 2 patients on the call light, no nursing assitatnt. One patient was going crazy tachy 150- 170s d/t to his afib and tried paging the team numerous times, was able to get help in drawing cardiac enzymes did a 12 lead provided stat digoxin extra dose after am dose, IV lasix (my first time) d/t possible fluid retention. WORST THING- order to start on amiodarone titrate with loading dose ( i have never done) , another nurse ended up hanging it up for me close to end of shift because I was catching up with my other orders and medications and STAT lab draws. when giving report realized amiodarone drip was running at the wrong rate ( lower dose) and labs were not drawn prior to giving amiodarone. the nurse who hung it was not able to clarify with me on what she did before she left. luckily patient was okay, no adverse reaction but I am soo scared of losing my license. to ADD on I didnt have time to follow up on labs bc I dont have access to the computer and have to wait for everything to fax back from lab.

I know I always try to ask for help and I am contracted at the hospital for a couple more weeks. even though I cried every day since I started, I have learned so much in those three days and am willing and eager to learn. I always try to be safe and look up everything before giving medications but because I am unfamiliar with some of the meds and procdures, i fall very behind. I need advice on what to do, stick it out or break my contract ?


Specializes in NICU.

Wow, sounds like you are on a very busy med-surg floor and have had some terrible days. We have all had days like that, but if it continues to be this physically and mentally straining, you can be on a quick road to burnout. You need more help. I am not a traveling nurse but am a float nurse so I know what it's like to be the outsider. One thing that took me a long time to realize was, if I don't learn how to ask for help when I need it, I would not be able to do this job. Usually, but not always, the float nurse or outsider gets the heavier patient load. When you are in the thick of it and have several important things to do at the same time and notice someone sitting at the desk, just go up to them and say, "Hey you guys, I am having a really hard time right now and I have two critical things that need to be done at the same time. Can you please give me a hand?" You need to ask other nurses to help with lifting transferring. Not acceptable if they can't help you with this. You already said you hurt yourself physically but you don't want to hurt your back so much to the point that you can't work at all.

If they are not able to help for whatever reason, you may need to talk to the manager. Everyone on the floor, even the float nurse or the traveling nurse, should be seen as part of a team. The other RN's may not know that you need help. If you reach out to them and still don't get any help, and after talking to the manager, it may be worth it to break contract. This sounds dangerous what your doing right now. Something has to change. Good luck!

Esme12, ASN, BSN, RN

Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma. Has 41 years experience.

Are you monitor trained and certified? Do you have ACLS? Do you have malpractice insurance?

You are in a little over your head. Sounds like you did a good job considering the circumstances.

Seriously all nurses should have malpractice insurance it will offer license protection.

JustBeachyNurse, RN

Specializes in Complex pediatrics turned LTC/subacute geriatrics. Has 11 years experience.

Why would you accept/your agency place you in an acute telemetry unit when your most recent experience is in subacute rehab?

It sounds like you are way out of your skill set and comfort zone. Have you spoken with your agency recruiter or the nurse manager?


Specializes in Flight nurse, flight medic, ER, ICU, NP school now. Has 20 years experience.

Stick it out, you'll be a better nurse for it. Take a deep breath, prioritize, and try to relax.

Wow! Thats what im worried about my SNF experience too...there's really more action going on in an acute care setting and to adjust from a sub to acute can be nervewracking. I would suggest for you to stick it out. A med surg experience will land you better opportunities in the future. If in doubt, always ask...it's hard to put your license at risk.

I don't understand you describing the first three days like it just happened and finally say you only have a couple weeks left? You have been there over 10 weeks and still feel like you are under water?

Otherwise, I concur with the other comments here. Stick it out, ask questions and request help when appropriate and you will become a much stronger nurse. The acuity sounds a little high, but your license is not in jeopardy. If you are really just describing three days, the acuity should level out or you will find out how other nurses handle it. If really are at the end of your assignment, you should know what to do next (get a staff job from the sounds of it).

icuRNmaggie, BSN, RN

Specializes in MICU, SICU, CICU. Has 24 years experience.

