scholarly articles on travel nursing

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Travel Nurse Onboarding: Current Trends and Identified Needs

Affiliation.

• 1 Author Affiliations: Clinical Education Specialist (Mss Bethel, Olson, and Uyeda), Clinical Education, Banner Health, Phoenix; Research Director, Nursing (Dr Johnson), Research, Banner Health, Phoenix; and Consulting Statistician (Dr Bay), Biostatistics, A.T. Still University, Mesa, Arizona.
• PMID: 31436742
• DOI: 10.1097/NNA.0000000000000781

Objective: The purpose of this study was to describe current practices for onboarding travel nurses (TRNs) and identify TRNs' specific onboarding needs.

Background: Onboarding must be streamlined and organized for TRNs to provide safe patient care.

Methods: Cross-sectional descriptive survey was used with 306 TRNs throughout United States who were recruited electronically from a closed social media group page.

Results: The TRNs identified critical information, including unit patient ratios, onboarding schedule 7 to 14 days before travel assignment start, and login IDs/accesses on day 1. Travel nurse onboarding and competency assessment checklists should be specific to the unit/facility where they will work.

Conclusion: Findings from this study have the potential to support hospitals in the development of streamlined and tailored TRN onboarding to support regulatory compliance and patient safety as well as realize significant cost savings for TRN onboarding.

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Travel Nurses and Patient Care: Their Impact on Patient Outcomes and How Hospitals Can Help Them Succeed

• Hospitals are using more travel nurses to fill staffing gaps.
• Travel nurses typically cost more financially than staff nurses.
• The use of travel nurses is sometimes associated with worse patient outcomes based on limited research.

Travel nurses help fill gaps in hospital staffing, but there are questions about their impact on patient outcomes. Hospitals have consistently relied on travel nurses for decades to fill temporary nursing shortages — and that number is only growing – so healthcare providers must understand the potential impact on patient care.

A recently published systematic review concluded that the relationship between travel nurses and patient outcomes is unclear. The use of travel nurses may be associated with some adverse events in patient care, but these events may be due to hospital staffing and work environment issues.

The review found limited or no impact on patient falls, the number of medication errors, or patient satisfaction but a consistent correlation with hospital-acquired pressure ulcers, the severity of medication errors, and the incidence of nosocomial infections (healthcare-associated infections).

Discover how hospitals can better accommodate travel nurses to reduce the effect on patient outcomes.

What Is a Travel Nurse?

Travel nurses take on shorter-term assignments at hospitals, often traveling out of town or state to fill staffing gaps. While many of them work to fill the role of a specific staff member absent for vacation, parental leave, illness, or other reasons, employers also use travel nurses to alleviate nursing shortages.

Travel nurses generally earn higher salaries than staff nurses because of the additional stress of travel, being away from home, and lack of benefits. Travel nurses must adapt readily to new situations, procedures, and colleagues. Registered nurses can become travel nurses as independent agents or through a travel nurse agency.

The total hours worked by travel nurses as a percentage of the total hours worked by hospital nurses grew from 4% in January 2019 to 23% in January 2022, according to the American Hospital Association .

How Does Patient Care Differ Between Traditional and Travel Nurses?

According to the review, staffing levels did show a consistent correlation with travel nurses and worse patient outcomes. This finding is unsurprising since hospitals employ travel nurses to address low staffing levels. There is also a strong and consistent evidence-based association between nursing staff levels and patient outcomes, according to a qualitative study.

Staffing levels were the key variable affecting patient outcomes, according to the systematic review. Some patient outcomes did not show a consistent correlation with the use of permanent/traditional nurses rather than travel nurses. The outcomes that did not show an association include:

• Patient falls
• Number of medication errors
• Patient satisfaction

However, some negative outcomes did show a consistent correlation with the use of travel nurses. These include:

• Hospital-acquired pressure ulcers
• Severity of medication errors
• Nosocomial infections (healthcare-associated infections)

Because the research on patient outcomes and travel nursing is still limited, the systematic review included only 21 articles. Many reviewed articles tracked only one or two patient outcomes, and sometimes, studies of the same outcome found different results. For example, some studies found better outcomes for some variables with greater use of travel nurses. More research is needed to further understand the relationship between the use of travel nurses and patient outcomes.

How Can Hospitals Better Accommodate Travel Nurses?

The review also examined how hospital structures, patient risk factors, and travel nurse experience levels impacted patient outcomes. Ultimately, the work environment strongly correlated to patient care.

The study did not find that the type of unit (such as critical care) had a consistent correlation with outcomes and the use of travel nurses. Similarly, patient risk factors and travel nurse experience levels did not show a relationship between travel nursing use and patient outcomes.

The work environment had the strongest impact on overall patient outcomes. Some, though not all, of the studies in the systematic review, indicated that work environment may be the underlying factor that determines whether travel nurse use is associated with adverse patient outcomes.

