Chapter One

An Introduction To Travel Nursing

Highway Hypodermics:  Your Road Map To Travel Nursing

By Epstein LaRue, RN, BS, Travel Nurse

If you were a female in the 1950’s and worked outside of the home, odds are you were either a teacher or a nurse. Women became more liberated in the 1970’s and began branching out into other jobs, leaving the nursing field void of needed workers.

The estimated need for new nurses will be over one million by the year 2010. According to a study published in the Journal of the American Medical Association in the year 2000, the nursing shortage in the United States will continue to grow with an estimated twenty percent increase in the demand for nurses needed in our nation’s health care system by the year 2020.

As a result of the vast nursing shortage, seventy-five percent of all current hospitals have vacancies for registered nurses. This number is directly proportional to the need for the travel nurse.

As the patient numbers increase, so does the need for quality nurses to take care of those patients. The law of supply and demand affects nurses’ salaries and travel nurses rank at the top of the scale.

In the year of 1985 when I graduated from high school, I felt the calling to become either be a nurse or teacher. I chose to be a teacher. The problem with this decision didn’t hit me full force until I graduated from college in 1989 and discovered that there were not many jobs for a high school science teacher. After a three-year career as a substitute teacher, I made the decision to go into nursing.

The minute I graduated from nursing school, I knew that I wanted to be a travel nurse but since I didn’t think that it was possible until my son graduated from high school, I set forth getting as much diverse experience as I could get in medical, surgical, rehabilitative, psychiatric, and emergency nursing.

In April of 2003, my world came crashing down upon me.  After working at the same place for four years, I decided to leave my current place of employment.

It all started   when I decided to write up a statement of concern.   I was promptly thanked for this decision by receiving a statement of concern about my attitude.  Before I turned in my statement of concern, I had told the girls that I carpooled with,   “You watch, I haven’t had a write up in the two years   I have been in the emergency room but now that I have written up my house supervisor, I will be written up.”  Within only a few weeks, my prophecy had been fulfilled.

My child had not doing well in public school, so we   decided to look at home schooling. The week that I received my write up, he started going to public school until lunch, and then coming home to do his afternoon schoolwork.   

God, are you trying to tell me something?

I   always wanted to do travel nursing, but didn’t think that I could because I believed   I needed to provide a stable environment for my son. But if public school wasn’t working for my son, and my current place of employment wasn’t working me, maybe I would get my chance to do travel nursing five years before I had planned.

After thinking about it   and discussing it with my husband, I   decided that   I would resign my current position and go on the road. I would work out my two-week notice and I had a month’s worth of vacation time to carry me. Surely I could find something in six weeks. I sent out several resumes from which I received numerous emails and phone calls about placement opportunities. 

One of the nice things about being a registered nurse is that there is always a job out there waiting for you, thanks to the nursing shortage.

Just what has caused the nursing shortage? Not any one entity caused the shortage. I have explored several factors about this crisis   in the following pages.

The age of the baby boomer is upon us and as these middle-aged Americans age, so does the demand for nurses to take care of them. The only problem with this demand for nurses is the supply. Not as many young men and women are entering the field of nursing. 

In a 1990 study, the median age for nurses was forty-five. These nurses are invaluable with their more experienced years, but who is going to take their place when they decide to retire? In today’s society, the numbers of retiring nurses outnumber the nurses who are graduating from nursing school by 20%. I also know plenty of more experienced nurses who now use their knowledge to the best of their ability by consulting. Just because they are older and their legs doesn’t work as well after forty years of running up and down hallways doesn’t mean that their brain is lame also!

Why would anyone want to go into a profession where they are begged to work overtime even when they   hear from the families a confirmation of the fact that nurses don’t have time to take care of patients the way they should. Some families are somewhat more tolerant of this situation because they know that “all hospitals are short staffed.”

Why would anyone want to run around “like a chicken with it’s head cut off” for six hours before they get time to stop long enough to get a drink, go to the restroom, and grab a sandwich on their way back because they can’t waste time for lunch, That abscess has to be drained!

Why would anyone want to get into a profession where a foot masseuse is their best friend? If they are not one of the lucky ones to marry a masseuse, they had better learn self-message techniques and get some comfortable shoes.

The other day, I heard someone exclaim, “All the house supervisor does is prance around the hospital gossiping, chatting on the phone, or is in the office reading a book.” Although that might be the easy way out, what kind of profession is that? What kind of professional is that?

I would rather spend my time on the floor wiping butts, giving enema’s, taking blood, and then giving some back, cleaning up vomit, and my personal favorite, cleaning up that stringy sputum!

I am expected to work long hours, contend with ridiculous understaffing circumstances, be treated like crap by the administration, be yelled at by the physicians while dodging the clipboard, and be ridiculed by my nursing colleagues because I am definitely not working as hard as they are and I am not as good as they are.

I never could understand the old saying, “nurses always eat their young,” but that is what we do. The new graduates are inexperienced and “stupid” because they haven’t been around the block like we have.

But I drag myself out of bed at 4:00 a.m. every morning because I care about the patients that I take care of. I don’t know why anyone wouldn’t want to live the dream of being a nurse!

No, career nurses are nurses because we are dedicated to our profession, because we really do care about patient care and the health of others. But it is hard to convey to someone else that the nursing profession really does have its high points.

