To be certain their quality assurance (QA) initiatives remain current and effective, a number of staffing agency representatives and facility administrators continually polish and reassess their internal systems. These decision makers identify areas ripe for change and swiftly implement new or updated methods. Here, a veteran nurse manager and an experienced travel company executive share matters worthy of regular evaluation, as well as winning strategies for measuring competency.

Comprehensive evaluations Asked about the first element she reviews when considering mobile nurses for assignments on her unit, Paula Moynihan, BSN, RN, CCRN, nurse manager of the Cardiac Intensive Care Unit (CICU) at Children's Hospital Boston (CHB) in Massachusetts, sums it up in a word: References. "We have one of the most complex acute care units for children in the nation and a very collaborative system. I want to know about a nurse's skills set and ability to work as part of a team before any interviews even take place. Travelers coming into our facility must be able to think critically and possess excellent interpersonal skills. Decisions are not made on paperwork alone. During the telephone interview, it is essential to listen very carefully so that this conversation backs up the paperwork."

Ruth Stiehl, PhD, RN, vice president of nursing operations for PPR Travel, in Jacksonville Beach, Florida, believes obtaining feedback from a candidate's previous managers is a QA cornerstone, as well. "Like any other employer of nurses and allied health providers, my company depends on recommendations and asks all candidates for references. We will not employ a healthcare professional without them." During a traveler's assignment and after its completion, Dr. Stiehl also requests evaluations from hospital administrators. "I personally monitor all of the assessments that are returned to our firm. Unfortunately, at this point in time, only 25 percent or so are sent back to us. I would like to see that number change. If a nurse makes a medical error, I want to be made aware of it. And if she is doing an exceptional job, I want to be apprised of that, too. The more we know, the better we can serve our clients."

Before they are hired, healthcare professionals interested in traveling often must take a series of tests. "We, of course, administer a medication test," she continues. "But we have discovered that many facilities also favor a basic skills test, so we combine both, covering medication administration and basic nursing knowledge common throughout all fields of nursing, regardless of specialty." Taking it a step further, Dr. Stiehl has added unit-specific examinations. "My background is in testing, so I have developed competency tests for all the areas in which we place clinicians—such as ICU, telemetry, and med/surg. We have even made these tests available online for the sake of timeliness and ease."

For Ms. Moynihan, validating solid cardiovascular skills is the most important. "If a traveler were to indicate that she had a lot of experience with ventilators, but had only been out of school for a year, our perceptions of what constitutes 'a lot' would probably differ." Fortunately, the traveler recruiter for CHB's traveler program is sensitive to determining who best fits immediate departmental needs. "Having a savvy liaison is key. She maintains constructive dialogues with several staffing company representatives and effectively communicates our requirements."

Enhanced orientation and education Part of the allure of utilizing travelers is that they are able to adapt to different settings in a short period of time. While many must become acquainted with an unfamiliar unit and facility protocols in a few short days, some nurse managers, like Ms. Moynihan, believe a more detailed orientation can be invaluable in terms of quality assurance. "We have a competency based orientation, and travelers must demonstrate specific proficiencies in approximately two weeks. Each person is paired with a preceptor and must also complete certain competencies outlined in their manuals before practicing independently."