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Running head: ASSIMILATION OF TRAVEL NURSES

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

of Assigned Nursing Units

Kristen Eden

Bethel College
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Abstract

Travel nursing has become a popular means for hospitals to bridge staffing shortages and

continue to provide patient care. Though travel nursing may be an exciting career option for

registered nurses, there are challenges that must be considered before choosing this career. The

purpose of this study is to explore the lived experiences and the factors affecting assimilation of

travel nurses into the culture of their assigned nursing units. This qualitative descriptive study

will employ interviews with travel nurses to explore their lived experiences, including the

benefits and challenges faced by travel nurses, and assimilation into the culture of the assigned

destination units or facility. The information gleaned from these interviews may be used to assist

nurses who are contemplating a career in travel nursing to be prepared to face the opportunities

or challenges they may encounter.

Keywords: travel nursing, assimilation, culture, temporary staffing, temporary nursing,

enculturation
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The Lived Experiences and the Factors Affecting Assimilation of Travel Nurses into the Culture

of Assigned Nursing Units

Travel nursing is a popular trend in nursing. It allows health care managers to fill staffing

gaps when shortages would otherwise cause an interruption in safe and quality nursing care in an

organization (Randolph, 2003). Travel nursing gives nurses the opportunity to travel to new

destinations, gain experience by learning to thrive in new environments, and earn extra

compensation while filling difficult positions (Hinson-Smith, 2003). The purpose of this research

is to explore the lived experiences and the factors affecting assimilation of travel nurses into the

culture of assigned nursing units.

Data gathered may be useful to assist future travel nurses with their decision to venture

into travel nursing. It may also be useful to help prepare first-time travel nurses to face the

challenges of assimilating into the culture of their assigned unit and to feel comfortable and safe

while practicing. Previously published research was reviewed for content related to travel

nursing. For data gathering, travel nurses will be interviewed to describe their lived experiences

working in their assigned clinical agencies. Their responses will be evaluated for themes that will

add insight into this unique culture.

Background

Travel nursing is defined as a career choice when a a registered nurse chooses a

destination to practice nursing by contracting with an agency that places the nurse in an

assignment (Morrison, 2011). This process involves assimilation, which is defined as “a much-

contested notion whereby on entering a new country immigrant groups are encouraged, through

social and cultural practices and/or political machinations, to adopt the culture, values, and social

behaviors of the host nation in order to benefit from full citizen status” (Holohan, 2012, p. 92).
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For example, in this study, the host nation would be the host nursing unit and the travel nurse

would assimilate into the social norms of the assigned unit.

Though travel nursing has become very popular since the late 1990s, there is little

research published on travel nurse satisfaction and retention (Faller, Gates, Georges, & Connelly,

2011). Factors, such as the nurse’s level of experience, support systems, and destination facility

reputation, all affect how the travel nurse will thrive in the new work environment (Dawson,

1996). There are many reasons why nurses choose travel nursing; including dissatisfaction with

the current work environment, increased pay, and flexibility in work schedule (Faller, Gates,

Georges, & Connelly, 2012).

When travel nursing began in the 1970’s, travel nurses were often provided with housing

near the hospital (Professional Association of Nurse Travelers, 2016). This provided a fun living

experience for the travelers, as they had many people to spend their time off with during their

sojourn. This is no longer the case, though often travelers choose to take work assignments with

other travel nurses and find their housing together. Because of this lack of community previously

offered to travel nurses, it is important for hospital staff to embrace the traveler and include them

in unit activities and outside gatherings.

While travel nursing is a wonderful opportunity for growth in a nurse's career, it can

often be a stressful situation for those who are not prepared for the challenges they will face

while travel nursing (Fraleigh, 2010). The proposed qualitative study will explore the issues

faced by travel nurses and provide more information for future nurses to consider when choosing

a career in travel nursing. Travel nurses will be interviewed related to their assimilation and

feelings of acceptance by nurses and management in their assigned clinical unit or facility.
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Problem

Travel nursing has become a popular means for hospitals to bridge staffing shortages and

continue to provide patient care. While temporary nurses make up 30% of the United States

nursing workforce, only 2% of these temporary staffing registered nurses (RNs) are travel nurses

working in the acute care setting (Faller, Dent, & Gogek, 2017). Travel nurses, or temporary

nursing staff (TNS) as they are referred to in the business sector, cost the medical industry in the

US approximately $3.6 billion dollars a year. Policy makers and healthcare managers may see

this as a problem and decide to find more effective ways of dealing with staffing shortages. They

may also choose to support further research on the effects of using TNS in their facilities to

determine whether or not the use of travel nurses is the wisest decision for their units and

facilities (Mazurenko, Liu, & Perna, 2015).