Some of the factors associated with a positive work environment include but are not limited to:

• Appropriate level of challenges
• Career advancement
• Collaborative work environment
• Control over work environment
• Manager support
• A non-punitive environment
• Nurse input into error prevention
• Job satisfaction
• Patient-centric culture
• Perception of being valued by leadership
• Support for education and development
• Workplace civility

Hospital work environments and staffing levels may have an association with greater use of travel nurses. If permanent staff find staffing levels inadequate or the work environment unsupportive, they may be more likely to leave. Negative work environments can fuel the nursing shortage, which may lead to greater use of travel nurses. Where adverse outcomes seem to be associated with travel nurses, it is entirely possible that the work environment and staffing levels are the underlying causes.

AHA Senate Statement on Examining Health Care Workforce Shortages: Where Do We Go From Here?” (2023). AHA

Blume K, et al. (2021). Staffing levels and nursing‐sensitive patient outcomes: Umbrella review and qualitative study . NIH

Kieft R, et al. (2014). How nurses and their work environment affect patient experiences of the quality of care: a qualitative study . NIH

Krupp A, et al. Intensive Care Unit Utilization Following Major Surgery and the Nurse Work Environment . AACN

Vander Weerdt C, et al. (2023). Travel nurses and patient outcomes: A systematic review . NursingCenter

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The Lived Experiences and the Factors Affecting Assimilation of Travel Nurses into the Culture of Assigned Nursing Unit

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The Staffing Shortage Pandemic

The coronavirus disease 2019 (COVID-19) pandemic has led to an understaffed pandemic. The recent surge of COVID-19 and the highly transmissible omicron variant increased positive patient exposures and mandatory quarantines. To complicate matters, topics such as pandemic fatigue, ‘The Great Resignation’, and the aging population of baby boomers eligible for retirement are contributing to the nursing shortage. Healthcare systems, human resources departments, and nursing leadership are facing many struggles in recruiting and retaining staff to maintain patient safety and reduce nurse turnover. There are temporary solutions to ameliorate these issues. However, leaders need to subscribe to strategic planning and innovative ideas to resolve this staffing crisis.

Staffing challenges are spreading throughout every state in the healthcare system, not to mention other critical industries such as hospitality, restaurants, retail, and other businesses. The US hospitals are experiencing critical staffing shortages that are among the tri-state areas, with New York at 1.49%, Connecticut at 2.63%, and New Jersey at 9.57%. Worse areas are Vermont at 64.71%, South Carolina at 25.29%, Wisconsin at 23.65%, and Washington at 11.65%. Hospitals are reporting these critical staffing shortages based on the hospital’s operational needs and guidelines for staff nurse-to-patient ratios ( Becker's Hospital review, 2022 ).

Short-term solutions

Currently, healthcare administration and nursing leaders are succumbing to temporary measures to stay above water. These short-lived options are impacting the healthcare systems’ bottom line and return on investment. To put it bluntly, it is ‘hemorrhaging money’. Therefore, healthcare systems are taking immediate actions to address nurses staffing issues and using contingent workforce solutions to recruit candidates in a short period of time. Companies, such as vendor management services, create partnerships with nursing staff nurse placement agencies, called ‘suppliers’, and bridge the gap between the suppliers and the healthcare system ( The People and Processes, 2020 ). There are also vendor-neutral companies such as managed service providers (MSP). MSP is a healthcare staffing company that becomes a ‘single sourcing provider’ of healthcare staff for the hospital ( Schmidt, 2020 ). Sourcing is the process of vetting, selecting, and managing vendors or suppliers to provide a service to run businesses’ day-to-day operations ( What is the Difference, 2021 ).

The implementation of nursing staff placement agencies or travel nurses is not sustainable and negatively impacts the economy of healthcare systems. Although there is a compensation gap between the hospital-employed nurses and travel nurses, it is not realistic for hospitals to provide the same hourly rates to staff nurses as it would cripple the operating margin ( Carbajal, Plescia, & Gooch, 2022 , p. 1). Nonemployed hospital staff such as per diem agency nurses and travel nurses is a cost-effective staffing strategy solely for periods when patient census fluctuates and census is high ( Carbajal, Plescia, & Gooch, 2022 , p. 1). Unfortunately, the COVID-19 pandemic has created census volumes higher than normal, driving the demand for travel staff rates to also be higher than normal ( Carbajal, Plescia, & Gooch, 2022 , p. 1). This form of ‘price gouging’ to meet the high demands is contributing to higher rates.

Healthcare finance departments resort to traditional compensation packages by offering retention bonuses to permanent nursing staff and other allied healthcare professionals. In addition, they are offering overtime rates and incentive hourly payments for healthcare professionals who are deployed to areas that are considered high-risk such as COVID-19 units.

