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Featured in OR Manager: Why Nurse Travelers Are More Friends Than Foes

October 4, 2024

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Featured in OR Manager: Why Nurse Travelers Are More Friends Than Foes

-written by Josiah Whitman, CEO of Whitman Partners

Many are quick to blame travelers for the poor state of hospital finances. However, isn’t there a difference between a traveler in the OR—an interim staff member in the hospital’s profit center—and an interim RN in an area financially supported by OR profits? What about the argument that travelers can be considered an investment in the financial health of the hospital, particularly in examples where surgical services or even the entire facility would shutter without them?

In short, travel nursing is a nuanced topic. Here, interviews with three hospital executives shed light on how travelers fit into staffing strategies. They also highlight the importance of strategic planning, cultural integration, financial management, and regulatory compliance for making the most of their investment.

Stability amid turmoil

Travelers can cost as much as four times more than regular staff. However, for rural hospitals like Gerald Champion Regional Medical Center in Alamogordo, New Mexico, the choice is often between using travelers or being unable to provide essential services. “We did not want to transfer patients out of the community,” says Robert Middleton, Chief Administrative Officer. “It was about sustaining capacity.”

Such difficult choices are not unique to rural hospitals. During the pandemic, many found themselves having to balance the high costs of travelers with the need to maintain patient care standards. “We couldn’t have managed without them,” says Ruth Shumaker, BSN, RN, CNOR, who was interim Director of Surgical Services at Regional One Health in Memphis, Tennessee, during that tumultuous period. “Travelers helped prevent burnout among full-time staff and ensured we could continue providing care during a critical time.”

Prior to the pandemic, Regional One used travelers primarily in areas such as the trauma OR due to its “high-stress, 24-7 nature,” says Shumaker, who is now a principal with Perioperative Consultants. Middleton reports a similar pattern. “The highest utilization has been in the emergency room and surgical services, as training new staff for these areas takes a long time,” he says.

Both leaders say travelers can offer strategic value beyond providing a temporary solution to staffing gaps. Sal Ababneh, hospital president at UW Health in Wisconsin, is of the same mind. He sees travelers as a strategic investment to help manage periods of growth or higher demand. Also, “Travelers bring in new perspectives and ideas,” he says.

Change catalysts

Capability to deploy relatively quickly is a major part of travelers’ strategic value. Hiring for a perioperative nurse role permanently takes 4 months or longer; however, in most cases, an agency supplying interims can help fill that demand in 14 days.

“Building a strong internal team is crucial, but travelers can help bridge gaps during transitions or growth periods,” Ababneh says, citing the example of high-demand seasons for surgical procedures. “We went through phases of decreasing and increasing contract labor based on our needs. It’s about ensuring quality and safety while also managing financial stability.”

Travelers also offer diverse experiences and expertise that can contribute to long-term improvements in hospital operations and patient care. Ababneh’s approach, for instance, includes a focus on continuous improvement and feedback. “We regularly gather feedback from both travelers and permanent staff to identify areas for improvement. This helps us refine our processes and ensure we are providing the best possible care,” he says.

Middleton echoes that sentiment. “One of the big benefits of bringing in travelers is their diverse experiences,” he says. “They can offer insights and improvements we might not have considered.”

Examples range from alternative scheduling methods to new strategies for tackling emergency cases without overhead alerts.

Costs management

Using travelers strategically to accelerate broader improvements could help mitigate the financial burden associated with bringing them on board. For instance, the “right” traveler, such as one with a couple years’ worth of departmental experience, can mentor and train permanent staff. They can be preceptors and relieve some of the educational strain most facilities experience.

However, events like the pandemic could result in a need for more extreme measures. Shumaker recalls hospitals offering full-time staff retention bonuses to prevent mass exodus, creating a strain on already stretched budgets. “It was difficult for staff to work alongside travelers making significantly more money. This created tension and necessitated retention bonuses to keep our full-time staff,” she says.

Faced with such challenges, hospitals are being pushed to develop innovative financial strategies to manage labor expenses. “We have negotiated better rates with staffing agencies and explored flexible contract arrangements to reduce costs without compromising on quality,” Ababneh says.

Other examples of such strategies include:

• Seeing how alternative staff such as licensed practical nurses can take on certain tasks that fit their licenses and certifications

• Offering different shift structures such as extending hours worked (working 48 hours instead of 35, for instance) and paying more for all the hours, not just the extra shift

• Looking at internal staffing models many health systems are employing, such as circulating staff among different hospitals within a single system.

