- Email: [email protected]
A look at travel nursing: Two sides to the coin
PROFESSIONAL NOTEBOOK
A Look at Travel Nursing: Two Sides to the Coin Author: Jan Daubener, RN, MSN, Concord, NC
Jan Daubener, Metrolina Chapter, is a Professional Health Care Recruiter with ExecQuest, Inc, in Statesville, NC. She was previously a recruiter in the travel nurse industry. For reprints, write: Jan Daubener, RN, MSN, 3080 Chelwood Dr, Concord, NC 28027; E-mail: [email protected]. J Emerg Nurs 2001;27:507-10. Copyright © 2001 by the Emergency Nurses Association. 0099-1767/2001 $35.00 + 0 18/9/118574 doi:10.1067/men.2001.118574
October 2001 27:5
I
n addition to practicing their chosen profession, travel nurses can also choose their location and climate to create a more meaningful work experience. Nurses who travel traditionally have strong clinical skills, an adventurous outlook, and a pioneering spirit. Travel nurses must have the willingness to move “home” every 3 months, although often the facility at which they are working offers an extension of the contract to the traveler. The traveler must consider all aspects of the job when considering an extension: how welcomed they feel by the staff and manager, the overall work experience, the work schedule, the challenges of the position, the geographic location of the facility, as well as their salary and housing. Contracts for travel nurses are usually for 13-week periods. Agencies constantly interview new candidates to submit to hospitals to replace nurses nearing the end of their contracts. Hospitals across the United States hire travel nurses to complement staffing patterns. Hospitals pay travel companies an hourly contract rate that is 11⁄2 to 2 times the hourly salary paid to the travel nurse. The cost to the hospital covers the salary of the nurse, pre-employment screening, background checks, and agency-specific benefits for the nurse, which may include furnished housing, utilities, cable TV, travel reimbursement, licensure, insurance, a 401K plan, and various bonuses. Agencies net between $5 and $15 each hour a travel nurse works. Although the hourly rate paid to the travel nurse is usually comparable to that of a hospital staff nurse, lucrative benefits packages add considerably to the income of travel nurses. In addition to the salary and benefits for the traveler, Internal Revenue Service regulations allow a
JOURNAL OF EMERGENCY NURSING
507
PROFESSIONAL NOTEBOOK/Daubener
portion of the travel nurses’ hourly rate to be tax-free because of allowances for meals and incidentals (offering a tax advantage).
Lucrative benefits packages add considerably to the income of travel nurses. Travelers are beneficial to hospitals hampered by staffing shortages, which are particularly evident in specialty areas and critical care.1 Travelers augment staffing to provide an adequate nurse/patient ratio necessary to provide safe, quality patient care. Both travelers and per diem agencies are used to meet staffing needs, but travelers cover more consistent, long-term assignments.2 Jon Hendrickson, RN, accepted his first travel assignment in the emergency department of a hospital in Cambridge, Md, and before the end of his first week, he asked to extend his contract. “The ED manager and the staff treat all the travelers like family. We really feel welcomed at the hospital, and it’s beautiful here.”
Although positions for travelers are available in other areas of the hospital, adequate staffing in the emergency department is crucial to meeting the needs of patients seeking care. Positions for travelers in emergency departments may be open consistently in some facilities or may only be temporary during peak seasons or staffing shortages. Rado says that currently he is using travelers to meet staffing needs. “This is my first experience with travelers, and we now have 3 very mature and competent travelers on auto-pilot after a brief orientation.” Jon Hendrickson says, “It was good to start in a smaller emergency department rather than a trauma center. The first assignment is a challenge in itself, and could be overwhelming in a high-acuity, high-census environment.”
The most frequent complaints from travel nurses are about the housing provided by the agencies.