Long-term solutions

During these rapidly evolving times, leaders need to explore a different perspective within their organizations. Healthcare systems are introducing their own internal travel agency programs. Large multihospital systems are aiming to combat the nursing shortage, recruit back their staff nurses, and simultaneously reduce competition rates from external travel agencies ( Carbajal, Plescia, & Gooch, 2022 , p. 1).

The recruitment of international nurses from overseas is another option for healthcare systems. Healthcare systems must navigate through a few key steps to meet legal criteria. Nurses that are recruited from Mexico and Canada may work in the United States with a special TN visa, an RN license from their country, and pass the NCLEX and state licensure requirements. Another pathway is where nurses who qualify for an H-1B temporary work visa and then apply for a green card. These specialized nurses work in critical care, emergency rooms, and cardiology units ( Gaines, 2022 ).

Last, nursing leadership can retain staff by creating flexible staffing schedules to include staffing preferences. Nurses are seeking a work-life balance and flexible staffing schedules, such as 8-hour shifts or 10-hour shifts that may be preferable than the traditional 12-hour shifts. In addition, leaders can develop cross-training programs for other nursing units and nurses would gain familiarity with other areas over time ( Virkstis, K, Herleth, A., Langr, M., Rewers, L., & Fennell, E, 2021 ).

In conclusion, healthcare systems have an obligation to continue to thrive and develop sustainable solutions. By creating a unique outlook, nurse leaders can seek alternative staffing models and make ongoing adjustments to appeal to all nurses.

• Becker’s Hospital Review Staffing shortages by state. 2022. https://www.beckershospitalreview.com/workforce/13-states-experiencing-workforce-shortages in-at-least-25-of-hospitals-23-anticipate-it.html Retrieved from.
• Carbajal E., Plescia M., Gooch K. Why don’t hospitals just pay full-time nurses more? Becker’s Hospital Review. 2022. https://www.beckershospitalreview.com/nursing/the-complexity-behind-travel-nurses- exponential-rates.html Retrieved from.
• Gaines K. How to work in the us as a foreign-educated nurse. 2022. https://nurse.org/articles/work-in-us-as-foreign-educated-nurse/ Retrieved from.
• Schmidt K. The debate over vendor management services in travel nursing. (No. 15) [Audio podcast episode] In Travel Nursing Blog. BluePipes. 2020. https://blog.bluepipes.com/ttatn-015-debate-vendor-management-services-travel-nursing/ Retrieved from.
• Virkstis K., Herleth A., Langr M., Rewers L., Fennell E. Nursing’ staffing mandate: build a more flexible workforce. Journal of Nursing Administration. 2021; 1 (51):177–178. [ PubMed ] [ Google Scholar ]
• The people and processes of vendor management systems. 2020. https://www.contigotechnology.com/the-people-and-processes-of-vendor-management-services/ Retrieved from.
• What’s the difference between sourcing and procurement? 2021. https://kissflow.com/procurement/sourcing-vs-procurement/ Retrieved from.

New Report Reveals Hard Truths About Travel Nursing

• Pre-COVID Travel Nursing
• What's Different Now?
• Travel Nurse Concerns
• Basic Needs
• Industry Takeaways

As the travel nursing industry booms and more and more nurses are leaving staff bedside positions for highly paid travel nurse positions , it can seem like the best possible nursing job. But, there is also an often untalked about side to travel nursing . 

Despite the high pay, our 2022 State of Nursing study found that the travel nurses surveyed (127 in total) are actually reporting the highest levels of dissatisfaction, burnout, and work-life balance compared to other types of nurses. In fact, they were least likely to report feeling that nursing is a great career compared to staff, part-time and per-diem nurses.

While we know that this isn't reflective of all travel nurses' experiences, these responses were notable enough for us to feel compelled to share them. To see the full independent study conducted by Nurse.org, you can download the report here . 

>> Click here to see available high-paying travel nurse opportunities!

What Was Travel Nursing Like Prior to COVID?

Prior to COVID, travel nurses were oftentimes treated like one of the hospital's own. Sometimes they were given assignments just like any other staff nurse, while other times they were given the patients that the regular staff needed a break from. 

While this wasn’t ALWAYS the case - more often than not, travel nurses experienced many perks that staff nurses didn’t. They also previously reported much higher job satisfaction than bedside staff nurses. 

COVID Has Drastically Changed Travel Nursing 

At the start of the pandemic, crisis nursing and travel nursing were where the money was.  

Nurses would hop from New York to Washington to Texas in search of those highly coveted and elusive contracts. Working 6 out of 7 days didn’t sound terrible when pulling in paychecks in the 5 figures. Travel nurses would work, eat, sleep and do it all over again, day after day.

Oftentimes, these contracts came with increased risk. Generally speaking, they were COVID contracts where nurses had to work in highly infected areas with severely sick and dying patients. These nurses were exposed to COVID every single day, for upwards of 16 hours a day. On top of that, they often had to do this without proper personal protective equipment (PPE).

