The proverbial Hatfields versus McCoys has its own version of the tension between traveling nurses and staff nurses. Many of us growing up in other professions have experienced similar tensions. I got to witness it in the advertising business between in-house advertising departments versus outside ad agencies. The relationship was always tenuous.
But the advertising business never experienced workforce shortages that required the outsourcing of services. And surely it was never related to the health and well-being of patients.
Nurse.org reports in its 2023 State of Nursing survey that 79% of nurses say their units are inadequately staffed, while 71% of nurses said improving staffing ratios would have the greatest impact on the nursing shortage.
Much has been written about the reasons for tension between staff nurses and traveling nurses. Among a few of the gripes about the travelers are: pay inequities, more flexible hours, exemption from union dues, distancing from organizational culture, and intimacy. And the converse, travelers love the higher pay, the adventure, the flexibility, and being arm-distance from a stress-producing enterprise bureaucracy.
What has become apparent is that hospitals can not afford to live without travelers despite the tensions this strategy creates.
But as with any “blended family,” the modern healthcare leader must find a way for the two to coexist. Not to simply tolerate each other, but to combine forces for the common good. And perhaps to leverage the tension and stressors between the two in what noted author Nassim Taleb refers to as antifragility or becoming more robust when exposed to stressors, uncertainty, or risk.
If there is any doubt that the growth of traveling nursing causes stress, see the infographic on How to Stop Travel Nurse Bullying in the ICD Nursing Month library.
So can healthcare organizations actually leverage the traveling nurse movement to unify teams and provide higher-quality of care?
The process must start with transforming the perception of pro re nata or PRN (translation: as necessary) nurses to one of being an integral part of the enterprise culture and not just “necessary”.
To be clear, this requires the traveling nurse to have incredible adaptation skills based on the number of healthcare cultures they will be embedded in. This skill is perhaps one of the greatest attributes that each provider can tap into when a new traveler comes into the organization.
In order to do this, some organizations look at travelers as windows into best practices from their previous assignments. This can be the first step in transforming them from being just “necessary” to becoming “insight providers”. This requires periodic debriefing sessions where the traveler can share strengths and weaknesses as compared to other providers they have experienced.
Since the charge nurse can be the victim of many of the stressors from traveling nurses (as well as internal floaters) the ability to delegate some of the onboarding responsibilities is critical. This is typically done using a “buddy system” where the traveler is paired with a staff nurse as soon as possible. Some hospitals try to pair travelers with nurses who may have formerly been a traveler as well to help translate and navigate the cultural issues.
This cultural adaptation process is especially critical for travelers who have just recently entered nursing and have no frame of reference on how different systems or departments work as compared with travelers who may have done it for a decade.
Most charge nurses will tell you that they hear the words “get me someone with more experience” in their nightmares, so buddying a rookie traveler with an experienced staff member may not always be an onboarding solution.
Many traveling nurses are returning to full-time staff positions after becoming disenchanted with the travel while feeling the need for a longer-term relationship with a provider team. As such it seems that buddying between the previous traveler and the new traveler might help with mutual understanding and reduced trepidation.
In closing from an antifragility perspective, despite the tension created by the convergence of these two cultures, these conflicts need to be studied rather than avoided as an opportunity to build stronger hybrid organizations.
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