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The health care sector is struggling with staff shortages. Travel nurses help bridge the gaps, allowing healthcare facilities to maintain service standards. While the use of travel nurses is important, it has created new risks. Here are the key issues for healthcare leaders.
Risk factors for travel nurses vary.
Covers analyzed five years of risk data from nearly 7,000 closed malpractice claims and identified more than 12,000 risk management issues. From this information, we identified the following three areas of vulnerability.
• Critical decision making.
• Technical performance.
• Clinical systems.
For claims related to travel nurses, the highest risk areas are:
• Clinical systems.
• Electronic health records.
• Human factors.
Dive deeper into the information
Within the broad risk categories are subcategories that help us better understand key claims drivers.
Subcategories of clinical systems include:
• Failure to manage the patient’s follow-up care.
• Lack of coordination of care.
• Results or samples that are lost, misplaced or not brought to the supplier’s attention.
• Failure or delay in tracking or reporting incidental findings.
• Inability to evaluate results quickly.
• Inability to compare previous test results.
Travel nurses may not be in one place long enough to monitor. They may also be unfamiliar with the organization’s specific processes or communication methods.
Subcategories of electronic health record (EHR) include:
• Documentation issues.
• Lack of active or updated medication list or allergy related documentation.
• General use of EHR.
Subcategories of human factors include:
• Inability to work as a cohesive clinical team.
• Cultural or organizational vulnerabilities.
• Failure to ensure a safe environment with adequate staffing.
• Workplace design.
• Distractions or lack of situational awareness.
It’s easy to see how these risks can be heightened by travel nurses. They may find it difficult to adapt to document guidelines or to form a cohesive team within a short period of time working for an organization.
How these risks affect patients
Although data can provide clues to vulnerable areas, individual stories explain the problems in human life and financial loss. Here is an example:
Due to staff shortages, the outpatient dialysis clinic needed to use a traveling nurse. Two patient care technicians went on vacation, leaving a travel nurse with 12 patients. A traveling nurse is one of the patient care technicians operating one of the dialysis machines, causing the configuration to change from patient/machine/patient/machine to patient/machine/machine/patient.
As the traveling nurse administers one of the heparin bolus in the resetting area, he realizes that he is injecting it into the wrong patient machine. He immediately got off the line and looked at the patient’s order. Unable to find the patient’s heparin order, further research was conducted and the patient was found to be allergic to heparin. The traveling nurse returned to the patient and found them unresponsive. He called 911, but he didn’t know the emergency protocols and there was a delay in responding. This incident resulted in the death of the patient and a judgment of 2 million dollars.
On board travel nurses with passion
Although travel nurses help alleviate staff shortages, they are not always well received by other team members. Often, staff members associate them with high costs, which can lead to dissatisfaction.
A negative environment can inhibit cooperation and open communication. Travel nurses and regular staff must work together to form a cohesive team across staffing issues and maintain an acceptable standard of care. Therefore, it is imperative that healthcare facility leaders have programs in place to help travel nurses adapt to the new environment.
Boarding practices must be carefully designed. Leaders are encouraged to look at their own incident and nearby data to identify areas of vulnerability and incorporate relevant risk management measures into onboarding.
Boarding for travel nurses must cover:
• Access to the electronic health record necessary for patient care.
• Expected documents.
• Physical visits to patient rooms and suites so that travel nurses know where to find supplies in case of an emergency.
• Chain of command policies and expectations.
A travel nurse mentoring program can also help. An experienced staff member should be available for questions similar to the approach of the student nurse. Beyond that, it’s important to treat travel nurses with compassion, remembering that starting a new job in a new environment can be stressful.
Leaders should prepare their teams for the arrival of traveling nurses and ask staff to welcome them. Conduct surveys of current staff and brief interviews of travel nurses to assess the culture and determine how to make improvements. Finally, leaders should take the time to warmly welcome travel nurses and help them navigate their new environment.
Data-driven risk management systems can help you manage the unique risks associated with the use of travel nurses, ultimately improving patient safety and outcomes.
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