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.

How Does Pay Work?

One of the main questions people have in regards to travel nursing is how compensation works, and rightfully so. It makes sense to want to know how you will be paid for your efforts in the hospital and for the potential inconvenience of being away from home. This can be a little complicated, so don’t get intimidated before we start. I will do my best to simplify the process as much as possible without sacrificing the integrity of the information presented. Please also remember that this is very much from the point of view of a traveling nurse. There are many many traveling nurses with countless staffing agencies so it would be nearly impossible to depict every situation as it applies to individuals and the agencies they work under. That said, I will try to explain how compensation works in a way that can be applied to the majority of agencies that I’ve come across. The best way to visualize how compensation works is to think of your compensation as going into a pot. Keep this “pot” in mind as you continue to read.

As I begin to write this, I empathize with math textbook writers. You may notice that there are more images and spreadsheets to explain as it may be better than trying to explain with words.

Bill Rate

You are earning the agency you work for money by working at the hospital during your shifts.  Your company technically bills the hospital for your services per hour. This amount of money that is paid to your company per hour worked is called a bill rate. The hospital and the company have already agreed upon a bill rate at this point for which to pay. This was conducted in the contract between the hospital and your company. Some hospitals pay for contracts upfront, and others pay it like they would an invoice or credit card statement. I imagine that it differs based on relationships and agreements already in place. However, none of this concerns us. The bottom-line is that you work, your company bills the hospital at a predetermined rate for your hours worked, and then that money gets placed in your pot.

bill rate

Company Cut

The money from the hospital gets paid to your company and gets placed in your pot. From your pot, your company takes a portion for services provided. The way in which companies do so differ. Some companies take a percentage where others charge a flat fee. It’s important when interviewing companies and recruiters that you ask how they go through this process. Depending on how you feel, you may be more inclined to work with one model over the other. However, you may not at all feel this way which is okay too. Just know that the incentives for each model are different. With the flat rate model, they may offer you as much as they can right away because they work more towards acquiring higher volumes of contracts. Whereas the percentage model may be more inclined to offer in order to submit bigger price-tag contracts to make a juicer pay-out. Neither way is wrong as long as you look out for your well-being, analyze the packages, and research the areas. Following this process, the remaining amount is yours and reflects what many companies will refer to as your gross pay (or pre-tax pay).

gross pay

Keep in mind that the contract your company and the hospital have is different than the contract that you and your company have so the payout is different. Remember there are services that your company provides. It is not common practice for companies to share what they are charging the hospital. They typically will not mention bill rate, and only focus on gross pay when quoting pay packages. In order to keep a working relationship, it’s important to know what you’re worth and what the area pays. Again, what’s fair is fair.

Stipends

Remember that I am not a tax professional and that you should seek the assistance of a professional if you have any questions. My aim here is to summarize as best I can. For this explanation, I am assuming that you qualify for tax-free stipends because you are working away from home and duplicating your expenses, thus maintaining your tax-home. For more in-depth information, please see TravelTax.

This next part is tricky and can trip people up. All that remains in the pot is yours (and Uncle Sam’s in the form of taxes). However, there are certain ways that the money can be divvied up which is unique to travelers in order to maximize the take-home amount on our paychecks. There is the possibility for many travelers to qualify for tax-free stipends or per diems. These stipends can be etched into your gross pay to shrink your taxable income all while keeping your gross pay the same. The result is a lower taxable income amount, lower taxed amount withheld, and a chunk of tax-free money in the form of stipends or reimbursements.

taxable income

You might ask, “Why don’t I just have my pay situated in such a way that the whole part is in the form of these tax-free reimbursements?” Well, you’re not foolish for asking. The reason is that the taxed part of the income is reported W2 income, whereas the tax-free reimbursements/stipends are not. You will most definitely get audited and owe A LOT of money if your pay is structured this way. The general rule of thumb which I’ve seen is that your taxable hourly rate should never be less than $20/hr for the sake of increasing your stipend amounts.

But, wait! How do I know what the stipend amounts are for the area I’m traveling to? Well, the government has defined them here. Basically, you look up the area in which you are traveling – by city and state or zip code – and the site will populate the per diem rates (or a number of money employers are allowed to offer as reimbursements per day for employees who travel). The categories listed are 1) lodging and 2) meals & incidental expenses. Some companies will clump these together while others may list them separately.

