How has the recent economy affected the cardiac travel nursing industry? Travel nurse Epstein LaRue, RN, BS, gives us an update. It seems you can’t walk down the street these days without hearing about how bad the economy is right now. Everyone had big hopes for the United States’ economy once a new president was elected, but what differences have we seen so far in healthcare, cardiac nursing and travel nursing? The number one force that drives healthcare is the availability of nurses. Yes, although the demand for traveling nurses has gone down in the past few months, there is still an overall shortage of nurses. Nurses are still retiring faster than we can train, and nurses are still getting burnt out. On top of all of this, hospitals are feeling a bigger crunch related to not as many elective surgeries being done, since people are being more selective about their healthcare. There have also been insurance problems, since people either cannot afford their own healthcare insurance anymore or they no longer have insurance from being laid off from their jobs. How have all these changes affected the traveling industry? First, hospitals are being forced to cut down on their travel and per diem staff. They just simply cannot afford the extra expenses that come along with travel and housing. The hospitals that are using travel staff are still paying the same bill rate as they always have, but it is taking more money to send the nurse to those other destinations because of higher fuel costs, although that has not been as much of a factor since gas prices have fallen under $4.00. In addition, housing is getting more and more expensive related to the fact that apartment complexes are not taking three-month leases as often now. There are pretty slim pickings out there in some cities for quality housing for travel nurses. When housing is found, there is often an additional $100 to $200 fee for costs related to having the short-term lease. Hospitals are cutting down on travel nurses; therefore, with the decrease in jobs, once a position is posted, the unit manager or human resource person is swamped with travel nursing resumes. In some instances, jobs are closed within thirty minutes of opening because the manager has at least a hundred profiles on her desk. Nurses with one or two years of experience are probably not going to be picked over a nurse with ten or twenty years of experience, so this is quickly becoming a difficult option for those younger nurses who have a strong desire to travel at a younger age. At this time we are seeing more traveling nurses taking longer assignments. They start out with a three-month contract, and if things are even tolerable, they are extending to six or nine months. Some nurses are traveling to the more “exotic” places like Hawaii and Alaska with six- or nine-month contracts to start out with. It is very important for a traveling nurse to remember that once he or she stays past a year, then all the tax advantages of being a “traveler” are gone, and they will be considered a full-time employee by the federal government. However, the advantage to staying longer is that at least you have a stable job that you enjoy. Another option is traveling closer to home or doing per diem staffing. Many nurses are not venturing much farther than a hundred miles and prefer to be closer to the husband or significant other’s job. In the “good ole days,” many families could allow the nurse to work while the spouse stayed at home as the “home manager.” Now we are seeing less of this type of travel nursing group. Today the nurse is required to stay close to home so that the spouse can fully function in their career. Some nurses are opting to take staff jobs close to home because they are not able to find a travel nursing job where they want to go for the pay rate that they have been making the last few years. The financial hardships are just too great for them to stay in such an unstable travel nursing market at this time. What’s Ahead? It seems like the biggest question that I get asked now is, “When are things going to change?” That I don’t have a definite answer for, but I can tell you that the new presidential administration does have a plan to make our healthcare system better. I believe the three things that will make the biggest impact on nurses include the plan to: invest in electronic health information technology, improve access to prevention and proven disease management, and ensure quality care through promoting patient safety. Changes in Electronic Health Information Technology The first change is the plan to invest in electronic health information technology. When I started out as a nurse in 1992, the only computer in the facility was the one in the Nursing Director’s office. The computer was used to keep track of staffing schedules and was used more as an office tool for administration — nurses had no direct connection with computers on the floor. In the later 1990s, we started using the AS400 “dos” system of computers to put in our lab, radiology, dietary, and therapy orders. The big jump came for me in 2004 when I took an assignment at a facility in Oklahoma City. Not only did we put in our lab and dietary order, but we also made nurses notes, did assessments, and put in blood sugars. In the last two years, I am starting to see an increased use of computers, including for the use of uploading blood sugar information, scanning medications, maintaining patient organization through a task list, and showing red flags when something is due. All this technology can be very helpful, that is, as long as you can keep it running. With more and more computers, the face of nursing careers is changing in that we now have nursing informatics. Nurses are not only learning