Travel Nursing

Accelerated Programs Offer a Fast Track to Nursing

Posted in Independent Contractor, Nursing Jobs, Nursing Specialties, Per Diem, Permanent Placement, Travel Nursing, Uncategorized

If you are reading this and you are considering a career in nursing, an accelerated or fast track nursing program may be the answer for you, especially if you already have a bachelor’s or master’s degree in a non-nursing discipline. An accelerated nursing program allows you obtain your BSN in as little as a year or your MSN in as little as three years. How can this be accomplished?

Accelerated nursing programs utilize the coursework you have already taken such as biology, anatomy, and the social sciences. In addition, accelerated nursing programs do not take breaks between semesters or courses, and usually require that you carry a heavier course load, while at the same time participating in an intense clinical training process. (more…)

Fostering Effective Communication in Nursing

Posted in Independent Contractor, Nursing, Nursing Jobs, Nursing Specialties, Per Diem, Permanent Placement, Travel Nursing, Travel Nursing, Travel Nursing Company Reviews, Uncategorized

Effective and clear communication is critical during the countless interactions that occur between health care professionals on a daily basis. The staff should know how to communicate effectively with one another so that appropriate information is shared in a timely manner. When effective communication does not occur, the patient’s care is compromised.

The Joint Commission, which accredits and certifies more than 19,000 health care organizations and programs in the U.S., states that communication problems have long been cited as a root cause in the majority of the cases studied. The Joint Commission’s Sentinel Event Database reports that hierarchy differences, conflicting roles and power struggles can all lead to communication breakdowns which ultimately compromise patient safety and the quality of care.

Communication, at its most basic level, is the exchange of information between people, groups or entities. (more…)

Get the Facts About Travel Nursing

Posted in Nursing, Nursing Jobs, Travel Nursing

Travel nursing can present new, exciting and challenging opportunities. If your present job situation is just not satisfying, don’t let yourself be stuck. Stick your neck out and try something new.

The beauty of nursing is that it offers so many different opportunities. Don’t be afraid to try some of them. Here are a few tips to help you get started.

First of all do your homework. Not all travel nursing agencies are created equal and not all facilities that hire travel nurses are among the best employers. Word travels fast, and information is available; you just have to do a little research.

This site offers a large forum for discussion about all things nursing, and among them, travel nursing experiences. Spend some time reading through the threads and posts. Ask questions and get the information you need.

There are a multitude of books, websites and blogs by travel nurses with much valuable information. Read everything you can to understand the pros and cons of your next adventure.

Talk to travel nurses who work in your current facility. Some of the questions you may want to ask include:

  • Which travel agency they currently work for?
  • Do they have other agencies they would recommend and why?
  • Have they had bad experiences with any agency and which ones?
  • What do they like about their current assignment?
  • What don’t they like?
  • Do they have a favorite place to travel and why?
  • Where don’t they like to go and why?

Some of their answers may be more personal especially if they have chosen locations close to family or friends, but their experiences can provide good insight into what to expect in a travel assignment. Even if the assignment was for their own convenience, the job satisfaction factor comes into play somewhere.

Current travel nurses can help to provide valuable information about what to include in your contract, what kind of information you need to know about a location, a facility and specifics about the nursing assignment.

Each and every one of the travel nurses you network with will probably be able to give you at least one new tip or trick to make life on the road more enjoyable and successful. Take notes and keep a file of these handy tips and tricks. As you become a veteran travel nurse, be sure to share your own tips with others.

You may want to start with a short assignment close to home or near to family and friends so that you have your own support system at hand. Any new situation can and will be stressful and having support systems in place will help to reduce some of that stress.

You may also want to consider taking a leave of absence from your permanent employer while you take a short travel assignment. This ensures you have a job, seniority and benefits to fall back on if this isn’t something you want to do.

Remember to give yourself ample time to evaluate any new venture. No job is perfect, and it may take some time to get used to being a travel nurse as compared to a permanent employee.

By Kathy Quan RN BSN. Kathy is the author of The Everything New Nurse Book, and the owner/author of

©2008 by All Rights Reserved.

Travel Nursing in a Faltering Economy

Posted in Nursing, Nursing Jobs, Permanent Placement, Travel Nursing, Travel Nursing

A couple of weeks ago, I spoke with a friend who works for a travel nursing company in southern California. He got into this field because he felt that the nursing field was going to be a sure bet in this faltering economy. Now he’s nervous and not so sure about the security of his job.