 

When considering a contract, it is important to have a basic understanding of algebra and be able to shift focus and reverse engineer from gross pay to hourly pay rate and vice versa. Doing this will help you to ensure you are meeting that $20 minimum rule of thumb. It’s also important to note that we cannot exceed the amount of per diem guidelines in most situations. (For the exceptions, please see the resources listed above). Let’s create a quick example to hopefully illustrate this process a little better.

Say you wanted to work at Yale-New Haven Hospital in New Haven, Connecticut – one of the best health systems in the North East – starting in September 2017. After discussing with your recruiter, they determined that they have a contract there and your company is willing to pay you $1800 gross per week for 36 hours worked.

$1800 gross ÷ 36 hours worked = $50 per hour worked (before taxes)

Now that we have our pay rate, we need to see how the stipends can be maximized, so we look up Per Diem Rates for New Haven, Connecticut on the GSA Per Diem Rates Look-Up.

new haven per diem

Above we see that highlighted in the lodging rate for September and the meals and incidental expenses rate per day for the city of New Haven.

In this example, the monthly lodging rates are the same throughout the time span shown. However, some counties and cities, especially those that are more seasonal, may have varying lodging rates each month for which you have to take into account.

Also, remember that you are living away from home 7 days a week, but are working 3-5 days per week. Make sure to take that into account when trying to understand the math here.

Start with the $20/hr rule:

$50 – $20 = 30

(Hourly Rate) – (Rule of Thumb Taxable Hourly Rate) = (Stipend Potential Per Hour)

___

$30 × 36 = $1080

(Stipend Potential Rate Per Hour) × (Hours Worked) = (Stipend Potential Total)

___

($104 + $64) × 7 = $1176

[(Lodging Per Diem) + (Meals & Incidental Expenses Per Diem)] × (Days in a Week) = (Maximum Combined Stipend Amount Per Week)

___

$1080 < $1176

(Potential Stipend Total) < (Maximum Combined Stipend Amount Per Week)

Therefore, the stipend amounts we estimated using the $20 rule of thumb work because we did not go over the maximum limit as outlined by the government. However, if the estimates we made were more than the maximum limits, we would need to increase our taxable rate and do some tweaks.

The good news is, most companies do all of this math for you. I just feel that it’s important that you know how it is produced so that you can be more educated when negotiating rates and effectively bring home the most money possible by maximizing your tax-free stipends in your pack package.

Pay Periods

Pay periods differ from agency to agency as well as their pay frequency. Although, I find that it’s common for agencies to use a Sunday to Saturday pay period with payday each week on either a Thursday or Friday.

Other Benefits

Other benefits may include travel reimbursements to and/or from assignments, sign-on and completion bonuses, medical/dental/vision, and 401K plans. Some contracts or companies may offer all these benefits whereas others may not offer any. This allows for flexibility and creativity when forming a contract and relationship with a company. It all depends on the situation and the individual’s needs. It is important to remember that this all comes from your pot, so in reality, these are all just routes to receive the compensation you have worked towards.

Key Points

  • The money you earn working each hour is placed in your “pot” with various ways of being divided up before it reaches your bank account
  • Bill rate is the amount your company charges the hospital for your services
  • Pay rate is the taxable amount you receive from your company per hour
  • Stipends/Per Diems/Reimbursements are tax-free amounts for those who qualify
    • These provide a way to shelter your income from taxes and are typically paid out in weekly checks alongside your wage
  • “Blended rate” is what some recruiters will call the sum of hourly pay rate and stipends per hour amount
  • Pay periods and frequency are unique to each company
  • Benefits offer flexibility and creativity

Travel Nursing: What’s That About?

“Oh, you’re a travel nurse? What’s that?”

That is typically how people or my patients respond when I first mention I’m a traveling nurse. At least once, I experience the following exchange with one of my patients while on assignment:

“So how long have you worked at XYZ Hospital?”

“To be honest, only a few weeks. I’ve been a nurse much longer than that – don’t worry. I’m actually a traveling nurse, so I’ll only be here a few months. You’re in great hands though because the people here are wonderful.”

