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When it came to travel nursing orientation, my biggest concern was usually trying to figure out how I was going to get up early and stay awake all day. Travel nursing orientation isn’t something to be worried about. Most hospitals run their orientations very similar. If you have experienced one nursing orientation in your life, than you should have a general idea of what to expect.
In most cases, hospital orientation lasts approximately 4 days from 0800-1630. The first two days usually consist of your typical “learn our mission” stuff with general introductions to the administrative staff. During this time you will most likely cover JAHCO required material such as HIPAA, ethics, infection control, and ergonomics (body mechanics). You will most likely receive your badge during this time, so make sure you’re lookin’ good that day. During this time you will be combined with all of the other travelers and newly hired permanent staff. My favorite part of nursing orientation is listening to introductions. I like to hear where people are from and a little part of their story. This is an excellent time to meet other travelers and exchange info; I met some of my closest friends in travel nursing orientation.
On days 3 and 4 of hospital orientation, you will most likely learn how to use certain medical equipment such as IV pumps, glucometers, beds and lifts. Make sure that you have glucometer access before you start your first unit based orientation. There is nothing worse than having a DKA patient with no glucometer access. It is also during this time that you will probably go over the hospital’s computer charting system. This is probably the most important part of hospital orientation. Make sure your username and password are working before your first shift. Most places will hand out cheat sheets for you to bring with you to your unit to help you with charting. It is important that during this time you ask questions if you don’t understand. Make notes on your cheat sheets to help you navigate the system. I also like to write down what the minimum requirements for charting are and how to chart specifically on care plans. Many times the regular staff on the floor doesn’t know the proper way to chart care plans, so make sure you ask in orientation.
At some point during hospital orientation you will have a chance to tour your unit and meet your manager. This is a good time to ask about your schedule. You should have already discussed time off prior to starting your contract, but your manager may have filled you in, so make sure your requested time off is honored.
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After you are all finished with hospital orientation, it is now time for unit based orientation, which is typically your first shift of the week. I recommend arriving to your first orientation day at least 30 minutes early to
make sure your badge, computer access, and pyxis access are all working properly. Most hospitals only give you one day with a preceptor and then you are on your own. Your preceptor will show you the ropes; they will give you the codes to the doors, show you where the linen is, teach you about the flow of the unit, go over protocols, teach you how to get a hold of doctors etc… I recommend keeping a notecard with your passwords, door codes and physician phone numbers in your pocket until you remember them to save you a little time. Separate all of the papers and cheat sheets you got from hospital orientation and only bring the ones that are useful in a folder with you to work; also, make sure you have the name of your manager and the phone number of your unit programmed into your phone just in case you are late or have to call in.
If you have a good recruiter, than you should be well prepared for orientation. They will usually email you an itinerary of general orientation a week before your start date with the name, phone number and address of the hospital. I recommend driving to the actual place of orientation sometime before the first day to get an idea of the parking and traffic situation. There are certain documents that are always required at each orientation. Make sure you have the following with you at all times:
Not all travel nursing orientations are exactly the same. Some states, such as California have certain requirements, like a fire card that requires a special class that you have to attend within 30 days of hire. Other places will allow you to bring a TB mask fit test card from a previous employer, others will require you to have it done on your own time, and others will do it for you during hospital orientation. There are some instances when a hospital requires that you complete certain online tests or competencies prior to your start date. I have even had a hospital require me to learn their computer charting system prior to arriving. You will be paid for your time, but you will be expected to do it on your own. Here is a list of questions to ask your recruiter prior to starting orientation:
Your recruiter should be able to answer some questions about orientation but it is ultimately up to you to get the information you need. One thing to keep in mind when considering your next move, is that if you extend your current contract, you do not have to go through orientation again and often times you will get an extension bonus. Starting a new contract can be both exciting and stressful at the same time. Take the time in nursing orientation to organize yourself so you can enjoy the rest of your contract stress free.
