Sorry, Sorry, Sorry

Hello dear reader...sorry I have been absent. I can't begin to describe the pile of shit personally and professionally I have had to sift through in the last months. I shall leave the personal stuff...well...personal. Professionally is a totally different ball game. This picture accurately describes how I feel about my current assignment:

My feelings on the subject are somewhere past that 11 mark. I was told by the nursing recruiter that this assignment was a transitional ICU from ER. That means we take patients that are too sick to sit in the emergency room, stabilize them, and then dispurse them among the various ICUs as appropriate. It sounded like my dream. Stabilize and ship em out. When I phone interviewed with the nurse manager, she told me it was fast paced and interesting. Psh. 

What I have walked into is a mish mash of inappropriately labeled "ICU" patients and chronically ill ventilator patients with tracheostomies.  It's miserable, long term care patients with no hope of ever getting better, with a quality of life that is similar to a field of cabbages. It's damn depressing. 

Let's get this straight right now. I am not knocking the nurses that do that type of work... God bless them. However, I would rather pluck each one of my eyelashes off with a dull spoon than do it. I have a serious ethical problem with keeping these people artificially alive. Many times, it's against their will. In my humble opinion, the families have created a cruel cage for their loved ones soul. Put that in your pipe and smoke it the next time you see someone on life support. 

I digress, however.  As a new travel nurse, I have learned so much this assignment. The first and largest thing is that your co-workers can make or break your assignment. I have met some of the most caring, knowledgable nurses and ancillary staff this go around. They have treated me with respect, kindness, and made me feel a part of their team. I am sad to move on from such a great group of people. They sick and twisted sense of humor has made working all of the time hilarious and easy. 

If any of you are reading this, I expect a party:

Another doozy I have figured this time is money, money, money. 

My current agency ain't payin' me shit. When I accepted this new assignment, I was not aware of this obviously. Other than the fact that I don't pay rent, I make no more money than I did at my full-time job in Florida. Florida is one of the lowest paying states in the nation. Does anyone see the problem here? The wonderful thing about travelers is that they stick together. A very nice woman at this assignment gave me some education about traveling, including how to squeeze money out of these agencies like a sponge. She's been doing it for five years and has cleared $100,000 a year for the past two. Say wha?!?

This nurse laid it down for me. These recruiters are not your friends. They are nice to you, ask how your assignment is going, show concern for your quality of life, etc. They ultimately do not care. What they do care about is keeping you happy enough to take a second and third assignment with them. It turns out that recruiters work on a system that is similar to commission-based pay. They need you to make money. I have discovered that you, however, do not need them. After you muscle through your first couple of assignments, finding a new one is a piece of cake. You will have recruiters calling you so often near the end of assignments that you have to put your phone on silent. Literally. Several months ago I had put my resume in with different companies and at one point last week, I was receiving five calls a day about my contract ending soon. These people are literally tripping over themselves to hire you! 

The trick to making money with travel nursing is shopping around. All recruiters will tell you not to do it: "It's a bad idea" "You won't get interviews if you're submitted twice." "It's poor manners"

Screw. Manners. 

I want my money. It's mine. I earn it. I sacrifice a life with family and friends for it. I disrupt my dog's routine for it. I sacrificed my 40 pair shoe collection to move. Give. Me. My. Money. You as the travel nurse, the one that has to crawl out of bed, show up to work, stay up all night, get bled on, puked on, and yelled at, are the one in control. It requires you to be assertive and organized. Two things that a lot of people aren't good at. For my upcoming contract next month that I will discuss later, I negotiated a much better deal for myself with a different agency then I am using now. However, before I accepted and interviewed with this one, I was working with six agencies. Six! I was being submitted left and right to places. I had 3 phone interviews in one day. You know how I made that happen? I was bluntly honest with each recruiter. The people that know me in real life know that that isn't an issue with me, but for some it is. The recruiters try to upsell their companies various programs, free this, free that, "advantage program #367," etc. 

