Dan:
Jeri, it's great to have you.

Jeri:
Hi, I'm so excited to be here. Thank you.

Dan:
How has travel nursing impacted your career? I'm super interested, because you've seen a bunch of different hospitals, different sizes, different specialties, different academic versus community. What has that done to your professional practice and your skillset?

Jeri:
I feel so well rounded and I feel that sounds so corny, I know I've heard other travelers say that when I had first started, I'm like, yeah, yeah, yeah, okay, sure, you're well-rounded great. But now that I've been doing this six years and I look back and I'm like, "Oh my gosh, I have done so many things." I did a Peds orthopedic clinic, so I've done clinic side.

Jeri:
I've done a small little tiny peds unit in Hawaii, I've done major children's hospitals like Dallas and LA and San Diego, I mean I've just kind of done it all. Within these assignments I've also floated to a ton of other units. There was actually one assignment where I floated to, I would say about one third of my contract I was in the NICU. So by the time we were done with that I felt like I was basically a NICU nurse. So it's just way cool to have seen so many places and done so many different types of nursing, whereas if I stayed at one hospital, I would have definitely not seen all the things I've done.

Dan:
One of the things that I'm hearing from the nursing and healthcare leadership standpoint is that, there's this misconception that travel nurses are seen as not as good as the maybe full time staff of a hospital, and I wondered if you experienced that misconception, if you've actually felt that from a nurse leader or a leader within the hospitals you rotated at, and also what are your thoughts on that misconception?

Jeri:
I have kind two examples where, when I started with the peds ortho clinic, it was my first clinic job. So I will give them that, throw them that bone. I did not know the clinic side, so I didn't really totally know what I was doing there, but I don't think that they, or I do think that they totally underestimated what quick learners we are as travelers. And so I definitely felt that backlash. I mean, I tell people all the time, the story of, I remember walking into that office, the manager saying, "Hey everybody, this is our new travel nurse. This is Jeri. She'll be with us for a while," and literally no one said hi. Everyone just looked up and kind of looked at me. It was the most uncomfortable I've ever been. I've never been used to that.

Jeri:
Usually it's just a hi, so that was really bizarre. So I kind of knew from that day going on that they were going to be a tough bunch to win over, and that they probably had all these misconceptions about us and I ended up finding out down the road that there were some other backstories. They had never even ever had a travel nurse before. They didn't really know much about them. They thought that I was just this hoity toity nurse coming in, not knowing what she was doing and then it didn't help that I didn't have clinic experience. So when I would ask questions that were reasonable, they thought I was the dumbest person in the world.

Dan:
Do you feel like you have to win over the staff first or the manager first or kind of both at the same time or who's the hardest one to kind of deal with?

Jeri:
Definitely the staff. For the most part, my personal experience has been that the managers have been accepting for the most part. It's the staff, sometimes that would be the toughest I'd say.

Dan:
What do you think drives that?

Jeri:
They probably had bad past experiences. I've heard that from a couple of different places, but they've had certain travelers that weren't good, but my response to that is always, there's a bad Apple in every bunch, I think is the expression. I mean that's such as life. That's every single thing. That's every group of people you ever look at, so of course, with travelers there are going to be some bad in the bunch. For the most part we're not. We're really great. We're a great resource. So I feel like that's kind of the only time that I've actually had, I felt like I had a battle is when they've had bad past experiences.

Dan:
In my clinical experience, I didn't have a lot of opportunity to work with travelers. I was in the ER and we just didn't have a need down there. And so I never really had an opinion on it. And then as I've gotten more into the travel area with Trusted, I really see travelers as special operatives like that special forces type nurse that has so much amazing experience and can come in and just hit the ground running, bring in new insights, bring in new evidence for decision making and clinical care and just has this unique skillset and knowledge and expertise. And I don't know if hospitals totally understand that or know how to leverage that. Has there been any experience in your travel history where the hospital was like, "Oh my gosh, thank you. We need your insights. We need something new. Come in and help us solve some of these problems?"

Jeri:
No. There's been so many places that are so excited. Like this most recent unit I was on was transplant and renal and neuro and I just so happened, that was my first unit I was on as a new grad was transplant, renal and neuro. And that is super bizarre to have all those three specialties paired and for that to be where I came from. So I know this manager most recent was super excited that I was coming in with that knowledge already and having worked with those specialties within the pediatric realm. But as far as them being excited to have us come on and help them solve certain issues? No, I am always shocked. I could go on and on about how shocked I am how many managers actually haven't asked for my opinion for certain things when I'm just sitting there with some info. It always surprises me.