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For some, the greatest attraction of travel nursing is the adventure of visiting new places, making new friends, and enjoying unique experiences; for others, it’s the high salary that makes it worthwhile. One thing is for sure, traveling can be expensive, but doing so as a travel nurse can help you rake in some seriously big bucks.
Many would argue that high pay is just reflective of a high cost of living; however, a substantial contributor to this is the high cost of housing. In this regard, travel nurses are in luck because most travel nursing agencies will pay for housing or include a stipend commensurate with local housing costs.
Here’s a list of states with the five highest salaries for nurses, along with highlights and cost of living in each state.
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The Golden State boasts some of the best weather in the country, along with the highest salaries for nurses. The hourly rate for RNs in California averages $48.68.1 Meanwhile, the demand for nurses is higher than most states because California law requires specific nurse-to-patient ratios.
California is ranked as the third most expensive state to live in.2 And while it has a very high cost of living, housing costs are the main factor, eating up an average 33% of a resident’s income.3 Since your travel nursing agency pays for your accommodations, this affords you a significant boost in spending power.
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The cost of living in Hawaii is the highest in the nation.2 Despite this, everyone still wants to live here, and can you blame them? With its beautiful beaches, tropical climate, and rich local culture, Hawaii is a travel nurse’s dream. Like California, a relatively disproportionate amount of Hawaiians’ income is spent on housing, putting travel nurses in a strong financial position.3
The majestic scenery and pristine waters of Alaska will have you reveling in all its natural beauty as you cash in on the high demand for qualified nurses. Paying an average of $42.55 per hour,1 Alaska is a veritable gold mine. Additionally, housing costs are 38% above the national average,3 making your housing allowance even more valuable.
One of the earliest proponents of the organic, sustainable, and “slow food” movements, Oregon has established itself as a mecca for quirky, progressive creatives, offering some of the highest wages for RNs with an average of $40.29 per hour.1 Though the housing costs are relatively high,2 Oregon beats out every other state on this list for food and other living expenses.3 In fact, transportation costs in Oregon fall below the national average and gas stations are mandated to pump your gas for you4.
The New England state that is home to so many significant moments in U.S. history is also one of the few states whose law mandates a specific nurse to patient ratio in hospital ICUs. With the hourly wage for nurses paying an average of $43.331, you’ll be making history of your own as you explore the Boston Harbor, visit Plymouth Rock, enjoy music at world-famous Tanglewood, visit Emily Dickinson’s home, or walk along the roads of Paul Revere’s Midnight Ride.
Though it ranks as the 4th most costly state to live,2 housing costs can be as high as 50%5 of a normal resident’s income; luckily, you won’t be just a “normal” resident.
There are many benefits of being a travel nurse, and the earning potential in these five states could make those benefits even better. Best of luck exploring your options in these locations that will give you more bang for your nursing buck!
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Sources:
1. “Occupational Employment and Wages for Registered Nurses.” US Bureau of Labor Statistics. BLS.gov. May 2015. Web. Accessed Jan 2017.
2. “Cost of Living Data Series.” Missouri Economic Research and Information Center. Missourieconomy.org. Oct 2016. Web. Accessed Jan 2017.
3. “What percentage of Household Income is Spent on Rent in Each State?”. Overflow Data. Overflow.Solutions. Oct 2016. Web. Accessed Jan 2017.
4. “Why can’t Oregonians pump their own gas? Let us count the reasons.” The Oregonian. Blog.Oregon.Live. Feb 2012. Web. Accessed Jan 2017.
5. “Housing puts heavy burden on many in Greater Boston.” The Boston Globe. Bostonglobe.com. May 2015. Web. Accessed Jan 2017.
Nursing is currently and will continue to be one of the professions in high demand over the coming years. Because there is so much need for highly skilled RNs, travel nursing is growing as well.
Travel nurses work as contractors through an agency, taking on assignments for a few weeks at a time. They are sent to areas to help fill the talents gaps at hospitals and other medical facilities. What started as a way to help health care facilities in smaller cities and rural areas fill their talent gaps has grown into a thriving niche career for RNs.