Many hospitals in southern California have apparently cut way back on their need for travel nurses at the present time. This is especially true for general med/surg nurses. Many specialty areas such as ICU, NICU, telemetry, etc., are still looking to fill positions, but too many of the applicants only want med/surg and are still demanding high salaries. They aren’t finding too many options here.

With the current economic downturn, nursing will remain more recession proof than most careers, but nurses have to be realistic in their goals today. Hospitals are looking at every possible way to cut costs. Paying high salaries for med/surg nurses is one place they have cut back, whereas they may still be willing to pay for specialty nurses they cannot recruit from their own local community.

In many communities, nurses who had left nursing to raise families or to retire early, have returned to work. Retirement funds such as 401Ks have been lost or significantly impacted, spouses may have lost jobs, and extended family members may be in dire need of financial assistance. For a nurse returning to work after a long hiatus, med/surg is probably the best place to start out and rebuild confidence and skills, so these jobs are scarcer.

One factor that is somewhat beyond the realm of economics is affecting hospitals. This has been a very slow flu season in most of the country. The flu shot for 2008-9 seems to have been effective, and cases are more widespread this year.

In recent days however, the news seems to indicate that this may change. There has been a mutation in the flu specimens of late that appear to be resistant to the Tamiflu antiviral medication. This may result in more complications as patients find that their symptoms are not weakened by this medication.

In a bad flu season, hospitals can become inundated with the elderly and chronically ill as well as the very young. In a slow flu season, censuses remain low and the need for nurses diminishes.

With few elective procedures being performed these days, hospital censuses are also lower as well. On the other hand, as more people put off health care for lack of insurance or funds to pay for medications or rising co-pays, patients who do need hospitalization are generally sicker and need more specialized care.

The need for nurses continues to vary across the country. Some areas will continue to have a strong demand while others may diminish somewhat. Travel nurses will continue to find work, but they may need to change their expectations about locale, perks and salaries. Those who have or attain more specialized experience and skills will have a better chance of being in demand.

By Kathy Quan RN BSN. Kathy is the author of four books including The Everything New Nurse Book and the recently published 150 Tips and Tricks for New Nurses. She is the author/owner of

© 2009 by All Rights Reserved.

The Fifty Mile Rule and Travel Nursing

Posted in Nursing, Nursing Jobs, Travel Nursing

The Fifty Mile Rule and Travel Nursing

Is there really a 50 mile rule for travel nurses or is this just something someone made up to keep the locals from benefiting from travel nurse perks?

The truth is there is no real rule. There are some qualifications that the IRS imposes on travel nurses regarding tax free benefits. Some travel nursing recruiters confuse these IRS rules with the so-called 50 mile rule and sometimes hospitals do impose an imaginary 50 mile rule to keep it’s community nurses happy. It’s really up to the travel nurse to know the difference and to discuss the issue with the recruiter.

In a large metropolitan area such as Los Angeles where the locals are used to driving long distances for everyday events such as shopping, entertainment, sporting events, school and religious worship, driving 50 miles to and from work is not an unusual task. For someone in a more rural area, this might seem to be unusual and taxing.

For a restless nurse living in Los Angeles, the opportunity to take on a traveling nurse assignment 50 miles from home may be just the spark s/he needs to renew the sense of why s/he became a nurse and loves this profession. It could serve the nurse and his/her patents well to bring this renewed sense of caring spirit to work each day.

How this nurse approaches the travel assignment is key to whether s/he qualifies for the tax free benefits of a travel nursing assignment. This is subjective data and will vary with each individual nurse. Assuming our restless nurse has a home in the Los Angeles area, how s/he approaches the IRS Sleep & Rest Test will determine the amount of tax free benefits s/he is entitled to.

If our nurse drives to and from the assignment each day, returning to his/her own home then s/he is not entitled to any tax free reimbursements for meals and housing.

If however, the particular drive takes significant time and the nurse feels that this drive would make him/her unfit to care for patients, s/he can accept the tax free temporary housing/meal package nearby the hospital as long as s/he does not return home during his/her travel assignment.