Travel nurses provide healthcare facilities with a plethora of experience, strong nursing

skill sets, and ability to thrive in high-stress, chaotic situations while providing quality care.

Though travel nursing is a wonderful and exciting career option for RNs, there are challenges

that must be considered before choosing this career (Fraleigh, 2010). These challenges include

handling stressful situations with minimal support (Cottingham, 2017), acclimating to new

environments frequently (Hinson-Smith, 2003), and leaving behind family and friends (Travel

Nursing, 2009). To provide the best possible care, travel nurses must be able to face the

challenges and continue to provide excellent care to their patients. Lack of published research on

the lived experiences, and the factors affecting assimilation of travel nurses into the culture of

assigned nursing units, inspired the inquiry into this topic.

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Purpose

The purpose of this qualitative, phenomenological research study is to explore the lived

experiences and the factors affecting assimilation of travel nurses into the culture of assigned

nursing units.

Review of Relevant Literature

Travel nursing, its challenges, and benefits are reviewed through the literature review.

Most of the research articles were obtained from Bethel College’s online library source. Specific

literature sources include EBSCOhost, Ovid, and Cumulative Index to Nursing and Allied Health

Literature (CINAHL). Key words and themes included in the research were travel nursing,

assimilation, culture, temporary staffing, temporary nursing, and enculturation. The nursing

research material on travel nursing is very limited.

Empirical Review

Travel nursing has become a popular health care trend as managers of health care

facilities find themselves needing to fill positions quickly with qualified RNs. Travel nursing,

however, can pose many risks for RNs. This descriptive qualitative research study will explore

the factors behind what makes travel nurses feel a sense of assimilation into their assigned unit’s

culture.

Faller et al. (2011) suggested factors, such as years of experience, the proximity of travel

destination to RNs home life, and family presence, affect a travel nurse's satisfaction with their

travel nursing assignment. Faller et al. also stated that nurse-to-patient ratios were an important

determinate as to whether a travel nurse succeeded during their assignment or become burned

out. One conclusion of their research study was Magnet status hospitals showed an increase in

nurses' perception of quality care and an improvement in staff and patient satisfaction (Faller et

al., 2011).
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Randolph (2003) stated that nurse-to-patient ratios greatly affected job satisfaction of

both staff and travel RNs. Randolph explored reasons to consider travel nursing and how travel

nurses can benefit a facility. Because travel nurses can jump right in and start doing the job of a

regular staff member with minimal training, it is more economical and practical to hire a travel

nurse instead of a new graduate nurse when there is an acute shortage, such as when a staff nurse

leaves for illness or maternity leave (Randolph, 2003).

Tuttas (2013) stated that the amount of nonproductive nursing labor drastically decreased

when hospitals staffed with travel nurses. Multiple week-long orientations and continuing

education are not required for travel nurses to perform their duties, whereas a new graduate RN

will require both of these to be compliant with hospital policy. Because of the decreased

onboarding time required, staffing with travel nurses makes a financially savvy decision.

Hospitals also save money on paid vacation and sick time, reimbursement for certifications, and

healthcare benefits because these are only offered to nurses by their travel agency instead of the

hospital they are contracted to work for (Tuttas, 2013).

Need for Travel Nurses

Cottingham (2017) described how travel nurses help fill the gap in the healthcare

industry. The shortage of nurses continues to grow. As the current nursing population ages and

retires, an estimated 74 million patients will require nursing care services. Cottingham explained

how new nurses are leaving the field because of the stressful work that is typical of nursing. This

has made travel nursing more enticing to new RNs who are looking for some adventure and an

increase in pay.

Wood (2015) indicated that a 10% increase in travel nursing growth is expected to occur,

leading to an increasing number of options for travel nurses from which to choose. Factors that
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contribute to this growth are the improving economy, increase in insured patients due to the

Affordable Care Act (ACA), and the aging population who require increased healthcare services.

