Three nurses– a new traveler, a veteran traveler and a staff nurse – spoke at Qualivis’ annual Roundtable conference in May 2022. Each brought a unique perspective that illuminated the data outlined in the Mind the Gap research. They spoke to what prompted them to travel – or to remain as a staff nurse – the challenges they face in new assignments and how hospitals can support the mental health of their nursing staff. Here are highlights from the panel.
What prompted you to become a travel nurse?
Zac Shepherd: There’s a point I think anyone asks in their career, “Am I getting back what I’m putting into my career?” With nursing it’s more than just the tasks that you do – it’s the heart and the soul that you put into it.
I saw travel nursing as a way to potentially revive my career, because I felt like, I don’t know if I can keep doing this as is. All of that burnout and exhaustion, what did I have to show for it? About $1.25 more an hour than I did five years prior.
I felt as though traveling was a way for me to potentially empower myself to keep doing something that I was good at.
Melissa Mac: I chose travel nursing because of the flexibility. I value autonomy a whole lot, and my day-to-day decisions working. And choosing where and when I want to work and the lifestyle that follows with it has really made me pursue travel nursing.
It’s been one of the best decisions that I’ve ever made in my nursing career, like on a personal level and professional level. And I’ve learned so many different skills. I’ve seen so many different delivery models of nursing that I wouldn’t have seen in my home-based hospital. And I’m able to bring that experience and skillset from one contract to the other.
Janet, you’ve stayed at one hospital your whole career. What shaped your decision to stay as a core staff nurse?
Janet Tanner: There are things that happen in your life, and you make decisions. I got married very early. I had children very early. And my hospital offered to me a place to work and still be able to manage my life, my wellbeing, the things outside of the hospital. I had four children there and I worked full-time part of those years. But part of those years, I worked PRN. And my hospital allowed me to do that.
They also invested in me professionally. During the pandemic, my job that I was doing just got closed down. And instead of me not having anything to do and get laid off like I heard a lot of hospitals were doing, our CEO and our chief nursing officer said, “You’re going to have a job.” They retrained me to do something else – a site manager.
Maybe that would’ve been a belittling job for an RN, but it became a team member job. I was helping my fellow nurses to protect themselves. And I felt like my hospital invested in us that way as well, because we never ran out of PPE. And so many hospitals did.
The fact that they applied site managers to the COVID patients for the nurses said, “We’re investing in you that way, too. We want to protect you on a day-to-day basis, on an hour-to-hour basis by giving you this site manager.”
What has your experience been welcoming travel nurses into your facility? Have there been challenges? Is it smooth sailing?
Janet Tanner: When traveling nurses first started coming to the hospital, they were an anomaly. We were like, “Why would you want to do that and what are you doing?”
But during the pandemic, they were a necessity. We could not have done what we did without them. I think there are times in hospitals where there’s a “them and us” mentality. That changed during the pandemic as well. It became “we” are taking care of these patients. And there was a bonding that was different than any other time I think in history for traveling nurses. The whole pandemic brought us together as nurses.
The challenges for travel nurses: you are the new kid on the block. What we try to do at our hospital [is] treat them like they’re a full-time nurse. So, when we have our nursing activities, they’re invited, they’re given the gifts that we get and they participate in the activities just like a full-time nurse.
But there are things like, they don’t know where the bathroom is. It’s not only they don’t know where they are but they don’t know what the code is. Or they don’t know what the code is to the soiled utility room. Or they don’t know what the code is to the clean utility room.
And those are things that we have tried to work on. There are managers that do that differently than others, but I think our managers have tried to buddy up people together and just offer a helping hand to a traveling nurse and not have them be so much as the enemy, the one that’s making more money than you because you chose to stay.
What are your biggest challenges when starting a new assignment?
Zac Shepherd: I think the challenging thing at the beginning of any new assignment for me is just you’re starting from scratch. So, they don’t know you from Adam. They have no idea if you’re competent or not. You obviously passed through whatever checks that the agency did to make sure that you at least hold a license and these sorts of things.
But unfortunately, during the pandemic, I’m sure everyone has stories of travelers who were in situations where they should not have been taking care of acuity at that level. And because of that, there is a little bit of this awkward dance of like, “Okay, does this guy know what he’s doing or not? Should he be taking care of these patients?”
Because ultimately, patient care and patient safety is paramount. It’s the hospital’s job, it’s the manager’s job to make sure that they are adequately triaging the nurses who are taking care of these patients. And so, it’s hard, because even as an experienced nurse who’s taken care of a wide variety of ICU patients in my career, it can be hard to be like, “Oh, well here I’m going to go and start, and they’re not going to know me from anybody.”
And I have to reestablish all these relationships with my fellow nurses. I have to reestablish relationships with the MDs that I’m working with, the manager, prove my worth. And that is a part of the challenge of being a travel nurse. That’s an expected part of it. It doesn’t mean that it’s not work. It takes a certain mentality to be like, “I’m going to come in… to be very adaptable… to be very nimble. I’m not going to be offended by things easily. And I’m going to try and come and adapt.”
And then as you get to that point in a unit where you have that equity built, then it becomes much more smooth sailing from there on.
What do you think the media gets wrong about travel nursing?
Janet Tanner: That they’re in it just for the money. I think that’s the impression that a lot of people have. And it’s just not true. There are a million reasons someone chooses to travel.
Zac Shepherd: This idea that there’s all this angst and hostility between the full-time staff and the travelers. I personally have not experienced that. I have done traveling for five years. I’ve worked in hospitals all across the US. I can think of maybe two interactions I’ve ever had where I thought someone was being intentionally salty to me because I was a traveler.
Do you think that the pandemic driving a sense of unity, a feeling of “we’re all in this together”?