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Over the last few years, travel nursing has become an attractive option for those who wish to take their patient care skills on the road. Travel nurses who line up well-paying jobs throughout the year can earn salaries that are comparable to that of hospital staff RNs. They also enjoy other perks including having their travel and living expenses paid for. Add to that the ability to make your own schedule, and you can see why travel nursing is an appealing option for some people.
Take a look at some of the major trends impacting the travel nursing industry over the last couple of years, along with predictions as to what’s in store for travel nurses in the future.
If you’ve done any research into the profession, you’re probably aware that there is a shortage of nursing professionals, and it’s likely to get worse. According to the Bureau of Labor Statistics, through 2022, there is expected to be 1 million job vacancies for registered nurses. This mostly has to do with a workforce that is reaching retirement age, and not enough younger nurses to take their place.
However, it also has to do with the demographics of the country, and its changing health care needs. The aging population has more senior citizens than ever before, many of whom will develop one or more chronic health conditions. As per U.S. Census data projections, by 2050, there will be 88.5 million people over the age of 65.
Looking ahead: As a result of the continuing nursing shortage, it could very well end up that medical centers begin to rely more and more on travel nurses and other contracted workers to meet this demand. In many cases, it is more cost-effective for them to bring in nurses as needed as opposed to hiring full-time staffers.
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According to the US Department of Health and Human Services, the Affordable Care Act (ACA) resulted in 20 million people gaining health insurance coverage. As a result, with the passing of this legislation, health care institutions and hospitals needed to pivot quickly, and travel nursing is one of the ways they were able to accommodate more patients.
Keiser Health News even attributed a 20-year high demand for travel nurses directly to the ACA.
Looking ahead: There’s no telling what will become of the ACA once President-Elect Trump takes office. He has promised to dismantle Obamacare, but any changes will likely happen incrementally over time. That being said, he has stated that he plans to keep the parts of ACA that have welcomed formerly uninsured people into the system. This policy includes making sure that those with preexisting conditions have access to healthcare, and allowing young adults up to age 26 to remain insured on their parent’s policies if needed.
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As medical organizations look to reduce costs, they are turning more and more to advanced nursing professionals (such as nurse practitioners) to take on larger roles so that fewer physicians are needed. Hiring or contracting more nurses can also help save money in the long run by reducing readmissions and costly medical errors.
Once again, bringing in travel nurses who are trained in a specific area – such as those with credentials to treat a specific condition like cancer, or who work exclusively with pediatric patients – has provided a solution for improving patient care.
Looking ahead: As more specialty nursing responsibilities emerge, top institutions will seek to find professionals who have the most up-to-date skills and certifications. It’s not just about filling job vacancies; it’s about finding the right professionals who have the exact skill sets needed. For some employers, working with a travel nursing agency helps simplify the recruiting process. In some cases, such as in Florida when senior citizens flock down during the winter months, travel nurses are the perfect solution to meet seasonal demand.
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Overall, there probably won’t be any monumental shakeups in the travel nursing industry in the coming year. However, based on potential changes to the healthcare system, as well as the aging workforce, older population, and greater reliance on RNs and nurse practitioners, travel nurses will continue to find great opportunities to work across the country.
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When I started traveling I never even considered that fact that I would or could be canceled for any reason; after all isn’t there a huge demand for qualified nurses throughout the country?
Well, let me tell you that having your contract canceled as a travel nurse is a real phenomenon and believe me it happens.
I personally have had my contract canceled early once, one threat of cancellation and in one instance, canceled my own contract.
There are a few reasons hospitals will cancel travel nursing contracts. In my case, I was working in a facility in Florida, which is a seasonal type of place, and my contract was canceled early because of low census; I was supposed to be there until March and ended up leaving a month early.
What happens in seasonal places such as Florida and Arizona is snowbirds flock there in the winter, so there is a huge influx of people and hospitals have to increase staff. This makes it difficult to predict staffing so if the census stays low for a few weeks then facilities will cancel travel contracts early.