There are only a few things you need to know about your contract in the long run:

1. How much am I taking home after taxes every Friday? (And yes, you can insist they pay you every week.)  We will label this "The Bottom Line"

2. When does my insurance start and how much is it costing me every month? We will label this "Benefits" (duh)

3. Can and will you give me a sign-on bonus and/or a completion bonus and/or travel reimbursement? We will label this "Free Money" 

• This one is complicated. "Bonuses" are taxable, "Travel reimbursment" is not. Depending on what it is labeled, you will have to factor in -40% for taxes of whatever number they give you. You learn all sorts of things about tax laws as a travel nurse that you wish you never knew. 

4. This last one is for people who don't care about how much money they make and have no sense of adventure and who are scared of life in general. Housing. Ugh. Look, I took housing this assignment because of the situation created by my last one (see previous posts), but I will NEVER, EVER do that again. It's not worth it.  All I have ended up with is a too large apartment with rent-a-furniture and a tiny paycheck. If it's your first assignment, or if you're going to the middle plains of Montana with no Craigslist, then you need this list item. Ask how much the housing is taking from your pay, and EXACTLY what accommodations you are going to be given. Down to whether or not you are going to have sheets provided or not. We will label this "Housing" (2nd Duh)

So. This is how the quality of a nursing contract is formulated, not necessarily in any order, everyone has different priorities: 

Currently, mine are location and money, therefore:

Location+Money(Bottom Line+Free Money)+Benefits+Housing(Sissy!!) = 

Magical Nursing Contract of WOW!

If after plugging in all of those items you aren't left with the above feeling, NEXT!!!! I have the perfect example. I was first offered a contract in a hospital in LA. First of all, I think I would hate LA. Second of all, it's more expensive than NYC, and not half as worth it. Too much silicone. The money was pathetic...even for the location I am at now and there are Amish people with buggies here. The insurance was free and Day 1, but as a healthy 20-something I could give two shits. Then comes the housing. Even if I didn't take the housing, the pay was abysmal, and then they told me that the company wanted to place me in Long Beach. EW.  When I plug that into the equation, this is what happens:

Now, I contacted the agency the above referenced seasoned traveler uses, and got a great recruiter. I told him I wanted to go one of three places, in a specific order: Washington state, Colorado, or Southern Florida, not North. I then explained that if he couldn't find me anything there, I would work with someone else. I also told him I wouldn't work for less than a certain amount each week. I'm mildly uncomfortable flat out telling my readers that number, because people in my personal life read this. Furthermore, I told him I would no longer work in Medical ICUs because the only type of medicine I really liked was Surgical and Neuro Trauma. You know who I interviewed with two days later? A hospital in Washington, for a combination Neuro and Surgical Trauma ICU, with more money than I asked for, with Free Money and an advance for travel, and cheap benefits. They are also paying my deposit on the place I found to live while I work. So, there. 

You know what my current agency said to me the DAY before that? "I'm sorry, I'm just not seeing anything with the requirements you gave me."  BOOM!!!!!!

Most of the time in life, you can't always get what you want. Bad things happen (See previous post, sometimes it's for a reason), situations go awry, and things out of your personal control get in the way. Then...sometimes...you work your ass off and your dreams come true.  

Now I need a nap.  I have a 3,000 mile drive to complete.  

What am I doing here, and who are you people?

Over the past couple of weeks, I have packed, moved 2.5 hours south, unpacked, taken a 200 question ICU/EKG pass/fail test (I would have gotten cancelled, more on that later), gotten six hours of orientation in a hospital I have never stepped foot in (not unusual), started the new assignment, picked up overtime, lost all of my mail, set the stove on fire in the company apartment (crisis averted), spilled the contents of a fist sized sacral wound on my shoe, coded a patient, and finally, got punched in the face by a detoxing psych patient.

I need a beer.

I will say, this facility and its surrounding city is a huge improvement over my last assignment. The unit is mostly organized and clean, the staff is fairly nice, and their computer system is tolerable. After comparing the worst case scenario from my last assignment with my current one, I seem to have found the two extremes of work conditions within travel nursing. I had to learn the hard way, but I am glad that I got it out of the way early. However, after settling into a routine over the past several days, I have encountered my toughest obstacle yet: 

Loneliness

Professionally, I feel as though I can handle most situations either crisis or routine. If a patient's heart stops, you press the big blue button and start compressions.  If someone's sugar is a whopping 10 points and they are unconscious, I just give them dextrose through their IV.  As a nurse I can deal with screaming physicians, condescending families, and bitchy co-workers that need an attitude check. What I can't seem to navigate are my "feelings."  Ugh. Just the word makes me shudder. While I was preparing to take this nursing position, all I could consider was the glamorous opportunities that I would have while I traveled all over the US with my dog. I had faintly mentioned to myself that I would have a reduced social life, but it was a fleeting thought that was overrun by my elation at the possibilities.  

