How can I transition from home care to a travel nurse position?

Ask a Travel Nurse, Travel Nursing

confused travel nurseAsk a Travel Nurse Question:

I wanted to be a travel nurse even before I went to nursing school. So I graduate from nursing school just to find out that no hospital would hire new grads. Went into homecare but requested acute care. I did everything from wound vacs, injections, picc line care, decubitus care, ostomy care and stuff like that. I spoke to a few agencies who are trying to place me on a Med-surg assignment stating that I have enough acute care. What advice would you give me in making the transition. I’m a quick learner, hard worker and very determine but I welcome your input.

Ask a Travel Nurse Answer:

You did not mention how long you have been in home care, but let’s assume that it is at least the one year that most agencies require ( and by the way, many agencies now require two years as the bare minimum). However, even if you were to tell me you had many years experience in home care, it would not change my advice, which would be to transition into a hospital before embarking on a career as a traveler. I know that is not what you wanted to hear, but I have quite a few reasons why you should consider this.

First, no matter what experience you have in your current setting, hospital based nursing is a completely different playing field; plus, you are talking about going into a med-surg area. I work ICU and even if I have two patients coding at once, my night is still probably easier than most med-surg floors. Even though I have long been an ICU nurse, I have worked ER, tele, and med-surg. I can tell you with certainty that some of my worst shifts have been on med-surg floors ( and that was even after having years of ICU experience).

Hospital based med-surg is all about time management and prioritizing. Having a single patient that requires more than just their meds and a quick assessment can throw off your entire shift. Plus you have to contend with things with which you have probably not had much (or any) experience such as IV starts, and insertions of Foley caths and NG tubes. When you take a travel assignment, the hospital already expects proficiency with these things. Many contracts come about because a floor is understaffed and looking for additional help. You can’t rely on having other nurses that are able to help you start an IV or show you techniques to pass a troublesome NG tube. And once again, time management is an issue here. If you spend 30 minutes trying to start an IV, you might have another patient that has been waiting for a pain med for 15 minutes, another that needs a dressing change, and the ER on the line waiting to give you report on an admission to your open bed. Sure, I paint a pretty bad picture of med-surg floors, but ask any med-surg nurse and they will tell you that this can be the norm rather than the exception.

I have also always contended that “on the road” is nowhere to gain your nursing skills (such as the aforementioned IV, NG, and Foley insertions, plus the time management skills). Patient triage is also a BIG part of med-surg nursing. You are used to dealing with one patient at a time. However, you might be in the middle of a complex dressing change only to have your tech tell you that Mrs Jones is slurring her words or Mr Smith is having a pressure in his chest (hopefully not both at the same time, but stranger things have happened). Travelers are also expected to operate very independently. What would your steps be in the situation above? What if it were two patients with those problems at once? Which patient would you see first? What if there were no other nurses to help and the charge nurse was off the floor? Knowing what to do in extreme situations is not just a skill that you need in the critical care areas.

Finally, what if there were an incident while you were on assignment? Do you have years of hospital based experience to fall back on? Since one or two years of hospital based experience is the “norm” in the world of travel, how do you think it would look in a court of law if you were traveling with less experience than is normally required? Who would back you? You are just a temporary employee at the hospital, so it is doubtful they would come to your aid. Are you traveling with a reputable company that would have your back? (the same company that tried to push the boundaries to get you into that assignment). If anything were to happen while you were on assignment, you have to think about how you would be viewed in the eyes of the legal system. Is it worth it to try to take a short cut when it could end up costing you your license?

Yes, all of these are extreme situations and you might very well start traveling and never look back. The point I’m trying to make is that it is a risk; only you can decide if it is an acceptable risk. There will always be companies that can get you a job; after all, what do they have to lose? They have a vested interest in getting you on the road. They will be earning money off of every single hour you work. If you have talked with many companies, I’m sure there are some that have told you that you cannot travel yet. Why would these companies, who also have a vested interest in getting you work, turn you down? Because they cannot send out a traveler who does not meet the required experience that is the norm in the industry. Plus, I suspect you might have difficulty getting an assignment when your experience comes up in the hospital interview prior to taking an assignment.

I can always give advice, but only you can decide what is best for you. If you do decide to assume the risk, you must be VERY careful in your assignment selection. When you interview with hospital, you will often be speaking with the nurse manager of the particular unit on which you will work. Ask them what the acuity is like on their floor. Ask them about the typical patient population and generally speaking, how “busy” the floor tends to be. Many managers will be up front with you if it is a particularly difficult floor on which to work. However, some might tend to downplay the acuity just to get some help for their unit. Stick to your intuition and if you ever hear a manager say, “It’s usually not too busy”, steer clear.

It might be hard for you to find an assignment in a hospital based setting with only home care experience, but a manager of a low acuity floor might be willing to let you cut your teeth on their floor. You can certainly promote yourself and speak to your strengths as a nurse, but NEVER exaggerate your experience level. Many of these managers are doing you a service by declining you if they don’t feel you have enough experience to work on their unit.

Also look for an assignment in a state that has nurse-patient ratio mandates (California and the western states come to mind). I have worked back east where I could have up to seven tele patients and on nights, as many as ten or eleven med-surg patients. By contrast, in the Phoenix hospital where I currently work, I believe four is the max number of patients for the tele floors.

If you are still on the fence and confused by what the travel companies are telling you, let me know and I will put you in contact with a few recruiters I use at companies I trust. If they tell you it’s a no-go, I would listen to them. I would also welcome anyone reading this to comment if they have personal experience with this situation (especially those nurses currently working on med-surg floors or on a med-surg travel assignment).