From now on you need to say: I do not have telemetry experience. I have never done this before. My background is LTAC and rehab.

I would respect you for being honest and if you are a good worker I would adjust the assignment. Go find a nurse where you work, the one you want to be like and ask for her advice. She might say something you don't want to hear like I am not comfortable with you taking these patients, or she may choose

to be your unofficial mentor.

The recruiter had no business submitting you for this position without at least one year of telemetry experience. Make an appointment to talk to your manager and be honest about having no telemetry experience and that you know that you are not qualified to take care of the unstable patients or patients with IV drips. Maybe he or she can find you a safer situation within the hospital.

I am ACLS certified, but not monitor trained and certified. I am definitely looking up a class as we speak.

the Manager that interviewed me failed to tell me that most of the patients were on tele and no phlebotomists.

I spoke with my recruiter requesting at least a full shift orientation, to at least get used to all the paper charing and orders

it was my first three days on the floor out of my 4 week contract with them. only having 4 hours of orientation

Wow, failure by all three parties here to properly qualify the candidate. In no way should you have ever been allowed to take a four week contract. I'd be very interested to see the profile your agency sent this hospital. Some agencies doctor profiles to make travelers such as you employable. Did you save a copy of your skills checklist? See if you can compare it to what the hospital received before you go. If it is different than what you did or remember you did, the agency needs to be drummed out of business and you need to let the hospital know.

It is too late for classes, and frankly, you do not need help with rhythms if you actually prepared well for ACLS. There is a monitor tech or nurse watching at all times right? It is great if you can spot developing issues at a glance, but you don't have time like an ICU nurse to watch monitors. What you need is actual experience with these kinds of patients and a four week assignment is a recipe for failure. Four week assignments should only be taken by experienced travel nurses well grounded in their specialty. You are neither.

I don't know what to suggest now. The best thing from what I've heard now would be to bail now. If you believe professionally that patient safety is compromised because of your lack of experience, you absolutely should bail, to do otherwise indeed puts your license in jeopardy. If you feel like you can prioritize properly and practice safely (letting unimportant care and charting go), try to hang in there. You may get fired, but that's life. Do not bail in the middle of the shift, that is patient abandonment. Either way, buy malpractice insurance now! It might be a low risk, but should you be reported to the BON deservedly or not, it would be good to have paid legal representation for license defense.

Never again take a short assignment until you are a seasoned traveler no matter what they offer. I'm assuming this one is paying very well, and the hospital may well be horrible. These are called rapid response assignments, and they pay well for a reason. Please tell us who the agency is after this is over.


Specializes in ICU/PACU. Has 10 years experience.

The nurse manager, the company and you as a traveler are all to blame here. It's irresponsible and not safe for you to continue working there. Just my two cents. I would quit.

Wow, I agree with most of these responses. You are definitely way in over your head. You never should have even been considered for this position without any previous tele experience or even true med/surg experience. I also agree all parties involved are to blame, but the top priority here is YOUR license! Sounds like very dangerous situations for you as well as your patients. Amiodarone drips are NO JOKE and the fact that you have never given IV Lasix before this concerns me even more (more so because IV Lasix is very common). Honestly I would get yourself out of this situation and either stick with strictly med/surg or get a staff position to gain further experience. Best of luck to you!

wow, I swear I must be at the same hospital and same unit as you! Also my first travel/registry assignment. I am also wondering what to do.....

I have 10mo experience on night shift on a busy med-surg (some tele ) floor, and my preceptorship was in a cardiac heavy ED, so I feel pretty ok with the tele aspect of the unit, I know the meds, etc. but that is about all I feel ok with. I dont understand their weird weird 2 chart-file folder-charting system, it makes no sense at all. no one warned me there are NO PHLEBOTOMISTS. I had 4 hours orientation and I dunno...have to work my second shift tomorrow and I am feeling not good about it. The freaking charts, chasing them down, trying to figure out how the process for blood, how things are done, the forms for typing and crossmatching blood etc .everything takes SO LONG, so I my first day I got incredibly incredibly behind, even though doing actual nursing stuff doesnt take me a long time.

