Closing the Gap Between You and the Permanent Staff

So there’s a little backstory to this post. Someone contacted me through LinkedIn to participate in a study that aimed to understand how nurses with different employment statuses communicate in their work environments. I usually don’t respond to LinkedIn messages, but I figured “why not?” As I’m fielding questions and offering responses over the phone, the wheels in my head were turning and got me thinking about the topic. It wasn’t so much a “light bulb” moment as it was a “well, duh!” moment. Of course there are some distinct barriers that are present when temporary and permanent interact, at least initially.

During my time as a traveler, I must have subconsciously identified and addressed these barriers because I never really thought about it before that phone interview. Although the phone interview only lasted an hour, I found myself thinking about the topic for quite a while and think I finally have a handle on it.

This goes without saying, but every unit is going to be different because they are staffed with individuals with varying cultures, personalities, ethnicities, and have different challenges to traverse. Based on the makeup of the staff, you will find that time it takes to “break the ice” varies. Sometimes, you can stroll in and have the run of the town. Other times, you’ll find yourself on the set of “Mean Girls” and “you can’t sit with [them].” Despite these varying degrees of acceptance, there are some common obstacles which will be present no matter where you travel.

What Do You Mean, “Obstacles and Barriers?”

When I say obstacles or barriers, I mean anything that could portray an “us vs. you” mentality. In other words, anything that could inhibit the cohesion or chemistry of your new unit. Our goal is to remove this frame of mind as soon as possible when arriving on assignment and working to prevent this from forming as the assignment goes on. Below, you’ll find some strategies to address these.

Put Yourself in Their Shoes

The first thing we need to understand is the reasoning that you were hired on as a traveler. Of course you’re a great, qualified nurse, but more importantly, the hospital sought to fill this position because of a need. It could be that the census was super high, they were understaffed, or possibly a combination of both. As you can imagine, this probably doesn’t lead to the most ideal working environment for staff. They’re most likely stressed, burnt out, and frustrated.

If the reason you were brought on is a staffing issue (e.g. unable to retain nurses), you could be viewed as a short-term fix instead of a long-term solution (i.e. hiring new permanent staff). Furthermore, there could be some element of resentment there as well. This isn’t the case all the time though. Other times, people are genuinely thrilled to have some help, even if it is only a temporary relief. Regardless of each individual’s stance, your goal is to convey that you are there to help and contribute to a positive work environment; you are their ally.

Alleviate Their Fears About You

Let’s face it – you’re an unknown element in a very familiar place. You’ll likely get the impression that they’re feeling you out, seeing what makes you tick, and observing your work flow – and you’d be right in thinking that this is happening.

I’ve already touched on the topic of being the new guy in a previous post. The highlights from that post are listed below, but it’s definitely worth it to read the whole thing.

1) Be Approachable – smile, make a good first impression

2) Show Gratitude – chances are you’ll require some help when you’re getting started. Be generous with your thanks. Take the time to thank those who helped you in the moment.

3) Ask Once – show that you’re paying attention and try to figure things out first before asking for help.

4) Prove Your Worth – bring all of your skills and past experiences to the table. However, do not dwell on how you’ve done things in the past if it does not align with your new facility’s protocols. One thing people hate hearing is how they SHOULD be doing something because you did it that way somewhere else. Tips and tricks are welcomed, but stay away from lecturing people or trying to change the way they do things.

5) Be a Team Player – buy into the thought that this is your unit while on assignment, help your colleagues

6) Do Your Due Diligence – just as you are being observed, try to figure out those you can count on when you’re in a bind.

Show Them That You’re One of the Good Ones

This barrier presents itself when the staff have had bad experiences with travelers in the past or think you’re not invested in them or their unit because you’ll “come and go.” It’s similar to when you’re starting a new relationship with your boyfriend or girlfriend and they have trust issues with you because of something their previous partner did. To continue with the dating example, it could also be a situation where your love interest doesn’t want to make anything official because “this could only wind up being a summer fling.” It’s not necessarily fair, but it’s something we have to navigate from time to time.

