The ratios are too high, the hospital is too busy, and there isn’t any help!What do I do?!
As a Traveler, you may have felt these sentiments or even voiced them. Feeling unsafe on assignment is a scary experience — and that can be especially true in a new hospital where you really don’t know anyone. Who do you turn to for support in that situation? Because every scenario is different, there are no black and white answers, but let’s look at some assignment safety concerns commonly reported by nurses and how you can best address them.
Ratios
Many nurses report being “out of ratio” or facing high ratios. What exactly is high? Well, it really comes down to what the nurse’s experience is and what their expectations are of a hospital. California is the only state with nurse:patient ratio laws. Med-surg, for instance is a 1:5 ratio there, but this ratio could be much different elsewhere in the country. Some states see up to 1:7-8 ratios and more!
So, what is “unsafe”? Well, one common average is 1:6 on a med-surg floor. If a Traveler comes from California and starts an assignment on the east coast, they could suddenly see 1:7 ratios when they are used to seeing 1:5. This is a drastic difference. The nurse could suddenly feel overwhelmed and unable to meet the needs of the patients. Their expectation of the position may have been unrealistic as well.
Perpetually Short-staffed Units
Another common complaint is that a unit consistently does not have enough staff to care for the patients on the floor, causing higher ratios as well. Most Travel Nurse positions exist because a hospital recognizes that there’s a critical shortage of nurses on their floors. So, travel assignments will often be short-staffed due to the nature of the work. However, this makes a big difference whether or not a hospital is actively seeking new permanent employees and/or Travelers to fill its gaps.
It’s important to do your research before accepting a position. Ask why they have a travel need when interviewing. This is a great way to get more information about this area. Even gauging howthe interviewer answers the question will give you insight.
Being Asked to Take Patients Outside Your Skill Set and Comfort Level
This is a very serious situation. Travelers asked to take patients outside their skill set often feel like they have to — to keep their job and stay in good standing with their travel company. But hear this: No nurse should be forced into taking an assignment outside of their ability! Travelers must be vocal when this issue arises and calmly state the reasons they cannot accept a patient assignment. The worst thing you can do is blindly accept this kind of assignment and hope to “fake it, ’til you make it.” Be professional but be firm.
Always know that anything that happens with the patient under your care will be your responsibility and under your license. Continue to take the issue up the chain of command if the hospital is adamant. Also, contact your recruiter! Many travel companies — including Medical Solutions — have in-house clinical staff that can be your advocate in the field. Find out if you have this resource before you accept an assignment with a company.
Being Asked to Cut Corners Because “That’s How it’s Done Here”
There are no circumstances where it’s acceptable to do anything outside of the standards of practice set forth by Joint Commission standards and state laws. A commonly reported situation is perm staff telling a Traveler that a physician does not like to be called at night. So, they just order labs and the physician signs it the next day. This is never acceptable, unless there is a protocol order signed by the physician in the chart already. Always call the physician. Will they be upset? Probably. But this is better than ordering something without an official physician’s order and having a complaint sent to the BON on you practicing out of scope. The core staff will do what they do, but don’t assume that risk yourself just because everyone else is doing it!
There are several other issues that Travelers tend to report as unsafe, and many of them are valid. Overall, what can you do to protect yourself?
What Can Travelers do to Protect Themselves?
Ask more questions
If the manager says their ratio is 1:5, but sometimes can be 6-7, then ask how often someone on the floor carries more than six patients. If the manager says Travelers float, then ask if they float round-robin with the staff or if they float first. Ask if floating mid-shift or more than once per shift is common. Ask where they expect Travelers to float. It is never out of line to ask questions during an interview.
Take a personal inventory and know your expectations of each assignment.
If your expectations don’t align with what the hospital expects, then it may not be a good fit. Trust your instincts!
Talk to your travel company and have them work for you!
Get enough information about an assignment from your recruiter before an interview so you can make an informed decision and be prepared to discuss any questions you have.
Traveling is an amazing experience, and you can make sure that it is just that and no less for you. Get answers to your questions, clarify your expectations, and find that perfect match!
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