how to do patient care, but some are even learning how to keep the computers in good health. In the next four years, when we transfer a patient, will we hand the ambulance crew a CD with not only the patient’s x-rays on there, but their whole medical chart? Once the CD is given to the next hospital, will they have the right system to read all that information and the right program to input it into their computer? As a traveling nurse, the big challenge is going to be to adapt to all these new computer systems and technological advances. Today traveling nurses already have to learn how to use such programs as Meditech, Cerner, PowerChart, StreaMed, EasyNotes, IntelliDoc, QS and Amelior. Some of these systems are not only hospital based, but there are programs and systems designed for a specific unit (ER/OB/ICU) that have to be learned. Improving Access to Prevention and Proven Disease Management The second objective is to improve access to prevention and proven disease management. When I first think of disease management, I generally think of people managing their renal failure, hypertension, heart failure and diabetes. We are seeing more and more cases now where renal problems are a result of years of diabetes that runs out of control. These diseases have a lot to do with having a healthy diet, but with all the information that is out there, it can get confusing! In order to improve the health of Americans, we need to provide the public with quality information from a registered dietician on what exactly is a renal diet, what exactly is a heart healthy diet, and what exactly is a diabetic diet. These pamphlets need to be written in a format that is easy to read, but contains quality information about dietary changes that need to be made. Ensuring Quality Care Through Promoting Patient Safety Next, President Obama plans on ensuring quality care through promoting patient safety, aligning incentives for excellence, utilizing comparative effectiveness research, talking disparities in healthcare, and reforming medical malpractice while preserving patient rights. Now that we are making some headway on mandating staff overtime and nurse-to-patient ratios, some states are trying to say that the ratios are not fair and that we need to adopt an acuity system. However, I believe that the problem with acuity systems is that every place that I have been to that has this system, I see that the nurses generally will bump up the acuity so that they will get one or two more nurses. Yes, there are times when I get to sit down for a few hours with a six-to-one ratio, but I’ve also had nights when I’ve only had four patients and didn’t ever sit down. I’m a firm believer of nurse-to-patient ratios, so as a traveler, you have to ask about ratios! Right now I’m working at a hospital that has a five-to-one ratio, and a friend of mine just went to a hospital with an eight-to-one ratio. There is a big difference in only having five or six patients versus having eight to ten. That is an important reason why nurses want to travel to California — because of their state-mandated nurse to patient ratios. With nationwide ratios, that would not be such a factor. Another concern regarding patient safety is the use of computers and scanners for medications, and the use of medication delivery systems such as Accudose and Pyxis. It may take a while to get used to, but once I was at a hospital that scanned meds and then went back to one that didn’t, I really missed scanning medications and having an electronic backup. There is also the issue of medical malpractice while protecting a patient’s rights. Medical mistakes happen because we are human, and even the best doctors and nurses have made mistakes at some time in their lives. The problem lies when healthcare workers don’t own up to their mistakes and the mistakes are not corrected, or when they continue to make the same mistakes. I think that we would be shocked at how many errors occur that are not reported related to the fear of losing everything in a lawsuit. Until some of the frivolous lawsuits are stopped, I don’t see this changing much. Final Thoughts So, what does all this mean for cardiac nurses? According to the American Heart Association’s Heart and Stroke Update, total procedures (CABG, PTCA, ICD and valve replacements) have increased 30% in the last ten years. While some procedures in other fields (such as a orthopedics with the knee replacements and hip replacements) may be postponed for a while, if a cardiac procedure is postponed, it can have a grave result. To me, this means that the need is much greater in the cardiac fields than for any other field, ranging from telemetry units to CVICU to the cath lab. In several of the hospitals where I have worked, their surgical and medical floors may have been down in census, but the telemetry and ICUs have had more stable patient and staffing levels. Jobs may be on the slow side, but I think within the next year and definitely in the next two years that the economy and healthcare should be on the rebound. You may not be able to find a travel nursing job at this time, but keep your eyes set on the goal of being able to travel the country freely and getting as much experience in a local hospital, while also keeping your eye on several travel companies and the job market. The more research that you do in the meantime, the happier you will be in your adventures! Epstein LaRue, RN, BS is a traveling telemetry/cardiac step-down nurse and the author of a best-selling nursing, trends, and issues series of books. Information on her latest book, “Highway Hypodermics: On The Road Again,” as well as travel nursing information, including hospital and company evaluations, can be found at www.highwayhypodermics.com.