Another nurse may chose to work the 50 plus miles from home grouping his/her 12 hour shifts together each week. This nurse accepts temporary housing in a hotel for the 3 days each week that s/he works, and returns home for the 4 days s/he has off each week. Because she is staying in a hotel and returns home each week, 4/7ths of this housing and meal allowance is taxable (or must be returned).

If this same nurse took an apartment as part of her package deal, the rent would qualify for tax free status, but his/her meal allowances for the days off spent at his/her own home would not.

The Sleep & Rest Test applies if the individual nurse feels it necessary to stay nearby the assignment in order to be adequately rested to be fit to care for the patients. This is subjective and will vary from nurse to nurse. Some nurses would prefer to drive back and forth and use the time to for such things as to unwind, to listen to books on tape or to talk to family and friends on the cell phone (hands-free in CA of course), etc.

If you’re looking for a travel nursing assignment closer to your own home, and being told about a 50 mile rule, get some clarification from the recruiter. Also have a good understanding of the tax implications if you accept a housing and meals package.

By Kathy Quan RN BSN. Kathy is the author of The Everything New Nurse Book and the owner/author of

© 2008 by All Rights Reserved

Five Rights of Delegation

Posted in Nursing, Travel Nursing

Within the realm of nursing there are Five Rights of Delegation which allow licensed nurses to delegate tasks to other nurses or to unlicensed assistive personnel as long as this criteria is met and the patient’s safety and well-being is not jeopardized.

The Five Rights of Delegation are:

  • Right Task
  • Right Circumstances
  • Right Person
  • Right Directions/Communication
  • Right Supervision/Evaluation

The Nurse Practice Act (NPA) allows for licensed nurses, namely RNs, to delegate tasks to LPNs, CNAs, and UAPs as long as certain criteria is met. First of all the nurse delegating the task must realize that s/he remains responsible for the task and the outcomes.

The Right Task
The RN must determine that the task is one that can be safely delegated in the first place. This includes such factors such as possessing the skills and knowledge of how to perform the task and how to evaluate the success or failure of the task. The tasks must have a predictable outcome, a minimal potential risk, and a standard, unchanging procedure.

The task must fall within the scope of practice and job description of the person to whom it is being delegated and they must have demonstrated competency in performing said task. The organizational policies and procedures of the facility must not prohibit the delegated person from performing said task.

Typically tasks which can be delegated frequently recur in the day-to-day care of patients on the unit. The tasks are not complex, and do not require critical thinking or application of the nursing process.

The Right Circumstances
The patient must be stable and the outcome predictable. The decision to delegate must be based on the nursing process and a careful analysis of the patient’s needs and circumstances prior to delegating. The person to whom the task is delegated must perform the task within their own scope of practice and job description. They are assisting the licensed nurse with the task, not replacing the nurse. If at anytime the patient’s condition changes, the nurse must reassess the situation and may rescind the delegation.

The Right Person
The licensed nurse delegating the task must ensure that the delegatee possesses and has demonstrated the knowledge base and appropriate skills and resources to perform the task and provide adequate supervision and evaluation to ensure the patient’s safety and appropriate outcome.

The Right Directions/Communication
The licensed nurse is responsible to ensure that the delegatee has the previously documented appropriate skills and knowledge base. The nurse is also expected to communicate to the delegatee specific instructions for this task. Each instance of delegation is to be specific to the patient, the nurse and the delegatee.

The nurse needs to clearly communicate the specifics and expectations of the task such as any data to be collected, the method for collecting it and the time frame for reporting results to the nurse. Any possible complications need to be communicated along with time frames for reporting them to the nurse. Further all outcomes must be reported to the nurse and the time frame needs to be pre-defined. The delegatee must agree to accept the delegated responsibility and understands the terms of the assignment.

It must be clear to the delegatee that s/he is not to make decisions or modifications to the care without first consulting with the nurse. This would be overstepping their scope of practice.

The Right Supervision/Evaluation
The nurse remains responsible for the tasks and the outcomes. The nurse is responsible to follow up and receive report on the task and outcomes if the delegatee has not done so. The nurse is responsible to ensure compliance with standards of care, and the policies and procedures of the organization. S/he is to intervene if necessary. After careful evaluation of the outcomes, the nurse also needs to ensure appropriate documentation is provided.