Dan:
Yeah. You see something that they're doing that maybe have been done better at another facility and that you can almost instantly help them improve it. It seems like with all the stress that's on nurse managers, that would be a welcome thing. But it sounds like not yet.

Jeri:
No. And I've just finished up my eighth children's hospital and I've never had any place actually ask me. I've never had a formal exit interview. I've never had really anything. I mean, there's some times where I'll just kind of give my opinion respectfully or kind of insert what I think in there. But it's never really the formal, "you've seen this, what are we doing here?" This most recent place they had an issue in an email going around. They were having an issue with participation in unit committees and I just came from CH LA where everyone was in almost, it felt like everyone was in a committee and they had huge participation and I could totally see the differences and I just feel like, I just remember sitting there reading these emails being like, man, if they would just maybe ask me, I could tell them here's what this hospital is doing. But no, no one ever really asks.

Dan:
Wow.

Jeri:
It's crazy. I know. It's so crazy.

Dan:
So that's a point for the nurse leaders and actually all the healthcare leaders listening. You have these special operatives in your hospital with amazing knowledge across multiple facilities, multiple policies, multiple practices and they're sitting there wanting to help and they see things that you may not see while you're embedded in the system. So leverage those travelers for more than just helping fill holes in the shift. So those are some great insights. You've been to obviously a lot of different places and had good and bad experiences. Let's turn our focus towards the nurse leadership at hospitals. What advice would you give nurse leaders to help incorporate travelers better into the fabric of the units?

Jeri:
First, I would definitely go back to what we talked about a little bit ago in the fact that I think every traveler should get an exit interview. And I know it's so difficult for those, some facilities hire 50 travelers plus for a winter season, especially pediatrics when all the kids are sick in the winter. So I know that can be super stressful and not super realistic to be able to actually sit down and interview every traveler. But I think that at least you could maybe send out some kind of survey, just anything to be like, hey, here's what issues we have. What do you think we could do better? What do you think our strong points are? Just anything like that, something as simple as that, would be wonderful. And that can take two seconds to type up on a document and have us fill it out when we leave.

Dan:
Yeah. Some of the managed service providers that we work with are requiring nurses to have manager level recommendations. Do you think the manager is the right level to give a recommendation or an evaluation of a travel nurse or would a charge nurse or some other level be a better data point for that?

Jeri:
I think a charge and even, I definitely don't think manager because I can't really tell you one manager of all my eight assignment or eight hospitals that I think knows how I work day to day as a nurse. I think they know that I followed rules and I was compliant, but that's about it.

Dan:
Yeah. You showed up basically, right?

Jeri:
Yeah, so I remember always being frustrated by that. The nurse in Hawaii, just because I was on night shift and I only was in Hawaii for three and a half months I didn't even meet her. She didn't even know what I looked like.

Dan:
Yeah, yeah, right.

Jeri:
And I don't even know what she looks like, so I'm like, gosh, she has to fill out my survey? She has no idea. So charge nurses definitely, but also, I feel like there should be more emphasis put on the peer-to-peer, nurse-to-nurse for sure.

Dan:
Yeah. I think that's really where you can get some good insights into the practice, which is really what I think hospitals are looking for, the skills and the practice and that fit for the units that you're working on.

Jeri:
Yeah, because there's a lot that another nurse will be able to tell you with how they fit in with a unit because that's important, too. I mean, not just skill set, but how cohesive you're going to be with the unit or if you're just going to cause trouble. I've seen that before, too.

Dan:
Yeah. So how do you fit into the unit? How do you make that transition every couple months to meet a whole new group of people, figure out a whole new set of policies and technology and charting and medication room location and patient population. That's some awesome adaptability and I wonder if you have any tips on how you do that.

Jeri:
Well, I tell people it's like learning to cook in someone else's kitchen. Everything's basically the same, you just have to figure out where everything is.

Dan:
Yeah, that's a good analogy.

Jeri:
I tell people that all the time. It's pretty much the same thing. I mean, all the basics of nursing care and communication and good communication is the same everywhere. I mean from East coast to West coast, in the middle, people appreciate and don't appreciate mostly the same things as far as communication and what you do and what you don't do. That's pretty much all the same. You just have to learn where stuff is and that comes pretty quick. It's just like riding a bike. You get back on and you can do it.

