Crunch time

It's almost time to leave the cactus behind us. 10 more days to go. I am still in the hunt for a job, but have decided to take whatever Columbus will give me and work with an agency as well. Luckily, I am working with Intelistaf, who does both. So, if no travel contracts come up I can still work. Agency or registry work is more flexible too.

It's been a rough week. Some really difficult patients, not that they were necessarily very sick but, their personalities were difficult. I really don't like being yelled at by patients or families, luckily I was able to keep my cool and defuse the situations without making them worse. Sometimes it works in my favor, sometimes nothing works.

I will miss my coworkers the most from this assignment. Some I knew from my last trip here but, a lot of new friends. There are some outstanding nurses at Good Sam, I feel lucky to have been able to work with them. I also worked with some fantastic nurses aids and secretaries. I wish I had the time and space to name them all...but I would rather just say thank you and if you ever have the opportunity to work on Tele (the first floor or the 5th floor) it's a great atmosphere. I hope to come back in the fall once the weather gets cooler. We'll see what the rest of the year brings.

My husband and I were discussing leaving Phoenix last night on our drive home. I am so lucky to have that time to relax after work. Most people have to walk to their car and fight traffic and be alert on their commute home, I get to step out the door and into the truck, relax and pet my dog on the way home. We will miss the mountains and the scenery. On our drive to work and home we pass through a small mountain, and as you crest the hill you can see all of Phoenix. It's awesome to see all the airplanes in the sky in the evening on our way home...there's usually 6 or 7 just staged across the sky waiting to land. We will also miss the weather, last week was hot in the 90's but this week has been 70 and 80 and always a big blue sky. But I'm in the job to travel...so, will keep you posted. Remember, non noc nocere.

Still waiting

Just waiting. I haven't gotten an interview yet. I have my profile in with Ohio State University hospital and Ohio Health, also with Norman Regional Hospital in Oklahoma. I am in a holding pattern, but, it's not the first time. I can always go to Columbus and work agency until I find something. It's not my first choice because I would not have the housing, but we do what we have to do when we are chasing our dreams. Who thought my dreams would take me to Columbus Ohio?
I had my orientee again this week, it was a rough day. I was back down on the surgical unit. Our thoracotomy patient who had her chest tubes pulled on Wednesday ended up getting them back in on Thursday. It was not a pretty sight. The patient has been in the hospital for almost a month. Lots of hostility and anger on the part of the husband was not making my job any easier. Then we got a transfer from the Dialysis center who was in rapid a-fib. Luckily she self converted before we had to hang the Amiodarone and start heparin. My orientee just wasn't able to keep up with the pace, the language barrier is really tough. I don't know if he is fully understanding me or the patients or the doctors.
Only 13 more days. It has been a fun ride here in Arizona, I really enjoy the hospital and my co-workers, some of them more than others. I would love to come back and work here again. The staff really tries to make you feel like part of the team, it's nice. We'll see what the future brings. Remember first do no harm.

Mistakes

Can't wait for the drive...ok, I really can, but I'm ready to go. My husband has his own personal style of driving and thinks no one else know how to drive. I find it rather annoying but, at least I don't have to drive. I am really not thrilled this time because once again we have a trailer full of stuff to travel behind us. Oh, and not to mention the lovely rise in gas prices. We figure it will cost about $500.00 just in gasoline to get from Arizona to Ohio. Sounds great, huh? Not to be out done by the fact that I don't have a job yet. Ah, the joys of traveling. The above picture was taken somewhere in California, I hate to see these especially when we are pulling a trailer.

So, I had an orientee again this past weekend. He's a nice guy, not the same guy as last time. His English is not the best, and I think I might intimidate him a little. He was looking for one of the patients Med records, I accidentally handed him a different book than the one he wanted. He administered the medication and unfortunately did not follow the 5 rights. Now, don't think that I was not doing my job. This guy is on his last week or 2 of his orientation. He has a nursing license, he has been administering medication for weeks by himself. But, he gave the wrong pills to the wrong patient, he went in the room with the medication record and claims he even looked at her name band and still gave her the wrong meds. I made sure he went right back in the room to assess the patient and take her vital signs. She was fine thank goodness. It wasn't all bad, some of the meds she got were actually right. Some were the right meds but the wrong dose. I reminded him that we are all human and not machines, we do occasionally make mistakes , we just hope no one gets harmed because of it. I had him call the doctor, but, due to his poor English I spoke with the doctor and told him what had happened. Luckily, nothing untoward happened and the patient never knew. When he went back in to administer some medications she needed and hadn't received she didn't ask why she didn't get them earlier. I would have told her they were not available earlier if she had asked. I know how it sounds, like I'm lying right? No, I am preserving the nurse patient relationship. If she had known that he had made a mistake she would not have trusted him the rest of the day. Plus he felt bad enough. I guarantee he will check every name band against every medication record from now on, probably twice. I told him that the way to stay out of trouble is to admit your mistakes, follow protocol and most of all monitor your patient for untoward reactions. It's the worse feeling in the world to know you made a mistake, I try to avoid them by following protocols and safety measures put into place. I always check my patients name bands against the medication record right there in the room. I check my meds 3 times, once when I get them together , again before I go in the room and a third time as I am opening the packages and giving them to the patient. That's why I hated giving meds at the psych hospital. They don't follow any of those rules, you can't even get most of the patients to tell you their name, plus they won't wait for you to sit there and open all the packages, so, you don't get that check. So, as I always say, first do no harm.