Sometimes, it’s hard to blame them. The fear of abandonment is something that a lot of people have difficulty coping with. To make matters worse, I’ve also had run-ins with nurses who barely do the minimum required, are toxic, and have an apathetic mindset because they’re only on assignment for X number of weeks more. I like to refer to these people as those who “have to travel.” These are ones who need to keep moving in order to avoid getting in trouble or those who simply abuse their welcome. Unfortunately, the staff might have encountered one of these types of travelers as well.

By contrast, you have to show them that you’re someone who “likes to travel.” You’re someone who enjoys seeing different parts of the world and exploring. You’re someone who wants to get to know new people and learn about different cultures. You’re a nurse who is a problem solver, not a problem creator. You’re a nurse who likes to see new and different approaches to solving similar issues. You need to show them that you’re different because you’re a nurse who is willing to do their fair share and consider this unit and city their new home for as long as your contract outlines.

Always Look to the Pocketbook

The last and most obvious barrier is money. Pay packages are going to vary. That’s the truth of the matter. It all depends on the contract, city, season, severity of need, specialty, etc. Sometimes, travelers get paid more than permanent staff. Sometimes, the opposite is true. It all depends on the situation. If you’re in a desirable location or vacation spot, you could find yourself making significantly less than your permanent staff counterparts and that’s okay because the assignment in Hawaii or San Diego is definitely worth it. However, what’s important to note is that traveler base rates are almost never on par with those on permanent staff, but because the bulk of traveler paychecks can be in non-taxed stipends, travelers can come out ahead by keeping more of their check.

For whatever reason, there’s a lot of misinformation about how much travelers make and I’ve seen some permanent staff nurses act on this. For example, they’ll drop a heavy patient assignment in your lap and follow it up with the reasoning that it’s because “you make more money than us, so you’ll have to earn it.” If this is the mentality of your new unit, make sure it’s addressed promptly and professionally because it’s something that you can’t allow to fly. You’ll need to advocate for yourself and your patients. The load should be distributed evenly so that it’s a safe and fair shift for everyone. Again, this behavior is more on the extreme end of things and will not be present at many assignments. However, I felt it was necessary to inform you that it may be an unfortunate roadblock at some locations.

On the more common side of things, a question might be asked while sitting at the nursing station which goes something like, “You’re a traveler, so you guys get paid a lot, huh? Do you mind if I ask how much?” If you don’t want to talk about finances – and that’s okay because some people don’t – then you can politely decline. If that’s not something that’s awkward for you and you don’t mind having that discussion, go for it. Whatever you decide, just make sure you are respectful. The pay structure for travelers and permanent staff is very different, so you might also find that they’re more interested in learning about how you find housing, etc. instead of a line by line breakdown of your paycheck. If you have trouble explaining or need some help guiding the conversation, be sure to check out the post “How Pay Works”.

Conclusion

I’m sure there are a few other universal barriers that could be at fault here, but these are the ones that I’ve revisited over and over as I’ve brainstormed the issue and chatted with other travelers. If you’re looking to coast during your assignment and avoid the cold shoulder, you’ll definitely want to implement some of these strategies and address any obstacles that might stand in your way.

What other barriers or obstacles can you think of?