After the fact, the nurse needs to evaluate the patient, the outcomes, and make any necessary modifications to the plan of care. The nurse should also provide feedback to the delegatee and thank them for the assistance.

In some states, LPNs can delegate to CNAs and UAPs. However, unlicensed personnel such as CNAs and UAPs may not delegate. Anyone to whom a task has been delegated may not reassign the task to anyone else.

National Council of State Boards of Nursing

©2009 by All Rights Reserved. By Kathy Quan RN BSN. Kathy is the author of four books including The Everything New Nurse Book. She is also the owner/author of

Nurses Position Yourselves for Future Opportunities

Posted in Independent Contractor, Nursing, Nursing Jobs, Nursing Specialties, Per Diem, Permanent Placement, Travel Nursing, Travel Nursing

The state of the nursing profession currently reflects the state of the economy. With unemployment hitting record levels, many non-active nurses have returned to the profession and others have taken on more shifts in order to meet the needs of their families.

Hospitals have been hit hard in the pocketbook by the fact that many patients are putting off elective procedures and anything that isn’t of an urgent nature. It has been a slow flu season and therefore the number of children, elderly and chronically ill have not required hospitalization for complications of flu.

Jobs are in Middle America
The number of nurses available for travel assignments has grown and therefore with simple economics of supply and demand, those who are more flexible and have more experience are getting the premier travel assignments. The east and west coasts have been more affected by the economic crisis than middle America and consequently the opportunities in these regions have been affected as well. The jobs now are available in the middle of the country, not Florida and California.

The good news is that the economy will turn around. How soon is being debated. Some predict a few months and others at least a couple of years.

The other factor is that in the next few months, we will see more nurses taking time off from taking on extra shifts or returning to work and being overworked and burned out. This will open up more opportunities.

Gain Experience and Improve Skills
For nurses who are employed or have current travel assignments, make the most of what’s available to you. Extend travel assignments as possible and look for opportunities to polish skills or to gain more experience in specialty areas. Continue your education.

Some travel nursing companies are looking for a minimum of 2 years experience in a specialty area, and making changes right now might even be a negative, but think further into the future and get the experience you want and need. The one thing that is happening across the board for nurses looking for permanent or travel opportunities, is that nurses with very little experience beyond basic med surg are having a harder time finding jobs.

As the economy improves, all those patients who have delayed procedures and care are going to need to have it done and the system is going to be overwhelmed. The nursing shortage has not been solved. There is still going to be a shortage of nearly one million nurses by 2020. Nurses who have positioned themselves to meet the challenges of the next couple of decades will be way out in front.

Post Acute Care Will Grow
Post acute care, especially home health care, is expected to be the fastest growing branch of the nursing profession over the next few years according to the Bureau of Labor Statistics. Nurses who have excellent skills in a wide variety of patient care will be able to make this transition more easily.

For older nurses who cannot stand for eight to twelve hours a day, home health care may offer a new career path for many years past what they could serve in an acute setting. The key to survival in home health is being confident in your skills, having strong critical thinking skills and being able to work autonomously. Documentation skills are a very important issue in home health care as well.

© 2009 by All Rights Reserved.
By Kathy Quan RN BSN. Kathy is the author of four books including The Everything New Nurse Book and author/owner of

Nurses Have a Voice and Should Not Go Silent

Posted in Featured, Nursing, Nursing Jobs, Travel Nursing, Travel Nursing

Nurses can’t find jobs either? What’s the truth behind this issue?

One thing that has happened in the past few months as 401Ks and other retirement funds have practically vanished, is that many nurses, who have not been actively employed for possibly even years, have returned to work.

With children in college, spouses losing jobs, and retirement funds evaporating, yes, many inactive or “retired” nurses have returned to the workforce. This will impact the nursing shortage to some extent, but will not solve it.

But, what else is really happening?
Nurses are being threatened and frightened into working mandatory overtime that states have regulated or outlawed. Nurses are being forced to take on nurse-to-patient ratios that are totally unsafe because administrators can hold their jobs over their heads. Working conditions and safe, quality, care are at risk!

Some states have passed nurse-to-patient ratio laws and have strong organized nursing unions enforcing them. But in far too many places, nurses have been afraid of such laws and hate the unions. Nurses will begin to see that hospital administrators, faced with huge reimbursement problems, are going to cut the nursing staff first and foremost because they have new found power to control the nurses.

