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Issues Update

American Journal of Nursing - August, 2002 - Volume 102, Issue 8

Have RN, Will Travel?
As opportunities for traveling nurses increase, so does hospitals’ dependence on them.

By Susan Trossman, RN

Given the staffing needs of hospitals across the country, registered nurses have more opportunities than ever to try out facilities from Hawaii to Florida by working as “travelers.” And while many nurse leaders believe that travelers have a legitimate role in today’s health care environment, they say relying heavily on short-stay nurses is not the answer to solving long-term staffing needs.

Moreover, leaders within both the ANA and its labor arm, United American Nurses, AFL-CIO, (UAN) emphasize that traveling nurses should never be used to staff facilities that have forced RNs to strike.

TRAVELING

Usually, traveling nurses are RNs who take temporary assignments, most often in three-month increments, at facilities in a different part of their home state or in another state or country. The National Association of Traveling Nurses (NATN) estimates there are approximately 255,000 travelers working throughout the United States, particularly in Arizona, California, Florida, and Hawaii, according to NATN director Leo Stoller. At the beginning of 2002, some 10,000 traveling nurse positions nationwide were unfilled.

Some hospitals have started their own traveling nurse programs, allowing their nurses to travel to other areas during nonpeak staffing periods.

And finally, there are firms that hire RNs with the express purpose of staffing facilities during strikes. One such company, U.S. Nursing Corp., based in Denver, has supplied nurses to hospitals where UAN-represented RNs were on strike.

FILLING A NEED

Hospitals in some areas are not able to provide care to their communities without employing travelers to meet staffing needs; some states, like Hawaii, have a long history of augmenting hospital staffs with travelers, many of whom go on to become permanent staff.

“In Arizona, our population fluctuates greatly between winter and summer, so some hospitals need to literally double the size of their staff to be able to deliver health care to winter residents,” said Marla Weston, MS, RN, executive director of the Arizona State Nurses Association (AZNA). Arizona is also experiencing a severe nursing shortage.

“Hospitals in our communities couldn’t possibly hire enough staff even if every Arizona RN was working,” Weston said. “So how do you fill that gap between what you need and what’s available?”

The 500-bed St. Joseph’s Hospital and Medical Center in Phoenix and others in Arizona increasingly fill it by using travelers, according to AZNA member and nurse recruiter Carol Stevens, MS, RN, CNA. She said that, in the past decade, traveler usage has grown exponentially every year.

“Travel nursing is a big industry, and it’s a necessary industry,” Stevens said. Currently, travelers account for about 11% of nursing personnel on most units at St. Joe’s, and that percentage is higher in the ICU, the ED, and pediatrics.. She added that that percentage is low when compared with other hospitals of similar size.

While Orlando Regional Medical Center (ORMC) in Florida virtually eliminated travelers following the nursing shortage of the 1980s, administrators began signing them on in the past six years to fill staffing shortfalls, said Sue Reed, MS, RN, CNAA, patient care executive and a Florida Nurses Association member.

The need for travelers increased because administrators underestimated the area’s explosive population growth and because patient acuity increased as a result of ORMC’s designation as a tertiary care facility and Level 1 trauma center, she said.

Both Reed and Stevens have said that they are committed to reducing the number of travelers at their facilities, in part because using them costs more than maintaining core staff nurses.

Over the past two years, ORMC eliminated two-thirds of the traveling nurses at the hospital, with the remaining travelers used to staff hard-to-fill surgical nursing positions, as well as cardiovascular critical care. However, Reed said that in the last six months she is seeing an increase in traveler usage in general medical–surgical and stepdown areas, in part, because of population growth.

Stevens believes that the future of staffing lies in continually balancing core nursing staff with traveling and agency nurses. “It will always be a challenge,” she said.

At registered nurse Paula Molzen’s Lincoln, Nebraska, facility, only a quarter of the 40 RN positions are held by permanent nurses. “As the shortage has gotten worse, we’ve had more and more travelers coming in,” said the Nebraska Nurses Association member. “And sadly, our administration is using them as part of the routine staffing pattern.”

She added that some of her coworkers have left to become travelers. “They are young, unattached and they want to see the country while making money doing it,” Molzen said. “I don’t blame them. I just feel sorry for myself.”

As a national staffing consultant, Carol Ann Cavouras, MS, RN, works with hospital administrators on the judicious use of travelers. There’s definitely a place for travelers, particularly in peak seasons and when facilities want to launch specialty units, such as a pediatric cardiovascular ICU, and don’t yet have their permanent staff trained or on board.

But what I’m finding is that health care facilities have no strategies in place for working their way out of depending on travelers and they’re not creative about building their permanent staff,” she said. One successful strategy employed in a Philadelphia hospital system involved offering nurses a retention bonus of $21,000 if they agreed to a three-year commitment.

TRAVELING PERSPECTIVES

Iain Grieve, RN, is one nurse who seized the opportunity to become a traveling nurse. A native of England, he signed on with an international company based in Savannah, Georgia, for a 20-month stint and landed at a Phoenix hospital. He now is a permanent staffer at the same hospital—having been able to “test drive” the facility.

According to Grieve, the professional benefits of working as a traveler are that it allows nurses to see how other hospitals work, choose to work in the best places in the country, and develop their skills at the right facility.

But being a traveler is not without its drawbacks. “Problems can arise when you end up at the wrong institution where you can be treated like a second-class citizen,” Grieve said.

How travelers are viewed by permanent staff—and vice versa—can be a potential source of conflict.

“Nurses are all about relationships—with their patients and coworkers,” said Sue Scheider, director of the Hawaii Nurses Association’s (HNA) Collective Bargaining Organization. “That piece is much harder for travelers. They don’t know how they’ll fit in and whether they’ll be accepted. They don’t have the same roots in the community, and they don’t have the same support structure as permanent staff nurses.”

While Molzen acknowledges that many travelers are competent, she is frustrated by their seeming lack of commitment to her community and facility. “Nurses who are staying for two or three months often make no attempt to get to know the doctors or our policies and procedures,” she said. “Also continuity of care is affected.”

But Grieve believes that a facility’s leadership ultimately affects how well travelers and permanent staff work together. If an institution treats its nurses well, then travelers are more likely to want to work there to fill staffing holes, and permanent staff are more likely to stay.

And in Hawaii, where travelers are represented by HNA, nurses are successfully working together to ensure good wages and working conditions.

NO GRAY AREA

While Ohio Nurses Association president and UAN director-at-large Linda Warino, RN, believes that working as a traveling nurse is a good career option, she maintains that firms that specialize in staffing health care facilities during strikes are engaging in an unethical and immoral practice.

“I endured an 81-day strike because they were available,” she said. “We went on the picket line because we believed working long hours was unsafe. But they were working 80 hours a week, 12 to 16 hours a day without concern for patient safety. In return, they were getting $50 an hour, time and half for over 40 hours, and $300 bonuses at the end of every week.”

In the end, nurses achieved their goals, while the hospital lost money and some excellent nurses who refused to return after the strike was over.

The ANA and the UAN both condemn firms that specialize in providing strikebreakers, and have been working on strategies to expose these companies and prevent them from succeeding.

At its 2001 National Labor Assembly, UAN delegates passed resolutions condemning the practice of strikebreaking and resolved to denounce U.S. Nursing Corp., a widely-used nurse strikebreaking firm.

The ANA, which also has spoken out against that firm and others, has a long-held policy in which the association doesn’t accept advertising and exhibition dollars from companies that provide strikebreakers.

Susan Trossman is the senior reporter for the American Nurse at the ANA.

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