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There are instances when facilities will cancel your contract prior to you even starting; this usually happens in cases where hospitals are staffing for EMR (electronic medical record) conversion. Hospitals like to have increased staff on hand so their own employees have enough time to learn the new EMR system.
Sometimes the EMR conversion will be pushed back, leading to canceled travel contracts at the last minute. In this instance they will cancel you a week before you are supposed to start orientation, leaving you scrounging for a new assignments.
The third most common reason facilities will cancel a travel contract is because of poor nursing performance. This topic can include patient complaints, attendance issues and even personality conflicts with staff. I personally had an issue with a staff member at a facility I was working at and was threatened with cancellation.
The facility contacted my agency letting them know that I was suspended from work for 2 days until they came up with a resolution. In the end, the manager of the unit made me write an apology letter to the other staff member involved and that was that. I ended up finishing my contract and declining their offer to have me extend. I was lucky enough to have an awesome recruiter who I had been working with for a while and knew that the accusations against me were false.
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Travel nurses do have the ability to cancel their own contracts but it is not recommended. The majority of reasons travel nurses cancel are because of family emergencies, personal health problems, facilities not adhering to agreed time off and schedule, and a poor working environment.
Cancelling a contract for family emergencies and health problems are valid reasons, just don’t make a habit of it. If this issue comes up in more than one assignment, then it may be time to go home. If you have an emergency and a good working relationship with your agency, your recruiter will do his/her best to find another traveler to take over your assignment and housing, without any financial penalty towards you.
When it comes to scheduling conflicts and poor working environment I would tell you that unless you feel your nursing license is being threatened, it’s probably best to choose your battles and bite the bullet because the financial and professional penalties can be devastating.
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If a travel nurse has the agency’s housing and decides to cancel his/her contract, then that nurse may be responsible for paying for the remainder of the lease if his/her recruiter can’t find a replacement.
If a nurse sets up his/her own housing, then he/she will have to deal with ending their lease early, if he/she can’t find another contract in the same city. If you get in the habit of cancelling contracts then it will be very difficult for you to obtain references for future employment. If you absolutely feel that you cannot finish an assignment then give your recruiter plenty of notice so he/she can fill your place with a new travel nurse so you don’t have any financial penalties.
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I personally do not believe there is a way to prevent a facility from cancelling you. The best you can do is have a clause written into your contract that prevents the agency from holding you financially responsible for anything if your contract is canceled.
You can also write in your contract that you expect to be reimbursed for any travel and licensing expenses you incurred if your contract happens to be canceled prior to you starting; this will be between you and your agency. You have to remember that the facility that is contracted with your travel nurse agency is a customer. Your agency is going to do everything in its power to keep them happy. If that means replacing you with someone else, then that is what’s going to happen. It may not be fair but that’s the way it goes sometimes.
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I can’t say that having a contract canceled happens often, but I do know it happens and it has happened to me personally. Flexibility has to be the ultimate character trait of every travel nurse. The field of travel nursing can be very unpredictable. It is always best to have a plan B just in case Plan A doesn’t work. If you get canceled, try to find a facility as close to you as possible to cut down on travel and housing expenses, always get your references for future employment early on in the contract in case a cancellation occurs by either you or the facility and make sure you have some money in the bank; it could take weeks to find another assignment. I have always thought that travel nurses needed a union. I personally feel that we get the short end of the stick sometimes and not much representation. Having a good recruiter and agency to back you up is of utmost importance; or if you are loaded, get a lawyer and fight for your rights.
If you have been canceled or have canceled a travel nursing contract, I wouldn’t worry too much about it. Even after my unexpected cancellation and conflict with that nurse, I still have multiple recruiters calling me every week with travel assignments. There are hundreds of companies out there who are looking for great nurses. Becoming a travel nurse is a huge commitment and it is important to understand that even though you are temporary, your presence will last a lifetime; make the best of it, be flexible and choose your assignments and battles your wisely.
