Chapter One of Highway Hypodermics: On The Road Again

Highway Hypodermics:

On The Road Again

Chapter One

The Changing Face Of Travel Nursing

Have you seen the price at the gas pumps lately? In July 2006 gas was $2.75 a gallon, and today it’s averaging $3.75 a gallon. On my first travel assignment in 2003 I paid rent of $600/month; for the assignment I’m just about to leave on (in 2008), my total housing costs over $1000/month.

I am starting to see a few changes in the economic status of some travel companies, but surprisingly, most of companies I have talked to say that there are still plenty of jobs.

It seems that the biggest change is to the nurses themselves with their traveling costs. My question is, if the costs are getting higher for the nurses, who is paying for the extra expenses, or are we just not traveling as often? The hospitals definitely are not…a lot of them struggled to make it before the economical down-slump. I’m really surprised that we haven’t seen more of a drop in the amount of travel nursing jobs out there. From my research, it appears that the number of nurses staying at home is directly proportional to the number of jobs that are available.

What nurses have to realize is that there is just so much money that the travel companies are allowed to give out of the bill-rate, and unfortunately, the bill-rates are not going up. I truly believe that most of the companies are doing their best to ease the pain, but the hospitals are not giving out more money to cover some of the additional costs.

What companies have to realize is that it is getting harder and harder to make a living on the road with all the added expenses related to traveling fulltime, especially if you love to make those across-the-country jaunts! Two months ago I came home to Idaho from my assignment in Myrtle Beach, South Carolina, and it cost me $1000.00 for the trip just for the gas. Depending on where your assignment is, that is a paycheck or two just for traveling expenses.

What are the true effects? The hospital’s need for traveling nurses will decline as it is related to more traveling nurses staying at home and doing per diem, but for those of us who stay out on the road there will be plenty of jobs left due to less nurses wanting those jobs. I also see that the higher wages that traveling nurses make over the staff nurse is being eaten up in traveling costs. I can definitely see more nurses taking twenty-six week contracts instead of just thirteen-week contracts and traveling closer to home.

It may be a little bumpy on the road and we might even see a washboard effect when the government tries to fix things, but there will always be dedicated traveling nurses and dedicated traveling companies that will carry on until they find the pavement and head down the smooth highway of travel nursing once again.

Through educating yourself with this book and the resources mentioned in this book you can have a very profitable travel nursing career, not only financially but personally, you can bring a wealth of information to other nurses who would like the freedom that travel nursing brings.

My Start as a Traveling Nurse

From the moment I became a nurse in 1992 until I hit the road in 2003, I had always dreamed of being a traveling nurse. It was in a small nursing home in Oklahoma that I met my first travel nurse from South Dakota. The stories that she would tell! They were all full of excitement and it seemed like there was never a dull moment.

It was then that I planned my strategy for becoming a traveling nurse by getting as much experience as I could in all the different areas of nursing. I started working long-term care, then I progressed to medical, surgical, rehab, psych, and eventually into the emergency room.

All this time, I was waiting on my son to graduate from school so we could go on the road, until one day the school counselor told me that he didn’t know what he was going to do with my son next year. I looked at my husband, then back at the counselor and told him that I didn’t think that he was going to have to worry about my son. I turned in my two-weeks notice at work and we notified the state of Arizona of our intent to home school our child, and off to Phoenix from Lake Havasu City we went.

That was in 2003 and we haven’t once looked back. Since then we have been to California, back to Arizona, Oklahoma, Mississippi, Iowa, Florida, Tennessee, Washington (where my son stayed since he turned 18), Oregon, and South Carolina. The first of November my healthcare support assistant (hubby) and I are starting a new assignment in the state of Texas. We have been through earthquakes in California, a gas pipeline crisis in Arizona, missed the tornado in Iowa and Tennessee, and survived one of the worst snow storms of the decade in the Seattle area. I wouldn’t trade a minute of it for a staff nurse job! I can’t wait to see what Texas will bring!

Anyway, back to 2003. At that time I already had two published novels (Love At First Type and Crazy Thoughts of Passion), and the minute I started traveling I started gathering information from travel companies and from older travelers. Instead of keeping all of that information to myself I started the website Highway Hypodermics and immediately started putting together Highway Hypodermics: Your Road to Travel Nursing, which was published in January 2005.

In Jaunary 2007, Star Publish and I put out the second edition, Highway Hypodermics: Travel Nursing 2007. In that edition there was a lot of information added about the PBDS test, JCAHO, homeschooling and traveling with family.

Well, it’s September 2008 now, and here I am with the my third “Highway Hypodermics” book, which has the subtitle of “On The Road Again.” This edition has a lot of the things that were in the 2007 edition, with the added aspects of traveling as an LPN/LVN, Allied Health traveling, and travel nursing when you are coming from other countries. All of the nursing stories are new and the travel company profiles have been updated, including several new companies!

Travel Nursing Goals

Living the dream… As I traveled the Oregon Coast last summer I was reminded about how fortunate I am to be living the dream of traveling across the United States and seeing some of the most awesome landscapes in the world. It leads me to wonder what dreams other traveling nurses have and how they are accomplishing their goals.

My first dream when I got into this profession was to travel along the Pacific Coast Highway in my Mustang convertible. Although I don’t have the Mustang any longer, I did make it down the California coast with it before the engine gave out. When I was on assignment in Washington state, I finally completed my Highway 1/101 loop from the Seattle area around the Washington State peninsula all the way down to San Diego.