From there, it sparks people’s interest. Some claim that they could tell that I “wasn’t from around here” or “[they] couldn’t tell because you blend right in” or “[they] knew it because of your accent” or “Wait, but, you don’t even have a New Jersey accent” or a combination of the above. Eventually, the conversation moves away from me and moves towards what travel nursing entails. Below is typically how I would explain it, with further details.

What is Travel Nursing?

I usually tell them that travel nursing is like the “band-aid” of nurse staffing issues. When a hospital has a problem with fully staffing a unit or units, they often utilize contract workers for temporary positions until they can resolve the shortage. Per Diem (or in-house, as needed) positions won’t entirely be sufficient because many times they aren’t required to work as much as the hospital might need in their particular situation. They also can’t force staff to work overtime to meet their needs. Travelers offer that little time-out to alleviate the pressure. We are nurses that bounce from place to place in order to meet the needs of the facilities and the communities they serve for a period of time.

When Do Facilities Need Travel Nurses?

Most times, there’s no crisis on the horizon. When someone retires or transfers, they have to fill that position of the retiree. If they have trouble doing so, and the unit was already tight, they might go ahead and get some help in the meantime until a qualified candidate comes along. When they find that qualified candidate (full-time), it takes some time to train him/her (up to 6 months). During this orientation period, you generally tie up two nurses, the nurse doing the training and the trainee. Orientation periods for traveling nurses are usually much briefer, and in my experience, last no more than one week. As a result, a traveling nurse carries a smaller opportunity cost than a full-time candidate, resulting in a more reasonable “quick fix” in tight staffing situations.

Other times, these facilities have good staffing, but there has been a sudden rise in a number of patients staying at the hospital. This is most common in the winter months due to the flu and the colder weather making those with respiratory issues more susceptible to becoming sick. These contracts can be a little longer due to the patient surplus, rather than staffing inadequacies. For example, if they hire a full-time candidate for a temporary problem, then the hospital could be wasting time and resources because, at this point, the hospital will be overstaffed once the winter is over.

How Does a Nurse Find the Right Facility?

That’s a great question. The facility has identified that they require a number of nurses to meet their needs. Now they need to find those nurses. This is where staffing agencies come in.

Staffing agencies work as middlemen for both the facility and the nurse. They put nurses who are in need of jobs in front of hospitals in need of nurses. They are very important in this whole process. These agencies do a lot of behind the scenes work. They maintain relationships with facilities and their staffing personnel, ensure credentials are up to date, manage payroll, find viable positions, help with housing (if needed), and many more things. Sometimes, facilities have exclusive relationships with companies called vendors. If the vendors are unable to adequately staff the needs with their own nurses, they will open up the contract to other companies in order to fill the need. The relationships of all the parties in the process are shown below:

Capture 1.PNG

I recommend you find an agency and recruiter you are comfortable with and that meshes well with your values and personality.  It’s not uncommon to work with more than one agency at a time while you’re looking for a job, however. Sometimes the agency you’ve worked with doesn’t have access to the contract that you really want. In those cases, it’s important to have eyes out there looking for potential jobs for you. That’s not to say there’s no loyalty, but this is your livelihood. Some recruiters will try to make you feel bad for working for someone else on a contract, but that’s all the more reason to leave. Nothing in these work relationships should ever be driven by personal reasons. As long as you are transparent with all parties involved and professional, then there should be no reason to worry. Remember: YOU are your greatest asset.

How Does Pay Work?

Remember back to when we discussed that the facilities reach out to these agencies and vendors? They also name what they’re willing to pay in regards to specialty, experience, and availability. When the agencies receive these pay rates, they reach out to their nurses and let them know what these facilities are offering in exchange for their care. If it’s a good fit, then the contract is drafted and signed. When thinking about contracts, it’s important to remember that the Facility/Agency contract and Agency/Nurse contract are different entities. When it comes to pay, the facility pays the agency, then the agency pays the traveler, following a similar pattern to the relationship pictured earlier. However, since these agencies offer their services, there’s obviously a portion that is deducted as a service fee. Some companies structure it in a way that is a percentage of the total contract and others set it up as a flat fee for a contract, regardless the size of the total package.