Before I started travel nursing, these are some of the issues I wish I would have prepared for a little better.
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Educate yourself on how travel nursing pay packages work. Do not be alarmed that your base pay is going to be significantly less than what you’re getting paid now. Just know that the tax incentives will make up the difference. It is also good to know that if you miss work you don’t get paid and you might actually have to pay your travel agency for part of your housing. Try to find a travel company that guarantees hours.
Packing up and moving every few months is a pain. Instead of bringing your dishes with you everywhere, maybe go to goodwill and buy just a few to get you through your assignment and then re-donate them when you move. As far a clothes and shoes go, if you haven’t worn it in three months, you probably don’t need it. Keeping your materials to a minimum is an important life lesson you will learn by the end of your journey.
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You know how to take care of people, this is what you were born to do. The trickiest part of traveling is figuring out where all the stuff is and who to call. You will find that traveling brings back the best part of nursing. It allows you to take care of your patients without having to get hung up on the inner workings of the unit.
Just because you worked in an environment that embraced personal opinions it doesn’t mean other people feel the same way about your opinion. You will find it frustrating that nobody really cares what you have to say, even if it means improving current nursing practice; not to worry, someday someone will seek out your traveling expertise and it will land you one of the best jobs you have ever had.
Just because you are a travel nurse doesn’t mean you have to move every 13 weeks. If you are loving the city you are in, then try to extend your contract or find another hospital within driving distance that is in need of an awesome nurse.
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This can be scary at first. You may want to quit an assignment or move back home. It is extremely important to push through this loneliness and find ways to combat homesickness. Plan for activities to keep yourself busy. Join a gym, buy a puzzle, plan touristy activities, get Netflix and make regular phone calls to the people you love. Learning to be your own best friend is priceless.
There will be times when you won’t get a paycheck for a month. Most of the time you will have at least a week off in between assignments and then it takes two weeks to get your next paycheck. Your budgeting skills will need to be on point. If you are smart, you will learn that buying material things does not benefit you in any way as a travel nurse. Not only is it usually a waste of money but then you have to lug it around with you all over the place.
I know it’s so much easier to just let your company do it for you but the financial incentives are way worth it. There are lots of furnished housing options out there and if you are feeling really zealous, you can even find a roommate. I know living with a stranger can be challenging but it will get you out of the house more and maybe expose you to some of the local culture.
There is only so much research one can do before going on an adventure. Most of the time, the unexpected experiences of the journey are the most important life lessons and are what make the adventure the most exciting.
When Lori heard about her 4 year old daughter’s plan to marry Matt, she texted the nurse at the Albany Medical Center Hospital to share the joke. Matt is Abby’s favorite nurse, her Prince Charming, at the Melodies Center for Childhood Cancer, where Abby is battling leukemia. Abby was in for a huge surprise the next day, when her dream wedding with her dream groom came true. You’ve got to watch the adorable moment when she says “I do”.
Being an operating room nurse means being focused, disciplined and a team player.
What does a typical day like for an operating room nurse? What emotions arise when you are dealing with life and death situations?
Here’s what two operating room nurses have to say.
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“It is a high stress working environment. But it is so rewarding seeing the problem and usually being able to fix it,” says Kelly Jewell, perioperative clinical coordinator at Fremont Health in Fremont. Neb. “I work in a great area of nursing that is usually hard to get in to. You don’t learn about surgery in school very much.”
You have to learn on the job, and it takes six months to a year to start to feel comfortable in the operating room, she adds.
For the 13 years since she became a nurse, Kelly Jewell, 35, has spent 11 of those as an operating room nurse.
“We all work together as a team for one patient at one time. From the anesthesia provider, surgeon, circulating nurse and scrub technician, we are all working together for those hours providing the safest and most excellent care that each patient deserves,” she says.