Even among the chaos of my last assignment gone awry, I had another traveler in my apartment building that was my age. We went for drinks a few times, bitched about the hospital, and were general companions. I've been in this new place for two weeks... with no one. Well, I do have Lucy, but you can reference my previous post about how she feels about me these days. Admittedly, I did kind of start seeing someone while I have been here. They are back in my last city though, 2.5 hours away. I can drive fairly frequently to see them, but it is difficult. So, you get the point, mostly alone all of the time.

This all raises a couple of questions about travel nursing. The big one is, "Is this all worth it?" I am away from my entire support system, anything familiar, and since I live in a company furnished apartment, I don't even really have my own things. At the recommendation of a traveler that worked at my last full time job, I did bring a few knick knacks with me that have sentimental meaning. I really do think that that was the best tip I received prior to my departure. When I come home from a 14 or 15 hour shift, it's nice to see stuff my Mom and some friends gave me, even if the benefit is subconscious. 

Normally I would just work 4-5 shifts a week, at 12 hours a piece to fill my time. However, this particular facility frowns on overtime for travelers. I can understand that. A normal employee cost them 1.5 times more than normal. According to my shady math, I cost them 4x more than normal by the time they pay the agency and me. On a healthcare system that is already burdened by cut backs, new Medicare reimbursement policies, and a push to go to entirely electronic medical records, the cost of travelers adds fuel to the fire. Each hospital you go to is going to be in various states of financial disrepair, that is becoming the new norm among medical facilities. It's disheartening, but it's the present reality. 

My personal reality is that I currently can't escape myself. It is just me, myself, and I, with no distractions. As someone that is in their twenties, that brings the whole quintessential "discovering myself" thing to a whole other level.  I have no one to tell me what to do, when to do it. I have several days off at a time, so I really have no schedule of any kind. I've never had this level of freedom before. It's...different. I am not really able to put my finger on it yet. Most people say they would kill for what I do, but the bottom line is that most people require structure to function in a productive manner as human beings whether they like it or not.

So, is this worth it? Absolutely. Sometimes I have to re-convince myself of that answer, but in the end it truly is. The nights alone and endless amounts of time may seem long and empty right now but the adventures I am having in between shifts and in between assignments has far outweighed my temporary bouts of sadness. The sadness and loneliness is not something that really gets spoken about a lot in other blogs and reference material, at least not the ones I looked into. I will tell you, it is there, and it sucks. Sometimes, its palpable. 

It's nights like that on an assignment where you discover who your real friends are. I have friends spread out all over the country and with the advent of Facebook, it's damn near impossible not to know what they are up too.  You have to learn to be honest with people, and vocalize where your head is at. When your primary means of communication is either in text or through voice, it's difficult for people to know that something is up. I find that being away from home has forced my conversation to be more dense and meaningful then before. The "Out of Sight, Out of Mind" theory will really teach you about the people you surrounded yourself with before you left. Friends that love you will remember to contact you, and check up on you. Remember those people, and take note of their efforts. 

I'm coming up on two months of traveling, and the most enjoyable thing I have learned is where my priorities lie. It's no longer about partying (I am really good at it, ask anyone), spending money on frivolous things (Also a talent of mine), or working my way into another tax bracket. It's about other people as human beings, and what you can contribute to their lives, may it be your family, your friends or your patients. If you keep that straight, the rest will work itself out. 

And PS: That pass/fail test? It's a test that some assignments give travelers on arrival in order to determine their eligibility to work. You can drive across the country to start a new job and your ass will be sent packing before orientation even starts if you don't know your stuff. Whatever your specialty may be, you better love it, own it, and learn it.

OH, and just so you know, I made a 95% IN YO' FACE!