As I was discussing my travel plans with some of the other travel nurses that I work with, one of them mentioned that they have a goal of visiting all the national parks in the United States.

Other simple travel goals are to tour the coasts for lighthouses or covered bridges.

Other nurses have goals of seeing their grandchildren, being close to other family members, or finding a new place to live.

Are you just roaming around the United States, or do you have goals? If not, I challenge you to write you down some short term-goals and long-term goals.

My short-term goal was to travel the Pacific Coast highway. In the long run, I want to travel through all of the states. As of writing this, I still lack the states east of Wisconsin and the states North of Maryland.

The Baby Boomers

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 is the supply, since not as many young men and women are entering the field of nursing as a career.

The median age for nurses in a 1990 study was about forty-five. Not that these nurses are invaluable in their more experienced years, but who is going to take their place when they decide to retire and travel fulltime without having to work?

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 don’t work so well after forty years of running up and down hallways doesn’t mean that their brain is lame also!

Working Conditions

After all, why would someone want to go into a profession where you are begged to work overtime so you can hear from the families a confirmation of the fact that nurses don’t have time to take care of patients the way they should. Families are, however, somewhat more tolerant of it because they know that “all hospitals are short-staffed.”

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

Why would someone want to get into a profession where your feet are abused by all the long hours spent traipsing down the corridors of illness? If you are not one of the lucky ones to marry a foot masseur, you’d better learn self-message techniques and get some comfortable shoes.

Why would anyone want to spend time wiping butts, giving enemas, taking blood, 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 staffing circumstances, be treated like a dog 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 exactly 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 I take care of. I don’t know why anybody wouldn’t want to live the dream of being a nurse!

Career nurses are nurses because we are dedicated to our profession—because we really are concerned about patient care and the health of others. It is just hard to convey to someone else that this 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 who 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.

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.”

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 a family to feed at home and a nursing license to protect.

Investigative reports show 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 of government interventions. With the rules and regulations of Medicare, medical treatment is ruled by money, not by patient need. This also is 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, tell your when your time is up. As a nurse, this bothers me terribly, because I see repeat patients that should have been taken care of longer the first time, who have been discharged only to return two weeks later with a severe infection and wound dehiscence.

Who wants to work with people who have new diseases like vancomycin resistance enterococci (VRE), methicillin resistance staphylococcus aureus (MRSA), AIDS, HIV, tuberculosis, hepatitis, and other life-threatening contagious diseases?

Educational Factor

It does take money and time to get a nursing education. You find yourself having to work at least part-time and fitting study time in at 10:00 p.m. after everyone else is tucked in.

The year I went to nursing school I drove an hour and fifteen minutes to school, stayed all day at school, and then drove 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 meant a major cut in pay, but I worked the weekends also to bring home enough money to pay the bills and keep my insurance by working at least thirty-two hours in a week.

Even if you do find the money to attend nursing school, thousands of potential nursing students are turned down from nursing schools every year, not because they aren’t smart or can’t make the grade, but because there is no one to teach them. The fact of the matter is that a staff nurse with an associate’s degree makes much more than a teaching nurse with a master's degree.

According to www.salary.com, a staff nurse in my hometown makes an average of $54,479, while an Instructor of Nursing makes $42,408. That is a 33% decrease in salary after you go to school for four more years. What part of this makes sense? It doesn’t, and that is why we can’t get good instructors in our colleges to help provide more nurses for the working world.

Legal groups are in the process of advocating better salaries and benefits for nursing instructors. These groups are involved in the long process of working with state and federal government to pass laws that will give additional money to schools to increase the salaries of teachers. Health-related corporations have campaigns to encourage people to go into nursing and supply scholarships. Other schools are networking with more hospitals to make room to educate nurses; still, not enough is being done to help make a big difference in bringing nurses into the field.

Burn Out and Job Satisfaction

Burn-out in nursing is very common. Nurses get in a rut of working the same hospital for years and years and get to the point of being so stressed out that they start to blame others for things that go wrong, have a depressed affect, feel very irritable and frustrated all the time, and even have a short temper, a sense of powerlessness, and a very negative attitude about their work. They hate their work, and they literally have to “drag” themselves to work everyday.

What makes the situation even worse is that for the every one burned-out nurse there are three others that are around her. The burnout feeds itself into a raging fire that can destroy a unit and a nurse if it isn’t carefully contained. Nurses are very dissatisfied in their jobs, and misery loves company. Soon staff morale is at an all-time low.

As a traveling nurse, things change with enough frequency that you don’t get burned out, related to the fact that a fire can’t get to raging stage if you are moving your fire every thirteen weeks. It doesn’t have a chance to grow from a small campfire into a gigantic bonfire.

If you don’t like the position you are in, travel nurses can just pick up camp and move on. Staff nurses have a tendency to stay in the same job for years and fight the burnout because they have settled into that geographical location because of family or friends. Most commonly, the way out is to leave the hospital or clinical situation and go into management, education, home health, or a physician’s office. When they leave the floor, the nursing shortage then increases.

Conclusion

Let’s face it, without a nursing shortage there would not be travel nursing. I’m all for better patient care and easing the nursing shortage, and that is why I take my turn helping out those hospitals in need. I don’t get bored in the same old routine because I change hospitals, and even floors, every three to six months. No, travel nursing is not for everyone, but after reading this book you can make a more informed decision on whether or not travel nursing is right for you.

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