In 2022, travel nurses still have the ability to earn much higher paychecks than their staff counterparts, but COVID has drastically changed travel nursing , and not for the better. 

How Are Travel Nurses Feeling During the Pandemic?

While many nurses have turned to travel nursing, or thought about exploring it during the pandemic, travel nurses have actually reported higher levels of struggle than any other type of nurse.

• 70% of travel nurses feel unappreciated
• 73% of travel nurses feel unsafe at work
• 77% of travel nurses feel they’re not being paid fairly
• Travel nurses were least likely to say “Nursing is a great career”

Travel Nurse’s Basic Needs Are Not Being Met

Despite the ongoing pandemic, advertised high salaries, and overall appeal of travel nursing - many have MAJOR concerns. 

• Over 85% of travel nurses say that they don’t take a full break during their shift.
• 65% report that they don’t feel like they can take a sick day when needed. 

No Breaks for Travel Nurses

Feeling unable to take a full, uninterrupted break during their shift is an ongoing issue with all types of nurses. Due to the ongoing staffing shortage, the overwhelming number of patients and increased responsibility, bedside nurses, in general, are not taking breaks. 

However, travel nurses, because of their higher pay than staff nurses, often have heavier assignments than staff nurses. Therefore, travel nurses may not be able to hand off their patient assignments during breaks. 

Calling in Sick Isn’t an Option

While sick days amongst nurses have been a major concern due to COVID, travel nurses often have stipulations in their contracts that make it even harder for them to take a sick day when needed.

Depending on the travel company, contract, and hospital - travel nurses might lose bonus money, weekly stipends, or other incentives if they call out sick. 

Travel nurses also reported the following safety concerns in our survey:

• Travel nurses don’t feel they can turn down extra shifts
• Travel nurses feel they have to go outside of their scope of work more
• Travel nurses have felt more uncomfortable making decisions outside of their comfort zone/moral code in the past year than other nurses
• Travel nurses feel unsafe at work

Mental Health Concerns for Travel Nurses

Travel nurses reported dealing with the following mental health-related issues during the pandemic:

• Travel nurses are more likely to be burnt out than other types of nurses
• Travel nurses feel less appreciated than other types of nurses
• Travel nurses feel less supported than other types of nurses
• 92% of travel nurses feel that their mental health has suffered because of their job (more than any other type of nurse)

The burnout amongst all nurses, but travel nurses in particular, is real! Travel nurse burnout can be attributed to COVID crisis contracts, unsafe staffing and patient assignments, and increased contract demands for increased pay. For example, more and more travel contracts are requiring 48- to 60-hours a week, versus the pre-COVID typical 36-hours a week. 

Travel nurses also don’t have the established connections that staff nurses do, which can make their job very isolating, especially during a pandemic. Most travel nurses reported simply going to work and staying alone on their days off to avoid getting sick.

Travel Nurses Feel Underpaid

While travel nurse jobs are known for their high pay, our survey found that travel nurses actually feel they are being underpaid. In fact, 77% of travel nurses feel they’re not being paid fairly. 

This may seem astounding considering the media constantly reports on the high pay packages for travel nurses, and some states have recently proposed legislation to cap travel nurse pay. But based on the unsafe working conditions, inability to take breaks, and high rates of burnout that travel nurses have described facing, it’s understandable that they don’t see their increased compensation as enough. 

According to Payscale.com , as of December 2021, these are some of the wages travel nurses can expect in certain states:

Higher rates can be earned for individuals who accept COVID contracts, but they need to be prepared for what they are getting into, including potentially being exposed to COVID-19. 

How Do Travel Nurses Feel About the Nursing Profession?

Interestingly, 43% of travel nurses don’t think that new nurses should join the nursing profession. This is significantly higher than any other type of nurse, which averaged roughly 30%. 

What Advice Do Travel Nurses Have for Staff Nurses Considering Traveling?

We asked real travel nurses on Instagram what their advice is for nurses considering getting into travel nursing. Here’s what they had to say:

1. Make a Pros and Cons List

"Do a pros and cons list, join travel nurse groups on Facebook, follow travel nurse IG pages and read the posts and comments, research different agencies, have all your documents in order, then go for it!" –  @nursekathleengreen

2. Be Prepared

"Get all your vaccinations, PPD, etc up to date. Get a physical and print out before you lose health insurance from your current hospital. Find all certifications, diplomas, licenses. Get everything together to make it easier for compliance." – @jennysilk

3. Start Slow

"Take a short assignment close to home first. It gets lonely. 4-8 weeks will let you know. Never sign on for 13 weeks for your first assignment." – @napologetically.jazz

4. Consider Your Finances

"It’s not as straightforward as you think, you are required to duplicate living expenses if you take non-tax stipends. Be sure to talk with a tax professional before taking the travel plunge!" – @thecranehouse

5. Choose Your Contracts Wisely

"1. Don’t just chase the highest paying contracts, strategically choose premium assignments aligned with your GOALS

2. Leverage each contract to build your skillset and increase your earning potential

3. Take advantage of your increased income and flexible schedule to invest in yourself (mentally, spiritually, emotionally and financially): learn how to build WEALTH, learn a NEW skillset outside of nursing, learn to REST (take that vacation— you deserve it!)

