Treat 'Travelers' Like Family

John Commins, for HealthLeaders Media, October 1, 2008

CEOs and other leaders at America's rural and community hospitals frequently complain to us that they have a hard time getting so-called rent-a-nurses or "travelers" to buy into their hospital's mission and methodology. And buying in to a hospital mission is particularly important with today's increased emphasis on teamwork and communication, standardized treatment plans using evidence-based medicine, quality outcomes, and the proper documentation of every move.

It's not that travelers are incompetent, reckless, or indifferent. But in many hospitals, they are seen as "outsiders" and "others," migrant workers who come in for a 13-week tour of duty and move on. And, let's be honest, there may be a little bit of generational tension out there. There is a perception among some hospitals leaders that travelers—particularly the younger nurses—aren't as committed to the mission of the hospital and are much more concerned with issues like pay and scheduling. That may be why they gravitate towards traveling in the first place.

Until recently, travelers were given the "outsider" status at Glendive Medical Center, a health system on the high plains of Eastern Montana that includes a 25-bed, acute-care hospital with 24/7 emergency care, a 75-bed, extended-care facility, an after-hours clinic, an assisted living facility, and a veterans' home. Like hospitals everywhere—and especially rural hospitals—GMC has had a hard time recruiting and retaining healthcare workers, particularly nurses. So they rely heavily on nurse travelers and other temporary, contract workers.

Scott A. Duke, CEO at GMC, says his hospital had an "A Ha!" moment about a year ago when, in the midst of what he called a planned "cultural transformation," they realized that travelers were a big part of the health system's operations but weren't part of the call for staff inclusion and connectivity. In Duke's view, nobody had really thought about enhancing that relationship before. "I've been to hospitals where the attitude is 'These people are travelers. They're not on our staff. We're not going to treat them bad, but we aren't going to treat them like our staff,'" he says.

Armed with this newfound realization, GMC made an effort to improve its relationships with travelers. It didn't involve any grand strategies or formal declarations. GMC had always provided orientation for travelers, but the emphasis and the approach now stresses inclusion. There was a systemic attitudinal change that made sure the travelers knew they were part of the system, that their role in the success of the health system was critical, and that their input and feedback was sought and valued. "We make them part of the family," Duke says.

A few travelers appreciated the inclusiveness so much that they joined the staff permanently, Duke says. Most, however, prefer to remain orphans. "They don't want to be a part of the organization or get to know staff in the same manner. It's part of who they are and how they want to work in their professional life. That's OK. As long as they are doing their job and providing professional high-quality care, they are filling a very necessary void."

At the end of their 13-week contract at GMC, Duke says, many travelers have expressed gratitude. "Several have said this is the best place they've ever worked at," he says. "They still want to be travelers but they want to be travelers at our hospitals." Duke says he can't say if the emphasis on inclusiveness is cost-effective. Traveling nurses are expensive and it's always preferable to have permanent staff. But if they feel good about the way they're treated, maybe more of them will join the staff. Or if they return for another contract, there are training and orientation costs that can be avoided.

Duke admits GMC doesn't have the data to suggest that their inclusive approach will save money. "We just feel this is more of a feel good approach, that if we are going to use travelers, this is the way to go," he says.

John Commins is the human resources and community and rural hospitals editor with HealthLeaders Media. He can be reached at
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