Unlike new, permanent employees who may have two weeks to three months-or longer in some cases-to become accustomed to unfamiliar settings and protocols, travelers are presented with a brief induction and ordinarily expected to hit the ground running within a few hours to five days. Similarly, how supplemental staff is prepared for practicing within specific units tends to differ from approaches used to orient recently hired, regular personnel.

Factors such as a hospital's size, rural or urban setting, and the number of travelers employed are other dynamics to be taken into account when striving for favorable outcomes. Read on to determine how managers can best establish supplemental staff's familiarity with the practice setting at an accelerated pace.

Advanced preparation The orientation process can begin as early as the phone interview...or sooner. Just as essential information about mobile professionals-including skills sets, credentials, years of experience, and personal preferences-is furnished to nurse managers or unit directors prior to setting up telephone conferences, it is prudent to ensure that facility specifics are shared with candidates ahead of time.

Whether these particulars are disclosed in interviews, through welcome packets, or directly to travel companies for dissemination, submitting details about an institution-such as its location, medication systems, patient population, floating requirements, and even length of orientation-in advance is akin to a preliminary introduction.

"We maintain comprehensive information about each of our client facilities," relates Cindy Hafenstine, director of the travel division for Health Specialists, Inc., based in Lenexa, Kansas. "When a traveler is interested in taking an assignment at a particular hospital, we can tell her everything from where she would report on the first day to the number of beds in a unit and the nurse-to-patient ratio."

In addition to straightforwardly contributing data, nurse managers should encourage candidates to inquire about everything from administrative policies to their facilities' corporate cultures during initial telephone conversations. Tips on other ways to learn about an institution and its community may be offered, as well. "The information available through public libraries and via the Internet can be viewed as an orientation preview," says Erik Swanson, nurse recruiter for Alvarado Hospital Medical Center (AHMC), in San Diego, California. "We urge travelers who are contemplating assignments at our hospital to visit our website for an overview of AHMC and its philosophies on patient care and employee satisfaction, in addition to visiting the URL for our city's convention and visitors bureau."

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Breaking down the process Hospital-wide and discipline-specific orientations present travelers with their first detailed glimpse of contract facilities' operations and typically take place before they are introduced to their respective units. "These comprehensive educational sessions are usually eight hours apiece and give supplemental staff the chance to collect their bearings," conveys Mr. Swanson. "Aside from the basics, we afford them a platform for asking further questions, the opportunity to become acquainted with core personnel, and an invitation to lunch with our chief nursing officer (CNO) and regular staff."

Unit-specific orientation, on the other hand, is typically more structured, customized to suit the individual needs of mobile clinicians. The extent of training provided commonly ranges from one to three 12-hour shifts-although it could be longer or shorter-and is largely at the discretion of management. "Due to their vast experiences, travelers are extremely proficient in their specialties, and therefore should require minimal instruction," states Ms. Hafenstine. "Rather than spending a couple of weeks in a classroom, these professionals orient quickly, inquire about any 'unknowns' upfront, and soon learn which other staff to contact when support is needed."

At AHMC, Mr. Swanson reports that travelers are furnished with roughly 36 hours of unit-specific orientation. "In the course of this adjustment period, they are given information focusing on issues like charting, patient care, the location of supplies, protocols, different codes, and hazardous materials handling...in print and verbally." He also recognizes the benefit of designating preceptors. "It is important that mobile providers have access to resource people they can easily locate when guidance is needed, which is why we assign a different mentor for each of their three shifts of unit orientation. This way, they have a number of staff members to call on for assistance, if necessary."

It is imperative that expectations and boundaries are covered during the orientation process, as well. Since hospitals may have different staffing needs, managers must outline what they anticipate from supplemental employees. "Some administrators may want travelers to simply provide relief to their permanent personnel," says Ms. Hafenstine, "while others might look to mobile professionals to assume training and teaching responsibilities since they often have more expertise than core staff."

Extended briefings and reorienting Requests for further orientation are extremely rare. "For travelers, adjusting to new environments does not have to be a long, drawn-out process," offers Ms. Hafenstine. "By and large, they are able to adapt to protocols of unfamiliar units in a day or two, and in terms of clinical experience, they are second to none."

Still, there may be occasions where granting extra time for training is appropriate. If certain expectations were not thoroughly communicated prior to a traveler's arrival or a facility employs a truly unique computer charting system, management might elect to offer additional orientation. "We prescreen our travelers so we already know their competency levels," says Mr. Swanson. "But, if someone found our method of documentation particularly challenging, for instance, we would be open to allowing her an extra shift or two to come up to speed."

He notes that the same logic may be applied when mobile nurses, therapists, or technologists request or are asked to float to another department. "Fortunately, a lot of our units are comparable with regard to paperwork. Should travelers wish to float and have the experience to do so, they would likely receive a detailed, four-hour orientation on the essentials, including where supplies are kept and who is in charge."

Variables to recognize Although orientation for travelers is carried out in a similar fashion at facilities nationwide, there are unique factors that may determine the manner in which it is orchestrated. For example, some hospitals may orient travelers with regular staff. A large majority, say industry insiders, do not.

Additionally, the amount of direction extended to mobile providers in rural or small institutions usually varies from the instruction they would obtain at urban facilities or large teaching hospitals. "At rural institutions, the process is typically not as formalized as it is in urban hospitals, which may conduct orientation for travelers twice a month, thereby necessitating their arrival on certain days,"

Ms. Hafenstine explains. "Since smaller facilities might not employ as many travelers, their systems are apt to be more flexible. As opposed to putting a clinician in an actual classroom or utilizing a 'check-off sheet' type of training, they often work with them individually to ascertain the extent of orientation each professional requires."

While foreign-born mobile healthcare practitioners have passed written and verbal tests, such as the National Council of State Boards of Nursing's licensure examination (NCLEX-RN), and meet state licensure requirements, some institutions may opt to provide cultural training, in addition to mentoring, for these individuals. "We require all of our travelers to have experience practicing in the United States," maintains Ms. Hafenstine. "With regard to foreign-born travel nurses from Westernized countries, like Canada, who accept assignments in the U.S., their educational preparation is similar to those of American nurses so further orientation is generally not an issue. However, if we had an exceptional candidate, the matter would be addressed with the hospital in advance to see if managers were interested in participating in some sort of specialized training. It would be a case-by-case situation."

"The travelers who come into our facility have one to three years of experience working in the U.S., as well as successful track records," comments Mr. Swanson. "We tailor our program to fit every mobile provider, looking at their skills sets and where they could benefit from specialized attention. It is a process that works well at AHMC."

While nursing leadership usually designs orientation guidelines and the education department administers them, every institution is bound by its corporate culture and available financial and human resources. By incorporating several strategies-beginning with the moment candidates are considered for assignments-hospital administrators can enhance existing programs and implement others, resulting in win-win situations for patients, permanent and supplemental staff, and management.

Bobbi Harrison is associate editor of Healthcare Traveler's Staffing Solutions.