Three years ago, Sara Kelly — a then-new divorcée with a “gypsy soul” — packed all her worldly possessions into her car and set off for Richmond, Va., the first stop on a journey that has taken her through six states.
“I’ve been up the East Coast,” Kelly said. “Last summer I was in Cape Cod, Mass. This winter I was in Fort Lauderdale, Fla., and then this summer, Colorado.”
The Texas native’s profession affords her the flexibility for such a nomadic lifestyle, but she isn’t an itinerant musician or a flight attendant. Rather, Kelly is a travel nurse, assigned to various care areas on a temporary basis to help fill short-term employment gaps.
In May, Kelly signed a three-month contract with UCHealth Memorial Hospital Central and joined the facility’s cardiovascular ICU. Her living expenses are factored into her weekly salary, and her weekly schedule of three 12-hour shifts leaves her ample time to explore Colorado’s natural resources.
Hearing Kelly discuss her weekend sojourns to Estes Park and Aspen’s Maroon Bells, or frequent trips to the Great Smoky Mountains during her time in Virginia, travel nursing’s allure is unmistakable.
“If you go somewhere and find you don’t particularly enjoy that location, or maybe that facility just doesn’t jibe with you, it’s three months,” Kelly said. “You can do anything for three months.”
Travel nursing as a health care specialty developed mostly out of necessity, when a national nursing shortage left hospitals, clinics and other care areas with unfilled staffing positions but no fewer patients to care for. In order to attract nurses to the vacant positions, employers began offering higher pay, housing and covering a new hire’s relocation expenses, according to registerednursing.org.
“Most of the facilities I go to that need travelers, it’s because their program has grown quickly and they can’t necessarily staff it — especially in cardiovascular ICU, because you can’t pull any old nurse in here and expect them to do this,” Kelly said. “Generally, that’s what I see — or they need seasonal work, like Cape Cod in the summer, or Florida in the winter.”
The Colorado Mental Health Institute at Pueblo works with five travel agencies that supply licensed practical nurses, client care aides and registered nurses, said Ronda Katzenmeyer, chief nursing officer at CMHIP.
CMHIP currently has 46 “travelers” on staff, all of whom signed a 12-week contract with the potential for extensions if they are a good match, Katzenmeyer said.
“Some of those staff do hire on with us, which is a great opportunity,” she said. “We have had some work here for three to four months at a time.”
The staffing agency pays for two weeks of on-boarding training, with CMHIP picking up the pay after that, Katzenmeyer said. Once the new hire has learned the hospital’s electronic health record system and safety measures, they then spend the next two weeks shadowing a nurse on the same unit, she said.
Travel nurses can leave CMHIP with a wealth of knowledge that may be in short supply at other health care facilities, Katzenmeyer said. In addition to providing inpatient behavioral health services for adults, adolescents and geriatric patients, CMHIP is a forensic hospital that provides care for individuals with pending criminal charges who require evaluations of competency, those whom a court has found incompetent to proceed with criminal charges, and those found not guilty by reason of insanity, according to the facility’s website.
“We’re a hospital that can take new nurses and give them a whole new perspective on the psych end,” Katzenmeyer said. “There aren’t a lot of opportunities for that psych experience during training.
“Most of the nurses that come here, even if they’ve had a lot of medical training, sometimes this gives them a break from the normal routine and gives them a chance to do something different and learn new skills,” she added.
With six years of experience working in cardiovascular ICUs under her belt, Kelly is well positioned to both hone the skills she already has and learn to orient them to different protocols and procedures, which often vary by facility. That also means flexibility is key, she said.
“When you come in, you realize you’re a guest in these people’s house, so you have to mold yourself to do things the way this particular hospital and unit work — while at the same time, if something is really unsafe, you have to be able to stand up and say that,” Kelly said. “You have to be moldable.
“There’s a million ways to skin a cat but when you stand back and look at it, it’s the same thing — it’s just a different way of doing it,” she added. “If I get a patient who just had a bypass from the OR, I know how to care for them through the first 36 hours of post-op. … But what drugs do these cardiovascular surgeons like to give? … It’s a bunch of little idiosyncrasies for that particular program.”
Surprisingly — or perhaps not, particularly in the Springs — finding living quarters often presents the greatest challenge to travel nurses looking to relocate, Kelly said.
“Living is actually one of the worst parts of the job, because you have to find an apartment for three months that will let you sign a three-month lease, fully furnished, all bills paid,” she said. “But there are websites for travel nurses, or your agency can help — or Craigslist, believe it or not.”
Filling the gaps
Now is a critical moment for the health care field at large, particularly the nursing profession. Projected increases in demand for nurses due to health care reforms, Baby Boomer nurse retirements, and Colorado’s growing older population will cause an increased need for nurses across the state, according to a report from the Colorado Center for Nursing Excellence.
“We, of course, are hiring all the time, but we’ve been kind of lucky. We’ve seen an increase recently in the number of applications we’re getting,” Katzenmeyer said. “But the nursing shortage is affecting more rural areas — like we are — all across the state. Everybody talks about their staffing levels and how it’s difficult to maintain those.”
Although the American Association of Colleges of Nursing reported a 3.7 percent enrollment increase in entry-level baccalaureate nursing programs in 2018, this increase is not sufficient to meet the projected demand for nursing services, including the need for more nurse faculty, researchers, and primary care providers, according to the AACN’s website.
According to a 2018 survey conducted by the National Council of State Boards of Nursing and The Forum of State Nursing Workforce Centers, 50.9 percent of the nation’s registered nurse workforce is age 50 or older, and the Health Resources and Services Administration projects that more than 1 million registered nurses will reach retirement age within the next 10 to 15 years.
These conditions make travel nurses like Kelly invaluable to the future of patient care. Being originally licensed in a state (Texas) that is a part of the Nursing Licensure Compact means she is free to practice in any of the 34 participating states without the burden of having to apply for additional licenses; plus, her prior experience at health care facilities makes for a gentler learning curve.
“I have three days of training, generally, and it’s more than anything teaching me the charting — what they chart, how they chart — and then I’m on my own,” Kelly said.
For this reason, Kelly said, travel roles are best suited to nurses with a few years in the field already under their belt.
“Give me a post-op cardiac patient and I’m going to take care of them just fine. It may not be the exact same way the program is used to, but at the end of the day, I can do that,” she said. “That’s why you absolutely have to have experience before traveling, I think, because you have to come in with the confidence of, ‘I know what I’m doing, I got this.’”