A Day in the Life of a Travel Nurse
By Christina Orlovsky, Contributor
One of the perks of travel nursing is the ability it affords a health care professional to combine a fulfilling career with a worldly curiosity to visit new places and try new things. As a travel nurse, you get to enjoy the excitement of exploring a new location and the valuable opportunity to immerse yourself in the culture of a new hospital. You are not simply a visitor, but a crucial component of the hospital’s nursing staff.
For one nurse on assignment at Scripps Green Hospital, in San Diego, California, relocation has enriched his career and opened his eyes to the unique culture of the West Coast, where the sun shines through the hospital windows, the ocean beckons just beyond its doors and the permanent staff makes him feel right at home even far away from home. While no day for any nurse can be classified as “typical,” for this travel nurse, one 12-hour shift in January brings about the same main concern as any other: taking care of his patients.
On this particular day in the 24-bed intensive care unit, Thomas Couturier, RN, BSN, CCRN, an ICU nurse on assignment with travel nurse staffing agency American Mobile Healthcare, is caring for two patients, in accordance with California ratio laws. The Boston, Massachusetts-area native remarks that in his experience as a floor nurse on the East Coast, he had been charged with as many as nine patients at a time, a situation he calls “difficult, but manageable.”
Ratio laws are just one of many differences between the regions that Couturier has noticed since he decided to try travel nursing on a whim in 2003, at the urging of a college friend who wanted to move out west. .
“I thought it was the safest and easiest way to experience a new place. Plus, it had an end date, just in case I didn’t like it,” he recalls. “I had never been to California before, and they made it so easy—they took care of everything.”
After one assignment in Los Angeles, Couturier relocated to San Diego. His coworkers, who praise his nursing skills and express gratitude for his presence on the busy unit, are partly to credit for his comfort level in the hospital.
What is it like to be a Travel Nurse
“Sometimes I have to remind myself that I’m a travel nurse,” Couturier says, humbly, adding that he feels so much a part of the team that it’s just as if he’s a member of the permanent staff. “My experience has been so great that I forget that I’m traveling.”
A full-fledged member of the unit, Couturier spends the afternoon checking in on his patients, one of whom is battling a brain infection and requires constant monitoring of support machines, and another who is alert and surrounded by family after undergoing heart surgery. Couturier, who spent three-and-a-half years as a permanent ICU nurse and one year as a nurse manager in New England before commencing his travel career, takes a moment to reflect on his specialty as one that lives up to his lifelong expectations of what a nurse’s role ideally should be.
“It’s the place where nurses have the most autonomy—I have a stronger sense of feeling like I am a part of their care,” he says.
With no nursing assistants in the intensive care unit, Couturier is the primary bedside caregiver, doing everything from bathing and turning patients to checking vital signs, administering medications and educating patients and their families. It’s this universal care-giving role that he finds most gratifying.
“One of the reasons I like intensive care so much is that I get to provide the type of care I learned in nursing school,” he says. “I like to do everything for the patient, as opposed to having to delegate. I think it’s the best job in the world.”
After checking on the comfort level and vital signs of his unconscious patient and speaking with the patient’s visiting wife about his condition, Couturier moves on to the room of the heart surgery patient, who was removed from a breathing tube earlier that morning and now needs to perform breathing exercises. With the Spanish-speaking patient’s adult children translating, Couturier explains to the patient the proper way to breathe into a monitoring tube. He notices that the patient may be in some pain, but his suggestion that the patient may need some pain medication is met with hesitation from the patient and his family. It is a situation that calls for more nurse-to-patient education, but for Couturier, it’s also a welcome chance to make the family feel comfortable about the patient’s care.
“I find it helpful for visitors to be in the room with the patient,” he explains. “I ask them to help with things they can help with, and it tends to make them feel more comfortable about how their loved one is being cared for and how I’m doing my job.”
His job right now is to explain to the patient—who is worried about the addiction risks of pain medication—about the dosage and its effects, and about how he needs to reduce the pain in order to get out of bed, move around and work toward healing. For instruction like this, Couturier is comfortable with the translation of the patient’s family. More complicated education, however, he explains, would require him to call in a professional medical translator.
Satisfied with the patient’s decision, Couturier uses the unit’s electronic medication dispensing system to retrieve medication for his patient. He demonstrates some of the many ways nurses work to prevent medication errors by checking and double checking the patient’s name and order on paper and in the computer.
“Medication is one thing we can control as far as negative implications of being in the hospital,” he says. “I do my best to check the five rights of medication safety: the right medication, the right dose, the right time, the right route and the right patient.”