4. Repeat steps 1-3 and you’ll be able to get out of the rat race and live your best life 💖  " – @sarah_gaines

Learn More About the State of Nursing Report and the Ongoing Nursing Shortage

If you want to learn more about the nursing shortage and our State of Nursing survey, check out the following articles and download the full report below.

• 1,500 Nurses Share the Real Reasons Behind the Nursing Shortage
• Best and Worst Specialties for Nurses During COVID

Kathleen Gaines (nee Colduvell) is a nationally published writer turned Pediatric ICU nurse from Philadelphia with over 13 years of ICU experience. She has an extensive ICU background having formerly worked in the CICU and NICU at several major hospitals in the Philadelphia region. After earning her MSN in Education from Loyola University of New Orleans, she currently also teaches for several prominent Universities making sure the next generation is ready for the bedside. As a certified breastfeeding counselor and trauma certified nurse, she is always ready for the next nursing challenge.

Plus, get exclusive access to discounts for nurses, stay informed on the latest nurse news, and learn how to take the next steps in your career.

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Travel nurse work experiences

A comparison of staff and travel nurses' burnout and job attitudes.

Spector, Paul E. PhD; Pindek, Shani PhD; Hayman, Melisa R. DNP, MHA, RN; Howard, David J. PhD; Arvan, Maryana L. PhD

Paul E. Spector is an organizational behavior science contractor at the Florida Health Sciences Center-Tampa General Hospital and a part-time professor at the Muma College of Business, University of South Florida in Tampa, Fla. Shani Pindek is an assistant professor at the University of Haifa in Haifa, Israel. Melisa R. Hayman is the director of patient care services at the Muma Children's Hospital, Tampa General Hospital in Tampa, Fla. David J. Howard is the director of the People Development Institute at the Florida Health Sciences Center-Tampa General Hospital in Tampa, Fla. Maryana L. Arvan is a courtesy professor at the University of South Florida in Tampa, Fla.

The authors and planners have disclosed no potential conflicts of interest, financial or otherwise.

For more than 63 additional nursing continuing professional development articles related to management topics, go to NursingCenter.com/CE .

Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

A survey of 330 hospital RNs assessed burnout, job satisfaction, turnover intentions, and perceptions of work assignments. Understanding how travel nurses' work experiences differ from the experiences of staff nurses can help nurse leaders determine the best approaches to manage and support these nurses.

Hiring temporary travel nurses to address understaffing has been a strategy used by hospitals for some time, reaching a peak during the onset of the COVID-19 pandemic. With the widespread use of travel nurses, it's remarkable that so little research has been published concerning their work experiences. There are some research reports that focus on administrative issues such as costs or the impact on patient care. 1,2 However, few studies have explored the travel nurses' experiences and whether their feelings about work differ from those of staff nurses.

An understanding of how travel nurses experience work and how their experiences might differ from those of staff nurses can inform the best approaches to manage and support travel nurses, which is vital for maintaining their well-being and ability to provide high-quality patient care. This article reports on a statewide survey of staff and travel nurses working in patient care in hospital settings, assessing their burnout, job satisfaction, turnover intentions, and perceptions of work assignments.

Literature review

Nursing is an occupation with high levels of burnout. 3 Burnout has been linked to patient safety, as well as job dissatisfaction and turnover, which have contributed to nursing shortages. 4-6 Healthcare leaders have employed travel nurses to fill gaps related to understaffing. 7 Although there are many published studies about nurses' experiences of working in hospital settings, few have been published specifically about travel nurses.

Faller and colleagues found that travel nurses had higher levels of burnout compared with another published study of employees in other occupations who were assessed using the same instrument. 8 Similarly, Raso and Fitzpatrick surveyed travel nurses who reported an elevated or “at risk” level of emotional distress on the job, and they noted that levels were similar to a sample of staff nurses, although no statistical comparisons were provided. 9 In a qualitative interview study, Ronnie identified issues of unfair task assignments reported by travel nurses. 10 What they describe sounds much like the concept of illegitimate tasks from the general job stress literature.

Illegitimate tasks are defined as assignments that employees feel are inappropriate, either because someone else should be doing them (for example, it's not their job) or they shouldn't be done at all (for example, bureaucratic tasks perceived to be unnecessary). 11 These studies identified potential sources of travel nurse dissatisfaction and job stress but provided no context because they didn't compare travel nurses with staff nurses. Such context is important to identify areas in which management needs to pay particular attention to travel nurses on their units.

