Traveling Nurses

ratchit · Jan 8, 2002

Travellers have been in the best ICUs all over the country for many years. Johns Hopkins, Washington Hospital Center, Mass General, Harborview, UCLA, Mayo Clinic... All use travellers routinely.

Travel nurses aren't very different from staff nurses. Some are strong, smart, capable assets to the unit. Some have, shall we say, missed their calling. The nursing shortages have been the worst in critical care, ER, and OR. Many hospitals can't keep their units open without travellers. Personally, I think experienced travellers tend to be above average- we're evaluated and reference checked far more frequently than staff nurses. No numbers to back that up, though.

I have been a traveller for a total of 5 years, 3 in ICU. I have been the first ever or only traveller in a unit, I have been one of 35 travellers on a unit that MIGHT have 2 staff nurses on out of a shift of 21. I might not know your doctors quirks but I do know how to take care of sick patients. Whatever little things are unique to your hospital should be easily learned, especially by an experienced traveller who knows what to ask.

Can you give more information about why you're asking? Is your hospital considering using travellers but has concerns?

LadyNASDAQ · Jan 8, 2002

Originally posted by CTnuse
I have a question!
What do you think of the use of traveling nurses in the intensive care area? Your feed back is greatly appreciated.

I am probably one of the very few Travel Nurses that also will take charge in the Intensive Care Unit where I work.

I have done a very good job during a time where much of the staff has quit and also gone agency but also, I am enjoying helping the hospital rebuild and be as close to an equilibrium as possible. I also have been working there over a year and they have continuously allowed me to extend my contract for more money without a problem. I like them, they like me, I get what I want which is an excellent schedule and they get a Nurse with 23 + years experience and the ability to expedite and work with staff in a way where there is less stress and more respect for everyone has definitely been achieved. I hate to work whre people gripe and are angry and resentful. That's one of the major reasons why I left my other job. People just go to work strictly for the job's paycheck and not to be kind and help the critically il with the loe and compassion needed to really do the job, well in my opinion.

CTnuse · Jan 9, 2002

ratchit,

I work in a cardiothoracic ICU and yes we do use travelers and they have helped out trmendously. The staff is getting frustrated because they are getting big bucks and do not admit frsh hearts or have them until at least 24 hours out. They pretty much care for the chronic patients.

What kind of ICU do you work in? Do you have the same assignments as the staff nurses?

Thanks for you response and your insight is helpful.

:)

PhantomRN · Jan 9, 2002

that sounds like a management issue not a travel nurse issue.

we utilize travelers in our unit and they take the same load as e do fresh hearts included. 9 times out of 10 they know their business and are excellent team players.

don't look a gift horse in the mouth, without the traveler the staff would be forced to take many more patients on their assignment.

ratchit · Jan 15, 2002

Hi CT. Sorry for the long delay- been dealing with computer problems.

Why don't your CTICU travellers recover fresh hearts? If they are trained for it but your unit policy says they can't be assigned to fresh hearts, that's not the traveller's fault. Look at it from the other side- being hired for CTICU and when you get to the hospital, you're only allowed to take chronic patients the staff don't want. No fun and insulting, in a way. That is a management call- maybe your staff could lobby for a change.

Is your manager hiring nurses who don't have CTICU backgrounds? Again, not the traveller's fault, it was a management decision. At least they can take patients.

As for my background... I usually prefer SICU but I do Trauma ICU and can do CVICU in a pinch, although I would like more training than I have. I wouldn't take an assignment in a CVICU but I've taken fresh hearts in mixed ICUs when there just absolutely was no one else to do it and I had backup. MICU... I *can* do it, not my preference. I like Neuro and I hate Neuro... I usually prefer teaching/trauma centers, but I've worked at a few community hospitals that I enjoyed as well.

My patient assignment varies by hospital... I've never said "I'm a traveller so I don't take x y or Z patients." I have said "I am unfamiliar with that... is there someone who knows more about it ? I could watch and learn and be ready next time." That's safe practice- I would do the same if I were on staff. I've never asked for a lighter assignment. If anything, travellers either get even assignments or, frequently!, get dumped on. The "you're making more money so you get the GI Bleeding/TB isolation/psych history patient AND the DKA with Q 30min fingersticks" garbage happens a lot. One hospital would routinely give me the 3 sickest (and often farthest apart) patients while their staff nurses would have 1 each and be taking naps. One charge nurse who made the night schedule told us "staff aren't going to work holidays or weekends- that's what travellers are for." Nice, hmm?

As for the money... Don't believe the magazine ads. My first couple contracts paid me less than my staff job did. The money and bonuses are getting better, but they are for staff RNs too. I make a bit more per hour than staff nurses at some places but there are always trade-offs. I don't get sick time or vacation time. If I miss a day, I get billed and many hospitals will refuse to pay a bonus based on that, even if I make the day up. Contracts that are supposedly binding can be ignored or cancelled at the hospital's whim, leaving the traveller stuck in terrible conditions or without a job. Our insurance isn't as good as staff's, shift and weekend diffs are extremely rare. The "free housing" is only free as long as you pay to maintain a residence at home and meet IRS guidelines for being away on business. So it's not free- it just prevents us from having to pay for 2 apartments. If there are any disputes, travellers can be fired with no HR or union representation to back us up. There are some hospitals that have no complaints with their travellers until days before the contract ends- then fire them to avoid paying a bonus.

There are lots of things about travelling that staff don't see. The big hourly rate that the hospital is billed for me covers my salary, benefits, and employer paid income/social security taxes on top of housing and the company's cut. The traveller isn't paid anywhere near the entire rate the hospital is charged. Staff RNs often don't realize that the cost of employer taxes and benefits can add 35-40% on to their salaries. That money isn't visible in your paycheck, but the bill rate for me has to cover it so it looks artificially high.

Don't get me wrong- travelling has been a great experience for me and I am so glad that I did it. There are ways to make money at it, same as staff nursing. But staff RNs often don't see the negatives. I think nurses everywhere are overworked and feeling stressed and often vent at any perceived imbalance. Travelling has been better than staff nursing for me for a while now- but it sounds like your staff might not know the big picture.

Argh- very long post, sorry. Just trying to imagine what might be happening from the travellers point of view. Can you expand on why your travellers don't recover hearts? Or why the assignments are uneven?

wendyssmile · Jan 16, 2002

Hello CT,

I work in a CT-ICU and we have traveling nurses and for the last year the traveling nurses took only the chronic assignments. Currently we have two traveling nurses that have returned to us and they are being trained to admit the fresh hearts. I think they are realizing it is hard to juggle assignments when you have to worry about what the nurse can and cannot do.

Personally I have found that most of the travelors that we have had , had an amazing experience base. The only problem with travelers that we have had are two nurses in which our unit was their first assignment and they came with little ICU experience.

At my hospital they have come up with an inhouse agency program so the nurses complaining about the traveler's wage cannot complain anymore.