In search of a new home

Well, it's that time again. Looking for another assignment is exciting and frustrating as some of you may know. Especially when the company you are with doesn't go where you want to go. That's my current dilemma, Banner travel only goes to Banner facilities, which would be great if I wanted to go to Alaska, Wyoming, Colorado, or California...but this time I want to go to Ohio. I have a goal to put my husband to work and to spend some time with my brother and uncle. Also my friends and some more family are just a stones throw away in Cleveland, so we can see them too. It's lonely being out away from everyone you know but it can also be freeing. No family/friendship demands. Sounds selfish doesn't it? But, I can only live that way for a little while, then I need to reconnect with my peeps.
So, in choosing a new assignment, I have to come up with my priorities. Like this time, location is my priority, then money (it's always on the top of my list), then company benefits. The hard part is weeding out the people who cannot help you at all. It's a game. It's kind of like buying a new car and recruiters are kind of like car salesmen. I have searched hundreds of websites and sent out lots of emails, some return my calls, some don't. Like RN Network, as I have said before I was not going to use them again because they left me high and dry out here in Phoenix last time I was here. They forgot to extend my apartment lease a week until my contract was over and I had to pay out of pocket for a 3 night stay in a motel. But, I called them and a recruiter left me a voice mail about 2 days later. When I called her back, she said she was busy and could she call me back, I said sure, and am still waiting for her to call me. That tells me she is way too busy to help me. So, I talk with the ones who do call me back and tell them a little of my backround and what I am looking for. All of them want you to fill out their paperwork, whick on average takes about a half an hour. I am not spending my time on paperwork if they don't have a position where I want to go. Everyone says "We have new assignments coming in all the time, if you have your paperwork done we can submit you that much quicker." Ok, but it only takes a half an hour to fill it out, how much faster do I really need to be submitted?
I always ask about benefits, like free housing and what that includes, also if their medical benefits start day one of the contract, some start the first of the month after you have worked for them for 30 days...that's about 3 months by my count unless you start on the first of the month then it's only 2 months. That's about crazy to me. I work in health care...I know s@%t happens when you are not expecting it, I need health insurance. Some people go on their own and buy personal health insurance but I am not at that point.
Those are really my priorities, location money and benefits. Other people are hung up on travel money or bonuses, I'd rather have more per hour than a bonus that is going to be taxed away. Yeah I got a $1500 completion bonus and it was lumped in with my regular pay check so it threw me into another tax bracket and I saw about $700 of it. Why don't they just tell you it's a bonus of some kind and you'll be happy when the check is bigger instead of wondering where it all went?
So, right now I have my paperwork in with about 4 different companies, 2 have submitted me for positions in Columbus, one at OSU (go bucks!!!) and the other at Ohio Health which owns Grant, Riverside and Doctors hospitals. Hopefully I will get into OSU. Now I wait for a phone call from the nurse manager on the floor for an interview. Keep your finger crossed...remember first do no harm.

Alone again

That's my quote for the week. My goodness, between my co workers and the patients and the patients families...it was a soap opera week. Starting with a coworker who had some drama on her early (8 am) morning break with her significant other, she called us to say she was having some trouble and would be back soon. At 930 when I went to get some coffee I saw here in the managers office with the Phoenix police. Needless to say, she did not return to work and left us short. The week before I was working with another female who is pregnant and spent the whole weekend sitting in the break room and telling me what she could not do because she was sick. I know it sounds cold but, come on people...leave your problems at the door.

If you wake up and don't feel well call in sick...don't try make it...most of the time it doesn't work. Monday morning I walked into my patients room, she was on the phone, as I stood at the end of her bed she says into the phone, "Ok, I have to go, I have to unload on these people." That's a good way to start your day. She was unhappy about her entire stay and felt the need to tell me all of it before I could even introduce myself. She showed me her arm where she had had blood drawn and "someone" had taken the tape off and also removed her skin. She wanted me to call the doctor to see what I could do for it. I wanted to laugh, was she serious, call a doctor at 8 am on a Monday morning and tell him his patient has a tape burn and wants something for it. Can you imagine that conversation? I told her we usually don't apply anything to a tape burn...well, that was the wrong thing to say, she was livid that I said that to her. Then I asked her what she wanted me to put on the tape burn. I thought she was going to explode right in front of me, "You are supposed to be taking care of me. How is it that you don't know what to do? Why don't you just go call the doctor and come back when you have some answers?" So, I left the room. My poor extern was standing right by my side the whole time. I composed myself and called the doctor's PA, all I had to do was mention who I was calling about and he chuckled and asked what she wanted now. I got her neosporin and she wanted Benedryl cream so, I got her that too. I had my extern take it to her and basically take care of her for most of the day. Her heart rate dipped to 39 so I went to check on her, her husband was there as well. She was fine and proceeded to tell me about the nurse who was in that morning and gave her major attitude and how she gave it right back...then, I told her it was me. Usually I would let it go and be glad that she didn't remember our earlier encounter, but she was so blatantly mean to me I couldn't let it go. I ended up discharging her after much delay and irritation on both parts. It was a week.