The current study

The current study used a quantitative survey design to compare the experiences of staff and travel nurses and included measures of burnout, job satisfaction, and turnover intentions, which are all concerns that have been noted for some time. A measure of pay satisfaction was also included, which the research team expected to be higher in travel nurses due to their substantially higher salaries; high pay is a major motivator for nurses to pursue travel contracts. 12 As noted, Ronnie found that travel nurses felt that they were assigned mundane tasks in an unfair manner. 10 Because the depiction of mundane tasks overlaps with the concept of illegitimate tasks, the researchers included a measure for illegitimate tasks. Finally, the researchers evaluated perceived workload. Given that travel nurses might perceive unfairness in work assignments, the researchers wondered if the travel nurses would perceive heavier workloads.

The study aimed to answer the following question: Do staff and travel nurses differ on burnout, job satisfaction, turnover intentions, and perceptions of work assignments?

The researchers surveyed RNs in Florida using a publicly available email list downloaded from the Florida Department of Health website. The design was cross-sectional (all data were collected in a single survey), which is commonly used in survey studies of nurses. Using the SurveyMonkey platform, researchers sent 87,008 invitations to nurses who were working in hospital settings and engaged in direct patient care asking them to complete the survey; 1,841 emails were returned as undeliverable, and 85,167 were successfully delivered to an inbox. The invitation noted that nurses had to work in direct patient care in a hospital setting to be eligible to participate. Of those emails delivered, 31.6% (26,878) were opened, according to SurveyMonkey analytics.

The landing page of the survey reiterated that participants had to be hospital nurses with direct patient-care responsibilities. After the informed consent page, the first question asked if the person worked in a hospital and provided direct patient care. Those who chose the “no” response were taken to the end of the survey. Of those who opened the email, 3.2% (864) clicked the survey link, and 373 provided at least partial data. Based on participants' responses to a question asking if the participant was a staff nurse or a travel nurse, the final sample included 29.8% (n = 111) travel nurses and 70.2% (n = 262) staff nurses.

All variables were assessed with established measures. Coefficient alphas for the current study can be seen in the main diagonal of Table 3 for the combined sample (staff and travel nurses). Two components of burnout were measured with two of the three subscales from the 14-item version of the Shirom and Melamed measure. 13 Physical fatigue (for example, feeling physically drained) consisted of five items, and emotional exhaustion (for example, having trouble concentrating) consisted of three items. The measures used a 7-point Likert-type scale ranging from “never or almost never” to “always or almost always.” This scale has been used in nearly 700 studies and has demonstrated high construct validity, factorial validity demonstrated in a confirmatory factor analysis, and predictive validity in relating to theoretically expected variables. 14-16 Internal consistencies reported exceed the recommended minimum of .70 (.90 for physical fatigue and .82 for emotional exhaustion). 17,18

Overall job satisfaction was measured with the job satisfaction subscale from the Michigan Organizational Assessment Questionnaire. 19 It consists of three items and was evaluated with a 7-point Likert-type scale ranging from “disagree very much” to “agree very much.” Bowling and Hammond reported a mean internal consistency for the scale across 79 studies of .85, and significant predictive validities with many theoretically expected variables. 20 The pay satisfaction subscale from the Job Satisfaction Survey was included. 21 It had four items and used the same response choices as the overall job satisfaction scale. Spector reported a coefficient alpha for the scale of .75 and an 18-month test-retest reliability of .45. It showed a convergent validity coefficient of .66 with the popular Job Descriptive Index, and a significant correlation with salary level. 21

Workload was assessed with the Quantitative Workload Inventory, a five-item measure using a 5-point summated rating scale, ranging from “less than once per month or never” to “several times per day.” 22 Coefficient alpha was found to average .82 across 15 studies, and the workload scale significantly relates to both physical and psychological strains. 22 Illegitimate tasks were measured with Matthews and colleagues' two-item measure, using the same response choices as the two job satisfaction measures. 23 They report evidence for construct validity provided by confirmatory factor analysis and predictive validity based on significant correlations with expected variables. Turnover intention was assessed with a single item that asked how often the person seriously considered quitting, using a 6-point scale ranging from “never” to “extremely often.” 24 This single-item scale relates as expected to job satisfaction and employee turnover. 25

Four demographic items were included: nurses' main department, their highest level of education (from associate to doctoral degree), whether or not they supervised anyone (yes/no), and how many years they had been a nurse (see Table 1 ). The eight most frequently mentioned departments are shown in the table.

Ethical considerations

The study protocol received an exempt approval from the University of South Florida institutional review board (IRB). The email invitation had basic informed consent information including that the survey was anonymous and voluntary. The landing page for the survey contained the detailed informed consent. As required by the IRB, the individual had to click that they agreed to participate to continue to the survey.

