So I recently received a DM from a friend who was starting her first travel nurse contract and she asked if I had any advice. I thought this would make a good blog post. I sometimes have trouble making content because I feel like it’s been done before (and probably more comprehensively than I could do it) but I have to remind myself that this is MY take on the subject and it’s what’s important to ME . . . so here we go . . .
10. Be Ready to Roll With It
Being a “quick study” is absolutely essential and sometimes that comes naturally and other times it’s something you have to struggle for. For me, I think it comes naturally (not being bragy I promise) - I’m more than a little “OCD” (not an official diagnosis) on organization and because of that I tend to recall small details well. I form a good map in my head of where things are once I’ve been shown (supplies, equipment, where to chart something, etc.). I’m also one of those people who really wants to know how to do things (even if they’re not super applicable to me) because it makes me feel more empowered and independent - i.e. I want to know how to use the fax machine (even if it’s usually the unit clerk that handles that), I want to know how to find scanned records in the “other” system (even if someone else typically does that) - basically, if I HAVE the capability, I want to know how to use it.
Also be ready to pick up quickly when it comes to charting. You may go from Epic to another Epic system with a slightly different layout or you may go to paper charting. Try to form that mental map of where you have to go to chart various things and be ready to throw out your map from the last place you came from. The same goes for equipment, you may go from Philips to Nihon-Kohden monitors - start with the basics: Where’s the blood pressure cycle button? Do they admit patient information on the monitor? Is it a 3 lead or full 12 lead ECG system? Do their vital signs cross over to the EMR? And then as you’re there longer, start to learn the nuances such as how to recall discharged patient data, how to eliminate ECG artifact, and where to change display profiles.
9. It’s the Way THEY Do It
Building on the last point of picking up quickly, also be ready to do it THEIR way - this is THEIR house. In conversations (especially with other travelers), its fun to compare how different places did things (for better or worse). And sometimes, in the right context, there will be opportunities to bring up other ways of doing things with core staff but in general avoid this. There may be some situations in which core staff or management are actively looking for a better approach and would be open to you sharing what you have experienced in other locations as positive input. For the most part, people aren’t going to be interested in hearing how you did it elsewhere; how great Epic is if they’re charting on paper, how amazing the huge trauma center was if you’re in a small town hospital, or how great the ratios were in California if you’re now in Florida at 6:1. Basically if that’s the way they do it, say “Great! Thanks for showing me! That’s how I’ll do it.”
8. Remember, You’re Not There to Fix Anything
This sounds terrible but one of the reasons I left staff nursing was that I didn’t want to be invested in the department, facility, system, etc. anymore (we’ll talk about why in a coming post). I was tired of going to staff meetings, inservices, being on committees. For the most part, you don’t have to do any of that as a traveler. You’re not invested, you are here to take care of patients and provide patient care NOT to enhance or “fix” things in the department. If that’s that way they do it, then that’s the way they do it - be ready to roll with it. There may be a ton of ways to make it better, more efficient, easier but if they’re set on their system then just accept that and take care of your patients. As a previous member of management who was very involved in process and workflow improvements these types of things could really start to irritate me and I’m a big fan of functionality and just plain common sense (as most of my work focused on efficiency and eliminating duplication of work) but I’ve learned to these things go. If they want you to chart the same thing in three different areas, then go with it. If you need a witness to pull out a narcotic med, to waste it, to administer it, and to chart it then that’s the way they do it (usually you can also tell where they have had issues before by the level of redundancy or auditing in a particular workflow). If the same piece of equipment has been reported broken for three weeks and their typical maintenance turn-around is six weeks, then don’t worry about it - let the natural course, take it’s course.
7. Ask What’s Important
I alway ask the question, “what things are important here?” For the most part this has to do with charting (specifically, what are they auditing for because this will show you what’s important to them) - Pain Reassessment, Fall Screening, Hourly Rounding, etc. This could also have to do with physical things such as how they turn over and clean their rooms, PPE requirements, to gown or not to gown patients, how they dispose of particular kinds of trash, etc. I find that knowing and keeping at the forefront the things that are particularly important to the department puts you on good standing with your fellow staffers, charge nurses, and your management.
6. Mind the Dip
In every job I’ve ever started, I experienced the same thing, and grew used to it and came to expect it. When I used to precept and orient new employees, it’s something I would always tell them. It’s going to suck for the first few weeks (if an experienced nurse on a new job) or months (if a new grad on a new job). For a while you’re going to drive to work with a little nausea, some butterflies in your stomach, some anxiety. It’s true of starting anything new but just stick with it because you will reach a point when you’re driving to work or walking into the department when you realize you no longer feel anxious, you feel confident and more assured of what you’re doing, like you’ve got this. Unfortunately, a large part of what makes you an effective nurse has nothing to do with your skills or knowledge base (although that’s also vitally important) but it’s knowing how the flow works, where to find things, who to call, how the providers work and how they like to be approached, and how to work well with others (for travelers, it’s learning a new set of people and personalities at each assignment). For travelers, this period is typically compressed down from weeks to a few days before you find your feet. Just know to expect that the first few days will not feel fun and you will not like coming to work but eventually you will and you’ll look forward to the patients and seeing your friends and coworkers again.