Technology can help with managing travelers by reducing labor costs and improve efficiency. “We use advanced scheduling and management systems to track performance, ensure compliance with protocols, and streamline communication,” Ababneh says. “This technology helps us maintain high standards and reduce potential friction points.”

Cultural integration, team dynamics

Effectively integrating travelers into a hospital’s culture and processes is critical to maximizing the value of a provider’s investment. Some institutions have created intense onboarding courses designed to get travelers familiarized with the facility as fast as possible. Others have checklists in place to ensure travelers get through the screening process more seamlessly. At Regional One Health, Shumaker recalls “robust” onboarding processes for travelers, including “detailed orientations and pairing them with experienced staff to ensure they understood our protocols and culture.”

Shumaker also notes the psychological impact on full-time staff, as working alongside travelers who earn significantly more can create tension and affect morale. The addition of travelers sparked more awareness in leadership over the need to recognize permanent staff’s hard work and dedication. “Regular meetings and open communication channels were crucial,” she says. “We had to ensure our permanent staff felt valued and supported, despite the disparities in pay.” This can include ways to foster regular team-building activities and be more inclusive of staff in decision-making processes, for instance.

At Gerald Champion, a “buddy system” has proven particularly effective, Middleton says. Pairing new travelers with seasoned staff not only helps them acclimate faster, but also incentivizes a sense of community and belonging for the entire team. Other team-building strategies include workshops and training sessions where travelers and permanent staff can learn from one another. “This not only improves skills for everyone, it also builds trust and camaraderie,” he adds.

An unexpected bonus? When in some cases, traveling staff decide to stay and become full-time employees. Ababneh says, deep down, that should be the end goal. “You want travelers to like where they are, to fit in your team, and related to your culture,” he explains. That is the hallmark of a good retention strategy because monetary incentives will only take them so far. “As leaders, we need to influence their working environments for the better,” he says. Identifying key projects of which travelers can take ownership, for instance, will help make them feel like they are making a concrete contribution to that environment and that team.

Impact on policy, regulatory considerations

“Healthcare regulations are constantly evolving,” Shumaker says. “We must remain vigilant and adapt our practices to comply with new requirements.” She explains that includes ensuring that travelers meet all credentialing and certification standards, and right alongside them, taking a pulse on the state of the permanent staff. This increased regulatory awareness keeps leaders mindful of another retention strategy—helping their staff advance toward their educational and career goals.

Middleton points out how travelers shed light on the need for advocacy. “Hospitals and healthcare organizations should advocate for policies that support flexible staffing solutions,” he says. “This includes addressing the financial disparities between travelers and permanent staff to create a more equitable system.” Ababneh agrees, citing the importance of collaboration. “We need to develop best practices and guidelines that ensure the safe and effective use of travelers,” he says. “That is a great opportunity to partner with regulatory bodies toward maintaining high standards of patient care.”

With this strategic mindset—and keeping in mind advancements in technology and changes in workforce dynamics—leaders are finding ways to integrate travelers to benefit the whole organization. Shumaker points to telehealth and remote monitoring technologies. “These innovations can complement the work of travelers, allowing for more flexible staffing solutions and reducing the need for on-site presence,” she says.

Middleton envisions a more strategic use of data analytics. “By leveraging data, we can better predict staffing needs and optimize the use of travelers,” he says. “This will help us manage costs and ensure we have the right resources in place at the right time.” And Ababneh again highlights the potential for greater collaboration. “Partnering with nursing schools and residency programs, for instance, can create a pipeline of well-trained professionals who can step into vacant roles seamlessly,” he concludes. “This approach ensures a steady supply of skilled workers while also fostering professional development.”

Whatever the future holds, these leaders’ testimonies prove that travelers can provide value beyond filling temporary staffing gaps. With innovation, strategic thinking, and a willingness to continually learn and adapt, hospitals can turn the complexities of traveler utilization into opportunities for growth and improvement.    

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Written by Whitman Partners’ CEO, Josiah Whitman.

Acknowledgments

We extend our gratitude to the following healthcare leaders for their invaluable insights and contributions to this article:

  • Robert Middleton, Chief Administrative Officer at Gerald Champion Regional Medical Center, Alamogordo, New Mexico.
  • Ruth Shumaker, BSN, RN, CNOR, Principal at Perioperative Consultants and former Interim Director of Surgical Services at Regional One Health, Memphis, Tennessee.
  • Sal Ababneh, Hospital President at UW Health, Wisconsin.

Their expertise and experiences provided essential perspectives on the value and role of nurse travelers in hospital staffing strategies.

*Published by OR Manager Magazine, September 25, 2024, Why nurse travelers are more friends than foes (ormanager.com)