The researchers began the analysis by comparing the samples of staff and travel nurses to see if they differed in demographics. There were no significant differences between the two categories of nurses in hospital department, education level, or tenure as a nurse (see Table 1 ). There was a significant difference in supervisor status: 22.1% (n = 58) of staff nurses indicated they had supervisor responsibilities versus 2.7% (n = 3) of travel nurses (Χ 2 (1) = 21.3, P < .0001).

The researchers next conducted a series of analyses of variance (ANOVA) to compare the mean levels of the study's main variables for staff nurses and travel nurses. As shown in Table 2 , travel nurses scored significantly higher on turnover intentions ( P < .0123), the physical fatigue component of burnout ( P < .0257), and illegitimate tasks ( P < .0169). The differences between the two groups were statistically nonsignificant for overall job satisfaction ( P < .1980), pay satisfaction ( P < .9444), the emotional exhaustion component of burnout ( P < .3966), and workload ( P < .1459). Despite substantially higher pay for travel nurses, the pay satisfaction means for the two groups were almost identical.

One possibility for the lack of differences between the two groups was that the staff nurses were more likely to be supervisors. The researchers controlled for supervisor status by repeating the analyses without the supervisors in the sample. Results were only trivially different, with the significant comparisons remaining significant at P < .05 and the nonsignificant comparisons remaining nonsignificant at P > .05.

Table 3 contains correlations among all the variables in the study for the two groups of nurses separately. For the staff nurses, all main variables in the study were significantly correlated at P < .05. This wasn't the case for the travel nurses, as emotional exhaustion wasn't significantly correlated with either workload or illegitimate tasks, and job satisfaction wasn't significantly correlated with illegitimate tasks. These results suggest that there might be some differences between staff and travel nurses in relationships among some of the variables included in the study.

A sample of licensed RNs in Florida received a survey designed to ascertain how travel nurses might differ from staff nurses in their experience of work. Specifically, the researchers wanted to determine if there were differences in burnout, job attitudes (overall job satisfaction, pay satisfaction, and turnover intentions), and perceptions of work assignments (illegitimate tasks and workload). There were several notable findings in terms of differences and similarities.

The survey included two dimensions of burnout: emotional exhaustion and physical fatigue. Results showed that travel nurses scored significantly higher on the physical fatigue component of burnout but not on emotional exhaustion. This pattern suggests that being a traveler might take a heavier physical toll, leaving the nurses physically worn out. Perceptions of workload didn't differ, so it's unlikely that the travelers were working harder but rather that the tasks they were assigned were more tiring or that demands outside of their work were contributing to fatigue.

Faller and colleagues, for example, discuss the challenges for travelers of adapting to a new location. 26 Another possibility is that travelers have fewer close bonds inside or outside of work, which can lead to lower social support, a factor that has been linked to burnout in nurses. 27,28 The lack of difference in emotional exhaustion suggests that being a traveler didn't take a greater emotional toll, so emotional distress isn't a likely explanation for physical fatigue.

Job attitudes

There was no difference between travel and staff nurses in their overall job satisfaction or pay satisfaction. Overall satisfaction is driven by many factors including rewards (such as compensation), work colleagues (other nurses and supervisors), and the nature of work. 29 The motivations and expectations of travelers are different from those of staff nurses, so the factors that are important to each group are likely different. 26 This can result in the two types of nurses having the same level of overall job satisfaction for different reasons.

One facet for which there was no difference was pay satisfaction. Given the large disparity in pay between travel and staff nurses, one might expect that pay satisfaction would differ. On the contrary, the means were almost identical at approximately 11 on a scale ranging from 4 to 24. This suggests that the pay satisfaction for both groups is toward the dissatisfied end of the scale; in other words, they're equally dissatisfied. One likely explanation for similar levels of dissatisfaction is that travel nurses don't feel that the higher rate of pay is enough to compensate for the personal costs and inconvenience of being a traveler. Furthermore, travel nurses work through agencies that take a portion of the funds allotted for the traveler, and perhaps some nurses feel that their cut is unfair, thus contributing to pay dissatisfaction.

There was a disconnect between comparative results for turnover intentions and job satisfaction. The two variables were highly correlated (-.62 for travel nurses and -.72 for staff nurses), so one would expect that differences between the two types of nurses would be consistent across the two variables. However, travel nurses' turnover intentions were significantly higher, but the difference for job satisfaction wasn't statistically significant. Perhaps there were additional factors driving travel nurse turnover intentions other than job satisfaction.

For example, when on assignment, travel nurses experience a transient lifestyle, living away from family and in temporary quarters, often with limited social contacts outside of work. These factors might have contributed to greater turnover intentions as some travelers struggled to remain in their travel assignments and contemplated leaving early. Another possibility is that some of the travelers interpreted the question to mean that they were going to leave the hospital at the end of their assignment as opposed to attempting to renew the travel assignment or transitioning to a staff nurse position. In that case, the meaning of turnover intentions wouldn't be the same for the two types of nurses, precluding comparison.