One role of the agency is to ensure the best match of a candidate with a facility. This match is accomplished by learning the specifics about the hospital and the job from the hospital contact and by inquiring about the needs, experience, and professional background of the nurse. Mark Rado, Clinical Director of Emergency Services at NorthEast Medical Center in Concord, NC, intently listens during the interview to the nurse’s description of his or her experiences. “Nurses tell stories of their practice, and through those stories, they lead me to believe whether they are at the expert level. More than merely answering questions, the nurses describe how they put knowledge into practice. This gives a clear indication of how they will function in our busy department.”
Travel nursing offers clear opportunities for professional growth. Hendrickson observes, “Holding patients for ICU has given me more experience, especially with calculating and titrating drips, working with ventilators, and managing invasive lines. It has built my confidence in critical care skills.” Catherine Woods, RN, a seasoned ED nurse and traveler, has worked with several agencies during her career. “Having a good recruiter makes all the difference in the world. Finding a job for a nurse is one thing, but a recruiter who spends time getting to know the nurse is able to find the right job. I like the outdoors, camping, and hiking with my dog. Getting to know me would keep a recruiter from trying to send me to downtown Los Angeles or Chicago. When the nurse is on assignment, it’s comforting to have a recruiter who is accessible in case questions or problems come up.” “It’s fun to anticipate newness of the next assignment,” Woods says. She enjoys meeting new people, networking with other travelers, and spending her time off exploring her new environment. “You can always work in the perfect climate,” she said, “and I have a clean new home every 3 months or so. I know where I want to go, and I plan my next assignment so I can get there.”
508
JOURNAL OF EMERGENCY NURSING
“It was good to start in a smaller emergency department rather than a trauma center. The first assignment is a challenge in itself, and could be overwhelming in a high-acuity, highcensus environment.”
27:5 October 2001
PROFESSIONAL NOTEBOOK/Daubener
Most assignments have been positive for Woods during her time as a travel nurse. “It’s stressful to learn a new situation so frequently, and you have to be very confident and assertive,” she says. “The nurses for the most part have been receptive and appreciative of our being there to help. Just as in any job, there are a few unfriendly people, but it’s certainly not the norm.” A former ED nurse manager in Maryland said that she incorporated both per diem and travel nurses in her department. “I believe that the advantages of using travelers are evident in the quality of care provided. We were committed to providing service to our patients regardless of the cost,” she said. In her experience, travel nurses are more cost-effective than per diem coverage, and “travel nurses become part of our team, sharing equally in covering off-shifts, holidays, and weekends.”
Sadly, temporary nurses are sometimes assigned to hospitals where nurses are striking because of unsafe conditions and issues like mandatory overtime. Because administration can rely on temporary nurses, it puts striking nurses—and patients—at a disadvantage. The most frequent complaints from travel nurses are about the housing provided by the agencies. Some agencies provide shared housing, and for private housing the nurse is required to pay the difference in the rent, utilities, and furniture rental. Travel nurses cite differences in work shifts and lifestyles as reasons for opposing shared housing. Travel nurses report that they extend contracts at the same facility primarily because of the way they are treated by the staff and managers. One traveler, who requested that her identity be withheld, said, “I left my full time job because my unit manager and the administration of the hospital didn’t appreciate what we did for them. They always wanted us to work more shifts and be at their beck and call, but they never thanked us for all we did.” She added, “A lot of travelers I’ve worked with say the same thing.” Sadly, temporary nurses are sometimes assigned to hospitals where nurses are striking because of unsafe con-
October 2001 27:5
ditions and issues like mandatory overtime. Because administration can rely on temporary nurses, it puts striking nurses—and patients—at a disadvantage. Often administrators equate retention of employees with financial incentives—salary, perks, and benefits. Employees often choose to remain on the job when they feel respected, appreciated, and treated with fairness and consistency.3
“It is not possible to maintain continuity in the patient care environment with constantly changing staff.” Wanda Richmond, RN, an experienced travel nurse, says, “If hospitals treated their nurses better, they wouldn’t have so many staffing needs [to begin with].” Whe adds, “It’s not just the money. Managers need to treat their staff with respect. Hospitals and physicians need to appreciate nurses and their importance to patient care. At least as a traveler, I can go to a facility, and if respect and appreciation are missing, I can go to another assignment after 3 months. Hospitals lose nurses to other employers, including travel companies, where the nurses feel valued.” Offering another perspective is Mary Ann Cardinali, RN, MSN, a nursing executive from the Midwest. “The cost of travelers is excessive,” she says. “Hospitals pay these rates out of necessity without an end in sight. When the contract period is over, the traveler leaves for a new assignment. Few travelers take permanent positions at the hospital.” Cardinali said, “Continuity of care is difficult to maintain when temporary staff provide patient care.” Gerry Goodman, RN, MSN, Vice President for Patient Care at St Mary’s Hospital in Evansville, Ind, used travel nurses in her previous facility. She says she will avoid using travelers again if at all possible. “The issue of quality concerns me,” Goodman said. “The knowledge base and clinical skills of nurses are not always as represented by the travel company,” she said. “Nurses are leaving full-time positions to become travelers and are starting assignments with less and less experience. Some have less than a year, and for this reason, they don’t strengthen patient care.”
