PROS TRAVEL NURSE CONS

By Don Sadler

It’s no secret that hospitals, ambulatory surgery centers (ASCs) and other health care facilities have been experiencing nurse staffing challenges lately because of the nationwide nursing shortage and ongoing effects of the COVID-19 pandemic. Many organizations are turning to travel nurses as one strategy to meet these challenges.

By using travel nurses, hospitals and ASCs can plug schedule gaps with experienced nurses who are ready to hit the ground running with minimal training and orientation. This can reduce stress and the amount of overtime required by staff nurses. But there are also unique challenges associated with using travel nurses, as well as challenges for travel nurses themselves.

More Essential Than Ever

Lisa Cadugan, MSN, RN, CNOR, CSSM, believes that using travel nurses has become a necessity for most hospitals since the beginning of the COVID-19 pandemic.

“Their use was common prior to this, but they have become even more essential since the pandemic,” says Cadugan. “Specialty nurse positions like OR nurses can be especially difficult to fill since we are such a small percentage of the nursing population.”

According to Kristine Little, MSN, RN, CNOR, clinical nurse educator, surgical services at UNC Health Johnston, health care organizations have been left with a profound void that needs to be filled the most effective way possible. “Deploying travel nurses has become common practice and helped bridge the gaps to ensure patients continue to receive the wellness they seek,” she says.

Cynthia Long, RN, Ph.D., says that expectations for nurses have changed in the health care industry.

“As a baby boomer, I was indoctrinated to believe you stayed with one facility for many years,” she says. “We had loyalty embedded in our mindset. For example, I retired from a trauma facility with more than 28 years of experience.”

But Millennials have different expectations.

“They are after more autonomy, more money and a balanced home-work environment,” says Long.

According to Pat Thornton, MS, RN, CNOR, the use of travel nurses is more common in hospitals than ASCs. “Even though ASCs usually pay less than hospitals, ASC nurses have a better work-life balance,” she says. “This includes permanent and adjustable hours, no call responsibilities, less stress due to better patient acuity, less complicated procedures and limited types of surgeries.”

ASCs face different staffing challenges than hospitals, says Brittany Sharar-Williams, BSN, RN, PCCN, nurse administrator. “Hospitals have a staffing pool that allows for more flexibility for sick calls or leaves of absences,” she says. “Therefore, ASCs may need travel nurses to cover these periods of time until the staff nurse is able to come back to work.”

Benefits of Using Travel Nurses

The biggest benefit to health care facilities of using travel nurses is easy access to highly trained staff when they’re needed. “As they say, ‘the show must go on,’ ” says Long. “You cannot keep ORs idle for long or the revenue declines directly in proportion to the staffing needs.”

“During times of great need, travel nurses serve as an effective way of bringing additional trained nurses to the bedside promptly to ensure the needs of the community, permanent staff and organization are being met,” says Little.

Using travel nurses also gives hospitals more staffing flexibility. “Hospitals can increase their staffing when needed and then decrease staffing based on admissions and census,” says Colleen Becker, PhD., MSN, RN, CCRN-K, director of perioperative education for the Association of periOperative Registered Nurses (AORN). “Typically, travel nurses are experienced and can come in and start providing care right away.”

“All competencies and regulatory education are already completed via the agency,” says Thornton. “One to two days of orientation and travel nurses are ready to go.”

Sharar-Williams notes that travel nurses can be brought in during the winter months when there are often higher numbers of hospitalizations. “This allows the hospital to meet the staffing demand when it’s busy and then during the slower months of spring and summer protect the staff nurses’ hours,” she says.

“Most travel nurses are highly experienced in their specialty and can come in and staff rooms within a matter of days,” says Cadugan. “Using travel nurses allows for right-sized staffing at all times while reducing the workload and overtime of permanent staff and taking their share of call.”

Challenges and Drawbacks

While there are many benefits to using travel nurses, there are also potential challenges and drawbacks, starting with their cost.

“It is well known that travel nurses are compensated significantly higher than staff nurses,” says Little. “So, there is a steep financial drawback that health care organizations face when utilizing these resources.”

According to Becker, travel nurses may earn two to three times more than staff nurses. “It can be challenging for staff nurses to work alongside travel nurses who are making up to three times their salary in the same role or possibly even a role with less responsibilities,” she says. “This creates teamwork and morale challenges for the entire team.”

Cadugan says she has witnessed this firsthand and believes it’s one of the biggest challenges of using travel nurses. “The permanent staff feels under-appreciated because the traveler is making so much more money,” she says. “Also, travel nurses come and go frequently, which can alter the culture of the permanent staff.”

For example, staff nurses sometimes get upset when travel nurses tell them that a previous OR where they worked does things better than they do. “They may have good suggestions, but the staff nurses feel like the travelers are criticizing the way they’re doing their jobs,” says Cadugan.

Little says she has seen some angst among staff nurses when working with travel nurses because of the pay variation.

“But I have also seen relief when travel nurses are hired because staff nurses have felt the burdens of being short-staffed for some time,” she says.

