Mobile medical professionals form a select group with a unique opportunity to see how the healthcare system really functions.

Well, if you really want the lowdown on what's happening in American hospitals, then look no further than the nearest nurse. With a workforce of more than 2.5 million strong, registered nurses (RNs) represent the largest single group of medical professionals and practice in virtually every setting, from high-acuity inpatient hospitals to outpatient surgical centers and skilled nursing residences.

Travel nurses have an even better vantage point from which to judge the ins and outs of healthcare. Experience in different locations and various-sized facilities allow travel nurses to gain a more-informed perspective. With that in mind, Healthcare Traveler tapped three travelers to share their observations on what they consider to be some of the influential factors affecting the industry today.

This month, Christina Lightner, RN, CCRN, shares her views. In September and October, Donna Raymer, RN, and Lyndell Howard, RN, respectively offer their perspectives.

Changing demands

Staffing needs can shift over time. There are seasonal swings—like greater demand in snowbird communities for the winter—as well as monthly, weekly, or daily changes caused by a plethora of reasons. It's enough to make a nursing manager's job challenging, to say the least. What's more, the deeply entrenched RN shortage still handicaps recruitment efforts and continues to be a reason why facilities tap into the talent pools of supplemental staffing firms. For immediate, albeit short-lived positions, per diem or registry nurses may be enlisted. Travelers, on the other hand, are contracted for weeks at a time to resolve ongoing personnel issues.

"We are used so the permanent staff can take vacations or to step in when nurses are out on family leave, for example," comments Christina Lightner, RN, CCRN. "The staff are usually appreciative of the help we offer because we represent a sense of stability over a period of time."

Searching for a community

Lightner just finished a yearlong assignment at Seattle Children's Hospital in the Evergreen State. "I was there 10 years ago and I loved it, so I wanted to come back to see what the area is like now," she says. This was her fourth assignment since becoming a traveler two years ago—the pediatric ICU and pediatric cardiac ICU nurse also fulfilled contracts in Maryland, Virginia, and North Carolina, all established by Clinical One, a healthcare travel company in Wakefield, Massachusetts. But she wasn't a novice to the mobile lifestyle. Rather, this is her second time on the road.

"I traveled the first time for about three and a half years before taking a break so I could be home for a while," Lightner says. "Previously, I did it because it was fun and I wanted to see the country. This time, I am looking for a new home and thought traveling is the best way to test out certain communities and hospitals where I might want to settle."

Having spent 12 months at one facility, Lightner was able to witness how the administration addressed its ongoing staffing needs, especially as the economy turned upside down. She recalls several other mobile clinicians who came and went throughout the span of her contract. She also noticed how managers' and travelers' attitudes adjusted to the economic upset. "Because of the limited availability of temporary jobs, I have heard of more travelers taking permanent positions for the financial stability. Also, I understand that hospitals are being more stringent in their qualifications," she comments. "It used to be nurses only had to prove two years of staff experience, but now managers prefer travelers to have four or more years' experience."

Adjusting to the economy

Although it did not appear that Children's cut back on its use of supplemental staff, substantial changes in patient census did generate some creative scheduling. "The patient population really went up and down over the last few months of my contract," Lightner says. "There were some weeks that were so busy I was called in for overtime shifts. Other times, some of us, including the core staff, were sent home because the need just was not there. It was very unpredictable." As a traveler, though, Lightner was guaranteed a certain number of paid hours, and between the extra shifts and being called off occasionally, the requirements of her contract were met.

Despite any personnel manipulations that took place, the nurse-to-patient ratio remained constant. "Most ICUs are staffed at two nurses to one patient, depending on the acuity level. I was never stretched too far on this assignment, and I appreciate that. When things did get crazy, the nurse managers stepped in to help, such as the admittance nurse, resource nurse, and charge nurse," Lightner explains.

Journeying on

As much as she enjoyed the year in Seattle, Lightner is not ready to decide if that is the place for her. She still has a few other locales on her list to check out before really settling down. Of course, how well a hospital controls its staffing situation will be an important factor in her decision. "The great thing about traveling is that you do not have to feel like you are tied to one place if it is not a good fit for you," she concludes.