When Jewell is working as a circulating nurse in the operating rooms rather than the perioperative clinical coordinator (assigning staff for the day and running the staff meeting), she first goes to check in with her patient and introduce herself.
“We discuss the surgery they are having and match that to the consent they have signed and give them the opportunity to ask any more questions they may have regarding the procedure,” she says. “After that, I head to the OR to make sure we have the equipment needed for the procedure so I have everything available at my fingertips so if the need should arise for the procedure, we have it in the room and ready to go.”
It is her goal not to have the surgeon wait for something that they ask for during the procedure.
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“We also assist the anesthesiologist as the patient goes off to sleep and provide the patient with that comfort and familiar face there by their side as they go off to sleep,” she says.
After the patient goes to sleep, everyone helps position the patient for the procedure at hand. Then she readies the surgical site to prep the area so it can be draped sterile.
“It is our job to monitor and maintain sterility throughout the procedure as well as limit the traffic, staff coming in and out of the room, as to reduce the risk for surgical site infection,” Jewel says.
During the entire operation, Jewell documents it on the computer into the patient’s record from every person involved in the case, equipment used, anything that may have been implanted such as a total knee or hip, medications given and the exact time that everything was done. She then assists transporting the patient to recovery. The entire team assists in cleaning the room and readying it for the next surgery.
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“The emotions displayed in the operating room can be compared to a roller coaster. There are many days where you are on top of the hill knowing you have safely helped all of your patients through surgery, and they will have a great outcome,” she says.
On other days, you may be at the bottom of the hill with the high stress levels that may present themselves with the emergency cases that are done. Fremont Health does take emergency cases 24 hour a day and that means the operating rooms are there for emergencies, too.
“We tend to do stat C-sections, laparoscopic appendectomies and bowel obstructions and any type of broken extremity during the weekends and evenings,” Jewell says.
Being an operating room nurse has taught her to be thankful for her own health and her family’s health.
“It has taught me a lot about respect and compassion for others. Going to surgery is a very stressful time for every patient and being there with them as they go off to sleep is so important so they know we are there to take care of them while they are unable to,” she says.
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Chaitali Bhavsar grew up in India and had worked in the pharmacy industry. But for the past seven years, she has been an operating room nurse and robotic coordinator at Danbury, Conn., Hospital.
“I like that you have to take care of one patient at a time, and you get to focus on them,” she says.
She works the morning shift in the operating room, which means being ready to go at 7 a.m. She said that most of the patients going into surgery are a little nervous.
“We try to reassure them that it will be OK and that we will take very good care of them,” she says.
After talking with them and verifying all the information, she wheels them into the operating room so they can meet with the anesthesiologist.
“My specialties in the operating room are urology and gynecology. We get patients from babies to those in their 80s. If they are children, we ask the parents if they want to be in the operating room until the child is put to sleep,” she says.
Bhavsar said most of the surgeries that she works on are two hours or less, but they do several of them per shift.
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“When the surgeries are long, we are very busy during the whole time making sure everything is there and doing all kinds of things,” she says.
One of her patients she remembers well was a young woman who came in on Christmas Eve. She had just had a baby a few days before, but her bleeding wouldn’t stop.
“The case was pretty crazy. She had just had a baby, and then we have to do a hysterectomy,” she says.
With some traumatic cases or long surgeries, Bhavsar says that sometimes operating room nurses just take a few minutes to themselves to gather their senses again.
“If it’s something really serious, everybody is stressed out,” she says.
Sometimes, people in the operating room are yelling and scaring. But as an operating room nurse, you still have to be focused and be thoughtful of what is happening, she says.
“There are surgeries where it is life or death. But I love my job. The job has made me much more thoughtful of the people around me. And I am much more appreciative of what I have and of life itself,” she says.
Being an operating room nurse uses your strengths as a medical professional and a compassionate and empathetic human being. It takes skills in patience, teamwork and accuracy along with having a sense of humor. Your patients rely on you to give them comfort, understanding and the best medical care to get them through one of the scariest and uncertain times in their lives.
