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Travel Nursing Woes; What Nurses and Recruiters Don't Tell You

Travel nursing, or as it should be called, contract nursing (as many are no longer traveling across the country but working travel contracts in their own backyards) appeals to many nurses for differing reasons. Some want to explore the country and be paid to do so. Some may want to care for a different demographic of patients. Some perhaps don’t want to commit to a single workplace just yet. Some would like better staffing ratios and to make new friends. And some, if not all want that bigger paycheck. Travel nursing isn’t for everyone though. Most of us know the positives, but here is a list of the negatives that many nurses and agencies alike, don’t like to elaborate on.

If you are going to travel nurse you of course need to have experience within your specialty, but more than that you need to be confident in your skill base. You will be thrown onto the floor of a new, unfamiliar hospital anywhere from 4 hours to 1 week after ‘orientation’ to the unit. This means you best have your nursing skills down because they only training the hospital wants to invest in you is how to use their charting system and how to find supplies/drugs. Yes, they may quickly show you how to use an IV pump you aren’t familiar with or how to run samples to the lab, but as far as nursing goes, you are expected to already be proficient. Training a nurse costs a facility A TON of money. Seriously, its estimated to cost anywhere between 60-90k to recruit, orient and train a new nurse, dependent on what part of the country you are in, the specialty and the length of training. This is a major reason why travel nurses are paid more, the facility Is still saving money at the end of the day.

You are never guaranteed employment. Traveler life is stressful. Contracts tend to be 13 weeks with the option to extend IF you like the facility, they like you, and there is still a need. If not, then after the first 8 weeks, it’s time to start the job hunt all over again. If you are picky, like me, and only want certain locations or institutions, you need to start a few weeks earlier. Why so early? Well contracts are like the stock market. Needs go up and down, certain agencies have contracts with certain hospitals, strikes occur and markets stabilize. Giving yourself at least 5 weeks is important as you may have to switch agencies, obtain extra certifications, find housing, negotiate contract terms and pay, switch benefits and prepare to move. It can be daunting but once you do it a few times…it’s still daunting. Living life like a nomad means you have to be ready to pick up and move at any time.

You need to have a backbone and learn to negotiate/turn down contracts. Travel agencies are all different, but the one thing they have in common is they are all in it for the money. Don’t ever forget that your agency is a business. Your recruiter needs to get paid, the staff need to get paid, and the company needs to get paid. That means, no matter how nice a company seems or how much they say that 'all they care about is how happy you are', it’s all corporate bull. You are just a contractor that they are using to get a paycheck. It's great for them because their overhead is minimal. You already have the skills and they don’t need to train you. They don't need to provide you with an office, you don’t need supplies, you really don’t need anything. They are just a connection service. The hospital gives the agency a bill rate, and then the agency gives you a bill rate. The lower the bill rate the agency can get you to accept, the more money in their pocket. Some agencies are obviously shadier than others *cough* AMN, TNAA, Cross-country *cough*, but they are all guilty of it. It becomes tiring but you have to let your recruiter know that you will not take contracts for less than *insert weekly gross here* or that you will not pay for parking at a facility, or that they need to pay for the specific certifications a site requires. Also don’t be afraid to shop around. You are not tied to a single agency or recruiter. See what other companies are offering for the same facility and don’t be afraid to play hardball. Recruiters love it when you call them back and say “well Flexcare is offering me 2400/week and you quoted me 2100/week…what’s with that? Nine times out of ten they will match it to keep you as a client, and if they don’t, well then there are hundreds of other agencies. All in all though its a lot of effort, especially to do every 13 weeks.

You'll watch the same orientation videos, listen to the same non-violent crisis intervention lecture, and take the same E.M.R. charting class EVERY. SINGLE. ASSIGNMENT. All while hearing about how their facility is 'different'. Its like groundhogs day, except everyone acknowledges the stupidity of it, and yet you still have to partake. Some institutions have traveler only orientations that skim the nonsense, while others just lump you in with all the new staff hires. Which means you get to hear hours worth of union practices, pay scales and PTO policies that have nothing to do with you. Yes, you are paid to sit and do nothing, but it grows old real quick. My main complaint is that they are generally 8-5pm and I'am a nightshifter who doesn't want to sit in daytime traffic.

Additionally, many hospitals require a drug test, so even if you are staying with the same agency, you may have to retake a test every three months...just keep that in mind you stoners. You'll have to get the drug test done on your own time (no you are not paid for this time) at an employment clinic or urgent care that your agency picks, and sometimes the wait can be 4+ hours...