With the medication properly administered, Couturier prepares for the remainder of his shift and his routine of closely monitoring each patient for signs of progress or setbacks. It’s this intensive monitoring that gives his unit its name and gives Couturier the greatest personal gains.
“It is so rewarding to have the ability to work with someone in some of the most difficult and amazing situations,” he says. “You see life and death, but you also see miracles.”
Just up the stairs from the Scripps Green ICU, Tara Mildenberger, RN, also reaps the rewards of her job as a travel nurse in the telemetry unit. For Mildenberger, however, the rewards don’t necessarily come from life and death situations, but rather from the day-to-day interactions with people of all walks of life.
“What I find most rewarding about nursing is making a connection with patients—getting to know them and their families and hearing the different stories they have to tell about their lives,” she says. “Time constraints do make this difficult, but I really like hearing about their kids and their grandkids and their stints in the military. It’s my favorite part of my job.”
Today’s job for Mildenberger, a Canadian nurse on assignment with an AMN Healthcare travel nurse staffing agency, entails caring for four patients, as required by California law. All patients in the telemetry unit are there because their condition requires their heart to be monitored. While Mildenberger and the other nurses on the unit check the monitors in the rooms frequently, and bells alert the unit of any abnormal changes, a 24-hour telemetry monitor technician keeps watch over the machines of all the patients in a small room. He is often the first to notify cardiologists if anything goes wrong with a patient’s heart.
“It is so much better with the telemetry technician because there’s someone here all the time,” Mildenberger explains, adding that the extra set of eyes is always helpful on a busy nursing unit.
The extra set of eyes allows Mildenberger to concentrate on her hands, which are constantly busy preparing and administering medications, such as the antibiotics she is gathering for a heart disease patient with an infection in his leg. At each visit, the patient is alert and talkative, although he is particular about being in bed when he receives his medication. Mildenberger’s knowledge of this patient’s preference is just one of the benefits of continuity of care, which Mildenberger often gets to experience when working consecutive days.
“It’s so much more convenient if the nurse comes back the next day,” she says, as she makes her way down the hall to the door of a second patient’s room, on which there’s a sign that reads NPO, indicating that he should receive “nothing by mouth.”
Mildenberger explains that the sign was left there by the night-shift nurse to remind her replacement that the patient’s condition does not allow him to eat or drink. The patient, who is experiencing gastrointestinal problems, is currently undergoing a camera endoscopy—he swallowed a pill that will take images of his digestive tract to be viewed by his physician. Alert, the patient is visually relieved when Mildenberger tells him he’s finally allowed to drink some water. Food will come later in the day.
Mildenberger’s third patient is a young man who has just undergone a colonoscopy. He is drowsy from drugs and so grateful for his nurse’s offer of apple juice and water that he accepts both. He, too, will have to avoid solid food for the day. Mildenberger casually jokes with the patient and reassures him about the normalcy of how he’s feeling and how long he should expect it to last.
Heading to check on her fourth patient, an elderly V.I.P. patient with her own personal caregiver and a room overlooking the ocean, Mildenberger passes a therapy dog, brought to the hospital by a volunteer from the San Diego Humane Society. A group of nurses and a nurse practitioner have gathered around Lego, the colorful, friendly terrier.
“Usually the nurses get more out of the pet visits than the patients do,” Mildenberger laughs as she pets Lego, who is clearly a stress reliever for the harried nursing staff. It has gotten to be close to lunch time, so things have gotten busier on the unit.
“There are three really busy times of the day,” Mildenberger explains. “Early mornings are busiest, because we’re taking over the shift from the night nurse, learning everything we can about our patients and doing paperwork. Then around 11 a.m. it gets busy because it’s getting close to lunch. It slows in the afternoon, until the end of the shift, when admissions typically occur.”
Mildenberger is used to the upswings and downturns of her 12-hour day—so used to them, in fact, that she can’t imagine working any other type of shift. It’s one of the things she likes about travel nursing, which she began doing years ago with her travel buddy, Crystal.
“I met travelers at my job who talked about the money and perks of traveling,” she recalls. “I get bored fast and had nothing tying me down. Plus, everyone had good things to say, so I decided to try it.”
As for where her career is going to take her, Mildenberger doesn’t know for sure. She would like to work in a cath lab, she says, but she’s not sure what else lies in her professional path. All she knows is that she’ll always be a nurse.
“It may get overwhelming at times, especially when you’re caught in the middle of everything in the hospital, but this is all I’ve ever known,” she says. “There’s nothing else I would want to do.”
It’s all a day in the life of a nurse—a travel nurse.
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