Travel nursing has several job opportunities and pay packages that are competitive. These

benefits are often successful in enticing nurses to try travel nursing (Wood, 2015).

Challenges

Goldstein (2014) recognized that one of the greatest challenges that travel nurses face is

the assimilation or fitting in on the unit he or she is assigned to work. Often staff nurses are

skeptical about welcoming a travel nurse into their unit. There can be jealousy because the travel

nurse seems to be making more money than the regular staff members, creating animosity

between the unit staff and traveler. With this in mind, it should be the job of the unit manager

and charge nurses to educate their staff on how the travel nurse will benefit their unit and to

encourage acceptance and warmth towards the new member of the team (Goldstein, 2014).

Mazurenko et al. (2015) found that poor communication between travel nurses and

permanent staff nurses hindered quality patient care. Often travel nurses reported experiencing

abuse and lack of trust and support from the staff nurses and inadequate support from

management. The same study found that travel nurses may negatively affect the quality of care

because of the disruption in strong work relationships, interdisciplinary staff communications,

and organizational loyalty. Suggestions to improve the care provided by TNS include effective

communication between the travel nurse’s external employment agency, comprehensive

orientation for the travel nurse including hospital policies and procedures, assessment of

individual nurses’ skill sets, and encouraging the development of trusting relationships between

travelers and permanent staff (Mazurenko et al., 2015).

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Yeh, Ko, Chang, and Chen (2007) found that temporary nurses, or travel nurses, reported

lower levels of organizational commitment and higher levels of stress compared to their

permanent staff nurse counterparts. Reasons for this included attituded among permanent staff

members towards travelers, less continuing education, and poor orientation to the contracted

facility.

Years of Nursing Experience

The Joint Commission (2012) recommended RNs should have a minimum of two years

of nursing experience before considering travel nursing. Goldstein (2014) confirmed that to be

fully prepared to face the challenges of travel nursing, RNs should have at least two years of

experience in nursing care. This requirement will ensure that the travel nurse is prepared to

handle the clinical aspects of the unit's care. Nurses with two years of experience are also more

familiar with medication interactions and adverse reactions, which improves the quality of care

provided (Goldstein, 2014).

Extracurricular Activities

Travel nurses should ensure that their time away from the nursing unit is enjoyable

(Travel Nursing, 2009). Bringing along a pet on assignments, making new friends, exploring the

assignment destination, and staying connected with family and friends back home are all great

ways for the traveler to avoid feeling lonely and homesick. This will boost morale and

discourage call-offs or even termination of assignment by the travel nurse (Travel Nursing,

2009).

Orientation

Travel nurses are often given very little orientation to the assigned unit and facility. They

are expected to have around one to three shifts orienting to the facility, charting system, and unit
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policies and procedures before practicing independently. This can be daunting for new and

experienced nurses.

Small gestures, such as welcoming the traveler with a smile, showing them where to store

belongings, and introducing the traveler to the permanent staff, are some ways the manager can

make the travel nurse feel welcome and secure in their new workplace. The traveler should be

told who to go to for questions and support, such as phone numbers to call in case of a code and

how to contact the physicians (Randolph, 2003).

Goodwin (2004) found that travel nurses determined policy/procedures review,

orientation to documentation system, and hospital/facility tour to be the most important things

for a traveler to be oriented to. Administration, hospital policies and general human

resources/employee benefits were the least important things for travel nurses. Travel nurses often

felt that the orientation they received to the hospital should be unit specific and cover only the

information that will be useful for the traveler to practice safely, assuming the traveler is

competent in the nursing skills required for the patient population on the unit (Goodwin, 2004).

Goldstein (2014) stated that the travel nurse should be given a minimum of two days of

general orientation that includes familiarizing the nurse with the electronic medical record

(EMR) service used by the hospital for charting. Knowledge of the facility's EMR is very

important to nurse managers in their selection of a travel nurse. The traveler should also be given

a two-day unit orientation, where the travel nurse can familiarize themselves with the unit's

environment, staff, and equipment. This knowledge of a facility’s unit will allow the travel nurse

to have a sense of readiness to take on the patient assignment and perform their duties safely and

effectively. It will give them a sense that they are part of the healthcare system as they assimilate

into the culture of the facility and nursing unit.