JOURNAL OF EMERGENCY NURSING
509
PROFESSIONAL NOTEBOOK/Daubener
Goodman said that the revolving door of travel nurses starting and completing assignments takes its toll on patient care. “It is not possible to maintain continuity in the patient care environment with constantly changing staff. The medical staff at our facility does not support the use of travelers. They want to know the nurses who care for their patients.”
“If hospitals treated their nurses better, they wouldn’t have so many staffing needs [to begin with].” She adds, “It’s not just the money. Managers need to treat their staff with respect.” “We spend considerable time and energy to keep our staff well trained. We have increased our nurses’ salaries several dollars per hour, and we have implemented a temporary bonus plan,” Goodman continued. “The staff know the hospital and medical staff support and appreciate them, and this has a positive impact on staff morale.” She says the staff is willing to work extra shifts while the hospital works to increase the number of full-time staff. “The staff would rather work more intensely and receive the money that would have been paid for travel nurses while we recruit additional full-time staff. Our nurses resented the travelers whose salaries and compensation packages were so much higher than theirs. In our thinking, the money we were paying for travel nurses is better spent and more appreciated by our own staff.”
Maintaining adequate staffing to provide care for patients is a challenge with an untold number of possibilities. The nursing shortage is expected to worsen before it is resolved. Identifying the critical issues related to the use of travel nurses is a first step. These issues deserve in-depth inspection to determine whether more effective opportunities exist for the travel nurse industry and hospitals. REFERENCES 1. Gray BB. What’s going on? NurseWeek [online] 1998 Feb. Available from: URL: http://www.nurseweek.com/features/982/short.html 2. Mathias JM. Too few nurses start a new shortage cycle. OR Manager 1999;15;1,9. 3. Kaye B, Jordan-Evans S. Love ’em or lose ’em. San Francisco: Berrett-Koehler; 1999. Submissions to this column are welcomed and encouraged. Submissions may be sent to: Gail Pisarcik Lenehan, RN, EdD, FAAN c/o Managing Editor, PO Box 489, Downers Grove, IL 60515 800 900-9659, ext 4044 • [email protected]
Conclusion
Because of the nursing shortage, many hospitals are experiencing significant staffing needs. The use of travel nurses is one of the staffing alternatives available to hospitals to meet those needs. Hospitals spend exorbitant amounts of money for staffing through travel nurse companies, with no end in sight. Travelers express concern about issues with the travel companies as well as with their treatment by staff and managers. Hospital administrators express concern about quality and continuity of care.
Thumbs Up to Andover Coated Products ([877]NO-LATEX), for contributing 50 cents to breast cancer research for every case of CoFlex bandages sold in 2001, in memory of Louise Sullivan, part of the Andover “family.”