How to Be the New Guy

One of the major reasons people never dive into the world of travel nursing is because they’re comfortable. They have been at their hospital for longer than they care to admit, and on their unit longer than they can bear. However, they never leave because they are not at the bottom of the totem pole. They know people throughout the hospital. They know the protocols, the codes for all the doors, where things are kept, phone numbers for the other departments, and where the most secluded bathroom is in case you ever manage to sneak away to take care of business. Being comfortable is not a bad thing, but it can be dangerous. Not dangerous in the sense that you should worry about your life, career, or family. Dangerous in the sense that it doesn’t allow us to grow and push past the limits that we set for ourselves. No growth comes from your comfort zone. The saying goes, “If you’re the smartest person in the room, you’re in the wrong room.” I feel that this can be applied to our desire to venture out once we’ve nearly reached our full potential in a facility or location in which we live. There’s so much world to see, and you can’t see it if you’re afraid to take the leap and go. Further, would you rather be a big fish in a small pond or a small fish in a big pond? I challenge you to be that small fish and tackle the world! If the only thing that is stopping you from taking the leap is the uncertainty of a new job, then I will unveil my secrets to becoming a professional “new guy.”

Be Approachable

Make a conscious effort to be approachable. This is your first step to gaining allies in your new job. People sometimes feel intimidated about new people coming into their circle, just as you are uncomfortable taking your step into it. Try your best to ease their reservations. You have to be proactive and put forth the effort if it’s going to work starting day one. In your first moments on the unit, take the time to introduce yourself. Your goal should be to be a stranger for as little time as possible. Do this by smiling, using humor, and trying to learn names. This might seem straightforward, but a smile is your first impression. Before you get a chance to say anything, people will pass their judgment on on you. They will see how you are dressed, how your hair is styled, peek at your ID badge (trying to be sneaky), and see your smile. It is the ultimate icebreaker and will signal to the other person that you’re there to help, whether it be a patient, family member, or colleague. Your smile has the ability to set the tone for the entire interaction, so it’s silly not to take advantage of that.  Take the time to look up at people and smile while walking through the hallways. When going about your day, remember that the nurses you work with are people too. Everyone likes a good laugh, so don’t be too shy to try to connect with others in this way if that’s something you’re comfortable with. Also remember that you work with others, not just nurses. Try to connect with others as well, including nursing assistants, secretaries, therapists, pharmacy techs, housekeepers, dieticians, etc. Everyone is important in allowing you an easy transition. In your first couple shifts, do your best to learn names. If you’re like me, it won’t be a breeze. It’s like being a teacher on day one with a classroom full of students. They have one name to learn, you have thirty. There are little tricks to help learn names, but if all else fails, you can always go with nicknames. I know I’m guilty of an occasional “my friend” or “lovely.” Be sure go out of your way to put people at ease and you’ll be surprised at how much more enjoyable your experience will be.

Show Gratitude

People like to be appreciated. This is a pretty universal thing and shouldn’t come as a surprise to anyone. What is surprising, however, is how rarely we sometimes hear these comments of encouragement. Be the catalyst in creating that culture wherever you work. People will be more likely to help you in the future because they know that you are appreciative and it validifies their efforts. When someone does a good job, let them know. When someone helps you, thank them for it. When someone is working hard, let them know it is not going unnoticed. The lessons that your parents and kindergarten teachers taught you should not be forgotten in the workplace. “Please” and “Thank You” go a long way. You also don’t need to be shy with thanking others. There are no limits are how often you can do so. Be generous with your thanks. Frequently, I find myself thanking people multiple times during the shift. It doesn’t cut it to do it only as you’re clocking out. Do it in the moment or immediately after the fact. If I let it go a while without showing gratitude throughout the shift, I find that “thank you so much for your help so far” is my go-to and seems to work pretty well.

Ask once

Do your very best to do as much as you can on your own. Strive to be self-sufficient, but don’t be afraid to ask for help. When first taking a tour of the unit, it can be information overload, but try to mentally bookmark the essentials (i.e. code cart, med rooms, supply closets, bathrooms). Some hospitals will give you a checklist at orientation and allow you to tour the units in a self-guided manner. Other places will entrust their staff to point out these areas during your first shifts. Either way, it’s important to be aware of your surroundings because it becomes much less stressful when you need to do your job on the floor. It’s okay not to know where anything is, how they chart something, or what doctors need to be called after hours. It’s reasonable that you’d have these questions because you’re new! No one can expect you to know everything on day one. I can guarantee that you won’t know how to do everything on your last day either. That’s okay too. In the event that you have a question, be sure to only ask about that thing once – at least to that person. Show them that you are not wasting their time by walking you through everything, just to have you forget it all. You don’t want to be known as the one who is always running around like a chicken with their head cut off, always looking frantic. If they show you all of the codes to the doors, be sure to jot them down, even if you never use that paper again. It comes across in a way that you are taking the matter seriously. That way, when you have a question in the future, they know that their assistance won’t be a wasted effort.

