Don’t leave home unprepared.

A recent rise in media coverage surrounding travel nursing related to the COVID-19 pandemic coupled with record-high compensation rates have many nurses considering leaving their staff positions to embark on a travel nursing assignment. On paper, travel nursing sounds lucrative and glamorous (and it has its moments), but it’s not for the faint of heart. Minimal orientation, challenging patient assignments, and uncertainty in the changing healthcare climate can lead to burn out, regret, and unexpected unemployment.   

Before you embark on your travel nursing adventure, get familiar with some of the basics so you’re prepared and ready to have a rewarding experience.  

Recruiters and stipends

Travel nurses work with recruitment companies, frequently several at a time, which fill hospital staffing needs. A quick internet search yields hundreds of results for these companies, so it can be hard to know which ones to choose. Word-of-mouth recommendations are important, but you also can look at reviews on Google or Glassdoor, or join travel nurse groups on social media to connect with companies and recruiters. Many companies require you to complete onboarding paperwork for a job profile before you’re assigned to a recruiter and begin the job hunt.  

Travel nurses receive a housing stipend and frequently a meals and incidentals sti­pend. In many cases, that “tax-free” money is how travelers do so well. If they find a great deal on housing, they pocket the remainder of the stipend. This seems like an excellent arrangement, but not if you don’t follow the rules related to duplicating living expenses at the tax home you maintain as well as at the assignment location, in which case you’re at risk of owing back-taxes on stipend money. If you maintain a tax home and duplicate living expenses (rent at the assignment location and rent or a mortgage at your tax home, for example), you likely qualify for the tax-free stipends. (See Do you have a tax home?)

Landing a contract

After completing the paperwork and establishing connections with a few companies, it’s time to start working on landing that first contract. Most companies have current open contracts listed on their website, and you can collaborate with the recruiter to decide which ones might be a good fit. Alternatively, the recruiter may run searches based on your preferences (day or night shift, location, specialty, pay rate), and send potential matches to you. Pre-pandemic, hospitals were sometimes particular about a traveler’s experience. If you had less than 2 years of experience in your specialty or had never done a travel assignment, you might find it difficult to get hospitals to hire you. With staffing now at a critical low in many areas of the country, hospitals may be more lenient with their traveler requirements and more competitive with their pay rates.

Finding an assignment seems like a simple enough process, and sometimes it is, but other times you can be in limbo waiting to hear back. I once missed out on an excellent travel position at a major hospital system in Arizona. The employee who interviews travel nurses was out of town for 2 weeks, so I took another assignment on the east coast. You may have to go through several people before you get to the manager who needs interview you, which can be frustrating if you’re ready to sign a contract and get to work. If a particular assignment really speaks to you and you can afford to wait, be patient. If you can’t, move on to another assignment.

The manager interview can be nerve-wracking for first time travelers, but typically they’re fairly benign and less formal than an interview for a staff position. Try to view the interview with an open mind. Your role is to augment a staffing need, so if the nurse-to-patient ratio is too high for you or you don’t feel comfortable floating where the manager may need you to, you can be transparent and come to a mutual agreement to either sign or decline the contract. Good questions to ask during the interview include scrub color requirements (you may need to provide your own scrubs), nurse-to-patient ratio, float policy, hospital parking, block scheduling, and traveler cancellation policy.

You’ll have more paperwork to complete during this process, as well as drug testing and pre-employment testing to complete after accepting and signing a contract. If you’re still in your staff position, choose a start date that allows you to give adequate notice to your current manager and provides ample travel time to the contract location. Don’t leave your unit in a state of disarray by quitting without notice.

Housing hacks and travel tips

Finding a place to stay while on assignment will be personal to your needs and the options vary. From hotels to home rental sites (for example, Airbnb), Craigslist, Furnished Finder, and even Facebook groups for travel nurse housing, you’ll find many accommodation resources. Questions to consider include: Are you open to shared space or do you want your own place? Are you traveling alone, with another nurse, or with your family? Will you be bringing pets? You also should research the neighborhoods around your contract assignment to find out what the commute is like and if the area will be safe. A little research goes a long way to preventing the unexpected.

The location of your assignment is a deciding factor in how you’ll get there. I’ve driven my own vehicle to all of my contracts over the years, from east coast to west and back again. But if you’re considering a contract in Alaska or Hawaii, you may need to pack light and book a flight instead. For a short-term staffing contract where you need to be on site for only 4 to 8 weeks, you may be able to fly to the location and rely on public transportation. Again, do your research before you go. I’ve taken remote contracts where there are no public transportation options, so my car was a necessity, but if you’re considering a contract in the heart of New York City, you may want to leave your vehicle behind.