Dan:
One of the other things I'm hearing is a lot of prolonged orientation for travelers. Do you have a special sauce for what orientation should look like for a travel nurse?

Jeri:
I feel like I've either had just right or too short. Actually. I would just say one hospital was too sure. It was just two shifts. That's it. And that was too short only because this particular hospital used a charting system that was unique to their hospital, meaning no other hospital has this exact system. So, and they didn't offer a computer training day. So I feel two shifts with no computer day just was like, okay, just figure it out. It was a free for all.

Dan:
Yeah, throw stuff at a wall and see where to chart it, right?

Jeri:
And just, yeah, I mean truly I felt like the first couple of days I'm like, well I'm going to be here until nine figuring out what in the world I'm charting and where I'm charting it.

Dan:
Or it all ends up in a nursing note.

Jeri:
Yeah. And there was some days I wanted to just throw in and say, yep, sorry if you want to read how this kid's doing, here's the note. But no, so we had to figure it out. But this hospital also used really strange pumps that I'd never seen. I called them dinosaur pumps. So I feel like that was even kind of weird to get used to. So I feel like if you have a hospital and you ask your travelers, "Is any of this familiar to you?" If they would have asked, they would have known that none of us felt comfortable. And I feel like it being my last assignment, I've been doing this for so long, if I feel like two shifts are too short, most likely other people are going to feel like that way too.

Dan:
Right.

Jeri:
So I personally think the sweet spot is three shifts with a computer day worked in there, too.

Dan:
Okay, so another great tip, right? At least three shifts and time to figure out that charting system.

Jeri:
Yeah. And if people want to opt out, Epic's pretty common and Epic I've seen more than anything else. So if you can opt out of that, then I guess you don't need the computer day, but it should at least be offered because you don't know what people have come from.

Dan:
Got it. So let's shift gears a little bit here. One of the other things that I'm super interested in is how nurses are doing things other than direct patient care. And I've heard that you are an entrepreneur, that you are what you called a private baby nurse, which I'm super interested about. Can you tell me about that whole side project that you've got going on?

Jeri:
My friend, another wonderful travel nurse that I got to know, we started working together. Her name is Kayla. We started working together actually in Indy when we both started, we were brand new nurses, so this was a long time ago we've known each other now. And we started traveling around the same time, we've gone mostly similar places, but some places different. Both had very similar experiences though across the country and met a ton of nurses. She actually got into this private baby nursing world and actually one particular time I was her relief nurse. She had a week where she took a break with this family and I came in and her and I just started talking and brainstorming like, what's going right, what's going wrong? And we're like, Oh my gosh, this is just like a brand new thing.

Jeri:
There's really not a lot out there. We kind of feel like we're going at this alone and testing the waters alone. Why can't we just help other people going through this? There's no system, there's no regulation through it. We totally have something really great here and we can help more families find better nurses and we can help more nurses find relief from the bedside to break up their bedside burnout possibly, which is what I was going for was just to breakup my burnout a little bit and do something different. So I feel like it's really helping out families and nurses both at the same time. And so the idea just kind of took off and we officially started earlier this year, actually in February of 2019.

Dan:
That's awesome. And we can check you out at www.yourbabywhisperer.com, correct?

Jeri:
Yes, yourbabywhisperers.com

Dan:
Oh, whisperers, got it, with "s".

Jeri:
Yes.

Dan:
So you brought up something there, too, which I think is interesting. So one of the flexible workforce trends that you took up was starting your own company, doing something a little bit different away from the bedside. I'm curious to see in your cohort of fellow travelers and actually the staff nurses and things that you interact with, do you see a trend to more flexible work? Do you see people picking up more interest in travel nursing or starting a company or doing these quote, unquote side gigs instead of trying to pick up multiple overtime shifts at the bedside, which was the trend when I was going through my clinical experiences?

Jeri:
I definitely see a trend and the trend itself is burnout and we see an increase in other avenues because of the burnout. So something I thought was interesting was I just recently, this past year, went to the TravCon, travel nurse conference, and one of the breakout sessions was jobs, I forget the actual official title of it. The theme of the breakout session was basically jobs other than bedside nursing and they had to bring in more chairs and people were standing because there were so many people that wanted to attend that one. I'm like, wow, if that doesn't show you that people are interested in the flexibility and doing something else and other avenues, I'm not sure what does. So yeah, I definitely see an increasing trend and I think it's all just because we want to see what else is out there and we're kind of burned out from the bedside.