Some new travelers tend to get upset about these cuts, stating things like “But I’m the one who is making them their money. I’m the one on the unit. I’m the nurse. I should get all of it.” In reality, that’s just being greedy, and without the help of these agencies, we wouldn’t have jobs. Also, think back to the services they provide. They offer a service and deliver their service. As far as I’m concerned, what’s fair is fair. I understand that there are profits that the company must make and goals to meet. As long as I take home my fair share, it’s more than fine with me. I understand that there are many people involved long before I ever step foot in the hospital. Just to name a few, there are recruiters, managers, compliance coordinators, salespersons, and things like rent and utilities. It’s very important to understand that it’s very much a mutual relationship where we both benefit.

From the bit that gets taken out by the agency (and possibly vendor), the rest is for the nurse (and government in taxes). The goal is to have the least amount of taxable income possible so that you can take home as much as possible and pay the least taxes as legally possible. There are a lot of tax implications (and I am not a CPA), but the basic rule of thumb is that you need to have duplicated expenses of living at home and on the road in order to receive tax-free stipends (please see TravelTax.com for more).

To better illustrate, please see the image below:

pie chart

Please keep in mind that this is a VERY rough estimate and that there are many variables, including contract specifics, the business model of agency, presence of vendor, qualification of tax-free stipends, etc.  I promise to go in more depth on the breakdown of pay in later posts.

Key Points

  • Travel Nurses aid in the management of staffing issues in temporary positions
  • The Nurse/Agency relationship is important when landing a contract
  • Facility pays the agency who in turn pays the traveler

Why Do I Travel?

Behind everything we do there is a why that gets us out of bed in the morning and fuels our passions. This why gives us our destination, but it is our responsibility to create the path to get there. Many times, like in a coloring book maze, it is easier to start at the endpoint and work backward to until we reach the starting point. The why gives us our mission, but it does not name for us the tasks. It defines what we truly want (spending more time with family, traveling the world, etc.). It allows us to refocus on the things we do and ensure they align with the goals we set and, eventually, meet. Our why will change many times throughout our lives as we also grow and change. In our pursuit of achieving these things we have set out to do, it also might be beneficial to have sub-goals along the way so that we do not become discouraged by failure.

Imagine, for example, you and your friend want to run a marathon. On your first day of training, you decide to run 26 miles. On your friend’s first day of training, she decides to run 5 miles, then eventually move up to 10 miles, 15 miles, and so on. Who do you think will likely be more successful? It will likely be your friend because they set smaller, more realistic goals in order to reach their overall goal of running the 26 miles. There are countless models for success when training for marathons. Many of which people have created, tweaked and adapted to their personal preferences. Much like this, I saw a life in travel nursing as a model that I could use to my advantage.

For me, my overarching why is to be the very best form of myself possible. As a result, I identified areas of my life which are important and needed to be improved upon. Self-worth is the sense of value as a person. For me, my profession in nursing is how I contribute to society in terms of my job, but I am also very fortunate because I have the opportunity to impact others on more levels than just showing up and punching my time-card. I have a responsibility to do more than that. Maybe it’s this pressure that I place upon myself and one that no one else expects of me, but nonetheless, this pressure is still present because I feel if I have not made someone else’s situation better, then I have made it worse by not improving it. Therefore, my nursing practice was something that I wished to enhance. I also understand that you are your most important asset. Without your health, you have nothing. So, my personal health – physical, emotional, mental – became a focus for my betterment. In much the same way that I needed personal health, I knew that financial health is important to provide for myself and loved ones. Lastly, I wanted a broader appreciation for various cultures, climates, thoughts, people, and places in order to better understand others and their viewpoints. In all, these aspects of my life have funneled into my goal of being the best I can be and helped me make my decision to become a travel nurse.

Nursing Practice

I got my start in nursing as a pediatric home care nurse. Everything was 1:1, mostly neurological issues (i.e. cerebral palsy, seizure disorders), and I loved it. The pay wasn’t great, but the kids were. They made going into work enjoyable and that helped me fall in love with nursing. They were all full of life and it was my pleasure to help them thrive the best they could. I spent my first six months as a nurse in this setting, focusing on my nursing skills – medication administration, g-tube care, airway management, etc. After I got the hang of things, I felt it was time to move into a new space in order to challenge myself. I eventually landed in a telemetry unit of a community hospital.