To help counteract this problem, Long’s facility offers critical pay to permanent staff nurses to counteract the effects of the travel personnel. “Our director has been proactive when it comes to retaining permanent staff nurses,” she says. “We have a program that offers travel assignments to our permanent staff as a carrot for retention.”

“Permanent staff are not eager or willing to make a new relationship knowing the traveler will soon leave,” says Thornton. “Sometimes travelers are given difficult surgical cases and/or difficult surgeons, and some permanent staff have been known not to assist a traveler with turnover or case preparation.”

Sharar-Williams says she hasn’t personally seen low morale among staff nurses while working alongside travel nurses. “The staff nurses I have spoken to understand that the travel nurses are there to help with staffing needs,” she says. “They know that without them they could be facing shifts that are shortstaffed and not have proper ratios or resource nurses to help on these high acuity units.”

Pros and Cons of Travel Nursing

There are clear pros and cons to working as a travel nurse. Of course, the biggest benefit for many is the higher pay. Other benefits typically include:

• A living stipend in addition to salary and bonuses.

• The opportunity to travel to new places and meet new people.

• The opportunity to learn new life skills and expand clinical experiences in different hospital settings.

• Scheduling flexibility, including not having to work on holidays.

• Getting breaks between assignments to decompress.

• Being able to avoid hospital politics.

But there are tradeoffs. Some of the potential drawbacks of working as a travel nurses may include:

• Unfamiliarity with new hospital environments and practices.

• Not being viewed as part of the team.

• Less employment stability due to short-term contracts.

• No paid time off (PTO).

• Unfamiliarity with new cities and lack of family and friend connections.

• Undesirable and/or more complicated cases and work assignments.

• Difficulty in forming professional relationships due to short-term assignments.

Communication is Key

Given the prevalence of travel nurses in health care today, facilities should be proactive in determining how they can use travel nurses most effectively while minimizing or eliminating some of the negative effects.

“Communication is key to increase understanding of the need for travel nurses and minimize any hard feelings between travel and staff nurses,” says Little. “Some management teams have eased potential bad feelings by pushing for higher pay for staff nurses and implementing programs that allow staff nurses to assume certain hardto-fill shifts for higher rates of pay.”

Cadugan urges management to make sure staff nurses know they are appreciated. “For instance, when down-staffing is necessary, ask the permanent staff if they’d like to be down-staffed before cutting travel staff,” she says.

“Nurse managers need to be aware of possible perceptions of deference toward travel nurses and determine how to balance this perception,” says Becker. “This will require creativity on the part of the leader.”

According to Sharar-Williams, reiterating that travel nurses are there to take care of patients during a time of need helps rationalize why they are there in the first place. “Also, make sure travel nurses are equipped to take on patient care independently so staff nurses don’t feel like they have to orient them during their shifts,” she says.

Becker encourages nurse managers to consider travel nurses as part of the team and introduce them as team members. “At the same time, travel nurses should be held accountable and responsible for the same care standards as the entire team,” she says.

To increase morale among staff nurses, Thornton says she fought for administration to allow her to open a full surgical team for weeknights and weekends. This allowed her to remove 95 percent of call hours, which let staff nurses to have their rest and be with their families.

Thornton also suggests that staff nurses be rewarded with gift cards, PTO or other perks for outstanding performance. “Rewards can be based on room turnover, patient compliments, meeting patient safety goals or teamwork witnessed by leadership,” she says. “Ask your staff nurses what kind of perks would be most meaningful to them.”

Best Practices for Using Travel Nurses

Following are some best practices for using travel nurses in a health care facility:

• Utilize shared governance models to address morale, teamwork and communication issues and opportunities.

• Decrease the utilization of travel nurses as soon as you’re able to.

• Develop an internal travel nurse pool within the organization to provide staff nurses with some of the same salary, scheduling and benefits opportunities as travel nurses.

• Put together a strong interview team to hire the best travel nurse candidates.

• Provide adequate orientation to travel nurses and pair them with experienced staff nurses.

• Have regular check-ins with travel nurses to help them feel supported.

• Make sure the experience of travel nurses you hire properly aligns with your facility’s needs.

• Be sure that travel nurses know your expectations before they start (e.g., call requirements, PTO policies, uniform expectations).

Sharar-Williams also recommends having regular check-ins with travel nurses. “This will help them feel supported and part of the team, instead of feeling like a temp employee,” she says.

“Don’t forget to discuss extension possibilities with the travel nurse, HR department and travel company in a timely manner,” says Becker. “Putting this off until the assignment is almost finished could lead to gaps in employment. Also be sure to complete evaluations on the traveler so future employers gain insight into the person they’re hiring.”

Thorton’s main advice for using travel nurses is simple.

“Build strong relationships with all staff, treat everyone with kindness and be genuine,” she says. “Go down the hall, make rounds and give a helping hand by turning over a room.”

Many hospitals and ASCs demand staff loyalty but do not give loyalty back, says Thornton.

“A pizza party is not what your staff needs or wants,” she says.