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Welcoming the Travel Nurse

Tuttas (2011) stated that the travel nurse needs to be enculturated into the nursing unit

where they are assigned to work. She stated enculturation of travel nurses into the assigned unit

as "as essential component of integration into the work arrangement of professional contract

nurses” (Tuttas, 2011, p. 24). For the culture of the unit to be conducive to excellent patient care,

the culture must include teamwork, true collaboration, leadership, and skilled communication.

Tuttas explained that the unit staff must be receptive towards the travel nurse for the traveler to

feel comfortable being enculturated into the assigned unit (Tuttas, 2011).

Goldstein (2014) suggested that the unit manager should prepare the unit's staff to

welcome the travel nurse. They should use the traveler’s first name and explain how the traveler

will be used to benefit the unit, encouraging staff to treat the travel nurse as a colleague.

Implementing these suggestions encourages the traveler to be comfortable in their new

environment and renew their contract if it is the need of the unit.

Contract Issues

Though there is a projected increase in the need for travel nurses, there can be times

when facilities hire a travel nurse for a 13-week contract and find that they do not need the nurse

for that length of time. This can be an issue for not only the healthcare facility, but also the travel

nurse. Rosenstock (2016) found that travel nurses were blacklisted by healthcare facilities that

did not want to honor the entirety of the contract because of financial reasons, though the travel

nurses were not found to have practiced unsafely or having caused problems on the unit where

they were hired. Rosenstock proposed that this treatment of travel nurses is devastating to their

career and should be prevented at all costs. If the hiring manager of the facility thinks they will

need the traveler for a shorter period of time, this should be addressed in the contract and
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discussed with the travel nurse and the travel agency. The traveler might also be willing to move

to another location within the hospital system where there is a need. In addition, most reputable

travel agencies will shorten the length of the contract if the hiring facility is honest about their

lack of further need for the travel nurse (Rosenstock, 2016).

Theoretical Review

The theoretical literature used to support the need for research on the topic of travel

nurses' assimilation comes from Leininger’s theory of culture care and sensitivity. Leininger

(2009) studied how culture affects groups of people and impacts the care they need. Leininger’s

work has affected how nurses care for patients from varied cultures and backgrounds (Nelson,

2006). As nurses have their own culture, so do travel nurses. This qualitative research will focus

on the culture of travel nurses, and how they assimilate into the culture of the units, to which

they are assigned.

The theory of culture care diversity and universality is necessary for nurses to provide

culturally competent care. Leininger (2009) claimed, “…cultural care knowledge and practices

have meaningful functions and structural patterns derived from the cultural values, world views,

social structures, and environmental contexts of diverse cultures.” These aspects of culture will

be studied when interviewing travel nurses. The goal will be to ascertain whether travel nurses

feel that they have a unique culture and whether they feel cared for as employees within the

culture of their assigned area of employment.

Summary of the Literature Review

Travel nurses provide hospitals and other clinical agencies with the staffing needed

during times of shortages and short-term leave of staff. Travel nursing offers RNs opportunities

to explore new places and build clinical skills as they frequently adapt to new clinical settings,
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staff, and management. Knowing the challenges and benefits of travel nursing is important

before signing a contract. The nurse must be prepared to act independently, make friends

quickly, and thrive in unknown environments to safely and effectively practice as a travel nurse.

Assimilation by the travel nurse into the culture of the assigned unit is important for the

traveler to feel supported and safe practicing in the new work environment. Leininger (2009)

explained that culture is the values, beliefs, norms, patterns, and practices of a defined group of

people. Every nursing unit has a culture that is specific to their location and staff. The traveler

must learn to assimilate into the culture of the unit by observing and practicing these aspects of

culture to encourage effective communication, collaboration, and teamwork on the unit.

Theoretical Framework

Leininger developed the theory of culture care diversity and universality in the 1950s in

response to a lack of culturally sensitive nursing care provided by nurses. She studied more than

52 cultures and described their cultural practices related to health and lifestyle. Leininger’s

culture care model will be used as the theoretical framework to guide this study (see Appendix

A). The norms and patterns related to travel nursing are described in the conceptual definitions

section.

The concept of assimilation is important to the study of how travel nurses relate to the

healthcare team. Buscemi (2011) elaborated on Leininger’s theory of culture diversity and

universality. He described her view of assimilation as that of a person or group choosing to take

on some of the feature of another culture without abandoning their own culture in its entirety

(Buscemi, 2011).