Perceptions of work assignments

Elevated scores for travel nurses on illegitimate tasks are consistent with Ronnie's findings that travel nurses noted they'd received unfair task assignments. 10 Likely the travel nurses in the current study sample felt that they were given assignments that were beneath their skill level. This might occur because nurse managers don't have sufficient opportunities to become fully aware of travel nurses' knowledge and skills, and because travel nurses don't have as much time to learn local policies and procedures. 30

For staff nurses, there was a significant correlation between illegitimate tasks and job satisfaction, which is consistent with prior research in other occupations and industries. 31 For travelers, however, there was a nonsignificant and near-zero correlation between illegitimate tasks and job satisfaction that was significantly smaller than the corresponding staff nurse correlation. Although the travelers perceived receiving more illegitimate tasks, it didn't translate into lower job satisfaction. Perhaps it's because the travelers viewed this as a temporary situation or they understood that illegitimate tasks are to be expected when a nurse is new to the hospital. These findings suggest the need for additional research to better understand what might drive job satisfaction in travel nurses.

Despite differences in perceptions of illegitimate tasks, workloads were perceived to be similar for nurses in both groups, suggesting that nursing managers are being careful to balance workloads. Thus, the greater burnout among travel nurses isn't likely due to being overworked, at least when compared with staff nurses. Therefore, the two groups of nurses differed in their perceptions of what they're assigned to do but not how much they're asked to do.

Limitations

Perhaps the biggest limitation of this study is the low response rate. Only 30% of those receiving the invitation email opened it, but there's no way to know how many of the 70% saw the email because the address they provided to the Department of Health when they were licensed might no longer be used, and many invitations likely wound up in spam folders. Of those who opened the email, only those who were eligible would have clicked the survey link because the inclusion criteria were clearly stated in the invitation, which would have disqualified a sizeable proportion of the sample. Nevertheless, even allowing that only a minority of eligible nurses saw the email, the rate was less than ideal, raising concerns about the representativeness of the sample. That said, there's research from the occupational stress literature suggesting that response rate has little effect on the relationships among variables. 32

A second limitation is that the study relied on nurses' self-reports of task assignments and workload. Although the study assessed how nurses perceive their tasks, it's not clear to what extent that reflects objective aspects of the job or the actual tasks that nurse managers assign. Additionally, the study's cross-sectional design can't shed light on the extent to which assignments might lead to burnout and dissatisfaction, and it's certainly possible that those who feel dissatisfied and exhausted perceive their assignments differently than counterparts who are having a more positive experience of work.

Finally, the sample was taken from licensed nurses in one US state. It isn't clear how well results would generalize to nurses in other states or in other countries that might have different staffing and pay practices.

Implications for nurse leaders

The results of this study underscore three areas of concern for nurse leaders when managing travel nurses; they're more likely than staff nurses to 1) be physically fatigued, 2) feel their task assignments are inappropriate, and 3) consider leaving their assignment prematurely. Their higher level of fatigue can be due to conditions both at and beyond work. At work, their perceptions of the tasks they're given differ from staff nurses, which could lead to greater stress and fatigue. Being temporarily away from home and their personal support network of family and friends can exacerbate this situation. This suggests a two-prong approach to addressing the needs of travel nurses.

First, the travelers likely need greater support from managers and peers. Not only are they away from their home support system, but their temporary status also makes it difficult to develop strong bonds at work. Extra efforts to provide support with continual check-ins and offers of assistance, as well as encouraging staff nurses on the unit to do the same, would go a long way to making the travelers feel welcome and less stressed.

Second, nurse managers should be mindful of how they utilize travelers to create a positive experience that supports their ability to provide good patient care. Managers should make an effort to learn about the travelers' knowledge and skills, so they know how best to utilize their talents. They should implement ways to validate travel nurse competencies, so their talents are better applied on their units.

Furthermore, nurse managers should be sensitive to travel nurses' perceptions of receiving leftover tasks that underutilize their capabilities. They should be transparent in explaining why assignments are given and allow travel nurses to provide input when possible. Even if the assignment can't be changed, the travel nurse would understand why they're being asked to perform certain tasks.

Promoting a positive experience

This study is among the first to compare the work experiences of travel nurses with those of staff nurses. Although they don't differ in emotional exhaustion, job satisfaction, or workload, travelers experience greater physical fatigue, illegitimate tasks, and turnover intention, which can lead to quitting an assignment early. If nurse leaders give greater attention to the experiences of travel nurses, it might enable these nurses to have a more positive experience that can contribute to better job performance, as well as a better use of their talents during their assignments.

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