Lately my hospital has had an influx of traveling nurses from all over the United States. And they’ve all been amazing! Some from Louisiana, Illinois, North Carolina, California, etc. And they really seem to enjoy being here. So why are we not all packing our bags and hitting the road?
Traveling nurses certainly have a lot of benefits. Most travelers can obtain up to $3,300 a month for housing expenses in addition to food stipends and their hourly pay. While their hourly pay may sound lower than usual, their stipends are usually tax free. (On a side note, if the nurse has someone to stay with, she can pocket said stipend!) Each of the assignments is usually 8-13 weeks long, allowing travelers to leave an assignment if it isn’t their favorite, but a lot of assignments offer the opportunity to renew, allowing the nurse to potentially stay somewhere for multiple months.
On the other hand, travel nurses have to cope with a certain amount of stress that comes with moving frequently. Being away from family, making new friends, and even finding housing can be stressful. A lot of times travelers take housing in a location without knowing the area well. For some this works out well, but for others they may end up in a sticky situation. Most agencies will offer some agency sponsored housing, which is often a safe alternative.
Besides housing, traveling nurses must beware of the hospital they are traveling to. Frequently in the NICU, I see travelers that come from a NICU that doesn’t accept certain types of patients or doesn’t offer a specific procedure. When you travel, you are expected to be able to perform the duties of that hospital’s nurses. Know your boundaries and always make sure you are comfortable with the assignment you are receiving. Sometimes a CVICU in one place isn’t the same as another. And watch out for those assignments that always give the worst assignments to travelers. Travelers are a blessing to a hospital in need and so they should be treated!
One of the most important things to look at when considering traveling is the implications of traveling on your current job. Will you come back to your position and be guaranteed a spot? Will you have to go to night shift and work your way back down the waitlist to days? Make sure you look into this before making any commitments.
There are a lot of advantages to traveling, and a lot of challenges as well. It’s important to know yourself and know what you’re prepared for. Doing things on your own, exploring new places, and getting to know different methods of doing things can be really enjoyable with the right attitude. The first step is to contact an agency and begin to explore their options and what licensure requirements are for you. There is no harm in investigating!
Lately I’ve heard so many people say that nurse retention is a management issue, or a hospital problem, or something to be dealt with “above” the bedside. No, no, no! We have to address the importance of our role as bedside nurses in helping to retain our fellow nurses. We should all be asking ourselves what we can do to help our coworkers get a job, and more importantly, we should make sure they want to keep their job!
Here’s what we can do at the bedside to help.
1. Introduce yourself.
This may seem obvious, but stop walking by nurses you don’t know! Stop them and initiate a conversation. You know that girl that you see that you’re low-key afraid of because she never says a word to you? Don’t be that girl. Just. Say. Hello. Not that hard! I usually say, “oh are you a float?” (Just in case they’ve actually been at your hospital for ten years, ya know?) And when they say “No, I’m new,” just introduce yourself and let them know you’re here for them. People really just want to know they have someone to help them and a friend to go to at work. And just because you introduce yourself doesn’t mean you have to be their best friend forever.
Furthermore, ideally your institution has already sent out a welcome email letting you know who your unit’s new staff are so that this isn’t even an issue, but if they haven’t, that might be a good suggestion for your weekly or monthly unit emails or newsletters.
2. Recognize nurses.
Nothing has really changed since kindergarten. People like snacks and naps still, right? Yep, and people also still like to be recognized. Help your unit recognize other nurses’ birthdays, achievements, life events, etc. It can be in the form of a card or a recognition system that your hospital uses. Even a verbal recognition in huddle or just in the hallway goes a long way.
3. Celebrate with your fellow nurses.
Celebrate life’s achievements! Celebrate 100 days CLABSI free, celebrate no IV infiltrates for the month, etc. Celebrate your group of guys and gals that get certified! Heck, we even celebrate random days of the week with chips and dip parties or cookie parties on night shift.
4. Teach your nurses something.
Everyone has something to learn, regardless of experience level. Help find out what areas are lacking in your unit and suggest these areas to your educators. Also, help precept new nurses or orient floats and travelers. You were new at one point, too, and everyone needs a good preceptor. Remember how challenging it can be coming to a new place, finding supplies, learning who your resources are, etc. Being a preceptor is an opportunity to mold someone’s positive perspective!
5. Help each other.
Always try and make rounds on the unit if you can and check and see if anyone needs help. If your unit isn’t laid out where you can reach everyone then try reaching out to your nearby buddies. Check with your charge nurse, too. Identify colleagues that may need some extra help throughout their day and let them know you are there for them. Consider sharing your phone number with them so they can reach out if they need you.