This view of assimilation of culture can relate to travel nurses in a variety of ways.

Leininger’s sunrise model (see Appendix A) depicts the aspects of culture as they relate to the
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many social structures within that culture. The three aspects of culture that may be most pertinent

to the study of how travel nurses assimilate into the culture of the assigned nursing units are:

technological factors, kinship and social factors, and cultural values and lifeways.

When beginning an assignment as a travel nurse, the RN must first become familiar and

quickly proficient with the EMR of the facility. This allows them to communicate with other

members of the healthcare team and record data important to the ongoing care of the patient.

Some travel nurses are given a thorough orientation to the facility’s EMR while others are

expected to have an understanding of the system before they begin the assignment. Learning how

the staff is expected to utilize the system is important to the assimilation of travel nurses if they

are to take on the technological feature of the host culture.

The kinship and social factors that define a nursing unit’s culture may be the most

difficult for the travel nurse to accept as their own and assimilate into. While the travel nurse

may be appreciated by the permanent staff, there is often a hesitation to immediately accept the

travel nurse into the social sphere of the nursing unit. This may negatively impact the travel

nurse’s morale, as they may feel isolated and without support from their peers. It is important for

unit leadership to encourage a welcoming atmosphere for the travel nurse. It is also important for

the travel nurse to make efforts to include themselves into the social dimensions of the host unit.

Travel nurses often have a unique social culture outside of the host unit as well. It is common to

find online social groups dedicated to travel nurses where support is given and activities are

posted so that travel nurses are not without fun activities to do while they are away from their

primary social groups, such as their friends and family from home.

Finally, the cultural values and lifeways of a unit must be adapted by the travel nurse in

order for the traveler to feel fully part of the unit’s culture. Some of these values may be the
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value of acceptance and respect of all members of the healthcare team outside of nursing.

Lifeways might include the way report is given from one shift to another, or how tasks are

managed during the shift. For the travel nurse to assimilate into the culture of the unit, they must

become familiar with these ways and participate in them.

As the examples indicate, nurses develop their own culture, seen through language and

technological factors, kinship, and cultural values and lifeways. Leininger’s sunrise model is an

excellent guide to explore these factors and others regarding the lived experiences and

assimilation of travel nurses into the culture of assigned nursing units.

Definitions

Conceptual Definitions

Leininger (1996) defined culture as “the lifeways of a particular group with its values,

beliefs, norms, patterns, and practices that are learned, shared, and transmitted

intergenerationally” (p. 73). This research study will explore how the culture of a unit affects

travel nurses and their ability to assimilate into the culture of the unit and feel comfortable

practicing. How the travel nurse relates to the permanent staff, management, and fellow travelers

at their assigned facility affects the culture of the unit and facility.

The values that travel nurses and permanent staff RNs should both possess are a

commitment to excellent patient care. Though the review of the literature indicates that

temporary staff or travel RNs do not share the same commitment to the organization as do

permanent staff members, they should respect the process of providing good nursing care to their

patients (Mazurenko et al., 2015; Yeh et al., 2007). This will encourage a sense of collegiality

and teamwork as well as respect among both types of RNs practicing in the facility.
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The patterns and norms of a nursing unit’s culture may be specific and highly regarded as

important to the way the unit is run. Travel nurses must respect these norms if they are to

assimilate into the culture of the unit. One such example is shift report. Some facilities have

policies that require nurses to do bedside reporting. Others do not have this requirement. Some

have a time dedicated at the beginning of the shift to give an overview of the patient population

and any pertinent information about patients such as do not resuscitate status, high-fall risks, and

discharge plans. The travel nurse must respect these practices of the unit despite them being

potentially different from how the traveler has previously been used to.

Operational Definitions

For the proposed study, travel nursing is a career choice by RNs to take their knowledge

and skills to an alternate destination to practice for a short period. Travel nurses work with

agencies that place them in facilities and offer benefits, such as housing and compensation for

meals and incidentals. Culture is the way of life on a nursing unit--how nurses interact with each

other and those around them including their patients. Assimilation is the way the travel nurse

becomes a part of the unit during their short stay as a contracted employee. Their feelings of

comfort, acceptance, and support are taken into consideration.

Research Questions

To avoid bias to this qualitative research study, a definitive hypothesis will not be given.