Day 12 of Unemployment: Things I have discovered thus far.

Well, here I am. I'm in my agency apartment with my dog and all of my belongings. Twiddling my thumbs...Looking around...with nothing on my agenda for...days. There's no where I have to be, nothing I have to do, for the first time in my life since I was a teen. I've had a full time job since I was 16. I went to the school board in high school and got a piece of paper signed so that I could work more hours than the laws allowed. As an adult, I have always worked overtime and offered to pick up shifts. I am a machine. Then, that whole "fired" thing happened.

I should start off by saying that my outlook is bright and sunny. My agency found a new assignment for me in 14 hours. Literally. My recruiter submitted me to five hospitals at 0830 that Monday morning, and at 2130 that night I had a phone interview with an ICU night manager. By 2230 she had called the agency and left a message that she would love to have me. Hear that people? LOVE. I certainly felt vindicated...then I checked my bank account. My victory balloon promptly deflated.  The realization that I would go an entire 4 weeks without a paycheck was more horrifying than an unannounced JCAHO inspection.  From that moment on, I went into financial hoarder mode. I prepared the apartment like a three week blizzard was coming. I stocked the cabinets with dry goods, bread and milk. I bought some extra dog food for my pug, Lucy, and withdrew $100 cash to keep in my sock drawer for an absolute emergency (wine is not an emergency). I was finally the poster child for preparation, so I went to bed.

Fast forward 12 days.  Since I was cancelled, these are the things I have discovered:

1)  I can watch 4.6 episodes of terrible reality television on my iPhone before it dies.

2)  It is actually possible for your dog to get tired of you. Lucy the Pug now resides under the side table in the living room despite my pleas for attention.

3)  If you walk in a circular pattern through my apartment 36 times, it equals 0.15 miles, according to Google Maps AND Apple Maps within 0.01 accuracy. 

4)  The night shift employees at Planet Fitness gym are NOT my friends at 0200,  they don't get paid enough.

5)  You can use a tea bag about 2.5 times before you actually HAVE to throw it away. It's 0.5 the third time because the taste really is questionable at that point. 

You get my point. I've had a lot of extra time on my hands. Time that would normally be filled with codes, poop, blood, and other delightful, fun things. Somewhere in that 12 days though, I happened upon some stuff that was unexpected:

1)  When you're on the road and you know no one within a 200 mile radius, you and your journal are your best friends. As a travel nurse, you have the unique opportunity to be whoever you want to be every 13 weeks. Don't waste it. Spend time discovering YOU. Want people to call you by your middle name for a while? Introduce yourself that way on your first day.  Want to chop all of your hair off and wear mostly black? Do it! (Stay professional!)  Just think of the freedom. It's terrifying and exhilarating.

2)  When implementing a five year plan, it only works if you actually follow it. There are thousands of "on-line only" BSN programs. I currently hold an Associate's degree in nursing which has gotten me very far. However, to really move yourself up the RN ladder, your bachelor's degree is the next step.  Turns out if you ask nicely, some of the schools will waive their application fee for various reasons.  Just do your research and make sure the school is reputable and accredited.  Thanks to my job's demise, I currently start school at the end of August.  Also, depending on your specialty, there are certifications that you can test for that usually turn into a pay increase. I am currently studying for my CCRN (Critical Care Registered Nurse), but there is one for Med Surg, OR, ER, and various other departments. 

3)  Learning never stops. When it does, you're in trouble. I have learned to how to make a penny stretch three different ways, and that I don't die because I failed to have my daily mocha-skinny-large-extra foam-half-caff monstrosity at $4.75 a cup. Between previously selling all of my belongings and now being essentially penniless, I realized why Tibetan Monks are so at peace. Ok! Maybe that last sentence was a little dramatic, but you get the point: Appreciate what you have when you have it. There are practical lessons also. I found out that you can wash ziploc bags in the dishwasher and they change into new, re-usable ziploc bags. Surprisingly, it turns out I don't have to have the most expensive toilet paper...it all ends up the same place. My ass is none the wiser. 

See? This is me, turning lemons into lemonade. Nurses love lemonade (with vodka).