Dan:
So we'll kind of start to wrap up here. So I'm curious to get your thoughts on a few questions here. So the first one, if you had to give a healthcare leader one piece of advice about how to view travel nurses differently, what would you say to them?

Jeri:
I would look at them as what can they bring to the table besides just being a body to fill a spot. I know that very few managers have asked me in advance what my past specialties are and I think that they could really, making note of that and letting charge nurses know that would be super helpful.

Dan:
So, to take us out here, Jeri, where can we find you? I hear you're on Instagram, you have websites. Can you tell us a little bit about where we can get ahold of you if we want to connect with Baby Whisperers and you answering travel questions potentially?

Jeri:
If you want to know more about the private baby nursing and the company, it's www.yourbabywhisperers.com. But if you want to talk to me specifically about travel nursing, I'm on Instagram. It's JerryLynn, J-E-R-I-L-Y-N-N underscore eight nine and you can just send me a message and I'd love to talk to you.

Dan:
Awesome, Jeri. We really appreciate having you on the podcast today. Your insights are great. I think we covered things that nurse leaders and healthcare leaders can do to better integrate travelers into their workforce. We talked about good and bad experiences so people can learn from that. We talked about how nurses can do so many amazing things outside of bedside care and super excited to see Baby Whisperers grow and continue to interact with you on Instagram. So Jeri, really appreciate your time and thanks so much.

Jeri:
Yes, thank you so much.

Dan:
And a special surprise with this episode. We're also bringing you a second interview with a travel nurse, Alex Herlocker. Alex is an ICU nurse who's been traveling for the last five years. He started his career in a neuro immediate care unit at the Medical University of South Carolina in Charleston. He's been traveling the country in an Airstream with his family for the past five years, including his wife, three children and two dogs. Alex lives completely off the grid and in the past nine months alone, his family has traveled to Colorado, Utah, Arizona, Nevada, California, and Baja, Mexico. Please welcome Alex to the show. Alex, its great to have you.

Alex:
Hey, thanks for having me, Dan.

Dan:
So Alex, would love to get to know more about you and your background. Can you tell us what specialty did you end up going into?

Alex:
Well, I first started in neuro step down and that was at Medical University of South Carolina. Then I went to the intensive care unit for neuro and we dealt with a lot of traumas, a lot of spinal surgeries, stroke, so mainly head up, but also the spine. I was very passionate about this area as I was a new grad, did some training in school on one of their sister units and really just rose up through the neuroscience department. So I've really got an affinity for neuro and neuro trauma. But through travel nursing, I've had the experience to work on many different types of intensive care units and also emergency departments.

Dan:
So what brought you into travel nursing? How'd you make that leap?

Alex:
I had a desired to travel, for one, but also a desire to work in different states for nursing. I've always heard that out West was a lot different than working as a nurse in Southeast. I first did an assignment from Charleston, my first one was in Washington state and I noticed a big difference in how their hospital's staffed and what a normal day looked like. Break nurses and scheduled breaks that, you're not shooting for the on time break, but just a little bit of a mental and physical break from the job, get back on the unit feeling fresh. That made a big difference for me and I really just felt like that was the coast I probably wanted to work on.

Alex:
So got the experience in the intensive care unit and have been able to travel throughout many of the places I've wanted to visit in America. And by doing that, I've also been able to travel outside of the country as well. So, ultimately I love traveling with my family, but I also, I'm responsible for them and need to find a good work life balance. And I think this has been doing it for us for a good while now.

Dan:
So you talked about seeing different best practices across the country. What are some of those best practices that you've seen specifically around onboarding and bringing in and utilizing your expertise as a traveler?

Alex:
With the contract I'm in right now, I'm at Mercy Medical Center. It's a Dignity owned facility. I think they've had an excellent orientation and would like to use them as an example of one of the orientations that really spoke out to me. On their training side, they were extremely thorough with regards to all the full time and travel staff. Often travelers are, we're expected to take care of patients, but that's not the hardest part of our job. The hardest part of our job is learning people's names, learning where the intensive care unit is, where can I get help. I think that all of those resources were ready from day one. Everyone got a binder with their unit specific orientation details. There was really nothing that wasn't streamlined, it seemed.