Fearing the loss of jobs, benefits and retirement funds, nurses will buck up and work under the worst of circumstances once again. Out of a false sense loyalty to the patients they serve, nurses will martyr themselves and continue to try to provide the best care they can.

But what about the quality of patient care and safety issues, never mind putting their own license on the line because they are overworked and burned out? Then where does this loyalty to the patients they serve stand?!

This economic downturn is going to prove to be one of the biggest issues nurses have had to deal with in many years! It already is.

Nurses need to remain strong and stand up for the patients. There is data available to support the theories that quality of care diminishes, and people die when nurses are not supported.

Medicare, for one, has instituted many important reimbursement factors and continues to collect and analyze data regarding the quality of patient care. There are numerous “do not pay” rules that affect reimbursement for hospitals such as decubs, UTIs from catheters, and blood clots post op.

Medicare also maintains a database of hospital comparison based on specific criteria and outcomes which illustrate the quality of care (or lack of) provided in hospitals all across the U.S. This too is used by Medicare to determine reimbursement rates, and it is hoped that consumers will seek out this data and avoid these institutions when they have a choice in health care.

Nurses have the power to make a difference not only in the lives of the patients they individually care for, but also in the overall quality and safety in care they collectively provide. This power cannot be relinquished for fear of losing jobs in a bad economy. Nurses have a voice and cannot go silent!!

Institutions that value patients and continue to strive to provide quality care to patients continue to have nursing vacancies because there continues to be a shortage of nurses. Those institutions who don’t value quality patient care, probably don’t have many vacancies because they have cut staff to the bare bones and have a hiring freeze.

Nurses need to stand strong and work together to continue to demand better working conditions and not lose ground that has been hard fought to gain in the past 30 years by falling prey to those who value the dollar more than lives. There is a lot more to be lost than jobs.

By Kathy Quan RN BSN ©2009 by Ultimate ALL RIGHTS RESERVED
Kathy is the owner/author of and the author of four books including The Everything New Nurse Book.

Home Health Nursing

Posted in Featured, Independent Contractor, Nursing, Nursing Jobs, Per Diem, Permanent Placement, Travel Nursing

Home Health Nursing

Have you ever considered home health nursing? Like any other nursing specialty, it’s not for everyone, but it can be a challenging and rewarding career option for the right candidate.

Not to be confused with private duty assignments in the home, home health nursing involves making several visits each work day to a variety of (at least temporarily) homebound patients.

These visits entail a complete head-to-toe assessment which can be brief or complex depending on the patient, the findings, or the physician’s orders. The visit will also include patent and caregiver teaching. Again the extent and complexity depends on the specifics of the situation. Each visit should build on the previous teachings and may involve some sort of return demonstration or pop quiz, if you will.

There may be a task to perform such as assessment and wound care, incision care, IV administration and/or site change, Foley catheter change, G-tube change, etc. The patient and/or caregivers may need specific instruction in the care of these as well.

Or the patient and caregiver may need in-depth instruction for a new diagnosis such as diabetes which would include such things as blood glucose monitoring, insulin or other medication administration, and how to identify and treat the signs and symptoms of hypo or hyperglycemia.

Patients and caregivers may also need instruction in medications including dose, administration, possible side effects, purpose and desired results. Other areas of common patient/caregiver education include specific dietary and nutritional needs or restrictions, and home safety issues.

Teaching caregivers how to safely assist patients with hygiene care (bathing, showering or a bed bath), transfers and ambulation may require the assistance of a PT or OT, but the home health nurse also needs to know how to perform and instruct in these as well.

Home health care is most often ordered by the physician following discharge from the hospital, or it may be ordered in lieu of hospitalization. In most instances it is not expected to be long term, but rather to help the patient and/or caregivers become independent in the necessary care.

For reimbursement purposes, Medicare and insurance companies have specific guidelines and criteria that patients must meet to be eligible for home health care. The home health nurse is responsible for reviewing this and documenting accurately. One of the worst parts of home health nursing is the paperwork! Much of it can now be done using a laptop or hand held computer, but there is still a lot of documentation to be done.

The nurse is the eyes and ears of the physician in the home. Many times home health referrals are made because the physician suspects that the patient needs more assistance or instruction in order to improve his/her outcomes. Or perhaps a higher level of care is needed.