I had a patient who lives 2 hours away and was brought by helicopter for a heart cath, she ended up in the ICU and then came to tele, her husband didn't visit the whole time she was there. She could press her call light but couldn't press the buttons on the bed to raise the head of the bed, ya gotta love that. It was sad, she was lonely I'm sure, but the odd thing was that she didn't want to go back to the city she lived in for her rehabilitation. I told her she would be closer to her husband but she said he wouldn't visit her anyway that he was busy. I had another patient who lived in another part of the state who's wife would call me 3 and 4 times a day. She didn't want to talk to the patient she wanted to talk to me and tell me how she couldn't come and visit and how she had bills to pay and on and on and on. These are the things that slow me down and keep me from my patients. That's why I say save the drama for your mama. I want to go to work and care for my patients and do my job. I know we need to take care of the whole person but I think they need to be an active participant in their care. A lot of people just come to the hospital and expect us to fix them without them having to do anything or change any of their ways. And when the return in a week or so with the same problem because they went home and continued to do the same things they did that got them into trouble in the first place. Just frustrating.

So, my extern is gone, he had a great time and I think he learned a lot. He won't be working in tele, it's just too busy for him. At least he got to see what it's like. Sorry for all the complaining but, I had to let it out. Remember first do no harm.

It's just rain people

OK, so it's been raining here. It's like no other place I have ever been in the rain. People actually go outside in the rain. They love it. They can't drive in it, but the love it. We were leaving the hospital the other night, my husband/chauffeur behind the wheel as usual, at it took us forever to get home. It's usually a 20 minute ride...almost 45 minutes! My husband is not the most patient man, especially when it comes to driving. He was like a caged animal between the cars. They were driving like it was ice on the road. Yeah, there were some spots of standing water but not a lot. It was a sight. You can tell a native Arizonan right away , just say it's going to rain and watch them light up. Amazing.
I have been blessed with an extra pair of hands this past week. I have an extern, he is done with school and has to work 96 hours with a preceptor. I feel lucky to be able to help mold new nurse. We had a patient with an amputation and a feeding tube and a central line and oxygen and a catheter. He was so nervous, didn't want to go in the room. I walked into the room and started talking to her, she's had a stroke so she can't talk back very well, but nods her head yes and no. I talk to her like I'm talking to you, like I do with all my patients. We flush her IV and check her feeding tube, reposition her and that's that. It took him the rest of the day to be comfortable enough to go into the room without me but he did it. Later, we sent her home, after we removed her IV and her catheter and flushed her feeding tube. He did finally admit he was afraid to go in the room. It's OK to be apprehensive about something new that you haven't encountered before, but you don't have to let anyone know. Portrayed confidence is just as good as confidence as long as it's believable. I'm not saying to do things you don't know how to without asking questions. I'm talking about walking in that patients room and making them feel confident that you will take care of them and keep them safe. Most of them are scared, even if they don't say it. Make them feel at ease and safe most of all. I have my extern for another 4 shifts so, we'll see what I can get him into.
Remember first do no harm.

Valentines day

What could be more romantic then a gondola ride? I bet the line at the Venetian is way long today. Wish I was there to see it. We thought about going to Sedona for the day but the weather is supposed to be pretty cold and snowy..not my idea of a fun Valentine's day. I think we will stay home by the fire place or maybe take a walk in the sunshine, while it lasts...supposed to rain tonight. It beats working though.
I am actually taking 2 days in a row off. Ok, I have to go to the hospital tomorrow for a mandatory inservice or I will not be allowed to work, I found this out yesterday, so, I was planning on taking 2 days in a row off. I think it's the first time in a month I have had more than one day in a row off. Not that I am complaining, I am here to work and everyday I go in with a smile on my face and a good attitude. I don't always leave that way but, I try. There are still a lot of people leaving and changing positions and new travelers coming in and a lot of new hires being oriented. 2 weeks ago I oriented a nurse who had worked at the hospital a year ago and had gone off to do home health so she could have more time with her kids. It turns out she needs something more stable with a more flexible schedule, so she came back. The 2 days she oriented with me there were actually 7 nurses on the unit..3 orientees in all. It was a little crowded but it worked. Just funny that they pick me the traveler to orient new staff.
Did you ever work with someone who told you their whole life story the first time you met them? What's up with that? I like the people I work with but, we work on a need to know basis. If I don't need to know something about you, don't tell me. I don't care where your piercings are or were. I don't need to see all your tattoos the first time we work together. I don't want to hear about your divorce, your DUI, your bankruptcy, or your love life in our first 12 hour shift together. Is that wrong? Seems like it happens to me alot, is it me?
So, interesting patients....hmmmm...I had a 572lb patient. That's always fun, had to get the special bed. I gave him a bath, with some assistance, he was grateful but it was difficult to say the least. It took only 4 of us to move him up in the bed because he was able to help. Hey I was happy he was able to help. He ended up going to the ICU with a CO2 of over 100 (very bad). Other than that nothing exciting, same old stuff.
As always first do no harm.