510
JOURNAL OF EMERGENCY NURSING
THUMBS UP
27:5 October 2001
A Look at Travel Nursing: Two Sides to the Coin Author: Jan Daubener, RN, MSN, Concord, NC
Jan Daubener, Metrolina Chapter, is a Professional Health Care Recruiter with ExecQuest, Inc, in Statesville, NC. She was previously a recruiter in the travel nurse industry. For reprints, write: Jan Daubener, RN, MSN, 3080 Chelwood Dr, Concord, NC 28027; E-mail: [email protected]. J Emerg Nurs 2001;27:507-10. Copyright © 2001 by the Emergency Nurses Association. 0099-1767/2001 $35.00 + 0 18/9/118574 doi:10.1067/men.2001.118574
October 2001 27:5
I
n addition to practicing their chosen profession, travel nurses can also choose their location and climate to create a more meaningful work experience. Nurses who travel traditionally have strong clinical skills, an adventurous outlook, and a pioneering spirit. Travel nurses must have the willingness to move “home” every 3 months, although often the facility at which they are working offers an extension of the contract to the traveler. The traveler must consider all aspects of the job when considering an extension: how welcomed they feel by the staff and manager, the overall work experience, the work schedule, the challenges of the position, the geographic location of the facility, as well as their salary and housing. Contracts for travel nurses are usually for 13-week periods. Agencies constantly interview new candidates to submit to hospitals to replace nurses nearing the end of their contracts. Hospitals across the United States hire travel nurses to complement staffing patterns. Hospitals pay travel companies an hourly contract rate that is 11⁄2 to 2 times the hourly salary paid to the travel nurse. The cost to the hospital covers the salary of the nurse, pre-employment screening, background checks, and agency-specific benefits for the nurse, which may include furnished housing, utilities, cable TV, travel reimbursement, licensure, insurance, a 401K plan, and various bonuses. Agencies net between $5 and $15 each hour a travel nurse works. Although the hourly rate paid to the travel nurse is usually comparable to that of a hospital staff nurse, lucrative benefits packages add considerably to the income of travel nurses. In addition to the salary and benefits for the traveler, Internal Revenue Service regulations allow a
JOURNAL OF EMERGENCY NURSING
507
PROFESSIONAL NOTEBOOK/Daubener
portion of the travel nurses’ hourly rate to be tax-free because of allowances for meals and incidentals (offering a tax advantage).
Lucrative benefits packages add considerably to the income of travel nurses. Travelers are beneficial to hospitals hampered by staffing shortages, which are particularly evident in specialty areas and critical care.1 Travelers augment staffing to provide an adequate nurse/patient ratio necessary to provide safe, quality patient care. Both travelers and per diem agencies are used to meet staffing needs, but travelers cover more consistent, long-term assignments.2 Jon Hendrickson, RN, accepted his first travel assignment in the emergency department of a hospital in Cambridge, Md, and before the end of his first week, he asked to extend his contract. “The ED manager and the staff treat all the travelers like family. We really feel welcomed at the hospital, and it’s beautiful here.”
Although positions for travelers are available in other areas of the hospital, adequate staffing in the emergency department is crucial to meeting the needs of patients seeking care. Positions for travelers in emergency departments may be open consistently in some facilities or may only be temporary during peak seasons or staffing shortages. Rado says that currently he is using travelers to meet staffing needs. “This is my first experience with travelers, and we now have 3 very mature and competent travelers on auto-pilot after a brief orientation.” Jon Hendrickson says, “It was good to start in a smaller emergency department rather than a trauma center. The first assignment is a challenge in itself, and could be overwhelming in a high-acuity, high-census environment.”
The most frequent complaints from travel nurses are about the housing provided by the agencies.
