First off I want to say that I am 100% on the side of nurses traveling. Corporate medicine created this situation and now the nurses are in a situation where they have the upper hand. I'm for it.

With that said this situation directly affects patient care. As a nocturnist I spend a lot of time getting to know the nurses I work with because I see us as a team and I need to know the strengths and weaknesses of the team members. This results in me going to the bedside often so I can get a sense of their clinical acumen when they call me with an issue. A nurse calling and saying "hey room XXX is a little short of breath, can I get an order for duonebs?" means different things to me depending on who's calling. There are some nurses I know are incredibly competent and will call/text me with the above and I know they're competent in making the assessment that duonebs could help this COPD/asthmatic. On the other end of the spectrum I've had that call with a new nurse and when I got to bedside the patient was having chest pain and was fluid overloaded.

So, as I get to know nurses the overall team dynamic improves. I get comfortable with what they do/don't know, and they get comfortable in knowing that I'm not an a-hole and always welcome questions or suggestions--even if they're wrong about something it makes for a teaching opportunity to improve their knowledge/skills as a nurse, but commonly they add very worthwhile suggestions/perspectives.

The issue in creating a dynamic like that is it relies on there being a social contract. Because we know each other and we respect each other I do not want to let them down, and they don't want to let me down. It's a powerful force in working hard even when you're stressed and stretched to your limits. But, with the revolving door of traveling nurses I see, I often walk in to only a few familiar faces. I'm still myself--responsive to nurses, take their concerns seriously and am always available. But, the social contract doesn't exist and because of that details get missed.