6. Have a committee.
Start a club or committee that solely functions to do good things for the staff. Make your goal to improve nurse satisfaction by representing your nurses and making them feel good. Consider putting together a brief pre/post survey to measure and track your results over time. Once you are established, consider expanding your goal to improving employee satisfaction, reaching out to all disciplines. Environmental services is one of my favorite groups to recognize and reward for the hard (and not so clean) work they do day in and day out! We initiated a “day” for different groups, ie: a PCT Day where we made cookies for the PCT’s and a Doctor’s Day where we hosted a potluck breakfast.
7. Prepare welcome gifts for new nurses.
My favorite project of all is the welcome gifts for new employees. Create a cute little poem, mnemonic, etc. that goes with a night shift survival kit or day shift energy kit. Consider gum, hair ties, K-cups, etc. Include a laminated list of unit resources for your staff so they know who to turn to!
8. Check in frequently.
This is a great way to keep tabs on all the newbies. Have a list of your new staff and go around and check on them once a month or once a week if need be. It can be a mental list and doesn’t have to be a formal conversation. I try to always remember one small piece about each person, e.g., “how’s your house hunt going?” or “how’s your garden project coming along?” People like to talk about what’s good for them, and what better way to promote a positive environment?
9. Ask (and give) feedback.
Always ask your fellow nurses for feedback. I keep a running list of areas for improvement in the back of my notebook that I hear in conversation. Make sure your management knows these issues. Never be afraid to email your managers with feedback you’ve received and suggestions for these issues or concerns. Maybe they haven’t heard of these problems yet! Be a liaison for your fellow nurses and your managers.
10. Ask about unit differences.
Differences are key here. It’s easy to get annoyed with the “well in my unit we…” especially when you’re precepting, but take that as an opportunity to ask your orientee or new friend to make a list of all the things that could be better in your unit, or that were smoother in their former unit. Share these ideas at your unit’s council meetings or with your manager.
Remember, it doesn’t have to be a huge difficult task. Nurse retention starts with the small things; the little things that people remember and carry with them. Often, nurse retention stems from how nurses feel day in and day out, which makes this our responsibility as bedside nurses to support our managers, directors, and hospitals in the effort to retain nurses. Comment below with what works at your hospital!
That is the question, my friends. I recall receiving this piece of advice in nursing school: “The secret to nursing is to never work overtime. Work 3 days a week and only 3 days a week.”
Unfortunately, this piece of advice was coming from my favorite nurse that i had worked with in clinicals, the one that never had a bad attitude, was a team player, and was down for whatever came his way. So what to believe??!
Here’s the thing. Nursing is crazy. It’s all so different, yet so similar. For instance, an ED nurse or a NICU nurse might feel differently than an adult med surg nurse. The ED and the NICU carry on around the clock. Babies don’t know the time difference, and the ED sometimes gets crazier at night. But during my practicum I learned that med surg units often have quiet hours for their patients from midnight to 0600. So, in this case, discussing overtime with a night shift NICU nurse might not be as daunting as it is for a med surg nurse to stay awake for a fourth night of the week. So, definitely do your research and get to know your unit and your position before tacking on a bunch of overtime. What is the night shift vibe for overtime? What’s your day shift vibe like on your fourth shift? I personally found on night shift I really wasn’t able to work a lot of overtime because it just exhausted me, but on day shift I don’t have any problems as long as my shifts aren’t all in a row!
The whole “getting to know your unit” concept brings me to what I believe to be the most important aspect when deciding whether to pick up overtime. It worries me to no end when brand new nurses two weeks post NCLEX are picking up four and five shifts a week. Even nurses a few months into it. I urge you all to give yourselves time; you are adjusting to far more than you realize. The biggest harm I think we can do to our patients as nurses is not taking care of ourselves. There is obvious harm like forgetting a med, but the biggest harm is when stress builds up, and fatigue piles on, and before you know it, your attitude about your patients, your mission, and your duty has changed for the worse. It doesn’t happen overnight; it happens over time. Just be mindful. Know your boundaries, and take your time. Quite honestly, even nurses with ten years of experience scare me when they pick up five or six consecutive shifts. There is no rush whatsoever for overtime. If you’re a new grad you likely have 40+ years for overtime anyway!
And finally, your motivation for picking up extra. Watch out for becoming dependent on overtime. I personally am guilty of this to the extreme. It’s really easy to plan a few trips and pay for them with overtime, but ideally you’re not paying for your car payment or your rent with extra shifts. Make sure you are living within the means of your normal paychecks and using any extra cash for trips, treats, holidays, etc.
So, I didn’t end up following that nurse’s advice after all. I do pick up overtime. Sometimes I pick up a lot. Ultimately, I had to use discretion about who I took advice from and what their role is. This nurse happened to have a wife and three kids at home, which isn’t my current situation. Be mindful of who you’re speaking to. In fact, be mindful of my advice! Maybe my situation isn’t the same as yours right now. Talk to people who are in similar situations as yourself or who have been in your place. Find out what works for them and sit down and think through the benefits and risks for yourself.