However, the goal of the study is to determine the lived experiences and the factors affecting

travel nurses and their assimilation into the culture of their assigned nursing unit. Two open-

ended questions will be used to gather data:

RQ1. Please tell me about your experiences as a travel nurse.

RQ2. What was your experience as you assimilated into the culture of the assigned nursing unit?
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Prompts

Prompts will be used if sufficient information is not delivered with the open-ended

questions:

1. Tell me how the nurses/unit/hospital made you feel welcome/included?

2. Tell me how the nurses/unit/hospital made you feel unwelcome/not included?

3. Tell me what you did to feel more comfortable on the unit?

4. Describe challenges you encountered as a new travel nurse feeling accepted/supported?

5. What were your fears about being accepted/supported?

6. Describe a memorable moment as a travel nurse of being accepted or not accepted into a

unit’s culture?

Methodology
Design

A descriptive, phenomenological qualitative research design will be used for the study.

This method has been chosen because it allows the participants to describe, in detail, their

experiences as travel nurses (Grove, Burns, & Gray, 2013). Colaizzi’s strategy for

phenomenological data collection and analysis will be used in this study.

Plan for Data Collection Using Colaizzi’s Strategy

In this study, semi-structured interviews will be conducted using two open-ended

questions. Prompts will be used if sufficient information is not delivered with the open-ended

questions. Participants will be encouraged to dialogue freely and describe their experiences.

Each interview will last from 45 minutes to an hour. This will be conducted by the primary

researcher. The need for a second contact will be arranged to discuss the data collected in the

first interview and to make sure that the collected data reflects their experiences. The level of

data saturation will be determined by the researcher and the research advisor. Data saturation
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will be determined by consensus between the researcher and the research advisor. The

anticipated sample size is 15 participants. The verbatim transcripts will be double-checked by the

research advisor who has experience in qualitative research to verify validity.

A convenience sample will be obtained from one of the online travel nursing Facebook

group pages. An announcement will be posted on the Facebook group page requesting

participation in a nursing research study regarding factors that contribute to travel nurses’

assimilation into the culture of their assigned unit. The researcher will also use the snowball

method for gathering participants and will start with acquaintances who have experienced travel

nursing.

Interviews will be scheduled at the convenience of the participants. Contamination of

data will be avoided by carefully recording the participants’ responses using a recording device.

Numbers will be assigned to the participants (as P1, P2 and so on) so that data will remain

organized and identities will remain anonymous. Printed informed consents will be kept in

envelopes separate from the transcribed interviews and notes. Electronic documents will be

carefully transcribed verbatim and kept in a password protected locked file on a secured hard

drive in the researcher’s home.

Online participants will be asked via Facebook messenger if they would be willing to

participate in a telephone interview on the topic of travel nurse assimilation. The acquaintances

of the researcher and participants found using the snowball method will be asked to participate in

person or over the phone. They will not be intimidated into participating in the study in any way.

Participants will be sent a consent form electronically regarding the specifics of the study and

will be informed about the anonymity of the results. Participants agreeing to telephone
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interviews will be asked for their email address to send informed consent. The interview will

begin upon receiving the photocopy of the signed consent.

Plan for Data Analysis Using Colaizzi’s Strategy

Speziale and Carpenter (2007) described the following steps for Colaizzi’s process for

phenomenological data analysis.

1. Each transcript will be read and re-read to obtain a general sense of the entire content.

2. For each transcript, significant statements that pertain to the phenomenon under study will be

extracted. These statements will be recorded on a separate sheet noting their page and line

numbers.

3. Meanings will be formulated from significant statements.

4. The formulated meanings will be sorted into categories, clusters of themes, and themes.

5. The findings of the study will be integrated into an exhaustive description of the phenomenon.

6. The fundamental structure of the phenomenon will be described.

7. In the end, validation of the findings will be sought from the research participants to compare

the researcher's descriptive results with their experiences. Findings will be shared with

participants via email if requested. A copy of the finished research study will be sent to them

upon their request.

The data obtained will be from recorded interviews that have been transcribed into a

Word® document. The data will be analyzed for themes and trends in the responses. Emergent

themes will be analyzed for categories of clusters, the frequency of occurrence by individual

word or phrases, and frequency of occurrence by clustered category (see Appendix B). To

prevent bias, an effort will be made to encourage participants to respond to the lived experiences

of a travel nurse rather than just answering the prompts. Demographic information will be
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calculated for frequency and percentage and displayed in a table. Significant information will be

described in the results section.