What have you been doing--are you sticking it out or what? Also, how did you ask for a longer orientation? People looked at me like I had 3 heads when I asked for lunch, so I am not sure how a longer orientation will go over....

NedRN i saw you wrote: "

Never again take a short assignment until you are a seasoned traveler no matter what they offer. I'm assuming this one is paying very well, and the hospital may well be horrible. These are called rapid response assignments, and they pay well for a reason. Please tell us who the agency is after this is over." Could you elaborate please? I wish I knew before! I won't, but I didnt know that. (and for me at least, it is NOT paying very well. I just moved back to california, it was just the first assignment I was offered and I needed it

You are finding out the hard way why they took someone who has less than a year of experience. Wherever you are is not a place an experienced nurse would want to go, especially if the money is not so good. You and your agency, and the hospital did not have the judgement to not hire you. At least you are the innocent, not enough experience to know better.

Rapid response assignments are for hospitals with critical needs, or those distressed hospitals who cannot get travelers unless they pay a lot more. Remember King Drew for example? The bill rate is higher, the travelers are paid more, and usually earn it! Often they are for 2 to 8 weeks compared to the much more leisurely standard assignment of 13 weeks. Even more than a regular traveler, rapid response travelers should be well seasoned and able to hit the floor running with minimal orientation. Sometimes such assignments are OK, but the need is what dictates the pay.

I don't know if you are at the same assignment as the OP, but hiring a 10 month nurse is highly suspicious of some real issues. You would do yourself a big favor by looking for a staff job at a less troubled hospital. It should pay better than a traveler normally makes at most any hospital in California. Bail if you find a staff job, you will be better professionally, and so will your patients (to be blunt). Don't worry about penalties and threats from your agency (I'd love to know the name of yours too).

When your assignment is done one way or another, I would suggest contacting one of the many law firms in California that you can find with a simple search online who specialize in overtime recovery. If you are not being fully relieved for a meals, I'd bet you are also not getting fully relieved for breaks either. Labor law in California mandates you are paid a full hour for every missed break, or one in which you were not relieved. That will be on the bill rate, so probably between $65 and $75 an hour. That will be a nice tidy sum, especially if as is likely, the law firm takes it to class action. Keep copies of your time sheet, keep daily notes, and grab a staff contact sheet so other's will prosper from this hospital's mistreatment (and for other witnesses).

Sorry you guy's first assignments are so bad, frankly I have never heard of hiring unqualified nurses for travel assignments apparently so deliberately. 4 hours of orientation for a 10 month nurse should be criminal for both the agency and the hospital. Often orientation at a new hospital for 13 weeks can drag on (in the traveler perspective) for over a week. Sometimes just the computer orientation can last close to two days.

Thank you so much. Interesting. Thank you soooo much, I really appreciate the information.

I told my recruitter person I would feel much more comfortable if I had additional orientation time, and she told me I could ask the nurse manager. (I am thinking that is a no)

Yea, I am seeing some issues with this place. I moved out of state (i'm from CA) because of the job market. I came back to CA after when I signed up with the agency.

I am just wondering what my options really are. I mean, I am not overwhelmned in the acuity or anything. But I dont get their 'system' so i am worried there will be orders for me to carry out, sitting in some file cabinet that was never shown to me. They still use file cabinets. They have absolutely nothing computerized. it is weird. oh well.

I dont know if i am just overwhelmed because it was my first day as a 'traveling' nurse, or because I am over my head and out-of-my-league, or because this place specifically has issues...

The first day can be rough, period. And you have no way to compare. But you need to ask questions. You absolutely need to know where the orders are found. Some systems can mix them up a bit, even to having orders appear in a narrative. Any signs of disorganization may be real, and dangerous. Sometimes even the secretary (if you have one) can be very helpful. Aides, etc, don't alienate anyone ever, especially before you get oriented - almost anyone can be an ally.