One role of the agency is to ensure the best match of a candidate with a facility. This match is accomplished by learning the specifics about the hospital and the job from the hospital contact and by inquiring about the needs, experience, and professional background of the nurse. Mark Rado, Clinical Director of Emergency Services at NorthEast Medical Center in Concord, NC, intently listens during the interview to the nurse’s description of his or her experiences. “Nurses tell stories of their practice, and through those stories, they lead me to believe whether they are at the expert level. More than merely answering questions, the nurses describe how they put knowledge into practice. This gives a clear indication of how they will function in our busy department.”
Travel nursing offers clear opportunities for professional growth. Hendrickson observes, “Holding patients for ICU has given me more experience, especially with calculating and titrating drips, working with ventilators, and managing invasive lines. It has built my confidence in critical care skills.” Catherine Woods, RN, a seasoned ED nurse and traveler, has worked with several agencies during her career. “Having a good recruiter makes all the difference in the world. Finding a job for a nurse is one thing, but a recruiter who spends time getting to know the nurse is able to find the right job. I like the outdoors, camping, and hiking with my dog. Getting to know me would keep a recruiter from trying to send me to downtown Los Angeles or Chicago. When the nurse is on assignment, it’s comforting to have a recruiter who is accessible in case questions or problems come up.” “It’s fun to anticipate newness of the next assignment,” Woods says. She enjoys meeting new people, networking with other travelers, and spending her time off exploring her new environment. “You can always work in the perfect climate,” she said, “and I have a clean new home every 3 months or so. I know where I want to go, and I plan my next assignment so I can get there.”
508
JOURNAL OF EMERGENCY NURSING
“It was good to start in a smaller emergency department rather than a trauma center. The first assignment is a challenge in itself, and could be overwhelming in a high-acuity, highcensus environment.”
27:5 October 2001
PROFESSIONAL NOTEBOOK/Daubener
Most assignments have been positive for Woods during her time as a travel nurse. “It’s stressful to learn a new situation so frequently, and you have to be very confident and assertive,” she says. “The nurses for the most part have been receptive and appreciative of our being there to help. Just as in any job, there are a few unfriendly people, but it’s certainly not the norm.” A former ED nurse manager in Maryland said that she incorporated both per diem and travel nurses in her department. “I believe that the advantages of using travelers are evident in the quality of care provided. We were committed to providing service to our patients regardless of the cost,” she said. In her experience, travel nurses are more cost-effective than per diem coverage, and “travel nurses become part of our team, sharing equally in covering off-shifts, holidays, and weekends.”
Sadly, temporary nurses are sometimes assigned to hospitals where nurses are striking because of unsafe conditions and issues like mandatory overtime. Because administration can rely on temporary nurses, it puts striking nurses—and patients—at a disadvantage. The most frequent complaints from travel nurses are about the housing provided by the agencies. Some agencies provide shared housing, and for private housing the nurse is required to pay the difference in the rent, utilities, and furniture rental. Travel nurses cite differences in work shifts and lifestyles as reasons for opposing shared housing. Travel nurses report that they extend contracts at the same facility primarily because of the way they are treated by the staff and managers. One traveler, who requested that her identity be withheld, said, “I left my full time job because my unit manager and the administration of the hospital didn’t appreciate what we did for them. They always wanted us to work more shifts and be at their beck and call, but they never thanked us for all we did.” She added, “A lot of travelers I’ve worked with say the same thing.” Sadly, temporary nurses are sometimes assigned to hospitals where nurses are striking because of unsafe con-
October 2001 27:5
ditions and issues like mandatory overtime. Because administration can rely on temporary nurses, it puts striking nurses—and patients—at a disadvantage. Often administrators equate retention of employees with financial incentives—salary, perks, and benefits. Employees often choose to remain on the job when they feel respected, appreciated, and treated with fairness and consistency.3
“It is not possible to maintain continuity in the patient care environment with constantly changing staff.” Wanda Richmond, RN, an experienced travel nurse, says, “If hospitals treated their nurses better, they wouldn’t have so many staffing needs [to begin with].” Whe adds, “It’s not just the money. Managers need to treat their staff with respect. Hospitals and physicians need to appreciate nurses and their importance to patient care. At least as a traveler, I can go to a facility, and if respect and appreciation are missing, I can go to another assignment after 3 months. Hospitals lose nurses to other employers, including travel companies, where the nurses feel valued.” Offering another perspective is Mary Ann Cardinali, RN, MSN, a nursing executive from the Midwest. “The cost of travelers is excessive,” she says. “Hospitals pay these rates out of necessity without an end in sight. When the contract period is over, the traveler leaves for a new assignment. Few travelers take permanent positions at the hospital.” Cardinali said, “Continuity of care is difficult to maintain when temporary staff provide patient care.” Gerry Goodman, RN, MSN, Vice President for Patient Care at St Mary’s Hospital in Evansville, Ind, used travel nurses in her previous facility. She says she will avoid using travelers again if at all possible. “The issue of quality concerns me,” Goodman said. “The knowledge base and clinical skills of nurses are not always as represented by the travel company,” she said. “Nurses are leaving full-time positions to become travelers and are starting assignments with less and less experience. Some have less than a year, and for this reason, they don’t strengthen patient care.”