On telemetry, I was faced with a new set of challenges. I now had to learn to manage multiple patients with a whole new set of diagnoses. I needed to hone in on facility protocols and procedures to provide more safety to my patients and uniformity throughout the hospital. I needed to learn how to work as a part of a team, the art of delegation, and to coordinate with physicians, therapists, dietitians, social workers, case managers, and discharge planners. Through this opportunity, I was excited to learn as much as I could. The more I could learn, the better. I attended classes related to caring for our patient population. I pursued national certifications as soon as I could in order to better my practice. However, after awhile, it felt as though I was stalling out in my progression. I loved the people I worked with and the patients I was taking care of, but, in a sense, I wasn’t feeling fulfilled. Not to say that I was peaking or anything, but I knew that I was reaching the ceiling as far as possibilities were concerned unless I wanted to transfer. But, that also wasn’t what I wanted. It’s not that I wanted higher acuity patients or more of a management or quality-based role. I wanted patients of similar acuity with new and different problems. I knew that as painful as it was for me to do and leave my work family, I needed to leave the community hospital setting and branch out into new areas to acquire new experience. After speaking with multiple colleagues who had worked as travelers or were currently on assignment and doing hours and hours of research, I knew that the benefits would be worth the risk.

Now, as a traveler, I’m able to take my experience and apply it to new settings. I soon learned that nursing is nursing no matter where you go. Whether you’re floating to a new unit or it’s your first day in a new facility, your nursing care remains top-tier despite having different tools and systems at your disposal. I became even more confident in my skills and assessments. My clinical judgment became even more important, especially when I hadn’t quite committed protocol to memory or gotten the hang of a new charting system. I realized that ultimately you are your most significant asset and important tool. All of your new patient interactions build upon ones you’ve had previously. In a way, the patients you take care of today extend their thanks to those who allowed you to care for them yesterday as they’ve enabled you to care for them better. I, for one, am truly grateful for these experiences.

On day one of traveling, I found out that I would be caring for patients on telemetry, but on a neuro unit. To be honest, this startled me a bit as it was not something I was expecting. However, I knew that this new patient population would help improve my practice because I was expanding my knowledge base. On this unit, I took care of patients with hemorrhagic strokes, neurological and spinal surgeries, craniotomies, halos, and more. All of which I would have never really seen at my home community hospital. At other facilities, I’ve taken care of VATS patients, those with specific cancers, and some post-trauma. Again, had I not traveled, I may not have had the opportunity to care for these patients and increase my level of comfort.

Financial Position

A driving force of many things leads straight to the wallet or pocketbook. As many of you reading this, in order to fund my nursing school, I had to take out loans. (Granted, I probably didn’t have to accrue as much debt as I did by going to an out-of-state private university, but that’s another story for another day.) Of course, as a teenager with no credit, my family had to help as cosigners, but I was determined to tackle the balance on my own. With more than $120,000 in the hole after my college career, I knew my journey had just begun.

As stated previously, I started in home care and worked as much as I could. Many times working multiple shifts, six to seven days per week. No matter how much I worked, it didn’t seem to help bring that massive number down. I continued to live like a poor college student and budget meticulously. As I earned more money, I dumped it all into my loans.

When I got the hospital position, I continued to work both jobs as much as possible. The increased pay rate at the hospital helped, but I knew there was still room to grow. Luckily, the facility had a way to increase your pay rate through national certifications and clinical ladder progression. I saw this as a way to increase my pay, improve care for my patients, and elevate the organization. It was a win-win-win. However, after speaking with a few travelers at my facility and doing some research, I knew that travel nursing would be that extra boost needed to jumpstart my future.

Travel nursing has many financial benefits, including high pay rates and tax advantages. Of course, “high pay” is relative to the area and the level of need for the facility, but if you can live economically and budget, you will typically come out ahead. High pay paired with the tax-free stipends for housing and meals, leads you to keep more of the money you make. (I will go into this further on future blogs). As a personal example, after my first year traveling, close to 50% more money hit my bank account after taxes while working close to half the amount that I had been per week while taking off nearly a month entirely. Of course, there are additional expenses required when traveling, but if you maintain your tax-free eligibility and do your research into the area, you almost always come out ahead.