If only they could see the patient’s son who gives us a hug because we took care of his mother so well as she slipped from this life to the next. If only they could visit with the patient that went into ventricular fibrillation before my eyes, and told me “thank you” ten minutes after I had defibrillated her. Making a difference in someone else’s life, THAT, my friend, is what nursing is all about.

It does take money and time to get a nursing education. I found myself having to work at least part-time and fitting study time in at 10:00 p.m. after everyone else was tucked in.

The year I went to nursing school, I would drive an hour and fifteen minutes to school, stay all day at school, and then drive back home. Once home, I would change into my nursing assistant uniform just in time to help feed thirty patients and put them to bed. It was only after my job was finished that I went home and studied. Working only four hours a day was a major cut in pay, but I also worked the weekends to bring home enough money to pay the bills and to keep my insurance by working at least thirty-two hours in a week.

I had trouble getting a student grant because my parents made too much money. The scholarships that I received only covered a small percentage of   my college tuition bill. I took out a student loan but I wouldn’t receive that money for another two weeks. I absolutely hated borrowing money, but I remember getting on the pay phone outside the financial aide office and calling my mother, with tears rolling down my cheeks because if I didn’t have the money in two days, I was going to be “kicked” out of nursing school.

My family life was on hold. With all the work and school, I hardly ever spent quality time with my son. For the first time in his life, he went to day-care. When I was at home, he would play with his cars in the “office” room because Mother had to study. I saw my husband even less because he was too busy watching   television, and I was too busy doing my studies to watch it with him.

It was not an easy year for me. I survived nursing school still married, but there are a tremendous percentage of nurses whose marriages do not survive nursing school. 

Another concern for professional nurses is the issue of mandatory overtime. My colleague, Melissa James, stated, “After working a twelve hour day shift at the nursing home, the night shift nurse called in. I was then informed by the director of nursing that I would stay or be turned into the state for patient abandonment.”

Although I never experienced this myself, I know that she is not the only one who has ever faced that situation. Threats of reprisal, including discipline, fear of employment termination, and reporting the nurse to the licensing board is not a fairy tale; it is a reality issue.

Once being coerced into working those extra shifts, the nurses recognize in their hearts that they should not be touching syringes, handing out medications, or providing medical treatment, but they carry on as instructed because they have family to feed at home.

Investigative reports have shown that insomnia has some bearing on more than just a few aspects of nursing implementation, leading to sluggish responses, delayed reaction times, failure to make a start when appropriate, erroneous functions, decelerated thoughts, and a diminished recollection of nursing actions already performed.

Another factor influencing the nursing shortage is the increase in government interventions. With the rules and regulations of Medicare, medical treatment is ruled by money and not by patient need. This is also a factor with insurance entities including HMOs, PPOs, and private insurance. 

The patient’s length of stay is governed by the patient’s DRG (Diagnostic Related Group). If you have a hernia surgery, the government, not the physicians, tells you when your time is up. As a nurse, this bothers me terribly because I see repeat patients who should have been taken care of longer the first time but were discharged only to return two weeks later with a severe infection and wound dehis­cence.

With the terrible money and medical crisis that the United States is experiencing, patients can’t afford their medications and end up as “frequent flyers” in the emergency room just for more medications.

Patients who are uneducated are repeat customers because they don’t understand the directions   they were sent home with. Even though they sign the little paper saying that they understand, how many phone calls do nurses get from patients who got home and couldn’t understand what was written?

Then we have patients who are non-compliant. These people are also in the hospital “frequent flyer” program until they fly in one too many times and end up crashing. 

What does patient behavior and length of stay have to do with the nursing shortage? How would you feel about taking care of these people month after month, year after year? You see them literally rot away, and your attitude goes downhill because you can’t stand to see the same old patients all the time. This might not be too bad in the larger cities but in a rural area, this does make a difference in nurses’ attitudes!

No, not any one of above-mentioned things has caused the nursing shortage by itself but with the combination of all these factors, one has to have a strong desire and dedication to choose nursing as a career.

With travel nursing, these factors are somewhat minimized. You have already taken the time and the money for your education and are quickly on the road to financial recovery. You are not governed by what the hospital “forces” you to do, but by what you set up in your contract.

As a travel nurse, I find that the hospital politics are of less concern to me because once I am there long enough to want to make a difference, my time is up and I don’t get into the politics.

As long as I show up on my contracted scheduled days, putting in overtime and   extra days are my choice. I don’t have to feel guilty about not coming in on my days off. The animosity that comes to play between managers and nurses when “regular-staff” employees do not pull their share of extra shifts isn’t as long lasting when you are a travel nurse.

Let’s face it, without the nursing shortage; there would not be travel nursing. I am all for better patient care and easing the nursing shortage. That is why I take my turn helping those hospitals in need. I don’t get bored with the same old routine because I change hospitals, and even floors, every three to six months. No, travel nursing is not for everyone. Some nurses need more stability in their lives but I really doubt that I will ever go back to full time staff.

My purpose in writing this book is so that you, a professional nurse, can make an informed decision about your career change into travel nursing. The nursing shortage isn’t going to ease up for a long time. Travel nursing needs quality nurses to assist those hospitals and those patients in need. I hope you find the answers to all your questions about travel nursing in this book.

The first eleven chapters will guide you through the processes of obtaining an assignment, what to expect when you get there, and what to do once you get there. The last two longer chapters were written to give the travel nurse candidate assistance in selecting the appropriate travel company, hospital, and destination.

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