Just another day

So, it's been a long week. Not really a difficult one since I had an extra set of hands this week. First I got a new nurse from the Phillipines that worked with me. His regular preceptor was out sick. He's doing very well. I can't even imagine how hard it must be to move to a new country to find work. Then over the weekend I had a nurse with me who is getting back into hospital nursing. That was really easy. Now, finally a few days off to rest.
I went to the uniform store last week and was looking for skirts. I know, don't pass out or anything. Nurses used to were skirts all the time. The store I went to had one style, in 2 colors. Wow, no dresses either. So, I bought the skirts and wore them to work. It was an amazing response. Everyone stared like they had never seen a skirt before. One transporter actually said,"I didn't know they made uniform skirts!" Pretty funny. I actually was more comfortable and no it didn't restrict my movement at all. I'm suprized more people out here in Arizona don't wear them. Just throwing it out there to remind you all that you have a choice.
I worked with a traveler yesterday that I recognized. I thought maybe I worked with her there at Good Sam but, it turns out we worked on the same floor on my first assignment in Denver in 2001. Small world, huh? We talked about where we had been. She actually went to NYC and worked days as a med-surg nurse. 8-1 patient ratio....crazy. She said she had run into another nurse at Good Sam who also had worked at St.Joe's in Denver. It just made me think of how lucky I am to be able to do what I do. To travel across the country and work and meet all kinds of people and see things many people will never see. Some of the people I work with have never been outside of Arizona. Many people have been more places than I have been as well,but I feel very fortunate. Maybe that's why I can remain so positive at work, I really do enjoy what I do and my life as well. I don't think there are a lot of people out there who feel the same. I hear a lot of complaining, I just try not to add to it. Remember............. first do no harm.

Following your patients

Yeah, I got a day off and it's the week of the Barrett-Jackson car auction here in Scottsdale,AZ. I was so excited! We spent all afternoon looking at the cars. We got to see the stage and everything. Now watching it on TV makes it that much more exciting. I was watching it Tuesday night and I remembered seeing some of the cars. Very cool.
So, work has been good. I got to work on a different pod. They reserve 2 pods for post cardiac cath patients and most of the nurses that workover there can pull the arterial sheaths...which is why I don't normally work over there. But,it was a good experience.I got to pull a venous sheath, with someone watching,it was pretty easy, just like pulling a central line.
I love it when I connect with my patients and am able to see that I have made a difference. I took care of a liver failure patient just after Christmas for 5 days in a row.She was really cool to talk to, she's a Army lifer...20 years, and so is her husband. She also has a friend that came from the east coast to visit with her. That, I thought, was a great gesture of friendship. Anyway, she's been in the hospital since before Christmas, waiting for a liver transplant. While she was my patient I had pet therapy come to visit her because she missed her dog. Then I arranged it so she could go outside and her husband brought her dog, you should have seen her face, it was very rewarding. She was moved up to the floor where they take care of the liver patients but I have been going up a couple of times a week to visit her and her husband. They really seem to appreciate it. I went to visit her last Friday and she was sleeping . Saturday I went to visit and she was not there, she had gone to surgery to get her transplant. My heart jumped, I was so happy for her! Now, if you have never had the experience of taking care of a patient in liver failure, I'll paint a brief picture. They are jaundice, skin and sclera, they have a huge abdomen from ascities and we generally make their life miserable by giving them Lactulose to get rid of the ammonia that builds up in their body. They lactulose gives them awful smelling diarrhea, not that there is any good smelling diarrhea, but this stuff is usually pretty bad. They have a difficult time controlling their bowels with it as well. Sounds wonderful, doesn't it? Most of these patients are very discouraged and some are very angry. Maybe that's why I like my patient so much. She really kept her spirits up, she had some down days but she kept her sense of humor. So, I went to see her yesterday because they transferred her out of the ICU and back to the liver floor...she looks so good! No more yellow eyes! Any the worry has eased from her husbands face a little. I smiled the rest of the day! I know her journey is no where near over but I'm so happy it's headed in the right direction. It makes me feel like I can do this for a little longer.
Someone e-mailed me and said it sounded like I don't like my job... I hope I don't come across that way. I do love my job . I just get frustrated. Remember first do no harm.

Doctors Progress Notes

Ok, I had a couple of different ideas for my blog today. Then I was cleaning out my closet, no, really,it's not a metaphor or anything (although I don't mind listenening to Eminem every now and then). I really was cleaning out my closet and I came across some doctors progress notes that I had copied way back when I was working my first job. I had to make them the subject of the blog. Now, as a nurse, you can get a lot of good information from the doctors progress notes, if you can read them that is. They write about their findings and their plan for the patients care. There was this doctor, who shall remain nameless, who wrote all kinds of weird stories and very odd orders. Needless to say he is excentric, but his patients loved him. His handwriting was atrocious which made deciphering his orders and notes that much more difficult.
I hope you enjoy and get a good chuckle from this actual prgress note.
Chief Complaint:
" I fell honey."
History of present illness:
This 92-year-old white female fell out of bed and she was brought here by the squad. Dr.____ phoned me and said she broke her right hip, which is correct. The lady has a history of electrolyte imbalance, hypothyroidism and postural hypotension. She is 92 and demented. I made my way to ____ Emergency Room, while every erstwhile administrator or attorney had taken vacation through Wednesday, because after all, you know it is Independence Day on Tuesday. However, there is no Independence for the lacky physicians, as myself, who struggle along for a pittance of remuneration. Perhaps I ought to have a Boston Tea Party. In any event, 'the patient' was lying there in the gurney with her two daughters present. She knew old Doc ____ , the kindly old soul.
Physical Examination:
Vital Signs. Her blood pressure was 130/80, heart rate 82 and respirations 12
Lungs: The lungs were clear.
Heart: The heart was sinus rhythm.
Extremities: The right hip was swollen with decreased motion.
Plan:
I said I would get ______, an orthopedist, Dr.___ to clear her heart-wise and Dr._________ to evaluate her sensorium. Therefore, we feel it is safe to admit Mrs._____ and we pray for her.
Wow, that is a piece of art isn't it? I am not sure if this particular physician is still practicing. But, I remember him still carrying the old leather doctors bag with him everyday...once we got a peek inside, it was full of saltine crackers and ginger ale from the refrigerator on the unit. Go figure, huh? Remember...first do no harm.