Setting

The setting for the interviews will be online, face-to-face and over the phone. Participants

will be asked to find a quiet, comfortable place to answer the research questions. For telephone

interviews, the researcher will be located in her own home in a comfortable setting where it is

feasible to actively listen and record the interview. The online setting was chosen to conduct

most of the interviews because of the broad population that will be found in this setting using a

Facebook group page. Travel nurses from all over the United States subscribe to websites on

travel nursing. This will potentially allow the researcher to gather travel nurse participants who

subscribe to the website, allowing for diversity in the research sample.

Sample

The sample for this study will be both male and female RNs over 18 years of age who are

employed by a travel nurse company or who have had previous experience as a travel nurse. A

convenience sample of nurses of varied levels of experience will be interviewed about their lived

experiences as travel nurses and the factors influencing their feelings of acceptance or

assimilation into the culture of their assigned nursing unit. To stratify the sample, and increase

the transferability of the results, the goal is to acquire as many nurses of varying age, gender,

education level, degree, experience, type of nursing, and ethnicity until data saturation is

obtained. Websites, social media groups, personal acquaintances, forum groups and snowball

sampling will be used to recruit participants of varying demographics.

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Method of Sampling

Participants will be requested to join the study via social media using the Facebook

website, previous contacts, and snowball sampling. The researcher through contacts knows some

of the nurses while working as a travel nurse. Members willing to participate in the study will be

entered into the study. Participants will be interviewed until data saturation occurs. Permission

for recording will be obtained through the informed consent and verbal request. The travel nurse

participants will be labeled as P1, P2 and so on until data saturation is reached.

Ethical Considerations

Permission to conduct the study will be obtained from the Bethel College Institutional

Review Board (IRB). The researcher has completed the National Institute of Health (NIH)

certificate (see Appendix C). Only after verbal acceptance will the researcher begin to request

interviews from the travel nurses. An informed consent (see Appendix D) will be sent via email

to the online participants. Consents for others will be collected face-to-face. Once signed,

participants will be asked to send or give the signed form back to the researcher via scanned

email. For the online interviews, confidentiality will be maintained by recording the interviews.

Names will be excluded from the interview documents. The recorded interviews will be

transcribed onto a Word® document, which will be saved onto a locked computer in a zip file.

This will ensure that participants’ responses will remain anonymous. The data will be stored,

password protected, in the researcher’s possession for three years and then permanently

destroyed. Any written paperwork will be double-locked and kept safe until destroyed with the

rest of the documents.

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Instrument

The researcher will use 1:1 interviews and telephone interviews to glean information on

the personal experiences of the participants’ experiences as travel nurses (see Appendix E). The

participant’s answers will be recorded, transcribed, and evaluated for themes related to

assimilation, acceptance, and culture. The questions have been developed by the researcher and

are based on a thorough literature review of travel nurses and their assimilation into the culture

of the assigned unit. The research tool has been developed and validated with the guidance of

nursing faculty. Prompts will be used as needed.

Potential Limitations

Some of the interviews will likely be conducted via telephone. The weakness of this

method is that the researcher and participant will not be interviewing in person. This may prevent

the researcher from making inferences about body language and assessing any extraneous

environmental variables that might be present during the interview. Finding a sufficient sample

size and demographic variability could be a limitation. Limited experience of the researcher in

the qualitative inquiry may be another limitation. Sometimes words may not be heard clearly on

the recorder, thus making it difficult to translate into verbatim.

Potential Implications

Results from this study may benefit future nurses interested in pursuing a career in travel

nursing. The information provided may give them a clearer understanding of the challenges and

benefits offered by this alternative. This study may also provide travel companies with a resource

to refer their new travel nurse clients to when explaining the lived experiences that are common

for travel nurses. Nurse managers may find this study helpful when deciding to hire their first

travel nurse.
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ASSIMILATION OF TRAVEL NURSES
This study may give nurses thinking about travel nursing a greater insight into the life of

a travel nurse. It may allow them to gain a better understanding of the challenges and benefits of

travel nursing before they choose to accept the assignment. This study may also assist travel

companies to better prepare their travel nurses before beginning a travel assignment.