Well-Being

Too much of something, even if it’s good, is typically not so good. Just think of peanut butter. There’s that fine line between “OMG this is amazing” and “My stomach is killing me, I’ve had too much.” As mentioned earlier, I had been working a lot. I believe 27 days in a row and 70-80 hour weeks was when I realized that I needed a change. I was 25 years old and was burning myself out. I was a machine. Wake up, workout, go to work, try to have a social life, sleep, repeat. It got to the point where even in my dreams, I was at work. The more I worked, the more money I made, but it ultimately didn’t seem worth it. I was drained all the time, struggled to be with friends and family, and when payday came, more and more money was coming out of my checks for taxes. There was a positive correlation between work put in and money out, sure. But overall, it just didn’t seem worth it. It was also obvious that I was ignoring my health. I couldn’t cut corners at work so I would cut corners at home. I stopped working out as much, stopped preparing food to bring to work and instead grabbed something from the cafeteria or fast food place.

When I started traveling, I stopped working as much. My first contract was for 36 hours a week, and the facility didn’t really like to pay for overtime, so that was it. No more, no less. At first, I didn’t know what to do with all my free time, but I soon learned how to use my time productively in other ways rather than working. I got back to the gym, meal prepping, playing basketball. Hell, it was southern California in the summer – there was plenty to do. I noticed my stress levels drastically decreasing and was able to think much more clearly when I wasn’t constantly on the clock. As an added bonus, in California, the mandatory ratios for patients to nurses was significantly lower than what I was accustomed to in New Jersey. I now had 3 to 4 patient at a time whereas I used to have up to 7. There are also scheduled breaks which I could have only dreamed of. When drafting a contract, you can put your required time off so you can go on that vacation you scheduled, and if you’re feeling a little lazy, you can take a break between assignments. This all just made work more pleasant which definitely impacted my life in a positive way. With the combination of working less often and more desirable work conditions, I was able to make some much-needed tweaks to my work-life balance and get my health back in order.

Cultural Experience

Everyone back home is just like me. If I had to guess, I’d say 98% of my town is at least one of the following: Irish, Italian, Roman Catholic, white, or Republican. And, I might be lowballing that number too. I value people’s differences. When everyone and everything is the same, it’s boring. I love to learn about people and new places. I got my first real taste of differences in people when I went away to college. Again, much of the physical make-up was the same having gone to school in the North East, but at least people were from different places. I found myself fascinated with everyone’s hometowns, what crazy words or phrases they’d say, or their accents. Like seriously, who calls a water fountain a “bubbler”? Also listening to a kid from Boston go on and on about how Tom Brady is one of the most important people to ever walk the planet followed quickly by a New Yorker who thinks otherwise was quite entertaining. Although this was all great, I knew I wanted more exposure to the world and to explore away from my comfortable little corner of it.

I’ve spent the last year working in Los Angeles, and it was a shock from the start – I still can’t tell if I’m impatient or everyone is just slow. In all seriousness, being immersed in this city, which is basically a bunch of mini-cities that grew in together, has been wonderful. I’ve gotten to learn about many cultures, enjoy their food, and stare blankly and nod when they speak to me in their language. Korean BBQ  – they supply the food and skillet, and you cook it. Taco trucks on the street with everything in Spanish. My barber is an Armenian guy who speaks some English but not enough to have a real conversation and I know absolutely no Armenian. We don’t really speak except for exchanging hellos and me saying “number two on the sides, trim the top,” followed by our good-byes. However, I value these conversations because as I sit in the barbershop and get my hair cut, I’m able to absorb a little of their culture even though I don’t understand what they’re saying. I’ve also been able to practice some of my Spanish, which is something I’ve always wanted to do for myself but also for the comfort of my patients. I still follow my little script, “Hola. Me llamo Tomás. Soy enfermero. Yo hablo español un pequito,” but I’m able to actually communicate a bit more which is always nice.

Key Points

  • Travel nursing allows me to improve my nursing practice, world exposure, and financial and personal health.
  • You can expand your nursing experience in different settings using previously acquired skills.
  • Less money out in taxes means more money for you thanks to tax-free housing and meal stipends for those that qualify.
  • Take that vacation without having to worry if your PTO will be approved.
  • Explore new places and be immersed in their culture while on assignment.