The first week of the new year

Ya gotta love that sign..it just exudes fun. Hopefully a sign of what is to come for the new year...fun. The first week was full of work for me. 5 days this past week...not in a row, but I could have if I had wanted to. The last 2 days were pretty exciting. Friday I discharged all 4 of my patients...I just love when that happens, NOT. Yeah because most jobs if you finish all your work you get to go home, right? Not in the hospital, we'll just find you more patients. I'm not complaining, I like to work and make money. I prefer days when I don't have to work so hard though. 3 of my patients went home and I sent one poor soul to the ICU for Cpap.She came in with pneumonia, a chronic copd patient, she just waited too long to come in and what we were doing wasn't helping. She had gotten her lasix and steroids and antibiotics but by noon she was on a venturi mask at 28% with a pulse ox of 90....not good, plus she was really sleepy. All that equals increased CO2 retention and someone who is quickly losing the drive to breathe. I called the resident who ordered ABG's and a trip to the ICU. Hopefully she will be back soon. Saturday I only sent one person home and got one from the ICU and then transferred another one to another tele unit due to staffing issues. Yeah, it always seemed to come at the end of the shift. My patient,who spoke very little English was so nice about moving.That made it all better. Attitude is everything.

So, I survived the first full moon of the year. It was pretty mild for me, thank goodness, as always with a little help from my friends. I can't tell you enough how much it means to be a good team player. I do my work and help my co-workers, including transporters and secretaries , even my nursing assistants. A lot of people beg to differ with me on that last one but, a kind word or a little assistance goes a long way to making you have a good day. You've been there, walk on the floor and you can feel the aura depending on who is working that day. You have to be a little in tune to it, but it doesn't take long. And any one person has the ability to uplift the mood on the unit, if even for a moment, it can make the difference between a good day and one of "those" days. It does take energy and a desire to do it but it's worth the effort most days. If you have the energy.

Remember, first do no harm.

Christmas in Vegas

So, I got to spend Christmas in Las Vegas. One of the reasons I work so hard all year. It was fun. We got to see all the sights, all the Christmas decorations. This is the Christmas tree in the botanical gardens at the Bellagio. They always have a spectacular display. The crowds were massive but, it was worth it. We saw the trees in front of Caesars Palace and the one on Fremont street. The fountains at Bellagio were set to Christmas music and the weather was perfect. We also got to see them take down the tree on Fremont street the next morning. Amazing how all of a sudden it's over and life goes back to normal. Why does it? Why not have that feeling all year. After all it's a feeling in your heart, isn't it?

Yeah, I'm a dreamer.

I heard it was pretty awful at work. Not enough nurses and all the sickest patients of course. Hats off to all the great people who worked that day and spent it away from their families. I have had to do it many times. It's really hard for the new nurses especially if they didn't work in a hospital setting before or during school. Most families don't understand. I remember so well... trying to explain to my friends why I couldn't go out on New Years Eve or to my new husband why we couldn't spend Christmas together. It's a whole new world...one that not many people understand. It's unfortunate because it adds just a little more stress to the holiday season and the new nurses life.

I returned from Vegas and had one more day off then it was 5 in a row. I couldn't have made it through that last day without the help of my friend and co-worker Mike. We laughed and joked through out the day and made it through. Thanks Mike.

This time of year is also when the travelers contracts are ending, usually right before or after the holidays..it's weird it just seems to work out that way. It's odd to stay on and see them leave when I am usually leaving too. My friend Christie is headed to Bakersfield. I wish travelers would talk to each other more before they make their decisions. She is headed to Mercy hospital..I worked there a couple of times before I went to Mercy Southwest...it was very busy and not terribly friendly. Hopefully things have changed and she has a great time. My friend Madessa was headed to Columbus so we will catch up to each other later this spring. And Carolyn, lucky dog, is headed back to Hawaii today. She was great to work with. She mentioned that she is writing a book about travel nursing... I wish her all the luck and if there is anything I can contribute...let me know.

The hospital is still filled with the really sick left over from the holidays, so the days are not so easy. Hopefully we will get a little relief soon, but not likely with the full moon. It was on the 3rd I believe so, we have 3 more days of craziness, woohoo! I know people don't believe it but, it is true, crazy things happen when there is a full moon. So, I have that to look forward to.

The other thing is my traveler friends Jeannie and Don are planning to come to Phoenix. They are currently in sunny, humid West Palm Beach Florida. The gambling is not so good there so they are headed this way next month. I can't wait!!!!! We had a great time here in Phoenix last time and a lot of fun in Napa. It's funny how sometime you meet people and stay in touch forever and some people you really like and want to keep in touch with don't make the effort. Weird huh?

Well, hopefully I'll have a great story next time from this full moon time. Remember, first, do no harm.