Melissa Mac: Definitely. With all the burnout that nurses have experienced, I think it’s more than ever now you have to be. Because the system’s already in a sense broken in certain ways. And it’ll be even more broken if we don’t have that teamwork.
Zac, you mentioned travel in a way being a way to draw nurses into the profession. Do you want to expound on that a little bit?
Zac Shepherd: The numbers are very clear – we need new nurses. We need nurses from every walk of life. Every hospital system in the US could come up with an incredible ad campaign and promote it through whatever channel they have, and it wouldn’t do as much work to draw people towards nursing as some of these nursing Instagram accounts that I follow. [They] are basically doing free PR for hospital systems, for the nursing profession to draw people in.
Travel in its very nature can seem very glamorous. I’ve written about how that’s not totally the truth, but regardless, perception is reality.
What do you wish people understood about the nursing workforce today?
Janet Tanner: I would want the public to know that our goal is for you, your family member or your friend, or whoever, to leave the hospital better than they came. Not just that they go out alive, but they actually leave better than they came. Because just to have a patient dead or alive is not our goal. We want them to leave with an education, to know more about their illness, to know more about how to take care of themselves and to leave better than when they came in.
Zac Shepherd: The emotional weight of healthcare lands on the shoulders of the nurse. In the ICU setting, when you’re talking about outcomes, it’s not always good, but it’s always important. So, whether someone gets all the way better, that work and that emotional journey that you’re on with the family. A lot of times in the ICU where their patients on the ventilator and not waking up and this sort of thing, that takes a toll on the nurse.
I’m working with these new ICU nurses, and not just travelers, new ICU nurses. And I can tell you, I worry about my younger colleagues. I had five years of this to learn how to deal with the trauma, to learn how to deal with the tragedy, to go and run a bunch and go to therapy and do this stuff to handle this job and keep doing it. A lot of the younger colleagues that I work with haven’t done that work. And they have seen something in the last two years that is way worse than I ever experienced in my first two years or early on in my career.
So, it is encouraging, and it makes me happy to hear that that’s the kind of things that are being discussed at a conference like this, because I think it’s so crucial and so important.
What can we do as employers to help nurses take care of themselves and especially their mental health?
Janet Tanner: I was thinking about this earlier, how we’re responsible for doing that. And how hard it might be when you leave somewhere every 12 weeks and not recognize PTSD in your employee or your team member. How that might be hard to know that if you’ve gone on to your next assignment.
As far as our hospital, when people start showing up late or calling out a lot, then there’s time to have a conversation. And offering time off. there are nurses that work way too many hours and we need to be aware of that and make them take their time off.
I’ve seen it at my hospital, that there are nurses that always say yes when you call and end up with lots of overtime and lots of [accrued] PTO. And so as employers, we have to learn to recognize that and ask them to take their time off.
And if you have to force them to take their time off, then you have to do that. There are services out there, and it’s not just your employee assistance programs, but sometimes they need counseling. Zac mentioned that. And getting that set up for them, and just being proactive. I think recognizing it before it becomes a real problem.
Zac Shepherd: I would just say that a lot of that mental health, you need to identify the sources of what is causing the mental health [issues]. Why are nurses stressed out? Why are they feeling burnt out? And I think a lot of that comes back to working conditions.
So if phlebotomy is short staffed and they don’t have people to stick their patients, that’s on the nurse. If transport, we lost two transporters this week, guess who is rolling that patient? It’s the nurse. If the palliative team isn’t here because it’s a Saturday, who’s having that conversation? It’s the nurse.
Ultimately, all of these things fall on the nurse. And so I think working conditions as far as having the right staff. Nurses should be doing nursing things.
Secondary to that, having the staff there for stuff like, “Hey, go and get off the unit for half an hour while we watch your patients.” Having resource nurses and charge nurses who are coming in and breaking. When you work in states that have conditions like that, have resources like that, it makes it hard to want to go and take a contract in a place that doesn’t do that. That’s just the gospel truth.
Because you need these resets in the chaos of those environments to just be like, “Okay, I’m going to step away. And I know someone’s watching my patients, I’m not making some other nurse drown while she’s watching 10 patients while I go take a run down and grab a lunch or whatever.” So having those
Janet Tanner: I was thinking too about the fact that a lot of times team members do not trust their nurse manager enough to be able to tell them, “I need time off.” And that’s a real problem if your teammates don’t trust you as their leader. That’s something a manager could work on.
And maybe they need communication training on that. Maybe asking the right question, “Are you okay?” Those are skills that not everybody has, and so sometimes there needs to be training for leadership and asking the right questions and recognizing the right symptoms.
About the Panelists:
Zac Shepherd is a Registered Nurse from Dallas, Texas with 10 years of inpatient experience in the ICU/Critical Care setting. After beginning his career as a full-time staff RN, he transitioned to travel nursing in 2018, and has worked in hospitals in Texas, Colorado, New Jersey and California.
Melissa Mac is a Registered Nurse from Chicago, Illinois with more than four years of experience in both skilled nursing and acute care hospital settings specializing in medical surgical telemetry nursing care. She joined Aya Healthcare as a travel nurse in September of 2021 and is currently working on her second assignment in Dallas, Texas.
Janet Tanner is a Registered Nurse and Nursing Excellence Coordinator, Pathway Coordinator, Prisma Health Tuomey, where she has been for 36 years. She started out as a nurse tech then, moved to telemetry as charge nurse, then spent 21 years in Endoscopy as a GI nurse as well as in Cardiac Rehab. During the pandemic, she has managed the COVID testing site as well as the COVID vaccination clinic. Most recently she is preparing the hospital for a second Pathway To Excellence designation.