When acute care administrators employ travelers to assist in fulfilling staffing needs, they acquire more than a quick fix to an endemic problem. Fundamentally, the mobile nurses, therapists, or technologists become integral parts of departments and are regularly on hand for a minimum of 13 weeks-or longer-offering a sense of continuity not commonly found through per diem, internal float pool, or other supplemental solutions. During their stay, they become familiar with facility protocols, develop relationships with patients, and offer quality services, improving the provider-to-patient ratio and morale of core staff.

How can unit managers, nurse recruiters, and other hospital executives ensure that their institutions not only receive the best candidates with the most experience, but also take complete advantage of such a staffing mix? Here, a nursing administrator, two company representatives, and a mobile clinician share their unique outlooks on blending permanent staff and travelers to form the ultimate "dream teams."

From the coordinator's desk

Over the years, Kathryn K. Scott, RN, coordinator of patient relations and traveler program, has assumed several roles at Children's Hospital Boston (CHB) in Boston, Massachusetts. But, the task of capably addressing nursing shortages seems to be a predestined calling. Following a two-year hiatus, Ms. Scott returned to the esteemed institution in the mid-80s to establish an in-house supplemental staffing pool. "After developing an internal program," she notes, "it soon became apparent the facility needed a little 'outside' assistance, as well."

When negotiating with the institution's first placement agency, Ms. Scott learned a valuable lesson-a golden rule for blending temporary and permanent employees. "The staffing company executive left a lasting impression with me. He said if we chose to employ his travelers, they should not be treated any differently from our regular staff," she recalls. "If our nurses were working every third weekend, travelers should not be asked to work more shifts-unless they agreed to the schedule up front. It was a point I made with all the nurse managers." Indeed, as CHB brought mobile professionals into its system, Ms. Scott took this industry insider's philosophy to heart. "To set the stage for teamwork, it is important that neither travelers nor permanent employees feel that they are obtaining special treatment or are perceived as second best. Happily, our administrators support this simple, yet significant, mindset."

During interviews, Ms. Scott screens every candidate thoroughly to ascertain whether or not they have the definitive skills and years of practice that her facility demands. For instance, if CHB needs a traveler on its cardiac unit, she looks for those who not only have solid pediatrics expertise, but also knowledge of cardiology and a minimum of two years recent experience-a combination that serves patients and permanent staff alike. More expertise is required for placement in the critical care arena, with a minimum of five years of experience for candidates assigned to the neonatal intensive care unit. While such positions mandate that professionals have successfully completed at least one other assignment, Ms. Scott will consider first-time travelers for regular pediatric units.

"To ensure a good fit, I also look at the other facilities in which they have practiced, comparing acuity levels and types of communities where they have lived. Screening is such an important part of the process for striking the right balance," she relates. "Though there may be a slight learning curve in filling a specialized position, it is essential that, after roughly three, 12-hour shifts of orientation, contractual employees have the aptitude to perform their duties competently and efficiently." By upholding such strict criteria, Ms. Scott asserts the potential for resentment on behalf of the regular staff is averted and delivery of care is never compromised.

Prior to their arrival, she aids mobile practitioners in becoming comfortable with new surroundings by speaking with each individual directly. Offering useful information about the community and practice environment, she helps them to acclimate more quickly and easily.

In addition to the details Ms. Scott proffers-which include directions, the specifics on public transportation, or where to park their cars-she makes sure that every clinician receives a warm welcome from a permanent staff member. "Our designated preceptors lend their support to travelers throughout their first week and beyond. We are very committed to giving them a good grounding, and it is a custom that sets the tone for thriving partnerships. CHB's supplemental employees are very much integrated into the nursing staff, able to attend parties, excursions, and other social events, including the coffee hour held during orientation."

Aside from the immediate need to fill vacancies, Ms. Scott conveys that contracting with travelers is a fine recruiting mechanism, as well. "Traveling allows professionals to decide if they like a particular community or work setting enough to consider relocation. Mobile nurses feel so welcome here, many have contacted me within a few weeks of their start dates to request extensions, enhancing continuity of care and postponing the need for additional recruitment efforts. In fact, a number of providers who have taken at least two assignments with us have elected to accept permanent positions at CBH," she reports. "Although we have never been charged a placement fee in these circumstances, it is crucial to note that different companies have distinct policies. Some may have caveats written into their contracts concerning employment of their travelers, so it is imperative to verify each agency's rules and regulations before attempting to convert mobile clinicians to permanent staff."

Having utilized traveling RNs in virtually every department-including one ambulatory setting-for nearly two decades, Ms. Scott offers this advice to hospital representatives wishing to complement permanent staff with travelers: "Unit leaders, managers, and coordinators must establish the overall attitude." She explains, "To be successful, they have to be supportive of contracting with supplemental staff, promote integration with permanent personnel, and never allow an 'us and them' situation to develop. Administrators should be mindful, however, that the issue of pay scales may come up and be prepared to address it. Whenever I have an opportunity, I mention the fact that the facility is paying an agency for the traveler's services but that doesn't mean the nurse is receiving all of the money, only a part of it. By taking the time to listen to these types of concerns and to present travelers as competent professionals who bring fresh perspectives, diverse experiences, and much needed assistance to the staffing mix, managers can initiate positive trends as well as optimistic attitudes and productive outcomes."

Travel company insights

Neil Trotta, business development director of national accounts and account representative for Clinical One, based in Wakefield, Massachusetts, has noticed a common thread in the traveler selection process. "Over the past 10 years, acute care administrators have become more selective. Executives want to confirm they are receiving not only the most qualified healthcare professional for each contract, but also a seasoned mobile provider who is the best match in terms of individual experience."