Contributed by: Angela Totora, MBA/HA, CHP, RN – Director of Nursing
I recently came across a question a nurse posted to a travel nursing Facebook group. The nurse asked, “Why do I need recent experience to work on a less critical unit?” She couldn’t understand why her recruiter said her ED experience from five years ago was not enough to qualify her submission to a Med/Surg assignment. The nurse went on to explain that she left the ED five years ago to further her nursing education and prioritize the needs of her family. Now that her children are older, she’d recently decided to start her travel nursing journey. The more I thought about it, the more I realized how her path was like many seasoned nurses with years of experience specializing as an ED or ICU nurse but eventually stepped away from the bedside.
Like this nurse, many nurses find themselves stepping away from the hospital setting to prioritize family or personal needs or further their education at some point in their careers. Some nurses transition away from the bedside to pursue different avenues in nursing like Case Management, Nursing Education, Clinic, or a Nursing Director role. Just imagine five years have passed since you’ve worked bedside, and you want a piece of that travel nurse gig. Given the substantial increase in pay compared to staff nurses AND the opportunity to work virtually anywhere you want – why not? Nurses with many years (possibly decades) of bedside experience probably feel confident about taking a travel assignment in any specialty – Med/Surg, Telemetry, ER, you name it.
Not so fast – as you start to talk to more travel nursing recruiters, you’ll likely notice another line of questioning – Not only do they want to confirm that you’ve had at least one year of experience, but they’ll also want to know what specialty you’ve been working in over the most recent year. Different facilities and agencies define 1-year recent experience differently. The most common explanation is a consistent 12 months within the last two years or less. But you know you can do the job. It’s like riding a bike – with a bit of practice and a couple of falls, you can do it.
I admit that I’m one of those OLD salty nurses with a slightly different nursing education experience than most nurses do today (through a diploma program followed by an associate degree program). In my many years as a nurse, I’m proud to say I’ve worked in every unit of the hospital (plus a few outside the hospital setting). Despite the last ten years of my nursing career being dedicated to teaching and administration roles, I still pride myself on my ability to remember everything. Bottom line – I know I’m a good nurse who can still work in any nursing specialty.
Know that the challenge is not your knowledge base – it’s the rapid advancements and changes in healthcare. For example, when was the last time you started an IV lock? Even basic things like an IV lock evolve little by little with time.
In nursing school, you probably learned that the first hollow needle was perfected in 1845, followed by the first metal syringe in 1853, and then the hypodermic syringe in 1855. Most of us won’t remember the exact year a centuries-old medical tool was invented, but we can (and should) rattle off the names of a few IV catheter types that have come and gone in recent years. Can you start an IV with an Insyte-auto guard, Safelet, AngioCath, Suresite, Jelco, and Introcan? Many facilities expect travel nurses to be proficient in whatever brand of catheter, tubing, or wound care products they have on hand.
Another example of healthcare innovation is fluid infusions. Can you count drops to calculate the rate? That is how we did it when I started. What about the ever-changing smart pump technology? These pumps could only set the rate when but were later improved to help with the more complicated medication drips (mcg/Kg/Min). Today, they are already programmed with specific drug names, rates, secondary line additional settings, wireless connections to the pharmacy, and more. The facility that accepts you on contract may use one of several pump models or manufacturers like Baxter, Hospira, Stryker, Braun, Abbott Plum, or Alaris. Are you confident about using whichever one they happen to have?
Reading this, you might have thoughts like: “Technology aside, isn’t nursing still nursing at the end of the day? Just because I haven’t done it RECENTLY doesn’t mean I can’t do it now, right?” or “We can’t possibly be expected to become subject matter experts on every single brand or type of medical devices and parts.”
All those things may be true, but you should at least have a healthy level of knowledge and hands-on experience to use it all with relative ease. These items seem to change faster than most of us change our underwear.
Luckily, we have the internet to look up any new piece of equipment, new medication, or even new procedures if you encounter something you’ve never been trained on before. However, there is more to nursing than the task itself. Remember that thing called time management? As a specialty nurse, you probably cared for 1-3 patients at any given time. You took great care of their multiple IV lines, prepping them for surgery, caring for advanced wounds, and educating family members on all the complicated things going on with their loved one. A typical shift in a Med/Surg or Tele unit consists of caring for 4-6 patients at once (on a good day), multiple doctors placing orders at once, administering 15-20 medications per patient, and processing multiple admits and discharges. Oh, and let’s not forget the family members that still need your attention.
I say all this to illustrate that it’s not that the staffing agency recruiter doesn’t believe you can “nurse” – It’s that most staffing agencies don’t want their nurses to take on more than they can handle – for the sake of patient safety and your own. Caring for a larger number of patients in Med/Surg is just as challenging as caring for one critically ill patient in the ICU, but with that added distraction of 5 other patients needing you too. Unfortunately, most travel nursing assignments lend very little or no practice time. After all, you’re probably there because that unit was/is short on staff nurses, so they expect new travel nurses to hit the ground running with very little help. This is one of the main reasons agencies require nurses to have at least one year of recent bedside experience in their specialty before they even consider submitting you for any travel assignments. Some facilities require two years or longer- especially for highly specialized units or challenging situations.
So, the next time you see that golden unicorn of a travel assignment and assume you can retrain yourself to be the nurse they’re looking for, remember your license and (most importantly) someone’s life depends on you being the most qualified nurse to provide them with the level of care they need.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6628554/ – Implementing Smart Pumps to Enhance patient safety – Sondra Davis
https://journals.sagepub.com/doi/pdf/10.1177/0310057X0603401S02 The Early Development of Intravenous Apparatus. C. Ball. Anaesthesia and Intensive Care, Vol 34, 1, June 2006.
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