JOURNAL OF EMERGENCY NURSING
509
PROFESSIONAL NOTEBOOK/Daubener
Goodman said that the revolving door of travel nurses starting and completing assignments takes its toll on patient care. “It is not possible to maintain continuity in the patient care environment with constantly changing staff. The medical staff at our facility does not support the use of travelers. They want to know the nurses who care for their patients.”
“If hospitals treated their nurses better, they wouldn’t have so many staffing needs [to begin with].” She adds, “It’s not just the money. Managers need to treat their staff with respect.” “We spend considerable time and energy to keep our staff well trained. We have increased our nurses’ salaries several dollars per hour, and we have implemented a temporary bonus plan,” Goodman continued. “The staff know the hospital and medical staff support and appreciate them, and this has a positive impact on staff morale.” She says the staff is willing to work extra shifts while the hospital works to increase the number of full-time staff. “The staff would rather work more intensely and receive the money that would have been paid for travel nurses while we recruit additional full-time staff. Our nurses resented the travelers whose salaries and compensation packages were so much higher than theirs. In our thinking, the money we were paying for travel nurses is better spent and more appreciated by our own staff.”
Maintaining adequate staffing to provide care for patients is a challenge with an untold number of possibilities. The nursing shortage is expected to worsen before it is resolved. Identifying the critical issues related to the use of travel nurses is a first step. These issues deserve in-depth inspection to determine whether more effective opportunities exist for the travel nurse industry and hospitals. REFERENCES 1. Gray BB. What’s going on? NurseWeek [online] 1998 Feb. Available from: URL: http://www.nurseweek.com/features/982/short.html 2. Mathias JM. Too few nurses start a new shortage cycle. OR Manager 1999;15;1,9. 3. Kaye B, Jordan-Evans S. Love ’em or lose ’em. San Francisco: Berrett-Koehler; 1999. Submissions to this column are welcomed and encouraged. Submissions may be sent to: Gail Pisarcik Lenehan, RN, EdD, FAAN c/o Managing Editor, PO Box 489, Downers Grove, IL 60515 800 900-9659, ext 4044 • [email protected]
Conclusion
Because of the nursing shortage, many hospitals are experiencing significant staffing needs. The use of travel nurses is one of the staffing alternatives available to hospitals to meet those needs. Hospitals spend exorbitant amounts of money for staffing through travel nurse companies, with no end in sight. Travelers express concern about issues with the travel companies as well as with their treatment by staff and managers. Hospital administrators express concern about quality and continuity of care.
Thumbs Up to Andover Coated Products ([877]NO-LATEX), for contributing 50 cents to breast cancer research for every case of CoFlex bandages sold in 2001, in memory of Louise Sullivan, part of the Andover “family.”
510
JOURNAL OF EMERGENCY NURSING
THUMBS UP
27:5 October 2001