Difficult assignment

[perfexion, ASN, RN]

I just took an assignment in a high risk labor and delivery unit. I've done high risk before but never like this. I should've known something was wrong when two other travelers who started with me quit their first week. All of the patients have either drug addictions, uncontrolled chronic diseases or their babies have anomalies I've never even heard of before. Half of them have had no or limited prenatal care. They're sicker than any patients I've ever cared for in my entire career. It's almost like an ICU for laboring mothers. There are almost no patients who are just normal full term, uncomplicated pregnant women having babies.

I keep getting red flagged and called into the office for things and I'm worried. For instance I've never worked in a labor and delivery unit where I had to do neuro checks every hour or head to toe assessments more than once a shift. I'm nervous that I'm either going to get terminated or I'm going to break and quit also. What can I do as a traveler to get help with a difficult assignment? The management is really not on my side, there aren't many regular staff (and they all seem to be hanging on for dear life themselves) and the other travelers don't really help, they just keep telling me to watch my back. Who do you turn to as a traveler if you need help?

[NedRN]

Tough situation! I would keep your head up and make the best of it. The longer you survive, the stronger you will be. Try to meet their protocols and if you cannot, know that you gave it your best shot.

This sounds like a good learning situation. That would be my takeaway. When you get such patients in the future, you may be the best prepared nurse, and find care easier than the other nurses.

13 weeks.

[aamy]

Talk to your recruiter and let him/her know your concerns. A friend of mine who travels (I travel as well), found herself in a difficult situation and actually terminated her contract. There were actually no hard feelings between the nurse and hospital because the hospital knew they were in the wrong (she got absolutely NO orientation...not even a day). The patient load was ridiculous, etc. She felt her license was at risk. If you feel your license is at risk, I would not hesitate to break this contract. Before you do, make sure you have documented what you have done to try to correct the situation (talk to recruiter, manager, etc). NedRN is right, it will make you better prepared in the future, and make you stronger, but is it worth the risk?

[Michi66]

My agency has a director of nursing who reached out to me before the assignment started. Her job is to provide clinical support like your situation and I think she can be reached almost at any time. I agree with aamy, reach out to your recruiter and agency for support. The earlier they are aware of a potential situation, the more they can be prepared and avoid any potential bad outcomes. I'm on my first assignment and like my recruiter and agency, but at the end of the day, it's in everybody's interest for you to finish you assignment, so I'm guessing their advice would be to "have a positive attitude" and stick it out. Good luck! That sounds like a tough situation but you can get through it! One hour at a time and don't work 3 shifts in a row :).

[NedRN]

The DON at large agencies is not really there for traveler support. They are a risk manager to evaluate and boot nurses for any reason that might damage the agency's relationship with the client. Just like your recruiter, her loyalty lies with the agency. Do not treat them as friends and allies, they are most assured not!

A professional and cordial business relation with your agency should be your goal. If you start treating them like friends, you will start talking to them like friends and relate personal and professional details and gossip. No good can come of that.

An agency DON can occasionally intervene on behalf of a traveler but those situations are very rare. Most of the time a hospital will (as they should in fact) back their managers over a traveler no matter who is "right". Nothing can be done at that point.

Most times I disagree with keeping your agency informed. Travelers need to view themselves as the professionals that they are. We need to utilize the hospital chain of command just as any other staff nurse would. We are contract employees of the hospital, our agencies are just paper shufflers. They are not equipped to help us with professional problems and only the larger agencies even use nurses in the office.