Dan:
Yeah, that's a good example. So a great onboarding, but not only just onboarding, access to the information at your fingertips so you're not having to run around and ask a bunch of questions and then support on the different documentation pieces, which I'm sure can get daunting. Even though an Epic facility you worked at before and now you're at another Epic facility, potentially the flow sheets and things are different, so support there sounds great. Would you consider yourself someone that speaks up freely or someone that kind of waits to be asked questions? I'm just curious.

Alex:
As far as the patient care, I question first. I'd much rather know the right way to do it. In patient care and the tasking of the day, as far as what documentation do they expect that is outside of the national requirement. I definitely like to raise the main concerns that need to be addressed. Of course, I have to, it's my job responsibility to bring those concerns forward and ultimately it's going to be the management at that facility that is going to be responsible for carrying that out. But it's up to me to bring those concerns if I have them.

Dan:
Just a couple more questions as we finish up here. So I understand that you and your family travel quite a bit and document it on Instagram. Can you tell me about that part of your life and what got you into the Instagram documentation of that?

Alex:
I guess it started, we are self-dubbed the Wee Little Nomads, so it's W-E-E Little Nomads and we started a blog, it's littlenomads.net, back probably five years ago when I took my first assignment. It was a big change for us. We knew that we wanted to travel nurse, but had never done it. We had been living in Charleston for probably 17 years at that time, me and my wife both. We both had graduated from MUSC nursing program together. She was then enrolled in their nurse practitioner program and has since graduated, but we together wanted to figure out travel nursing. We had heard awesome things about it. There was a smaller network of kind of the social media nursing crowd and traveling crowd. So as it first started growing, people had blogs and that's kind of how we started.

Alex:
We bought a teardrop trailer for my first assignment and I drove it from, I guess West Virginia where I bought it to Washington state. My two girls were five and eight months at the time and we had our German Shepherd. I drove the dog out and my wife met me in Portland, Oregon with the kids and we started our first travel adventure. So we wanted a place to document that for family with pictures and words on the things we were learning and the places we were seeing and the experiences that we were having that we never would have had.

Dan:
So last question. As you think back on your seven years as a nurse, what advice would you give nursing leaders about how to better work with travel nurses? If you could summarize it into one or two best practices that you've seen or things that you would desire, what are those two pieces of advice that nurse managers and nurse leaders should think about?

Alex:
There's a lot of information that each unit has that's different from the next, but I think there is a standard. I felt that the contracts that were easier for me, they typically had a better orientation binder. As silly as that sounds, sometimes that's my lifeline. The drips that I use, the ways we treat patients are typically the same, but the dosing for your unit can be different than one. Different units do different spontaneous breathing trials. All of those nuances that your unit finds important. Putting that in an informational binder on the documentation side, I think Mercy did a really great job in readying at this contract. What do I need to chart on every 12 hours? What do I need to chart on every eight hours? What about four and two and one? And then from there, creating an easy sheet that really highlights what the most important aspects of your charting are.

Alex:
I think that would be great for a new nurse as well. And just taking away some of that constant, oh, am I forgetting something or where do I document this? Did I do it the right way that their backend system is actually going to capture it? Because in today's day and age now you can't free hand note everything. They're not going to consider that an acceptable form of charting. Maybe per national standards but not per facility standards because of the softwares they use to collect data on the backend. So those units, they really are pushing for the data to correct and I agree that it needs to be concise and we need to try to click the box if there's a value for that because it does go somewhere besides just their chart.

Alex:
These are quality improvement measures. So it's a hard balance and we're constantly trying to figure it out together. But I think having that information for me on the front end, in a good organized binder, something I can hold on to and keep in my backpack the entire contract that's useful, not just policy after policy after policy. Highlight where I can find those online, but more what are the day to day types of drip and policy on that or your documentation. So I think that would make it easier for us to just come in strong and be able to do what you guys want us to do as soon as we get there.

Dan:
Sure. So it's access to information, being really good about getting the travel nurses access to all the things that they need to do in a concise way. So that's a great piece of advice. Well, Alex, it was great to chat with you today and thanks so much for sharing your journey. We are excited to learn from you and share these insights with nurse leaders and again, check Alex out at Wee Little Nomads on Instagram and his website, so appreciate it, Alex.

Alex:
Yeah, of course, Dan.

Dan:
Thank you so much for tuning in to The Handoff. If you like what you heard today, please consider writing us a review on iTunes or wherever you listen to podcasts. This is Dr. Nurse Dan. See you next time.