One of the core responsibilities of a nurse to his or her patients is advocacy. Nurses are expected to go to bat for their patients, acting as a liaison while addressing concerns with doctors, physician assistants, and advanced practice registered nurses as they arise and sometimes even before these issues come to light. This is often easier for bedside nurses to accomplish because they have more one-on-one time with their patients and are able to dive deeper into the aspects of their care that matter most to them. Essentially, it’s the duty of the nurse, equipped with this knowledge, to defend the integrity of patients’ and their wishes, preferences, and beliefs while engaged in conversations with other members of the care team and, oftentimes, families for when patients are unable to voice their own concerns and where an advanced directive or POLST is available. Many facilities have implemented multidisciplinary rounds, which seems to create a more transparent and facilitated environment for advocacy where many aspects of the healthcare team are able to construct, assess, and/or revise plans and goals that are patient-centered and collaborative. These have shown to have improved outcomes for patients, which of course is the goal for healthcare in general.
What about advocacy for nurses? Who is there telling everyone what you need or that you need to zoom out and take a break? Sometimes there isn’t that person, so you need to be your own advocate as well. For something so imperative to nursing fundamentals, nurses often forget to speak up for themselves as they are caught in their selfless frame of mind? Nurses need to care for themselves if they are ever to care for others, and sometimes this means speaking up or toning it down. If you’ve ever been on an airplane, you’ve heard the phrase, “Please put on your oxygen mask before helping those around you.” As a nurse, you need to ensure that you are satisfying the needs that make you human. Looking below at Maslow’s Hierarchy of Needs, you’ll see that the foundation of human needs are physiological and safety in nature. This means that calling the doctor for your patient who hasn’t urinated in eight hours is okay, but you should probably address the fact that you haven’t gone to the bathroom at all during your twelve-hour shift as well.
This is not an attempt to tell you how to live your life or bring you back on a trip down memory lane through nursing school theory. It’s simply a plea that you look out for yourself (as a nurse and a human being) so that you prevent burnout and are able to better care for your patients. Without further delay from rambling, let’s dive into some of the topics that travel nurses might need to address most regularly.
This is probably the biggest ticket item on most traveler nurse complaints. Many nurses claim that the assignments can be skewed to favor permanent staff, where travelers receive all or most of the “heavy” patients (e.g. tracheostomies, isolations, total cares, the confused old lady who bites – you get the drift) or are left open for admissions. Sometimes, this is true. It depends on the culture of the unit. This is also not the case in other instances. Sometimes, travelers are given the easier patients in lieu of more complex patients, especially on the more specialized units where they might not trust the traveler to know the protocols or care considerations for that type of patient. Regardless of your situation, you need to speak up if you are uncomfortable with your assignment. As the saying goes, “the squeaky wheel gets the grease” and in this case, you want to make sure you’re doing so respectfully, addressing any concerns you may have to ensure that you, your patients, and your license are safe.
A lot goes into securing a contract. There are many details that need to be ironed out, and the traveler needs to examine an assignment’s details (e.g. pay, location, facility, shift, duration) and make efforts to prioritize their needs. A good recruiter will take your preferences and advocate for you as well. However, oftentimes, there can be “too many hands in the pot” and communication and output suffer. This is when it’s important to check in to make sure that everything is going according to plan. Also, if you have in inside track to those who are processing the contract on the hospital end (i.e. knowing the staffing coordinator and/or nurse manager when signing an extension), it may be reasonable to confirm that things are coming along and press the issue if things have not come together just yet.
For whatever reason, this topic seems to have somewhat of a charged aura around it. While browsing Facebook groups that attempt to put travelers and landlords in touch for the purpose of short-term leases, it seems to be an all-on attack of landlords who list their properties in these venues because the travelers feel as though they are being taken advantage of. Is this true? Probably not. Should you do your research to ensure that you aren’t getting taken advantage of? Absolutely. It’s important to know that you got a fair deal that is mutually beneficial. The landlord has a tenant and the traveler has a place to stay. The landlord’s expenses of homeownership are accounted for and the price is at market value. Of course, there are details that would increase or decrease rent like whole place vs. private room vs. shared space, downtown vs. outskirts, parking vs. no parking, utilities included vs. utilities not included, vs. furnished vs. unfurnished, etc. Again, it’s all about priorities, speaking up for what you need in a respectful way, and negotiating if necessary. Remember, no one is forcing you to stay in one particular place, so make sure it’s a good fit before you sign anything and if it’s not, move on; and keep a good relationship with the landlord when you do sign a lease so that issues can be addressed at a later time as well.
Travel nursing can be an adjustment. It’s important to find the balance to take care of yourself. In order to do that, sometimes you need to put yourself first and think about what it is you truly need. For example, it might be the first time you’ve worked on night shift and need to figure out your sleep schedule. Others in your life should be respectful of that, and if they aren’t or just simply don’t get it, you might need to explain what you need from them in order to get your rest. Make sure you’re consuming a healthy diet as well. This might be another struggle if you share a kitchen or don’t have access to the tools or facilities you’re used to. However, you need to make conscious efforts to make things work in this situation. Since you’re traveling away from home, your support network might be lacking in terms of proximity. In this case, technology is our friend. Text messaging, FaceTime, Skype, etc. have made being away from the ones we love just a bit more bearable. Use these tools to your advantage and possibly schedule some time to video chat and catch up with those special people. Try your best to form relationships with those in your travel location as well whether it be at the gym, work, park, hiking trail, or cafe as it will add much more to your experience and well-being.