I leave in a few days for my new city, my new apartment, and my new assignment. I will get another paycheck in couple of weeks, and my life will eventually return to normal once I catch up a few things. One thing will be very, very different though. Me. I now know what it feels like to be completely alone and completely out of options. I barely evaded being homeless and unemployed. I never want to feel that way ever again. It's like a bad dream. So when my new job starts on Monday, I plan to show up with spankin' new Big Girl Panties on(Hot pink! With Lace!). I can't wait!

Oh, and because I have looked for an excuse for three entries now, here's my pug Lucy that I mentioned earlier:

She's truly my best friend.

The Most Embarrassing Moment of My Life...and the Wonderful Lessons that Followed

Hold on to your hats, because this might be a long one.

I was going to do this blog in an organized fashion, with posts remaining in chronological order according to my experiences but I really just wanted to get this post off of my chest and out of the way. It's embarrassing, humiliating, and frankly, I want to forget it ever happened. However, I believe that it has happened to other nurses, young and old, and it will continue to happen to other nurses: good nurses, terrible nurses, and nurses that are just average. If you feel it necessary to judge, please leave a comment or shoot me an email detailing your concerns.

I would like to preface this story with a disclaimer: I am a good nurse. I am on my way to being an excellent nurse because I have had excellent nurses train me. I hold a high standard of care, and I hold my co-workers to the same level. I am willing to help in almost any situation or emergency. However, no one, especially not me, is perfect. I had made "The Leap," I sold all of my belongings (I'll discuss sell vs. store in another post), I had quit my full time ICU position, and I had moved the dog and I 1,200 miles north. Here I was! I had arrived! I am living my career dream! I am full of hope! Vigor! Excitement!  Then, I got fired.

Yep! You heard me. Three weeks into my very first travel assignment, I. Got. Fired.

I am not willing to sit here and preface the reasons I was "cancelled," with a lot of excuses about the facility and the circumstances it was under and yadda yadda. I screwed up.  Plain and simple. The ICU I was working in hadn't had air conditioning for a while, and it was 82 degrees in the nurses station. It was about 0500, and I had just sit down to chart. I wrote 0525 on my chart, wrote a note with my head in my hand, and then jolted awake at 0529 according to the monitor I was sitting in front of. Three years of working 60-72 hour weeks of night shift, and this has never, ever happened. Ever. I got up, walked around and grabbed myself a cup of coffee. I continued on about my morning, vowing to never let that happen again.

It was about ten minutes later when the Nursing Supervisor and Nurse Manager that had come in early for a meeting, approached me. In front of everyone. Publicly. The supervisor demanded that I give her my badge, and get out before they called security. There was no preface, no warning, no privacy for me, and certainly no dignity. "Another nurse saw you sleeping at the desk and said you weren't doing your work, so get out. NOW" She actually yelled. All the while, I sat there with my mouth agape. I was in total shock.

I got in my car and drove to my company provided apartment, and started packing. I was convinced that I was going to be evicted first thing in the morning and it was in my best interest to flee in the night. I at least had the rational thought to call my agencies 24 Hour Emergency Clinical Hotline. I had no idea what it was going to accomplish, but I thought I would at least let someone know that on this fabulous Saturday morning that I had gotten shit-canned.  I then continued to maniacally pack my things...My apartment looked like a church rummage sale.

I eventually fell asleep (in bed this time!!!), and was awakened by my recruiter's groggy Its-Saturday-Morning-What-the-hell-is-going-on voice. I explained what happened, and do you know what her response was? "Ok, we will find you another assignment Monday, don't worry about it. Normally it would be an issue, but you have extensively documented the issues with the facility, and honestly, it will probably be better for you in the long run." For the second time within a 24 hour period, I was actually speechless. I'm never rendered speechless people!!!!

You see my dear readers, as every good nurse should, I used my nurse/spidey sense and recognized that I was in a high risk clinical setting, and had been documenting, through emails to my agency, all of my safety concerns with the facility over the past three weeks.  I won't list them here, but they were blatant and compromised my patients.  Sure, I really screwed up. I made a mistake. I let the heat and the time of day get to me and I dozed off. You know I will never make that mistake again, that's for damn sure. However, I learned a larger lesson. Document your face off. Documentation isn't always just in the patient's chart. Don't let your unfamiliarity of the facility overrun your deeply ingrained nursing "sense." Express your safety concerns to the chain of command. If they won't listen, you do the best you can in the situation for your patients, and then you call your agency. You can call the 24 hour hotline at night. You'll normally get a call back in three hours. Don't ignore that feeling in the pit of your stomach that something is wrong!

