*Original post released on 2/9/2022
Let’s face it, ICU travel nursing contracts are among the most lucrative of those being offered at this present moment in time. But, do you really know and understand what you might be getting yourself into if you decide to take a contract? This article will discuss some of the ICU contract realities I’ve come to see and note while working in the ICU setting recently and as a traveler. Disclaimer: these points won’t ring true for every single ICU taking in travelers, so keep that in mind. The purpose of sharing these realities isn’t to scare you away or discourage you from traveling; the purpose is to set your expectations realistically and help you evaluate if these conditions are something you can or are willing to handle.
One of the first things an ICU traveler will ask the agency/facility is what the staffing ratio is. This ratio is dependent on many factors, two of the foremost of which are acuity of the patient and staff availability. This past contract I worked, the ratios for nurse to ICU patient were anywhere from 1:1 to 1:4. When I experienced the 1:4 ratio, the patients weren’t any less acute. This situation was simply due to lack of adequate staffing. Those four patients were intubated and ventilated, on multiple drips, and unstable. Such situations can be dangerous for the patients and the nurses caring for them. Don’t embark on a contract without ensuring you have license insurance for yourself and have done research about any laws pertaining to safety of staffing ratios. In some states, there’s a “Safe Harbor Law” that aims to protect nurses during times of inadequate staffing so patients can still be cared for instead of the nurse flat out refusing the assignment altogether, making the issue and situation even less desirable.
When you first arrive to the facility, they’ll likely only give you a shift to orient to the facility and charting system by working with another nurse on the unit you’re assigned to. The expect you to arrive with experience and be able to handle anything thrown at you. Some facilities may even offer less than a whole shift dedicated to your orientation to the facility, unit, and job duties. Also keep in mind that many facilities view their ICU nurses as being competently trained for nearly any setting. You may want to double check your contract to see if the facility has the ability to float you to other units in order to address their staffing needs. Even though my contract explicitly stated that I was strictly ICU, the facility still insisted on floating me. In their opinion, you work in the most critical of settings so you should be able to easily take on patients from telemetry, med surg, progressive care, etc.
Adjustment to a new facility, unit, city, etc. can be difficult and overwhelming. You’ll be handling and learning new doctors/specialties, supplies and limitations, policies and procedures, and the like; however, you are going to be expected to adapt and overcome with little or no grace period of adjustment afforded to you. Expect your shifts to consist of 13-15 hour days, with at least 3 shifts per week. You will be exhausted. Also anticipate working holidays if your contract has any that fall within your dates. The facility will nearly always schedule you to work those days before they will schedule their own staff to. You may be able to explicitly outline in your contract refusal to work holidays, but this is rare to see accepted by the facility. Furthermore, expect the unit or facility to call you repeatedly to work or pick up a shift. Be cautious about giving out your phone number if this does not interest you. Nearly every day I had off during my contract, I was dodging calls from the hospital about coming in to work extra. That repetitive pestering in itself can also be exhausting.
Resources at facilities can vary greatly from one location to another and even from one facility to another within the same city. You may find yourself having to get creative with supplies to make do. Assistance from staff can also vary greatly from one facility to another as well as from one day to the next. Staff at the facility you’re placed at tend to be indifferent or even exclusive with travelers, so assistance can be little or nonexistent. As a travel ICU nurse, you’ll likely be expected to roll with any and every punch they throw at you…and believe me, they’ll keep those punches coming. One shift I was tripled with three covid patients, had to downgrade two of them to telemetry, and then received two ICU admissions all before midnight during my shift. It was exhausting, and they typically don’t entertain your complaints.
Be prepared to receive and take care of COVID ICU patients regularly…even when the facility’s own staff does not. I found it to be an all-too-common occurrence to be assigned at least one COVID patient each shift, even if that was the only patient on the unit with that status. From what I gathered, the thought was “why expose our own staff unnecessarily if we have travelers to take the assignment?” It’s a sad reality to know that many facilities are operating with this attitude. It didn’t matter that I was pregnant with twins and high risk; the facility and unit were aware and continued to dish out the COVID patient assignments like Oprah. Luckily for the facility, I want what’s best for my patients and knew that one of their staff nurses wouldn’t care for them like I would take the time to. I took every precaution and never contracted the virus during that assignment.
While these are just a few contract realities to touch base on, keep in mind that the ICU setting and acuity itself likely won’t vary much. You’ll still be dealing with the same or similar disease states, medications, and plans of treatment. Sometimes different areas may have higher quantities of patients with certain diseases or conditions, but in terms of this, your adjustment should be a smooth transition. For example, in my home city of residence, we see a lot of diabetic patients on dialysis and cardiac patients (CHF, MI, HTN, etc.). During my most recent contract in Chicago, I experienced a much higher incidence of patients from the psychiatric and substance abuse population. This was a fairly large adjustment for me personally, however still doable. Plus, it was one of the easiest adjustments I made during the contract. The shock of the others mentioned in this article were a bit more difficult to adjust to.
Let this serve as a wake up call to remind you of the realities associated with travel nursing. Sure, the pay and travel are great perks, but you are still there first and foremost to be a nurse. Without the nursing gig, you likely wouldn’t be living in that region of the country or working in that facility. Keep a level head on your shoulders, don’t get caught up in the glorified aspects of contract nursing, and remember you are still a nurse in the ICU and that role itself doesn’t vary much which should afford you some comfort.
Until next time, happy studying!