Decrease in acuity with travel nursing?

[guest4/24/17]

I have been travel nursing in the ICU for a year now and I notice the acuity has gone significantly down since I left my main hospital in Philadelphia. I have always chosen large teaching, level 1 trauma facilities because I love the acuity and working with the sickest patients.

Since I've traveled I notice I don't see as high acuity and when there are these high acuity cases, they don't get assigned to travelers -- fresh CABG, CVVH, fresh liver tx's etc.

Do you guys seem to notice the same trend? And if so do you hang up your traveling shoes and take a permanent position to work with the best cases? I'm starting CRNA school in the fall and I would like to be at the sharpest of my clinical skills. While the pay has been great, my ICU skills have definitely taken a hit.

[NedRN]

Write it off to human nature. Let's say you are running a high acuity unit and have key staff you have worked with for years and trust. Who are you going to assign to the most vulnerable patients? The traveler has been there for a couple of weeks, or trusted staff who has been there for years? Teaching hospital? That goes double, trusted staff are orienting newer staff on high acuity patients. Travelers get the leftovers.

Nothing the least surprising here. It actually speaks well of the pipeline of new nurses to staff pipeline and is a sign of good health.

That said, if you have a high acuity specialty, like open heart recovery, there are plenty of assignments where you will get fresh hearts. Still, no matter how good you look on paper, you may have to prove yourself first. The places you don't have to prove yourself are the places you don't want to be as a patient.

[guest4/24/17]

That's a good point. I guess I looked at it like hospitals hire travelers because they are experienced, proven nurses so they can have the tougher patients.

I was at a facility where they wouldn't give travelers any high acuity patients to the point where the assignments were completely skewed. I felt terrible watching the staff running around with two heavy patients while I had two patients waiting for floor beds. If I had been told about this during the interview I would not have taken the assignment.

[NedRN]

Your negatives may not be other travelers. No one will volunteer your negatives in an interview, how would they know? Up to you to identify what is important to you in an assignment, and structure your interview questions accordingly. Also, in the scenario you describe, help with those acute cases. Your coworkers will appreciate it, and it will be noticed. That is one way to build trust and get assignments rotated more equably.

On the few occasions where I got a country club assignment, I've been delighted at the change of pace. I've had two where I worked less than 20 hours a week. (operating room) Kept one of them for eight months. Big social life.

There are different aspects of traveling, and you can simply switch if one doesn't work out. Assignment from hell? Or boring as heaven? Start looking at the community, things to do, and sights to see. Professional development is all well and good (also a large part of the reason I became a traveler), but it cannot be the only reason to change housing every three months. You have to like the lifestyle. Focus on that when your workplace fails to meet your expectations.

[guest4/24/17]

Very good points. I always volunteer my help as it definitely helps transition into the new unit. Thank you for the input, I will start looking at other aspects of traveling that can help with my assignments.

[preemiepoweredRN]

Totally agree with what's been shared. As a current traveler, I feel your pain related to having less acute patients than you're use to, but none the less I wouldn't trade the experience for anything in the world. You have to appreciate and learn what you can, even in your stable, "simple" patient assignment. You really can learn something new everyday.. Maybe you have more time to brush up on reading, or studying for certifications, or just being a help to the other nurses around you. I've found over the last few assignments the best way to "prove yourself" is to help the other nurses on the unit and make yourself available. Everyone likes a team player. Another thing that I did personally the last 2 assignments (not that it always works but) I went to the charge nurses I worked the most with and discussed how "although I'm willing to work where I'm needed, I would prefer to work with higher acuity patients"- and it worked. I got a chance to work with these patients when it worked out for the unit..keywords: when it worked out for the unit. It's a trust game; they don't know you or your skill set ( nothing more than what's been presented on paper and most of the time the charge nurses don't even have time to read them). The biggest thing is not to become bitter-its only a temporary assignment and if all else fails, you just go back to a staff position.