While we may all be nurses, we’re all different. And worst case scenario, you’re just not sure if it’s right for you, then give it a try! One shift wont hurt. See how you feel and go from there.
You’ve read my thoughts on being a preceptor, but now it’s time to explore things from the other side: as an orientee. In the last two years, I’ve had the opportunity to orient as a student in nursing school, as a precepting practicuum student, and as a new graduate orienting to my current position in the NICU. It certainly doesn’t take much to channel these inner thoughts from what was not so long ago timewise, but feels like ages ago when I think back to where I was with my nursing skills. Here’s what I learned from the student experience.
1. I’m sorry for a lot of things.
“I’m sorry! I’m sorry! I’m sorry!” is all I can think. I’m sorry I didn’t remember to run a flush, I’m sorry I just kicked the back of your foot. I’m sorry! I know it’s annoying to keep apologizing, but I’m just very nervous and I’m sorry! I feel like I’m annoying you, I’m really worried you’re gonna tell my professor I did something wrong, and they’ll tell the hospital and then I won’t get hired and I won’t have a job! Point being, I’m a nervous wreck and I’m sorry I keep saying I’m sorry.
2. My preceptor is a bear tonight.
I get that it’s not always the most exciting gift to be given a student or a new grad to orient, especially when you’re not expecting it, or if your baby kept you up all night and you didn’t sleep, or if you had extensive plans to Facebook message and Tinder all day long. But… I’m here and I’m excited to learn…. and my preceptor is being a bear! If you could please try to not hate me and teach me something I would really appreciate it. Also, when you answer my question with an attitude I can’t help but feel like I shouldn’t ask any more questions, so please try to be understanding! P.S. We all know the look of a nurse that didn’t want a nursing student so please don’t think it’s not visible! Also, feel free to tell me to go sit at another computer while you’re charting if I’m not needed to help. Odds are that I want a break from you, too, and I could probably use some time to look things up!
3. I’m not as smart as I think.
I’m definitely not as smart as I think or act. I definitely don’t know all (or any) of the acronyms you’re using so please treat me like I know nothing and I can tell you if there’s something I’ve already learned. Further, please don’t leave me alone in a patient room while drawing labs off a central line for the first time (not that that’s happened to me or anything…). There will also be times when I’m acting like a know-it-all, but it’s probably just me overcompensating for realizing how little I actually know. If you work in a specialty unit, AKA anything other than med/surg, don’t forget that nursing school wasn’t focused on your specialty! So, no, I don’t know anything about your 23-week-old baby! Specialties are just that, specialties, so help me learn them!
4. These uniforms will never be less humiliating.
I feel like whenever anyone sees me in my student nurse uniform it’s a shout-out like “hey, ask me to come position your patient” or “I’m free to help transport patients—pick me!” When in reality, I’m here trying to learn. I do enjoy understanding that nursing isn’t all exciting procedures and numbers and diagnoses to learn; half the battle is balancing all of those things and still having time to turn your patients and meet their psychosocial needs, but my time is valuable and if I’m still in school I’m technically paying to be here, so I want to learn the skills I don’t know! Also, my uniform definitely does not mean that anyone can make jokes about what I don’t know or treat me like less of a person. I trust you and you are my guiding light for the day. Knowing that you have my back will help me relax and forget about the sign hanging around my neck that says “student”!
5. The elephant in the room: Lunch!
I promise it’s really OK if you don’t want to eat lunch with me. If you don’t and you do it out of obligation, I’ll know and feel uncomfortable, especially if it’s me, you, and eight of your friends all talking about your weekend plans that I’m not apart of. I’d honestly rather go eat with a fellow student at that point. Plus, I may be a vulnerable student, but I’m also an adult and can handle and enjoy eating on my own. And likewise, I’ll let you know if there’s a night when I really need to sit down with you and talk something through or talk about my experiences.
Ultimately, I’m stoked to be with you as a student, intern, or new grad. I look up to you, trust you, and likely want to be just like you. I know it’s hard having a student, but it’s hard to be one, too. Work with me so I can work with you. After all, nurses eating their young is so prehistoric, don’t you think?
I had the opportunity to precept a nursing student this month and I thought it would be a perfect blog post to share with you all, from my perspective as a nurse, and that as a student who not too long ago completed the preceptorship process myself. As it turns out, both parties have a lot to teach, a lot to learn, and a lot in common.
Here are six things I learned from my precepting experience.
