Your First Day: A travel Nurses Guide

 

On my first day of my travel assignment I was dressed and ready to go so I ended up having plenty of time to sit and enjoy a coffee at Starbucks close to my hospital. It got me thinking about things I needed to learn how to do and numbers I needed. Walking into my unit’s break room for the first time was extremely intimidating.  There was only 3 people in there because I was extremely early. Our start time in NYC is 7AM, but I am used to being ready for report at 6:45AM so I was in the break room at 6:40. Sipping the last bit of my coffee, took a deep breath and went for it. “HI! I’m Sage I am one of the new travelers for the unit!”   

And so, my adventure began, but reflecting back I have realized there are somethings I wish I would have known and task I would have accomplished in those first few orientations days on the unit. We all know the generic tips:

  • Get some good sleep before your shift
  • Make you lunch the day before. 
  • Have you bag packed and uniform ready so all you have to do is grab and go. 
  • Make sure you have you recruiters direct contact information in case you run into any issues. 
  • Are you taking public transportation? Have you been to the facility / unit yet? I always find it beneficial to make a dry run a few days in advance so I know when I need to wake up.
    • On my first dry run I didn’t have my badge, so I have to get a visitor’s tag to tour the hospital. Without my dry run, on my first day I would have embarrassingly been digging thought my backpack looking for my badge at the security desk.  
  • Bring important documents
    • Nursing license for a particular state 
    • Certifications: ACLS/BLS/CCRN/PALS/TNCC, whatever certifications apply for your specialty 
    • I make sure I always have a digital copy of my contract, in case there are any issues.  
  • Introduce yourself when you arrive and make an effort to converse with the staff
    • I find the assignment goes much easier when you build a rapport with the staff, and my favorite assignments tend to be the ones where I bonded with my coworkers and we explored the city together!  

  • The unit probably sees tons of travel nurse, so staff might not even make the effort to talk to you, that’s why I say that its best to initiate conversations at first
    • Of course, don’t force if the particular party seems uninterested 
  • Learn the names of the CAN, techs and secretary’s
    • They really can make or break your day, it’s always best when they are on your side.  
    • If you particularly feel that someone has been helpful to you, make sure you let them know that you appreciate all of their help. Genuine compliments go always way with any one!  
  • I always make a point to make sure the unit manager knows who I am, and to say good morning when I pass them in the hallways.
    • Rapport not only helps with extensions but makes them more likely to treat you like their permanent staff when then have gotten to know you. This is beneficial when you have schedule request, or when a rotten apple on the unit says something about you. Your manger will know more about you than what so and so said about you.  

 **If you “aren’t here to make friends” then continue to do you! I just prefer the “You catch more flies with honey” method. Also, I get lonely on assignment, and enjoy spending time with people. The locals always know where the best food and drink happy hours are!

But what about beyond the basics of the “be prepared” motto? I’m sure every travel nurse out there has the same question so I decided to make a list.  

I bring a note book so I can write down information to important questions? 

  • Do I need an order to use my central line/ NG/OG  /Arterial line? 
  • Do I assign myself in the computer to my patients? 
  • Required shift documentation  
  • Know how often you need to document 
    • Restraints 
    • RASS 
    • Braden 
    • CAM ICU 
    • Education 
    • Assessment / Reassessment  
    • IV/ A-Line/ CVC 
    • Fall Risk 
    • Care Plan 
    • Ventilator / oxygenation 
    • EKG rhythm  
    • Intake and Output  
    • Hygiene 
    • temperature 
    • Output for Chest tubes, JP, flexiseal  
  • Does information flow from the monitor to the charting system 
  • When do you change dressings? 
    • Central line 
    • IV  
    • Mepilex foam 
  • Are there task that are done on the Day / Night shift 
    • Empty canisters 
    • Weights 
    • QC for Accuchecks 
    • Change feeding bag  
  • Required Admission documentation and paperwork 
  • Know you most important numbers  
    • Medication room 
    • Supply room 
    • Emergency numbers 
    • How to call a code 
    • Tube station  
    • Pharmacy 
    • Chaplain 
    • Blood bank 
    • Central supply 
    • Know how your paging system works  
    • How to use the phone! I feel like this one is most often over looked   
  • Know the policy and procedures 
    • You won’t learn this in one day but look them up when pertinent to specific care 
  • Write down you pod mates for the day 
  • Are your lunches scheduled?  

I did all my training and working at a facility that wasn’t specifically for teaching, so if was a different world for me when I took my first assignment at a teaching facility. I had so many questions and had a hard time figuring out my role. 

  • What is the expectation of the nurse during rounds? 
    • After the resident presents the patient, do I have to stick around while the attending physician does their teaching to the resident.  
    • When do I present my concerns to the team?  
  • Is there a specific time and order that rounds happen, or is it by who is most critical? 
    • Sometimes they don’t round on my patient until 2:30 PM  
  • Are their formal rounds daily or only M-F 
  • Are the residents always on the unit? 
  • Learn the hierarchy of who is who. Attending, fellow, resident, intern.  
    • Usually you communicate mostly with the residents, unless you have a serious concern and feel as though you aren’t being heard.  
  • Your resident team in every changing, so I write down their names daily.  
  • Also figure out what you as a nurse can do vs what the residents have to do for you.  
    • Can nurses put in orders if given verbally or over the telephone? Can nurses pull A-lines, CVC, vascath  
    • Can nurses draw blood cultures 
    • Can nurses do Arterial blood draws 
    • Can nurses stick for ABG’s  

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