The Downsides of Becoming a Traveler in Your First Year of Practice

By Rose O. Sherman, EdD, RN, NEA-BC, FAAN

Almost every health system in the country now uses travel nurses to fill core staffing vacancies. High vacancy rates have resulted in an unprecedented number of requests for travel contracts. At this point, none of the travel agencies can meet the demand. Unfortunately, the growing need for travelers has also led to a concerning practice – some agencies now hire nurses with as little as six months of experience. Nurse managers are expressing frustration that today’s travelers don’t have the scope and breadth of experience they have expected. Some even need extensive orientation. Charge nurses are angry that they are teaching basic skills to nurses making 3-6x what they earn.

With this backdrop, a family friend contacted me to “talk some sense into their new graduate daughter, who was breaking a residency contract and planned to travel.” They had tried to talk her out of it and expressed concern about the integrity of breaking a signed agreement with a community hospital. She told them that everyone was doing it. She did agree to talk with me. I told her parents that I might not be successful but would pose some questions for her to think about.

I was interested in learning what is driving young nurses to consider working as travelers so early in their careers. Her reasons included the following:

A once in a lifetime opportunity
Making enough money to pay off all her student loans
The ability to take one month off between 13-week contracts
Paid housing
An opportunity to work in another geographic area

So I was also wondered if she saw downsides to traveling at this point in her career. Other than some guilt about breaking a contract (which others have told her is not enforced, so there would be no ramifications), she saw little reason not to do this. She felt she was clinically ready but acknowledged she had not cared for the most critically ill patients in her ICU.

She was smart enough to realize that I saw this career decision differently, so she asked me for my opinion. I told her that I always played the long game with career decisions asking myself how I would feel about this career move five years or ten years from now. I told her about the work of Canadian researcher Dr. Judy Boychuck Duchsher, who has spent her career building on the work of Marlene Kramers’s reality shock research. Duchsher has written about three phases of transition.

The Doing Phase (the first 3 months)– the new nurse is on a steep learning curve and overwhelmed meeting practice expectations. The stress and anxiety level of the nurse is very high.

Being Phase (months 3 – 6) – the nurse achieves rapid advancement in their thinking, knowledge, and skills. Nurses begin to feel comfortable in their roles.

Knowing Phase (months 6-12) – the nurse begins to see him or herself as a separate practitioner from others on the team. During this phase, nurses begin to find professional meaning and purpose in their work. They can begin to provide others with team backup.

All three phases are necessary to socialize into the profession and maintain a lifetime commitment to the work. When new graduates leave their first employer before these phases are completed, they may not achieve full professional socialization and involvement as team members. If the nurse’s next role is working for an agency or on a travel assignment, it is unlikely that they will fully integrate into a team and profession. The first year is always challenging, and Duchsher has pointed out that disillusionment and restlessness at the six-month mark are common. If you can work that full first year, things do get better.

I explained that I saw the following risks in leaving her first position so early in her career to travel:

Lack of professional socialization
Lack of psychological safety to speak up and speak out
Lack of experience working on a team as a fully integrated team member
Lack of engagement in professional activities
Lack of commitment to the profession
Lack of ongoing coaching and mentoring
Lack of continuing relationships with other nursing professionals

I shared with her that as a travel critical care nurse who has been deemed fully competent, organizations would expect her to manage high acuity patients without a preceptor. She would be making considerably more than the staff she worked with, and they would be unsympathetic about her inability to do specific patient assignments. She was potentially putting her license at risk. My guidance would be to stay through the one-year commitment. If she still felt the same way, she could pursue other career opportunities.

Now I am not sure if any of this conversation will have an impact, but it struck me as one that we should be having with new graduates before they graduate or at the point of entry into the profession. Why not assign and study Dr. Duchsher’s work. As a BSN student, I read Kramer’s book on reality shock. It made a big impression on me and foreshadowed some of the experiences and feelings in the first year. I understood that these were part of the professional transition. I expected the first year to be challenging but knew this was one building block in a long career.

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