Travel nursing basics

Hi all, I am blogging this time in reply to a comment on my last post. Lots of nurses and nurses-to-be out there still have lots of questions on how this travel thing works. I understand, I had lots of questions when I started too. Here are the basics as I see them, please send questions if you have them. First, most companies won't hire a new grad, they require at least a year of experience. I think a little longer would be better, but, I started traveling after 10 years of experience. There are tons of companies out there, like going to buy a car, have a list of things you must have and the rest is fluff. I require insurance day one. I refuse to pay for a one bedroom furnished apartment. I require a TV and some place that is cable ready. I need a first floor apartment. All these little things you can ask for. You can ask for a bigger apartment but most of the time you will have to pay a little. You can travel with whomever you want, husband, boyfriend, kids, dog,cats, or another nurse. You generally get travel money at the beginning and the end of your contract in your first and last paycheck. It's all about the same 400-800 dollars. I require weekly paychecks not bi-weekly. You can stay with one company or switch with every assignment. For me it all depends on who has what I want. Believe me not all companies have assignments in all the cities where you want to go. Sometimes they do and you can see who will pay you the most or give you better housing. Assignments are 4 weeks to 6 months or longer if you extend. I have not done a 4 week assignment but I think I would. I have been here in Phoenix since August and plan to stay until April. Whether you stay or not depends on the hospitals needs and how well you get along with others. Being a traveler means being flexible and calm. I have been floated after 4 hours on my unit, one time after I got report in the morning and just started seeing my patients I was asked to go to another unit. I smiled and said sure, if that's what you need. We are here, not as doormats, but as helpers. If you treat others as you wish to be treated, you won't be mistreated. Most hospitals don't purposely try to aggrevate their travelers, they know we have a network and let others know which places treat you well. I don't expect to be treated like a staff member, because I am not, and I don't wish to be...I am there to fill a need. Most hospitals give you 2 days orientation, one day of half hospital orientation and half paperwork and a day of orientation on the floor. Some places give more, I have had up to a week of orientation at some hospitals which I think is great, it's like free money to me. All I have to do is sit in a classroom and stay awake for 8 hours? No problem. I also see it as a waste of money for them. I won't retain half the stuff they are trying to tell me once I get out there. Lots of traveleres complain about their schedules, I think it's a waste of time to complain. If there is a certain day or days you have to have off, have it put into your contract or tell the staffing person on the first day of your orientation. We have to be flexible. I personally love to work weekends, there are less doctors around and on the weekdays I can go and shop and play while people are at work. Hmmm, what else? I travel with my husband and our dog. No, he does not have a 9-5 job. He sells on Ebay and does all the house work, plus he drives me to and from work. It's a rough job, but he got used to it. I have met people that travel with their husbands or boyfriends and they get jobs in each town they go to. I also have friends who do exactly what we do, I work and he stays home and does housework and cooks. It can get rather boring for him but he tolerates it because it's better than the alternative. Yes, we survive very well on one income because we have no housing costs. The hard part is the in between assignment times...we have to plan for the trip to the next assignment and for the amount of time I will not get a check. But, a little planning and it's no problem. Yes, I get to pick where I want to go and for how long. I have left an assignment without notice, but we had our own housing at the time so we incurred no cost. If we had lived in corporate housing we would be responsible for the remainder of the cost of the housing. Yes, I make lots of friends along the way and it's hard to leave. But, sometime your friends follow you when you go and it's a blast. Well, can't think of any more...send me your questions. Happy travels and first do no harm.

Nurse Extern

Hi all, I've been really busy with the holidays and working. It's amazing to me how many people come and go at Good Sam. One nurse I worked with yesterday is moving to Texas just before Christmas, too expensive to live in Phoenix plus she is a country girl. She grew up in the midwest and so did her husband, they ended up out here because of college. Arizona State University is one of the largest universities in the country. Also, one of our nurses is fulfilling her National Guard duties this week and next week. That's how I got my extra set of hands. It's really nice to have another person to work with, especially when they want to learn and work. It's funny she's completely amazed that we get out of work on time. I told her it comes with experience. I worked with her all last week, we had a chest tube and a new peg tube, the other nurses on the floor had some patients that got really sick so she got to experience that as well. One of them was going in and out of V-Tach and the other one was in respiratory distress and had to be intubated and they were both taken to ICU. All that before 9 am...I hate mornings like that. But my extern got to see what all happens, the code team and the resource nurses showed up and we were able to focus on the rest of the patients. Giving insulin and pain meds to the other nurses patients and making sure they are all safe. It was a good team work experience. I really enjoy teaching new nurses, I know some people don't. I spoke with another nurse who also has an extern, but all the extern wants to do is talk about her personal life and go on breaks. I have a really hard time with people like that. I am at work to work and take care of people, socializing is low on my list of priorities. Maybe that comes from experience as well, maybe it's just a character flaw. Either way, I'll keep it and I think my patients appreciate it as well.

Other than that I'm trying to get my Christmas shopping done, mostly online, while working 48+ hours a week...not easy but it will be worth it. Because on Christmas day I will be in my favorite place ....Las Vegas. Nothing like the sound of slot machines and Christmas carols...it's amazing. I hope you all have a great holiday...remember first do no harm.

I guess we are human

Hi all. It's been a tough week. One of the fantastic nurses I work with was killed in a tragic accident. It hit me like a lead balloon. This guy I had just seen 3 or 4 days before, someone you expect to be there, just won't be there any more. I know, we in the medical field deal with death all the time, but this time it's personal. This was a great nurse, I think he had been there at Good Sam for almost 20 years. He was one of the go-to guys, somebody who knew everything, or at least had an answer for you. If you needed a hand, he'd help you. His passion was hunting and Army stuff. He actually was supposed to go deer hunting last weekend. Just hard to believe he won't be back. There is a memorial service on Monday and I volunteered to work so some of the people who worked with him for years could go. The hard part is that no one is saying what happened, just that it was a tragic accident. Even the obituary was short and to the point, so you all know how the rumor mill is in a hospital. There are so many rumors about what happened, it would just be better if we knew what happened. I have not been a part of the rumor making or passing on. I think he deserves better than that and I tell the people who come to me with rumors the same thing. Hopefully next week is better, and I pray the law of 3's doesn't come this time. Remember first do no harm.

