When Karen Descent, RN, returned to California after spending five years away, she became a traveling nurse. I wanted to work at different hospitals and find one I really liked, Descent says. She worked as a traveler at Memorial Medical Center in Modesto, Calif., for another five years before accepting a position there as an ED charge nurse.
Cindy Young, RN, BSN, MHA, manager of emergency services, calls Descent her last holdout. When Young took over in September 2005, 27 travelers worked in Memorial’s ED.
I think we were in that situation because there was a feeling that nurses needed experience to work in critical-care areas, she says. At that point, it was difficult for an RN to get a job in the ER. That attitude lasted too long and became a problem to overcome.
To counter it, Young added a clinical educator position and started a new-graduate program. By January 2007, she had no travelers. Descent was finally swayed by the additional opportunities available as a staff nurse, and the ability to precept and mentor new employees.
Tender Loving CareFormer traveling nurses who converted and are now employed by Mercy General Hospital. Back row: Ryan Tamayo, Patty Armond, Aaron Albano, Tony Singh, Allison Cotterill, Elizabeth Garcia, and James Mims. Front row: Katie Covey and David Bryant.
Hospitals seldom intend to have long-tenured travelers, yet it’s a common occurrence. You’re in the middle of a situation, thinking paying agency rates will be short-lived, and it doesn’t turn out that way, says Lori Hayes, manager of recruitment and retention at Mercy General Hospital in Sacramento, Calif. Or it may be difficult getting the FTEs [full-time equivalents] approved. That step was critical in Mercy General’s effort to drastically reduce its use of travelers.
While the facility became more competitive with staff pay, sister hospitals with similar pay scales did not see the same results. A key difference was the work environment, Hayes says.
We used a lot of TLC, making sure travelers had a good experience, she adds.
Travelers were treated as staff, encouraged to participate in meetings and education and to provide input and suggestions. Recruiters identified travelers who had been at the hospital for more than two years, and asked them at least twice a week to sign on. They were offered open positions before public posting. The hiring process was streamlined.
Employees who referred someone for hot jobs received a bonus when the person signed. Once travelers started to convert, it created excitement on the unit, and a domino effect.
It was a bonus for our current staff to have these travelers converting, because they knew them and it gave some consistency of care, Hayes says.
Creating a community of people who enjoy working together is especially important in the chaos of an ED, Young says. As relationships develop and the staff matures, you see an ability to do a higher-quality, more thorough job. When you work with people you care about, you are more willing to go the extra mile.
Focusing on work environment over money helps avoid bonus hoppers, too. We want our nurses to be well-paid, certainly, but we also make sure they have job satisfaction, opportunities for growth, education, good relationships with peers, says Kimberly Horton, RN, MSN, FNP, vice president and chief nursing officer at Mercy Hospitals of Bakersfield in California.
The hospital looks for innovative ways to help people with the transition to the area, including leasing an apartment to temporary personnel until they find housing.
Flexibility is another key in turning travelers into staff. Mercy General allows nurses to work just a few days a month, for example. We look at how we can make it work so we have quality people doing what they do best, Hayes says. Being creative is a win for everyone.
A Firm Push
Travelers sometimes need a firm push. When Horton came to Bakersfield, some travelers had been there six years. They had settled down in the community, with mortgages and children in school. These individuals are no longer truly travelers, Horton says, but nurses who, for one reason or another, have not made a commitment to the hospital. They’re disenfranchised, and can demoralize your core staff. We made it policy that if you’ve been here a year, you need to look at signing on as permanent staff.
Another important step was changing the staff perception of travelers from intruders to colleagues. Then staff could see travelers as a pipeline for recruitment, she adds.
Horton also revamped contracts to make it more beneficial to be on staff. It’s a matter of where you put the cookie — on the hospital’s plate or the travel agency’s, she says. It ended up costing the hospital more money, but made it more inviting to be a core staff member.
Additionally, the hospital gives staff members shift preferences over travelers. The infrastructure has to be set up to pull nurses toward your hospital rather than push them away, Horton adds.
It’s important to realize, though, that not all travelers will make good staff members. You want individuals compatible with the mission and values of the organization to maintain the bar for nursing quality, Horton says.
Agency contracts may limit a hospital’s ability to recruit travel nurses, but generally only during the first assignment, according to Hayes. If you ask, the agency will probably work with you. If you’re looking at a company as big as Catholic Healthcare West, to maintain a good relationship, an agency will probably be OK with having some travelers transition to staff as long as others are on contract. It takes a proactive, focused effort.