Tag Archives: work

The Dark Side of Travel Nursing

So, I have been doing travel nursing again for essentially the past year. It has been mostly awesome. I spent 9 months in Houston, Texas, and most recently have come to St. Louis, MO. I have loved it. I have loved the freedom of working a contract and being able to take time off if needed, I have loved exploring new cities and meeting new people. It has been overall a wonderful experience!

Most recently (as in last week) though, the dark side of travel nursing reared it’s ugly head. Insecurity. Lack of benefits. No safety net. I had a “health incident”, which landed me in the hospital, on the other side of the rail so to speak. My shift started out as they usually do, getting report and developing my plan for the night. Midway through my shift though, I was having really bad chest pain. I had been feeling badly most of the week, increased heart palpitations, massive fluid retention, heartburn and fatigue. I had been chalking it up to overworking as I had been fairly consistently putting in 60+ hours per week for a while. As I stood there talking to the NP about my patient, I kept rubbing my chest unconsciously. She noticed and asked me about it, and proceeded to march me into an empty room. I took my blood pressure which prompted and “Oh my god Sarah, is that your pressure!?”. Needless to say it was a bit high. The long and short of it was, without me even being aware of it, she orchestrated someone to come in and take my patients and send me to the ER. I was furiously charting trying to catch up and they even snapped a photo of me with oxygen on refusing to get in the wheelchair until my assessment was completed.

I went to the ER, and went through the whole shebang. Because I have lupus, and I have been off my meds for 3 months, everyone started jumping up and down that I need to be admitted. Needless to say I was non-plussed. The first thing I thought of was “I can’t miss any work”. See, the dark side of travel nursing is, if you don’t work you don’t get paid. Additionally, if you opt for their housing, you can face penalties for missing your hours to supplement their expenses at maintaining your apartment. It is a very scary prospect to be a patient in the hospital, and even more so when you are facing financial issues to boot. After much foot dragging and arguing, I agreed to be admitted (have I mentioned I am a HORRIBLE patient?). My cardiac enzymes were negative, but based on my symptoms and my lupus, the doctors felt strongly that I needed a dobutamine stress echo. I will spare you the gory details, but suffice it to say, that was one of the worst experiences of my life. Nobody should ever have their heart go from 56 beats per minute to 176 beats per minute in the span of 2 minutes. I thought I was going to die. I cried.  A lot. And almost vomited on the tech, poor thing. By the time I got back up to my room, my blood pressure was so dangerously low I almost fainted in the wheelchair. Scared the poor CNA to death, but somehow managed to levitate my ass to the bed before collapsing. My blood pressure never came up to normal, and continued to be very abnormally low. I requested enzymes with my PM labs, because I truly felt like I had been having a heart attack during the stress test.

Needless to say, my stress echo was “abnormal”, much to the surprise of everyone. The cardiologists honestly thought they were just going through the paces and I would go home that day. I did not go home. They scheduled me for cardiac cath the following day, which absolutely terrified me. See, the problem with being a nurse, is you know too much. On one of my travel assignments , I sent a lovely lady to cath lab, and she never came back. I get report and transfer of all the patients with “complications” post cath. Scares the bejesus out of me. Later that night, about 1am, doctors came tiptoing in (always right when I need to go to the bathroom, like toddlers or cats), and went “ah well, tell us more about what happened during your stress test”. Suddenly everyone was interested to hear what I had tried to tell them before. Turned out I had a small MI during the test. By this point,  I felt like they were trying to kill me, to be honest. My enzymes had been negative up to that point, but their test suddenly has everyone going “um don’t get out of bed and here is a heparin drip”.  Through all of this though, my amazing friends and coworkers really saved the day. From listening to me freak out, visiting me at night when I couldn’t sleep, to making sure I was with the best interventional cardiologist for my cath, these nurses saved me. See, they didn’t see “a traveler”. They saw a fellow nurse, scared to death, and took care of me. Even my boss, went to cath lab to make sure everyone knew I worked there, came to see me, and hugged me when I was losing my shit before going to cath lab. All I wanted to do was go home….but these people kept me sane.

The next day I went for my cath. I asked for a radial approach, to have faster healing time. The cardiologist didn’t want to do it because of my Reynaud’s, but he did anyways (I begged). Turned out he was right and I should have listened to him, it hurt like a son of a bitch and still does. The long and the short of it was I apparently had a 68% blockage midway down my LAD. the put a stent in, and now I am on plavix and aspirin, with the lovely diagnosis of Coronary Artery Disease and Non Stemi Myocardial Infarction. There are no other lesions anywhere, and most likely the pain I have been having for a long, long time has been vasospasms. See, I never paid attention to my “chest pain” because it wasn’t like what I thought of as chest pain. I could point to where it hurt. Apparently that spotI could point to was halfway down my LAD. The doctor said it was a little hidden, but that I was extremely lucky considering this was in the main artery of my heart.