Prove Your Worth

You know a lot. You’re an excellent nurse. Your résumé says it all. You have a lot to bring to the table. You know this. Your recruiter knows this. The manager who signed you on knows this. The people you used to work with know this. Now it’s time for your new colleagues to know it too. And now that we’ve shaken off the nerves of being in a new place, it’s time to hit the ground running. Bring your past experiences and allow them to shape your current environment. Bring your work ethic, your expertise, and your know-how. One of the great benefits of traveling is being able to see how different places solve similar problems. The tools that you use may be different as you change locations, but nursing is nursing wherever you go. The way you take care of patients doesn’t change; what changes are the tools at your disposal. You are not a new nurse, you’re just a nurse who is new to this location. You’ll be surprised at how much you’ll teach your new coworkers while on assignment. I promise that you’ll get so much pride in being able to show how great and skilled you are. Do your best to be an asset to those around you. Good at starting IVs? Be sure your coworkers know that so you can help with that “hard stick.” Helped solve a similar problem your facility is currently facing? Offer suggestions on how to improve outcomes. Have pride in who you are, where you came from, and what you’ve learned and bring that all to the table whenever you start an assignment.

Be a Team Player

Every place is different, and so is their work culture, but I can almost guarantee that no matter how nice, charming, and skillful you are, you’ll start somewhere on the “outside.” Sometimes (not always), people will be less willing to offer a helping hand to the new guy or gal. After all, they don’t know you nor do they know that you’re the hard worker that you are. They’re looking out for themselves and don’t want to be taken advantage of which is understandable. This is where you have to prove them wrong. You have to show them all the things that you’re bringing to the table and how you’re an asset to the team there. You need to embrace the team player attitude even if you haven’t quite yet received any benefits from it just yet. You need to try to sense when someone is struggling or ask periodically if there’s something that you can do to help. You need to speak up when you need help because people cannot read your mind. When you’re overwhelmed, don’t be sassy or rude. Take it on the chin and grind it out. Be sure to ask for help in a respectful manner. You need to erase any me versus them mentality. The only way we survive is together. If someone is drowning while you are sitting at the nurses’ station scrolling through your Instagram, trust me – it goes noticed. If a new patient comes to the floor, follow them in and offer to transfer the patient over to the new bed and get vital signs. Sometimes just checking in on someone or answering a call bell is enough to take some pressure off someone. Anything helps. If you’re caught up with your responsibilities (and sometimes when you’re not), just make sure to make yourself available. It’ll go a long way in showing your commitment to the team’s success and ease of transition to the unit.

Do Your Due Diligence

Remember that these are all new colleagues, and not all of these tips can be sunshine and rainbows. You don’t necessarily know their work ethics and how thorough they are. Be sure to cover yourself and maintain patient safety by checking active orders, equipment in use, medications, IV access and drug compatibility, bed alarms, etc. You no longer have the liberty of taking someone’s word for it. When you’re just starting, you don’t know who the super nurses are – the ones you’d let take care of your mom – and who the slackers and airheads are yet. Be sure to be vigilant in bedside report. Be attentive and observant, writing down your report as you normally would, but also ensure you’re double-checking the chart for accuracy. Just remember to be respectful and that no one likes that annoying nurse who asks a million questions in bedside report that have no relevance to what we’re doing for the patient. If you always keep this in mind, you’ll be able to keep two things: 1) patients safe and 2) your nursing license in good standing.