Travel Nurses, The Good, The Bad, And Sometimes Ugly...

[mmc51264, BSN, MSN, RN]

With all that has happened during and after Covid, travel nurses have become the norm. I am struggling with the wide range of experience and behaviors. We have about 10 travelers on my unit right now and most (>80%), but there are a few that, quite honestly scare me. 

How do you all deal with it? Also, travel nurses, is if difficult to learn policies and protocols at each new facility? Personally, I could not do it. Kudos to the ones that are AWESOME! 

[Davey Do]

2 hours ago, mmc51264 said:

there are a few that, quite honestly scare me. 

You and me both, mmc.

The way in which I dealt with them, as charge nurse, was to not assign any task which proved their incompetence.

I have said such things as, "You're an RN, so you can deal with it". This was said to one RN who passed by a patient's room where the IV was beeping and came all the way to the NS to inform me.

Another, once while I was passing meds, told me that a patient was having difficulty breathing.

[JBMmom, MSN, NP]

We have had travelers in my critical care unit for just about all of the four and a half years that I worked there. They have ranged from absolutely fantastic to completely inept. We had one that walked off during a break and never came back, one that couldn't recognize VTach on the monitor of their patient, one that said "I'm not very good at pulses" during CPR (while backing away from the patient), those that couldn't insert foley catheters, didn't know how do some basic stuff, and we just have to deal. It's especially annoying as charge when you feel like you have your own patient assignment but have to hold the hand of the nurse making more than twice what you are. I understand why people would travel, and I'm grateful for the good ones. But I really wish there was some sort of actual competency requirement to travel. Anyone can find someone to write a recommendation (even if only to get someone out of the unit), but it's really not what's best for patients. 

[mmc51264, BSN, MSN, RN]

Agree with this!!!

[byebyebedside, BSN, MSN, RN, NP]

I have only done one travel assignment but I think the same question can be applied to working at different facilities as a per diem RN in the last year of my career. Keeping track of the different policies can be difficult, however I worked at a lot of facilities that prided themselves on evidence based practice so the policies weren't that different from what I was used to.

For my travel assignment, I personally found myself frequently appalled at how they did things, how many unsafe/outdated practices they used and how infrequently they checked in on me as a travel nurse. I took it upon myself to look up policies and procedures and ask the charge nurse for help directing me to the proper resources when necessary. My preceptor did say they have had travel nurses with 10+ years of experience but their skills did not translate to that particular NICU. A lot of the travel nurses I met were very confident and comfortable doing things "their way" and that is always concerning. 

[HarleyvQuinn, MSN, RN, NP]

On 9/21/2022 at 12:09 PM, JBMmom said:

We have had travelers in my critical care unit for just about all of the four and a half years that I worked there. They have ranged from absolutely fantastic to completely inept. We had one that walked off during a break and never came back, one that couldn't recognize VTach on the monitor of their patient, one that said "I'm not very good at pulses" during CPR (while backing away from the patient), those that couldn't insert foley catheters, didn't know how do some basic stuff, and we just have to deal. It's especially annoying as charge when you feel like you have your own patient assignment but have to hold the hand of the nurse making more than twice what you are. I understand why people would travel, and I'm grateful for the good ones. But I really wish there was some sort of actual competency requirement to travel. Anyone can find someone to write a recommendation (even if only to get someone out of the unit), but it's really not what's best for patients. 

Ohhh my. . . Just have that one go hide under the nursing station desk with one of the RNs I knew when a patient had a seizure ??‍♀️?‍♀️

[Tweety, BSN, RN]

I don't work critical care, but I've never come across a traveler that was inept.  They are confident and competent and are the first to float, get the worst assignments and the distain of lower paid RNs.

Now some of the permanent employees have me wondering "why do you still have a job".

Just saying what I know.  

[Tweety, BSN, RN]

On 9/21/2022 at 12:09 PM, JBMmom said:

"I'm not very good at pulses" during CPR (while backing away from the patient), those that couldn't insert foley catheters, didn't know how do some basic stuff, and we just have to deal. 

This really doesn't make sense as when you graduate from school and pass the boards you know this stuff.  But wow.  We have to check off on foley insertion yearly as part of our CAUTI competency.  Who doesn't know how to insert a foley?  

The caveat I'm going to add as a 30 year nurse is that I'm not good with pulses either and in a code situation where it's a matter of life and death I would have no shame in saying so and ask someone else.  I'm good with radial and pedal in every day head to toe, but ask me to find a posterior tibial and even a femoral......

[mmc51264, BSN, MSN, RN]

3 hours ago, Tweety said:

I don't work critical care, but I've never come across a traveler that was inept.  They are confident and competent and are the first to float, get the worst assignments and the distain of lower paid RNs.

Working is specialized area (orthopedics) we have had some that are not great at this, which is fine, a good nurse will ask questions and embrace what they don't know. The ones that are troublesome are the ones that are TOO confident and don't respect the policies of where they are. As a charge nurse, we have had some that do not communicate very well and we've had some tricky situations that could have turned out bad. 

I agree that they are the first to float, I do not give them crappy assignments and if they tell me they are being abused on a floor that they have floated to, I call that charge nurse, or even the manager, if they get a crap assignment 

[JBMmom, MSN, NP]

4 hours ago, Tweety said:

The caveat I'm going to add as a 30 year nurse is that I'm not good with pulses either and in a code situation where it's a matter of life and death I would have no shame in saying so and ask someone else.

There is no shame in knowing what it is that you know or don't know. And even with 30 years experience, there's no expectation that any nurse would know everything. This, however, was a nurse that chose to travel as a critical care nurse!

We treat out travelers well. We all float in rotation so they're not first to float. We do not give them the crappiest assignments. We truly appreciate that they are there. But in a unit that has many newer nurses, we're relying on travelers to represent themselves accurately, and truly be competent enough to work independently. It's not fair to us when have a traveler makes it more work for the staff. I truly love teaching the newer nurses about working in critical care and I am happy to be a resource. It's frustrating when I have to teach someone that thought highly enough of themselves to take on traveling, or those that are just in it for a better paycheck than ours.