How are travelers oriented/viewed in your unit?

[iyqyqr]

After 26 years in NICU, and 13 years at the same last unit(I had worked in 8), I was feeling stagnant and insignificant and knew I did not want to end my career on this note. I decided to experience travel nursing (we don't use travelers in my home unit) to see what it was like and to find out "if I had the stuff". I took a $10/hr pay cut to do this and have a huge mortage at home. I'm traveling to look at practice, design, and developmental care and to serve in the units I visit. I am now in my third unit at one of the top NICU's in the country and I have real concerns about how orientation is done and just how travelers are received.

As travelers, once we are done with our 2-5 days of required general hospital orientation, we then get two 12 hour shifts on the unit with a mentor. As experienced, (hopefully!),NICU nurses we know the pt and the conditions they present with, what we need to get down in those two days is your system, charting, where to find stuff, who to call, and identify who to go to with questions. Finding a friend to eat with would be a real plus! So it makes sense to me to pair me with a nurse who is good at communicating the above and give her a patient load that facilitates this. Then, when I fly solo my first few shifts, I would also hope to have a sane assignment, which doesn't mean 3 feeder/growers, but rather a stable vent or two, so I can pull my great orientation into my practice and get my feet on solid ground.

This is how I experienced things in one unit with helpful staff who made it clear they were glad I was there, so they wouldn't have to work as much overtime. The other two units were vastly different! My mentor either had the sickest infant, who coded at the end of the shift, or my mentor was asked if I could take the new 23 weeker on my first night solo, or I was assigned what would be considered a horrible assignment in my home unit ( and was in this unit also.) I have been told by other travelers and by unit staff that this is done deliberately to 'test' the traveler . . . "sink or swim", but I don't see the value. It is not safe for the pt, not reassuring for the family, and to me, smacks of "slapping the hand that is there to help you." I would like to challenge any NICU nurse reading this to be dropped into my home unit and be at the top of their game and without angst and have mastered a new computer and med system, new protocols,

new ways of pain mgmt, etc in two days!!! What the unit we go to does not realize is that there are 10 different ways to approach preemie care, as is clearly evidenced from posts in this forum. So when I say, "how do you do this here?" , it doesn't mean I am ignorant, it only means that I want to do it YOUR WAY and understand why you chose it?

So, my friends, if you work with travelers tell me how you orient, and how travelers are viewed in your unit. I really want to put my best foot forward wherever I go. I may end up in your unit and I hope you receive me well and beg me to stay!!

[SteveNNP, MSN, NP]

I've only worked here for 8 months, but from what I am told, we haven't used travelers for years, up 'til now. We currently have 4 for our ADC 70 unit. They were given computer charting orientation and 2 shifts. All are extremely competent and adapted easily. They have been taking the same sick vents and preemies that all our non-cardiac inclined nurses take. We all appreciate that they are here to let off some of the pressure we've been under during a continual high-acuity, high census situation. I haven't seen any problems. I hope they all stay on, though they are all getting pretty sweet deals through their company.....

[NebraskaRN]

We use travelers when we are busy in the summer. Travelers can be great and a relief to see, but we have had some travelers that were not a relief and made more work for us because we had to watch them and do our own work. We actually had a traveler that wanted to watch t.v. on the overnight shift. Therefore we love to have travelers on our unit that are compentent and want to work but when we get travelers we have to feel them out. Furthermore our travelers get 2-5 days hospital orientation then a week of unit orientation and a resource nurse to go to with questions. And all of our travelers have to fill out a compentancy tool and have it signed off to go solo.

[MA Nurse]

I think hospitals figure that as a traveler, you should be able to take an assignment quickly because you have a lot of experience. I don't do travel nursing because I have a family and I wouldn't make as much money...also I wouldn't want to be just thrown in there to sink or swim...I don't think it's right...but usually the units who use travelers are short staffed and they need you to help ASAP.

Frankly, I'm surprised at the amount of travelers who leave their state to work in one where they'll make a lot more, but they leave their family behind.

[RainDreamer, BSN, RN]

We don't use travelers anymore.

When I first started working there 2 years ago, there were a ton of travelers. They were great. They each got 3 days orientation, which included the computer charting and everything else. Quite a few of them actually ended up coming on as staff.

Now we are very well staffed and there is no longer a need for travelers. But when we had them they were great and everyone loved having them ..... well except the one that came to work drunk

[preemieRNkate, RN]

well except the one that came to work drunk

OMG! That probably doesn't go over well!

We don't use travelers much. About 2.5 years ago we had 2 Korean agency nurses who came and they had a 2 year contract. I don't know what kind of orientation they got as far as the general hospital one, but once on our unit they got pretty much a full orientation. Our biggest concern in the beginning with them was their English-speaking skills. They were great nurses, and we all miss them since they left.

[Gompers, BSN, RN]

Our travelers and agency nurses are treated about the same - before they can come to our unit they have to go through a 2-day hospital orientation which includes classes on computer charting. If it's a traveler we'll do 2-3 shifts of orientation - one with a feeder-grower assignment, one with a regular assignment (stable vent and a level II type kid, for example), and then one with a sicker baby. That way they learn who to call, where to go for what, and how our general routine goes. Agency nurses don't get any orientation - we put them with the feeder-growers from the beginning. If they come to us a lot, and there are a few who have become like staff members, they can ask for sicker babies and more responsibility. But we would never throw either a traveler or an agency nurse into a dangerous assignment!!! Why would we do that to our babies? Just for spite? I know some units give their travelers and agency nurses horrible assignments, saying they have to "earn all that big money" they make and such. We would never do that because it puts our patients at risk. If anything our travelers and agency nurses get BORED because they get all the feeder growers and chronics. But if we get to know them and are comfortable in their skills, we'll give them sicker and sicker kids. But we'd never give them admits or anything like that.

We're all there to take care of the babies as best we can. I hate when politics gets in the way.