You need to get used to being flexible. You are temporary, and thus, expendable. You are most likely not going to get to pick your schedule once you start. There are few exceptions to this but as the market becomes saturated, the rarer this becomes. It used to be you could supply the facility with a proposed schedule and days you needed off. Not anymore. If management sees you are asking for too many days off or not making them the priority, they’ll simply hire the next ‘Karen or Chad’ that is right behind you with no life and no requests.

On the topic of being expendable, you need to walk on eggshells. You are entering an institution you probably know little about. Their culture, their politics, and their cliques have all been cemented long before you arrived and they will still be in place once you leave. Cause waves, and you’re gone. You see, you are an “at will employee”. That means that if you so much as cough in a manner a manager doesn’t like, they can terminate your ass, with no explanation. No charge nurse or anyone in management is going to defend you, ESPECIALLY if the institution you are at is a union facility.

Let me give you a quick example. I started a contract at a new facility, I had two days of orientation and then the third day I was on my own. On the third night a manager I had never met came up to me and told me I couldn’t have my covered drink at the nurses’ station. “ok” I said, and I put it in the break room.

When I returned, he asked me why my patient was up for discharge and still not gone. I explained my patient was still receiving dialysis and that I could not discharge him until the dialysis nurse was finished. For some unknow reason this frustrated him and he walked off. I finished the remaining 6 hours of my shift and went home and to bed. I awoke 3 hours later to an email from the facility, which basically said, “Your contract at ******* has been cancelled, contact your agency for details on how to proceed”. Yup that’s all. No explanation, no reasoning. They didn’t know me, they didn’t know where I was from. I could have traveled from across the country and paid for housing already, but remember, they don’t care. Its not their problem. For whatever reason that manager didn’t like me and *poof* I was gone.

Its all a balancing act. You are going to walk into a break room your first day for huddle and some of the staff think you are a nursing student, some think you are a new staff nurse, some think you are a new tech, and maybe a few know you are a traveler. Either way, you’re a guest, and so you need to introduce yourself every chance you get. You cannot just start walking around like you’ve been there for years. There is a pecking order and you are at the bottom, in a ditch, probably in a puddle of shit. You’ll have to slowly start climbing your way out. Many staff members do not want to get attached as they know you are just going to leave. That is just an aspect you have to both understand and accept. You must walk in humble but not weak, skilled but not showboating. You want the staff to see you understand your place but also be able to trust you and know you know your stuff. It is hard to do without looking arrogant but it’s necessary.

You will need to obtain a quick rapport with your attendings and residents. Once again, you need to garner a good working relationship and trust so your job can run smoother. Introduce yourself from the start and show them you know what your talking about and have experience. Nothing is worse than trying to get an order for a patient while the doc stares at you like some crazed stranger who is just irritating him…because without a good rapport, that’s just what you are.

You are going to get the worst bed assignments. That’s right, remember you are temporary. They don’t want to invest in you and when you are first starting, they also don’t trust you. Unless you prove yourself and work at a facility that is all inclusive, you will take the worst patient assignments every time. In the ER that means you will mainly get assignments in psych, fastrack (urgent care), or the overflow/hallways. In ICU you will tend to get the walking ICU patients or those that were excitingly stabilized and had all interventions done and now you get to babysit and chart. The trauma bays, Critical and unstable ICU beds, triage, CRRT, IABP, ECMO patients are typically off limits for travelers. If you do end up working any of those assignments, well then not only have you proved yourself, but you are at a great institution that actually sees the benefits in using you to your true potential and keeping your skills up to date. If not, well welcome to the traveler life.

You will probably be floated to other units…a lot. You are an ICU RN, you were hired into the MICU, you have never worked on a med-surg or Tele floor…well guess what?

You can’t say that after this assignment! You are floating to the ortho med-surg unit so much that the ICU nurses on the unit you were hired on still don’t know your name 6 weeks later. You are a placeholder, the hospital is going to put you where there is a need, and it’s generally the med-surg and telemetry units. ER nurses are so specialized (aka: can’t chart or perform inpatient nursing care if their lives depended on it) that this doesn’t apply as much to them. Although I have worked places that ICU RN’s are floated to the ER and the results are nothing short of hilarious…to me…

You’ll make friends you’ll never see again. Part of the downside of travel nursing is that you will make friends. Other travelers, doctors, nurses, staff, etc will become a mainstay in your life for months and then one day, you’re gone. Its part of the adventure but can still be a bummer when you finally say goodbye…that is unless the unit was full of jerks…then being able to leave is just another perk of traveling! K. byeeeeeeee.