 You will hear that agencies don't like, "complainers."  This is for the most part, true. The reason the facility is hiring travelers is because they needed help. However, use your common sense. When something is either compromising the patient, or compromising your license, or both. Stop.  Express your concern. There is a difference between "complaining" and "protecting yourself."  No one can take your license away from you if you don't do something that you know is wrong or harmful. Always remember that.  A good way to lead into a problem is, "I have some safety concerns that I would like to address." No house supervisor will have a rock to stand on when you use that phrase.

Now that this situation has happened to me, the worst is over. I can only go "up" from here. I have learned from my mistake, but I also learned to listen to my gut. Your ultimate loyalty is to your patient, don't forget that.

P.S. My recruiter did find me another assignment that Monday, and I start next week. If this ever happens to you, you are able to recover. It's not the end of the world.

P.P.S. All of my documented safety concerns were addressed in a conference call between my agency's corporate office and the CEO, DON, and Unit manager of the assigned hospital. The change at the facility is pending.

The beginning of a new adventure.

While still in nursing school, all you hear about is how much money travel nurses make, how adventurous it can be, and what a lifestyle it is. I've been at it for approximately a month now, and it's.... fabulous! All of the things "they" tell you are true. The hardest part is truly making the leap of faith and then following through.  I'm here to tell you: You can do it!

About two months ago, I got an itch. I was living in a small town in Florida about ten minutes from the beach, in a perfectly nice apartment that I found at a reasonable price. I was working in a great surgical ICU where we also took care of traumas and neuro patients. The night shift crew I worked with were all fantastic people and nurses, and we worked (for the most part), cohesively.  Despite all of this, I kept feeling as though there had to be something else out there....something BIGGER. I'm not talking about the hospital, or the town I was working in. I'm talking in a global sense. This "feeling" is sort of what started this whole thing. 

Travel nursing is something different for everyone. Some are parents, spouses and partners that need the extra money and do it locally. Some are older divorcees and single people that want to meet new people and see new things. There are people like me that have really never been out of a particular region. Traveling for a living is a personal choice. Everyone has a reason. The people that don't have money listed as #1 usually are the most successful at maintaining and enjoying the lifestyle. Sure, the money is a powerful incentive, but to do long distance travel nursing, you have to have a thirst for MORE. That thirst is what will carry you when you are scared, alone, and lonely in a city you have never been. 

Before you start traveling, before you even contact a recruiter, be sure you sit yourself down and do some self reflection. Am I happy now at my current position? What ties do I have to my current community? Why do I want to sell or store all of my belongings and drive into the sunset with my dog and clothes? Am I crazy? When I made the decision, which I like to call, "The Leap," I had a three column list:

1. Why do I want to do this in the first place?

2.  How is this going to effect my life in the short term?

3. How is this going to effect my life in the long term?

My responses were personal, perhaps one day I will share on this platform, but it's another blog post. To make a long blog post a little shorter, the end result was me throwing the piece of paper away and calling a recruiter. I threw caution to the wind and just did it. I am not listing any of the companies or hospitals I work with for fear of being identified and slapped with a HIPPA violation (I knew I could fit it in somewhere! HIPPA is your master!!), but just google, "Travel nursing companies." Then once you find one, look up their reviews on-line. There are a million and one websites about it.  

I have set out to make this blog about travel nursing because I want it to stand out. There are a LOT of blogs about the profession, but I haven't found a single one about a young, newer nurse that is just learning by trial and error. All the other ones seem to start, "I have 1,000 years of experience and 500 of them have been spent traveling." I want my readers to see a nurse that is 20 something, and new at the game, and hopefully I am easy to relate too. This post has been much longer than I intended, so here is a picture of the sunset from my agency provided apartment in the mountains of Pennsylvania:

I look forward to hearing from you with questions, comments (even rude ones!)