Conclusion

Travel nursing allows health care managers to fill staffing gaps when shortages would

otherwise cause an interruption in safe and quality nursing care in an organization. A large gap

in published nursing research on the topic of travel nursing was found after a thorough review of

the literature. There seem to be pros and cons in travel nursing. Exploring the lived experiences

and the factors affecting assimilation of travel nurses into the culture of assigned nursing units

may help add to the current literature. This study may help future travel nurses assimilate

effectively into the culture of the assigned unit.

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ASSIMILATION OF TRAVEL NURSES
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Appendix A
Leininger's Sunrise Model

Leininger's Sunrise Model by M. Leininger (1996) in Culture care theory, research, and practice.

Nursing Science Quarterly, 9(2), 71-78.

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Appendix B
Results of Qualitative Content Analysis

Emergent Themes from Qualitative Data

Categories of Clusters of Emergent Themes (n = ) Frequency/ Frequency/

Occurrence Occurrence By
By Individual Word Clustered Category
or Phrase
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Appendix C
NIH Certificate
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Appendix D
Informed Consent

Study Title: The Lived Experiences and the Factors Affecting Assimilation of Travel Nurses
into the Culture of Assigned Nursing Units
Investigators: Kristen Eden, RN, BSN
MSN Nursing Student, Bethel College School of Nursing, Mishawaka, Indiana
Kristen Eden is an MSN nursing student at Bethel College. She is studying the lived
experiences and the factors affecting assimilation of travel nurses into the culture of assigned
nursing units. By participating in this study, you may provide important information to the future
nurses regarding travel nurse opportunity.
The Institutional Review Board at Bethel College, Mishawaka, IN, approved the study
and procedures. The study involves no foreseeable risks or harm to you. You are asked to
participate in a 45-60 minute interview. The interview will be recorded for transcription
purposes and the recording will be deleted after use. You are free to ask questions about the
study or about being a participant and you may call or contact Dr. Sam Abraham at the address
or phone numbers listed below if you have any further questions.
You are being asked to take part in this study because you are 18 years of age or older
and you are a travel nurse. Your participation in this study is voluntary; you are under no
obligation to participate. You have the right to withdraw at any time.
This consent and the interview notes will be kept separately to ensure confidentiality by
not associating your name with the transcribed documents. This consent and completed papers
will be safely stored in a secure location by the researcher for three years and then destroyed
permanently. The results from this study may be used for dissemination in conferences or
publication in a nursing journal.
By signing this informed consent, I agree that I have read and understand the content,
have had all of my questions concerning this research answered, and I agree to participate in
this study. I have been given a copy of this consent form and may contact the student Kristen
Eden through the phone number or e-mail listed below.

____________________________________ _________________
Signature of Participant Date

I have explained this study to the above participant, have sought his/her understanding
for informed consent, and have provided him/her with his/her copy of this form.

___________________________________ ________________
Signature of Researcher Date

Kristen Eden, kristen.eden@bethelcollege.edu Dr. Sam Abraham

Bethel College School of Nursing samuel.abraham@bethelcollege.edu
1001 Bethel Circle Mishawaka, IN 46545 Bethel College School of Nursing
P. 219-798-8730 1001 Bethel Circle Mishawaka, IN 46545
P: 269-240-7467
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Appendix E
Research Instrument

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

Demographic Background (please complete as appropriate):

1. How many travel assignments have you completed?

▢ 1-5 ▢ 6-10 ▢ 11-15 ▢ 16-20 ▢ 21+

2.) Age:

18-25 26-35 36-45 46-60 60+

3. Gender:

▢Male ▢Female

3. What is your highest level of education?

▢Diploma ▢ADN ▢BSN ▢MSN ▢Other_______________

4. What is your ethnic background? ___________________

5. What type of nursing do you practice as a travel nurse?______________

Qualitative Questions:

Please tell me about your experiences as a travel nurse. What was your experience as you

assimilated into the culture of the assigned nursing unit?

Prompts:

1. Tell me how the nurses/unit/hospital made you feel welcome/included?

2. Tell me how the nurses/unit/hospital made you feel unwelcome/not included?

3. Tell me what you did to feel more comfortable on the unit?

4. Describe the challenges you encountered as a new travel nurse feeling

accepted/supported?
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5. What were your fears about being accepted/supported?

6. Describe a memorable moment as a travel nurse of being accepted or not accepted into a

unit’s culture?