ACLS

So,I have been away studying for my ACLS renewal. Yeah, I've had my ACLS for 6 years now and I still study before the class. Luckily because I have had it before I don't have to go for the full 2 days, you just have to do that the first time. Being a traveler,my company doesn't pay for the renewal. Last time was here in Phoenix, I renewed at the hospital where I was working only it wasn't American Heart. It was ASHI...who ever they are, it was the same content but a different company and some hospitals would not accept it. If you haven't taken it, it's not so bad...and if you are thinking of working in ER,Tele,ICU,OR... it's probably going to be a must have. Years ago I guess it was grueling, it was run by doctors who intimidated the participants and lots of people flunked. Today, it's mostly run by nurses and the atmosphere is one of learning not intimidating. I went to a privately owned company that has the ACLS BLS and EMT classes. The cost was $130, but I got 8 CEU's. (some consolation) Part of this years ACLS courses have to have a BLS component because of all the recent changes. If it's been a while since you took it...I'll give you some highlights. Everyone gets 100 compressions per minute, the ratio is 30:2 for everyone unless it's an adolescent or infant 2 person, then you can do 15:2,the breathing is slow and deep,no more constant checking for a pulse, and big emphasis on good compressions with full chest recoil and early AED use. The instructor I had added another component that I hadn't had before...drugs of abuse. Maybe it's because of being in this lovely border state with no fences and the #1 rating for drug trafficking. The drugs come across the border into Arizona and get trafficked out to the rest of the US. Arizona is #2 in Meth manufacturing. Stuff they don't tell ya before you move here, glad I'm just visiting.
She went over date rape drugs and what effects the different drugs have on people. She sited a great website that gives information about drugs....www.erowid.org. It's a great thing to think about when your patients aren't responding to treatment the way they should...knowing these drugs and how they make people react can be a great tool.
She also talked about working at the poison control center...which I never thought about as a nurse but what a cool job. She had some great stories especially about Thanksgiving. I love nurse stories, so I'll share some I heard today. A lady made mashed potatoes with evaporated milk that was brown. She tried the mashed potatoes because they were white after they were whipped and she said they tasted fine. She called the poison control center to see if they thought she could serve the potatoes....of course the answer was no because evaporated milk is supposed to be white and just because she tried them and they tasted fine doesn't mean she should serve them...she was not happy, because she had to go to the store and start over with boxed mashed potatoes. Another caller said she had a fire in the oven where her Thanksgiving casseroles were, they had put the fire out with the home fire extinguisher. The casseroles were covered with foil. She wanted to know if she could serve them.....Uh...no. That fire extinguisher stuff is airborne it gets everywhere. She claimed it was probably water because she didn't see any foam...water doesn't put out grease fires in an oven so, no it wasn't water and no you can't serve the food. The sad thing is she still had the turkey, stuffing, vegetables, mashed potatoes and desserts and didn't think that was enough food. Incredible!!! So, if you are looking for some good stories, you might want to consider working at the poison control center in your town. Plus you get to help people, without worrying about hurting your back...lol. Remember first do no harm.

Just Work

Hello from sunny Phoenix, I still find it amazing,coming from the frigid Northeast, that November can be so beautiful. The mornings and evenings are cool, not cold, but I am finally able to wear my jeans and long sleeved shirts. The days are sunny with blue skies and warm air, still wearing shorts and tanks tops, we even have to have the air conditioning on most days. Sounds awful, huh? I just can't believe the number of people who dislike where they live and stay there. Every assignment I go on people tell me how much they would like to travel but.....there's always a but. Your desire has to be bigger than your but or you'll never do it. Recently I've been working with some new grads who are all envious of my traveling, they can't wait to have enough experience to travel and I encourage it. It's a great way to see the country and learn new things. I also encourage people to become nurses, it's a great career. There are so many different avenues to take in nursing, if you don't like one , try another.
I had a great idea for a blog the other day and now I can't remember what it was. I hate when that happens. Does that mean I'm getting old? I think it means I just have too much information in my brain. Too many drug names and generic names and dosages and calculations, phone numbers ,doctors names, recruiters...just overload ya know. Plus I have been working 4 and 5 twelve hour shifts a week, that will definitely overload ya. I have heard of nurse working 6 and 7 twelves a week but honestly, how long can you keep that pace up without hurting yourself or someone else?
Work has been good, lots of overtime available. I got Christmas off and Thanksgiving too...I am working New Years Eve and New Years Day...but, it's day shift so it's not so bad, and hopefully it will be slow. I feel for some of the travelers that are coming in now and the ones that came after I did, they are all working Christmas. That's one down fall of nursing, someone has to work on the holidays, all the holidays, the place doesn't close ever. It's an amazing concept really, 24 hours a day 7 days a week, 365 days a year, hospitals never close. When I was in Rhode Island the nurses all belonged to the union and they had mandatory overtime..and it was used all the time. I would hate that. I like my overtime when I want to do it.
Well , remember first do no harm.