The home health nurse learns to assess a home situation and to make recommendations for durable medical equipment (DME) and other disciplines to participate in the care such as a PT, OT or ST. A home health aide may be added to assist with hygiene care and to teach the patient and/or caregivers how to safely bathe and groom the patient.

If necessary, a medical social worker (MSW) may be called in to assist the patient and family in making more complex short term or long term plans for care, or help them to cope with life changing circumstances.

The beauty of home health care is being able to spend quality time with patients and caregivers one-on-one. But home health care is a team approach and the nurse is not expected to do it all.

It can be scary at times because there isn’t another nurse just down the hall to call for assistance or consultation. But there is backup a phone call away, and with cameras in cell phones, it can be even easier to get that consultation.

The autonomy and the ability to utilize skills that sometimes seem wasted in the fast pace of a hospital setting often draw nurses into the home health arena. Call a home health agency and ask to make a ride-along visit with a home health nurse to consider if this might be something you’d like to explore further.

By Kathy Quan RN BSN. Kathy is the author of The Everything New Nurse Book and the author/owner of

©2009 by All Rights Reserved

Dealing With a Nightmare Nursing Assignment

Posted in Nursing, Nursing Jobs, Permanent Placement, Travel Nursing, Travel Nursing

Dealing With a Nightmare Nursing Assignment

What happens when you encounter a nightmare nursing assignment? Whether you are a travel nurse or this is a permanent job, you may not be able to run screaming from the building never to return. So what can you do?

First off, take a deep breath and remember that you are a professional, If possible, leave the building, or at least the unit, for a few minutes to help clear your head. Perhaps the best you can do is retreat to the bathroom. Mentally punch a few walls and then try to decipher what just happened.

The most important thing is to make sure that your own patients are well cared for. If your issue is with another staff member, avoid him/her by spending more time with your patients.

If the issue is with a patient or family member, you can first try killing them with kindness while you make sure their needs are met, and then avoid them by spending more time with your other patients.

Let your nurse manager know what’s going on so that s/he can back you up and isn’t blindsided by complaints. Let him/her know that you’re trying to work this out, but need a little break from the situation. Perhaps s/he can offer some assistance.

Approach the situation using your critical thinking and problem solving skills. Try to step back and not let your emotions take precedence. Use the Nursing Process to assess, diagnose and create a plan to deal with the situation. It may take some time and require small but steady steps to make it work.

Some of the the things you need to consider include:

  • Is this something you can fix by yourself?
  • Do you need some advice, help or support from others to implement your plan or to make it work?
  • Is this a personality conflict?
  • Is this an issue of patient safety or quality of care?
  • Has there been some misunderstanding? How can you clear up the issue?
  • What can you do to avoid this problem in the future?

If this is your permanent job, you should speak to your nurse manager and decide together what can be done to improve the situation. Don’t go to him/her pointing fingers, go seeking assistance in solving a problem.

If you are a travel nurse, you may also need to consider whether the problem stems from being the traveler who “makes the big bucks and has all the perks?” If this is the core of the issue, you need to discuss this with your nurse manager and figure out how to turn this around.

Travel nurses are brought in to help reduce a specific nursing shortage situation and it’s up to the nurse managers in that facility to help permanent staff to understand this and to appreciate the help; not resent it, or to abuse a fellow nurse for accepting this role. Management needs to set the tone.
Travel opportunities are open to all nurses and just because someone does not take that option should not give them reason to resent or mistreat those who do. We all know that that isn’t the way it usually works, but travelers need to stand up for themselves and hold nurse managers and administrators responsible to set a positive tone about using travel nurses in their facilities.

The situation should also be brought to the attention of your recruiter. Hopefully it an be resolved without having to involve the recruiter, but s/he should be aware of the situation and it’s resolution for future reference.

If the situation can’t be resolved, or not to your complete satisfaction, you will just have to complete the assignment and/or make plans to move on as soon as you can. Put your focus on the positive aspects of this and learn something from it.

Understand the situation and look for something where you can avoid this situation in the future. Also count down the days left so you can see the light at the end of the tunnel. Remain professional and continue to provide the best possible care for your patients.

By Kathy Quan RN BSN. Kathy is the author of The Everything New Nurse Book and owner/author of

© 2008 by All Rights Reserved.