Advice from the trenches

Advice from the trenches

Mitchell, Thomas

How do you select a staffing company? Web presence and print advertising promote agency recognition, but many nurse leaders choose an agency based on word of mouth. Staffing companies capitalize on the power of nurse networking. “If an agency’s reputation is good with nurses, they tell friends and their friends tell friends,” said Gail Yoney, RN, Director of Business Development, HRN Services, Beverly Hills, Calif. Often, a peer or colleague’s endorsement is just as informative as in-depth research.

Agency selection can be a lot like choosing an employer: Before deciding, do some groundwork. Yoney advised, “Find out how long the agency has been in business and what kind of a reputation it has.” Lorrie Dohrman, RN, RN Travel Connection, Los Angeles, Calif., added, “Are the leaders of the agency also nurses?” Tap your colleagues for input or ask to speak with one of the agency’s travelers. Consider your department’s values, concerns, and goals and ask tough questions.

One area of great concern is pay rate. Traditionally, travel nurses commanded the most lucrative rates, drawing many nurses out of staff positions and into travel. With today’s budget crunches, hospitals are reducing spending on travel nurses, creating an obvious challenge for travel nursing agencies. But rising pay rates also affect nurse leaders because hospitals may not have the funds to rely on travel nurses to remedy staffing shortages.

One way to determine the travel nurse’s quality of patient care is to find out as much as you can about the agency’s application process. Agencies build their business around matchmaking; they keep a detailed database built from calls, advertising, and word of mouth. When a nurse leader makes an inquiry, the company representative consults the database and tries to make a match.

Agencies build a team of travelers by using a formal application process. First, the nurse completes a written application, including proof of licensure and professional recommendations. Second, the agency interviews the candidate over the phone. Agencies recruit nurses with several years experience in various environments with different nurse-to-patient ratios. They seek nurses with versatility. “Travel isn’t the place to train,” said Jerry Hofman, the Director of Recruiting for RN Travel Connection. If the nurse makes the cut, he or she joins the staff database and waits for an assignment. Most travelers have already held staff positions. They chose to travel for many reasons, ranging from higher pay rate to the opportunity to work in a new location. Belcher said, “Most nurses have personal goals. They know where they want to go.” Hoffman added, “We try to match nurses with assignments that suit their financial, professional, and personal needs.”

Foster cohesion

When you begin to use travel nurses, you immediately add a level of diversity to your unit. Because there isn’t much time for assimilation, the travel nurse relies on experience and expertise; however, he or she may also have to deal with resentment because of a higher pay rate and benefits package. Given these conditions, unit cohesiveness can become a major concern.

“The existing staff knows the new nurses are coming as travelers; they’re getting the higher rate, the subsidized housing,” said Yoney. In exchange for these benefits, travel nurses are expected to be flexible. Their term of service is often indefinite; they could be in a location for as few as 13 weeks before they move on. In addition, travelers “don’t have many choices,” Yoney added. They often work weekends and unfavorable shifts.”

It’s vital to understand that although these nurses receive above-standard compensation and benefits, they too can become drained. Watch travel nurses for signs of burnout, just like you would with your staff nurses. Yoney cautioned nurse leaders to notice “when it looks like they [travel nurses] don’t want to come to work the next morning.” By being aware of the factors that impact travel nurses’ morale, you can help your entire staff maintain a positive attitude.

Travel nurses have always represented a major cost. When over budget, hospital administrators look to eliminate using travel nurses to cut costs. But this isn’t a magical solution. Here’s an example: JCAHO regulations require hospitals to maintain specific minimum nurse-to-patient ratios (especially in areas such as the ICU and medical/surgical). If hospitals can’t meet those ratios, they have to go into “divert status” and shut down the department. Budget slashing is always a challenge; however, before you cut travel nurses, determine how you’ll staff the department. Is it better to go into divert status and reduce your number of patients, or is it better to cut your travel nursing budget?

Nurse leaders need to ensure that the level of patient care remains constant. Reevaluate the use of travel nurses when “you see it’s not a fit for your type of nursing,” suggested Yoney. Are other areas of your budget being cut because of travel nurse pay expenses? If budget priorities and patient care are affected, it’s time to take another look at the situation. You may not have a choice regarding the use of travel nurses.

Hospital administrators are tired of losing nurses to travel nursing agencies and squeezing their budgets to pay higher rates. As a result, many hospitals are implementing improved staff benefits. Rather than using high-cost travel nurses, hospitals may offer signing bonuses to new grads in exchange for extended stays. To avert the risk of losing staff to the travel nursing field, hospitals are starting to offer more competitive, elevated pay rates.

Copyright Springhouse Corporation Oct 2003

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