Learning

So, this past week I had a student. I love students, they make me slow down and think. As a nurse practicing for way too many years I find myself just going about my day, doing what I need to do for my patients. It's nice to be questioned (by someone other than they families of my patients) about what I am doing and why. I had a male student, it's his second career, he was in business. Quite a change! It's nice to see more men in the field, they bring another perspective. Plus, sometimes, when you work night shift and you have a confused patient, they will think the male nurse is a doctor and they will do whatever they say, like staying in bed...but, of course, I would never use this technique, I have only heard that it works.(lol)
I also signed up to renew my ACLS and BLS. Here's my advice on that subject...get American Heart and stay with it. Don't go for the online things unless you test online and do the skills check in person. Lots of places and people will tell you that they are all created equal...which maybe true, but, you cannot argue that fact with a hospital that won't give you a job because your ACLS came from some different company. I have had travel companies refuse to submit me for a tele job because my ACLS was not American Heart. A lot of hospitals trying to get their Magnet status will only accept American Heart as well. It's just not worth the aggravation.
And, since I mentioned it, what about Magnet Status? What are your thoughts? I have worked in both, I don't see a lot of difference in the actual day to day nursing. It's a great theory and all, but I don't see it.
Lastly, I have to talk about travel and registry nursing. Not as a new grad, maybe if you are and LPN turning RN and have had a lot of experience, otherwise I wouldn't suggest traveling for 2-3 years. You really don't get into your groove until then, and you haven't experienced enough general nursing stuff. But, after that, why would you pick up and move across the country , to somewhere you have never been, on the word of a potential employer? What a gamble!!! Their job is to get you hired, and if they pay for your relocation, then you owe them a year or so of service. Why not do a travel assignment to the city you are thinking of moving to? Feel it out, maybe do one day a week of some registry to see the other hospitals, maybe they are better, before you commit. I just don't understand it. I have a few friends that have done it, moved across the country to somewhere close to family or just somewhere they had vacationed and loved. I have one friend who has done it twice, even after I encouraged her to try travel and gave her names of companies and recruiters. Both times she has regretted her move, sad really, to waste all that time and energy just to be disappointed and unhappy. So, travel is the way to go...finding the right company is a whole other day.....Thanks for listening. Remember first do no harm.

Still getting attached

Yep that's me by a palm tree and a pond in the desert, ok it's not really in the desert, it's in Scottsdale/Phoenix area. It's a little park called Papago Park that we have visited quite often. It's a nice little oasis. This has been a long week, just really busy at work. I'm finally allowing myself a few days off to relax. I've been taking care of this patient off and on for the last month, and he finally got to go home yesterday. He was flown from a small town north of Phoenix with bilateral collapsed lungs, and has had chest tubes ever since. The diagnosis came back, and it was not a good one. Mesothelioma, that's my second patient this month with the same diagnosis, both worked construction. I lost my own father to lung cancer so it hits me pretty hard sometime to take care of these guys. So, this guy really wanted to go home as you can imagine, I mean his wife and daughter were here but he just wanted to be home. Good Sam hospital has a floor of rooms that families can rent so they can be in the building to visit the patient whenever they are needed. It's really nice for the patient and the family, especially when they live so far away. Unfortunately, the small hospital that he is going to cannot do any type of extensive surgery if it's needed or anything like that. He had to agree to be a DNR in order to go back home. Isn't that sad? I mean this guy is far from the edge he still gets up every morning and shaves and reads the paper, aside from the chest tubes to constant wall suction, he's what we refer to as a walky talky. I would go in every morning and say hello even when he wasn't my patient for the day. Yesterday we shared a tear when he told me about the conditions of his return to home. He was funny and cranky and made me smile and I think he looked forward to seeing me. It's nice to make that connection with your patients and their families. I know we are not supposed to get attached, but sometimes I can't help it. It may take a little out of me when they go but, if it makes their stay more comfortable, what's the harm? Death and terminal illnesses are not some of my favorite subjects. (Much like trachs and colostomies.) But , they have been a major part of my career. Of course, I think death is as much mental as it is physical. I had a patient quite recently that I helped take out to his car in a wheelchair, he got up into the car and petted his dog who was waiting in the car, he died the next day in his home. I guess he was ready. When you have a terminal illness, a lot of times it's a matter of being comfortable with the situation that makes it ok for you to go. I believe we have some control over it...anyway...on to better subjects.
The weather here has been warm about 100 still and, you guessed it, sunny. It should be cooling down soon...either way it's not going to be cold anytime soon. And, that makes me very happy, coming from Cleveland I have had more that enough cold to last a really,really,really long time. Well, remember first do no harm.

Raining again?

That's right I said it was raining again...only this time inside my apartment. There's a first for everything. Traveling for 5 years never had a flood. And who would think, right here in the desert.The sprinkler head in the living room in the apartment above us broke about 4 in the morning on Thursday. I woke to the sound of water running..only it was coming down inside the window in the living room. It was a pretty freaky sight. The water was coming through the ceiling fan and all the sprinkler heads and the vents from the living room to the dining room to the kitchen. Every phone number I called for the complex went to voice mail so I had to call 911. Yeah the cops came and so did a bunch of firemen, but the alarm that was going off got turned off and so did the water. The firemen did decide to put some holes in our ceiling, it was interesting. The poor guy who lives above us had just had a flood a month or so ago I felt so bad for him. But my company ,Banner professional registry and travel, was right on top of things. They called the apartment complex and got them to find me a new apartment. So we moved in the next day. They made it so simple and they were very caring and helpful. It's so nice to have a company care.
Work is great, I really enjoy working at Good Sam. The staff that is there is very knowledgeable and helpful. I never feel alone. Plus, I am all about the overtime and there's plenty of it. I have been working 4 or 5 days a week. The pay has been great especially after not working regularly for a month. Well, as always first do no harm.