5. It’s ONLY 13 Weeks
What if you absolutely HATE it? You can’t stand the documentation, the people, the equipment, the providers, the ratios, etc. Well, it’s ONLY 13 weeks, you can do almost anything for 13 weeks and it will be over before you know it. If it’s so bad that you feel like you need to terminate a contract early then I can’t really help you there, I’ve never done it and I don’t plan on ever doing it so I would advise you to seek counsel from your recruiter. But I also deeply research the facility, the department, and the town I’m going to so I know what I’m getting into and what to expect. I look at statistics, the facility website, Yelp/Google Reviews, and searches on group and forums such as Facebook’s Travel Nurse Network - The Gypsy Nurse. But if it’s bad, just try to stay positive, be a team player, be kind, be friendly, keep your head down, and you will come to the then and still be alive.
4. Be Friendly, Be Kind
Traveling can be lonely and if you’re an introvert like me then making friends takes a little more time, but there’s an old saying that goes “to make friends, show yourself friendly.” Reach out, be ready to share, be interested in others. I’ve usually found it best to weigh on the side of exploring the other person. Where your experiences related you can share that as well but don’t make it a showcase of you, put the other person on the pedestal and take a authentic interest in them.
I’ve got an entire blog post in the works on my philosophy on this subject but I think it boils down to how you treat others, and specifically showing kindness to others, speaks everything to the person you are and nothing to them or what they may have done. It’s who you choose to be and how you choose to show up in the world. It’s how you choose to feel inside - do you choose to think the worst, react with resentment and anger; or do you choose to give the benefit of the doubt, to try to see things from someone else’s perspective, to react with whole hearted compassion and kindness. This is what you choose for your soul.
3. Value Everyone
There will always be politics in the workplace (some going on for years before you came on the scene). The beauty of being a traveler, is that you don’t have to be involved in the politics and drama one iota. I always try to value everyone and make them feel like part of the team from the housekeeping staff, to the unit clerks, to the techs, to fellow nurses, to the providers, and also to the ancillary staff (radiology, respiratory, lab, etc.). We are here together as colleagues and collaborators to ensure the best patient care so let’s be professionals and work together as a team. This also goes back to treating each other with kindness and to recognizing when someone is having a bad day, to acknowledge that and then work around it. I also believe in utilizing the best strengths in people - if a unit clerk is awesome at arranging transfers, go to them, keep them in the loop, let them be awesome at what they are best at. Above all, let people know they are seen and appreciated - thank the EVS worker for emptying the trash, thank everyone and take time to say “good job,” “great teamwork” after a code. Even if it’s not coming from their management or coworkers, BE the one who lifts up the team.
2. Keeping a List
On just a functional point, I like to keep user IDs, passwords, door codes, links to email and online training, etc. in a Notes document on my phone. Some people like to write these down in a small book or notepad but I think the phone is easy because it’s almost always with me, it can be easily edited, and links can be live. I create a new Notes document for each facility and have the stuff I need the most often easily accessible at the top. After a while you do typically know the door codes by heart but there’s nothing worse than running to the Omnicell during the code to realize you have to change your password and you’ve been using your fingerprint for so long you can’t remember the old actual password - pull out the phone.
1. Be a Team Player
This is probably THE most important thing I could say and you might think it goes without saying but I’ve seen plenty of travelers who just don’t live up to this. You’re there to work, so work, work hard, the worst thing you can do is be lazy. There’s a saying that does “nobody sits until the team sits.” If you’re caught up and someone else is still busting their butt then go over an lend a hand (believe me it will come back around and the first person anyone wants to help is the one who is always helping others). Recognize when someone else is stressed and unable to accomplish their tasks and be the person to calmly step in and simply say “tell me what I can do to help.”
Don’t be above any task - be the one to answer the phone if the clerk is busy, to empty the trash when it’s full, the clean and remake the room after a patient is discharged - believe me, others will see it and it will make a difference. Don’t delegate tasks to others unless you are actually busy, if you are not doing anything then why are you asking someone else to do a task. Be flexible, don’t EVER complain (remember, if you don’t like it, it’s just 13 weeks, don’t extend). Be willing to try something new, to learn a new approach.
These are just some of the mindsets that I believe have helped me so far and in each assignment I feel I made a positive impact and a valued addition to their team. There's a ton more that could be said, but this is a start.
“Be curious, not judgmental.” (Walt Whitman)
(The end of my first assignment at CHI St. Alexius | Bismarck, ND)