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The Dauntless Nurse: On dysphoria and the travel nursing question

By: By Kathleen Bartholomew

The American Hospital Association has called on the White House to investigate exorbitant salaries paid to travel nurses—as if this situation was the problem to be solved instead of realizing that this is yet another symptom of our dysfunctional healthcare system.

The exodus of nurses from small rural hospitals to traveling positions that pay lucrative salaries is hurting our patients, communities, and our hospitals. One labor and delivery unit lost half of its staff: 25% to traveler positions and another 25% retired early. This unit is now valiantly struggling to meet the needs of its community. Nurses who stayed feel exhausted and betrayed. Numerous small rural hospitals are staffed with travelers because their own staff left for traveling positions that pay double the salary. Who could blame them? 

Nurses have role dysphoria—a profound sense of unease or dissatisfaction. Nurses are trained to holistically execute a treatment plan for their patients, which requires high-level technical skills, and to address physical, mental, and social issues. Anyone who’s been a patient knows that the nurse is the one who administers the chemo, starts the I.V. line, or administers life-saving meds in a code. Instead, nurses consistently find themselves working short-staffed and spending half of their time as administrative assistants or clerks.

Dysphoria occurs when we are set up to fail. Although nurses are responsible for the quality and safety of patient care, they have no say in how many nurses are needed to provide that care—even though they have the critical data needed to make that call (the real-time condition of each patient and the experience level of oncoming staff.)  So yes, there is a profound sense of unease when every day you can’t have what you need to keep your patients safe.

Instead of being aligned with the same goal, the situation now is nurses vs. hospital administrators. Doesn’t it seem odd that nurses have to seek legislation for the staff they need to keep their patients safe (both nationally and at the state level)? This is occurring because the system is fundamentally built on conflicting values: profit vs. service. And nowhere do these opposing values reveal themselves more than right now when hospitals are paying travelers double because their own nurses have left to become travelers. And why not? From 2005 to 2015, the average CEO salary increased by 93% and is now $3.4 million, but nurses’ salaries increased only 3%.

Dysphoria occurs when your values are misaligned with your employer’s. What is needed is a new healthcare system where nurses and hospitals have the same primary goal: safe, quality, evidence-based care in a system where nurses have the autonomy and power to staff the floor to deliver the care they were trained to give—a system where a hospital’s financial bottom line is guaranteed and both nurses and administrators work together to give patients the care they deserve.

What must end is the illusion. Both the move to traveling positions and short staffing are symptoms of the dysfunctional system that our policies created. If healthcare was primarily a service (and as important as broadband internet), then nurses wouldn’t have to fight to keep patients safe.


kathleen-bartholomew-dauntless-nurseKathleen Bartholomew, RN, MN, is an internationally recognized patient safety and health culture expert. Kathleen has spoken on leadership, communication, patient safety, and peer relationships to hospital executives and nurse leaders for twenty years.

All of her books come from her passion to understand the stories of nurses.  Her books, “Ending Nurse to Nurse Hostility” and “Speak Your Truth” illuminate our relationships with our peers and physician partners.  She is also co-author of “The Dauntless Nurse” which was written as a communication confidence builder.

Kathleen is also a guest Op Ed writer to the Seattle Times and has been interviewed twice on NPR’s “People’s Pharmacy”. Her Tedx Talk calls for changing our belief system from a hierarchy to equality in order to keep our patients safe – and also explains how disaster thrust her into ‘the best profession ever’.

You can also find more information about Kathleen on her websiteTwitter, and Facebook

The views and opinions expressed by My Nurse Influencer contributors are those of the author and do not necessarily reflect the opinions or recommendations of the American Nurses Association, the Editorial Advisory Board members, or the Publisher, Editors and staff of American Nurse Journal. These are opinion pieces and are not peer reviewed.

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