Orientation and beyond

After you arrive at your assignment and receive your first day instructions from your recruiter, the process typically is: Go to the hospital, get a badge, and maybe have a hospital orientation before heading to the floor to orient with a nurse. I’ve experienced everything from sitting alone in a computer lab doing online facility orientation modules to a full 2-day, 50-person interactive hospital-wide orientation. Most recently I had no hospital orientation and went straight to the floor during a pandemic crisis contract. Be aware that some hospitals may require additional pre-employment testing on specialty-specific content, such as basic arrhythmias or cardiac drugs. If you don’t pass these tests, you may be sent home without reimbursement for time or travel and the contract voided.

In my experience, travel nursing orientation typically is 2 days shadowing a nurse and then on my own by my third shift. About midway through the first day, usually I feel comfortable enough to take the reins and get familiar with the charting system, medication access, and floor layout. By the end of the second day, I’m ready to come in and take a full patient assignment.

Address any barriers to workflow (including badge access and login credentials) in these first 2 days so you’re able to operate independently after orientation. You’ll also want to familiarize yourself with your unit. I’ve done laps of the unit at a new contract to make mental associations: “Linen room is across from room 18. Break room is beside the elevator. Supplies are beside the med room.”

Two characteristics can make or break a traveler: flexibility and friendliness. To really succeed and do a good job on these assignments, you need to be able to roll with the punches and adapt to the unknown, while maintaining an upbeat attitude and positive demeanor. Frequently, the need for travel nurses is preceded by poor staffing, nurse burnout, and low retention of core staff. In other words, you might walk on to a floor of tired, stressed, overworked nurses, so your attitude will have a big impact on how you’re perceived by your new coworkers. A study by Gan discussed how travel nursing may not be well-received by staff nurses. However, poor staff reception is situation-dependent and has never been my experience. Most of the nurses I’ve worked with were grateful for the help and appreciated the willingness and friendly attitudes of travel staff.

Healthcare staffing ebbs and flows with census, which can spell an untimely end for a travel nurse contract. I’ve had contracts end early due to overstaffing (many new nurses finishing orientation at the same time) and census changes (most recently, COVID-19 cases dropped drastically, and my contract was cut short in New Jersey), as well as cancelled before I even left for the assignment. Travel nurses have little to no recourse in these situations. The wages are lost, the hospitals aren’t penalized, and we’re out of work. It doesn’t happen often, but you should never count on any travel assignment as a “sure thing,” even after the contract has been signed.

Nursing is nursing

Every assignment gets easier, and I’ve discovered one universal truth: Nursing is nursing, no matter where you are. Identifying problems, coordinating tests and procedures, alerting providers to potential complications, questioning orders, performing hygiene care and skin checks, administering medications, and assisting with mobility—none of that changes. A compassionate and thoughtful nursing foundation helps travel nurses build their practice into a flexible, adaptable, and effective routine regardless of location. And remember that a friendly demeanor and a willingness to ask questions and learn will make more of a difference in adapting as a traveler than any other factor.

As for me, I’m rounding off nearly 5 years on the road, and I’ve grown a little weary of telling my story anew every few months. I’ve been to some incredible places thanks to my time as a traveler and learned so much more than if I had stayed at my rural community hospital in Ohio. I’ve learned to care for patients immediately after a cardiac catheterization, participated in abscess drainages and bedside procedures I’d never even heard of, and rotated through specialty units I would have never had access to without travel nursing. I’ve also witnessed some of the most poignant and diverse interactions between patients and families, which I wouldn’t have been exposed to back home. I feel grateful every day for the opportunity to do this job, but as I near the midway point of an online master’s program in nursing education, I look forward to what is yet to come. As a future educator, I hope I can inspire a new generation of nurses to spread their wings and travel.

Gloria Gillam is an Ohio-based RN with Flexcare Medical Staffing, which is located in Roseville, California.

References

Gan I. Social comparison and perceived envy-motivated communication involving travel nurses: A qualitative study. J Nurs Manag. 2020;28(2):377-84. doi:10.1111/jonm.12939

TravelTax. Tax preparation for travelers. traveltax.com/tax-preparation-for-travelers.