1. I am tired.
No matter how hard I tried to be wide awake and energetic for my student, I realized I am just exhausted. My life is exhausting, my job is exhausting, and frankly, my student is exhausting. Lesson to be had from this slew of exhaust: space out your days when precepting a student. There are sacrifices to be made when precepting, and giving up the 3 on, 4 off perfect schedule is one worth making. The weeks where I was 2 on, 2 off, 1 on were refreshing for both my student and myself, even if we had different patients. In all reality, my student needed more variety in patient load anyhow, so it’s a win-win.
So, if you’re shadowing me and I’m visibly exhausted, hold me accountable! Don’t let me slack on teaching, but do realize there are times when you can use your resources to look things up, too. Sometimes I just need my morning coffee, too, so don’t worry if at 6:35 am I’m not bright eyed and bushy tailed—I’ll get there by 9, I promise!
2. I will never get to bed “early.”
All that being said, I will not and cannot get into bed as early as I wish every night. I definitely have my nights where I go to town and make it happen, but that’s not going to be every night before precepting, and that’s OK. I spent so much time beating myself up about not getting into bed early enough and not packing my lunch ahead of time so I could get more sleep that I could’ve just been taking a power nap. Chances are, students probably don’t go to bed before midnight, either.
3. I’m not that smart, and I probably won’t ever be, and that’s OK.
Nope. I don’t know. I don’t know the obscure gene correlation between the microorganism and its vectors or whatever mumbo jumbo there is to know. But you can absolutely ask! Please ask me, but please don’t judge me when I don’t know! Let’s look it up together and learn together. I would be a bad nurse if I told you I knew every single thing.
Further, quite honestly, there is nothing worse than a know-it-all, and we all know that. When you come into work with the idea that you know more than me, need to teach me, and want to point out in rounds that you know more than me, it just turns me off to teaching. I do believe you really know more than me and have lots to teach me, just remember that there is a time and a place for everything. Let’s have a “think through” discussion where we sit down and get a break, instead of debating in front of a family. Even a healthy debate about medical treatment can come across as inconsistency and lack of confidence to a family who doesn’t know the terms that we’re speaking about.
You are smart—this I know—but I am also here to teach you about my experiences, and that I do have more of, so allow me to help you put all of your awesome knowledge into clinical experience, too!
4. I make a lot of mistakes. And I don’t enjoy having those pointed out to me.
So if I dial up the IV pump for 35 ml instead of 36 ml, please don’t say so very dramatically in front of the patient or the patient’s parents. Instead, calmly remind me when we step to the side or calmly suggest adding an ml to the pump. If I make an urgent mistake please tell me immediately, but handle all with caution. Patients, especially children, pick up on the mood in the room. If you look worried, they will too. Confidently and calmly reminding me is a good way to keep everything under control.
5. I should’ve taken it easy on my teachers when they didn’t sign that form in 24 hours.
Let me tell you, it’s hard. I already get 15 emails a day from work, and when I get another email asking me to sign and fax a form, sometimes it just gets lost in the virtual pile. Don’t be afraid to remind me, and please be forgiving! I would prefer to be asked about these things while I’m at work, but if I’ve forgotten something you need immediately, you can absolutely reach out when I’m not at work. I would double check this with all of your preceptors, though, to make sure they are comfortable with being reached off the clock. Point being, it’s never malicious if we forget to respond to your email, forget to fill out your paperwork, or sign a form. That being said, there’s nothing worse than waiting till the last minute to hand it all to me and tell me it’s due tomorrow!
6. Learn, learn, learn. . .and then learn some more.
The experiences you’ll have as a student, a new graduate nurse, or an intern are some of the best experiences. We intentionally put you with patients that present learning opportunities. So please take them and love them! Your day isn’t over at 7 pm; you should go home and look up 3 things you didn’t know—just 3! Don’t study medical textbooks for hours on end, but google things, read opinions, read facts. In nursing we don’t always have to know down to the microbe, but we need to know the big picture. Ask yourself: Could I teach a parent how to feed through a g-tube? Could I explain necrotizing enterocolitis to a friend? Save the specifics for nursing school exams; focus on learning how all of the systems work together and the bigger picture when you’re at clinicals or with your preceptor. Always ask yourself why while you’re learning. Why are we doing this? Why does this child have this condition? Why is the doctor changing this order? Try to look things up on your own when you can, or ask me while we are charting or breaking!
Overall, having a student is an awesome experience. It is refreshing to have such a bright, eager mind, it is humbling to have someone remind you that you’re not that far from when you were a new grad, either, and it’s invigorating to watch your student grow and succeed. I am happy to have you, but every student has a different learning style and that takes me time to learn, too. Be patient with me, be kind to me, and let’s conquer this together. Understand that I’m human too—I get stressed, overwhelmed, and tired, too. With open communication we will be able to get to know each other and grow together!
Stay tuned for Precepting, Part 2: Inside the Student Experience for my perspective as a student!