All of this has been overwhelming to say the least. I can’t wrap my head around the idea that at 44, with no family history, normal blood pressure, perfect cholesterol that I am a cardiac patient. Yes I am fat- have always been so. But being fat in and of itself doesn’t clog your arteries. Turns out, the pesky Lupus does. For some unknown reasons, the near constant inflammation I experience from my Lupus is worse on my arteries then having bad cholesterol. This coupled with chronic arterial vasospasms led to me needing a stent. It is possible the “benign” heart arrhythmia I have had all these years was in fact this lesion developing. Being off the meds that reduce inflammation levels in my blood exacerbated all of this. Luckily, statins also help with inflammation, also for unknown reasons. So if I take my meds like a good girl I should be fine. Mind you, I stopped them because they were making me fat. Because we live in a society where it is better to be dead than fat. That is a blog post for another day, however.

They say that experiencing a profound health crisis changes you. I don’t know that it has changed me per se, but it is definitely giving me pause to rethink things. While I love travel nursing, it is a bit like playing Russian Roulette. Unless you are smart and have 6 months of salary saved up (and face it, who among us does?), you run the risk of losing everything if you can’t work. There is no safety, no backup, no net. None of us are immune, no matter how indestructible we think we are. This experience has taught me that it is ok to be a little selfish. To think about my needs first before others. I need to get back to classes and finish school (I am going for my RN to MSN, then NP). I need to have a less stressful job. I need to make more money so I can work smarter instead of harder. The days of “well I will just pick up an extra shift” as the answer to all the financial woes must stop. I cannot be this workhorse anymore. I need some safety and security in my life, as much as is possible in this crazy world to have.

I also realized I have been afraid to share what has been going on, because of the stigma associated with CAD. I know, that people assume by looking at me that I “ate myself” into a heart attack. I also know that the people who love and care for me know that is not true. I probably have better eating habits than most of the people I know. I avoid meat, fat, eat lots of veggies etc. I loathe cheeseburgers and mayo, and usually get chased after to eat something. Obesity is a complicated thing, and not easy to deal with. I had been losing weight fairly consistently after getting off the steroids, until the new Lupus meds- then over 9 months I gained 45 pounds back.  No matter what I did, how I restricted my diet, what exercise I did, I gained. According to my fitbit  I would hit my 10K steps in the first 4 hours of work.  I gained in weird places, not normal to me. So I went off my meds. In my mind, I could be ouchy and fat, or ouchy with Lupus, what was the difference? What I didn’t stop to think about was the hidden effect the Lupus was having on my body. The insidious inflammation and destruction of the unseen parts of my body. Sure, I started to lose weight again, slowly, but at what price?

So now, I am going back to work tonight. Nervous, only with a week recovery. Could I use more time off? Sure! Who couldn’t? But the sad truth is I can’t afford it. One week without pay was all I could do. While I adore travel nursing, and part of me wants to continue jetting around the world to exciting locals, meeting new people and seeing new places- I realize that I need to slow down and reconsider. The sad truth is I can’t “afford” to do travel nursing anymore. I need to seriously investigate a permanent position until I am finished with school. I need to get back on that bandwagon ASAP so I can finally have some viable financial options that offer nursing away from the bedside, but not in administration which I loathe with all my soul. Luckily, I love it here in St. Louis. I adore the people I work with, the unit, my boss, the hospital, the city. I am lucky I have support here and the backup to take a perm position. Hopefully that will work itself out by the end of this contract. I am still waiting to hear from HR, apparently they move glacially slow. But hopefully this will turn into something even better for me then I have had before. Meanwhile, it’s back to the grind, albeit at a little slower pace.

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Nursing is a War Zone

I have not posted anything for a while. I have stopped doing travel nursing, due to personal circumstances that are not allowing me to do it at the moment. I recently got married, and until we get everything sorted out with his immigration papers, it is easier to just stay in one place here. So, I have been renewing my agency contract at the local hospital here. I also recently applied to the LTAC facility here for a secondary PRN job. I desperately need a change. I have been experiencing maximum frustration with medicine and nursing in general, particularly here in this area.

Lately, moral has been in the dumps. And for good reason. It seems as though the hospital wants to eek out more and more from us, until we are wearied to the bone. I recently floated to the medical unit. I started out with 6 patients. discharged three of them and admitted 2. I felt like all I had time to do was run down the hall chucking meds down people’s throats and keep moving. Everyone wanted a piece of me. There was no time to do anything. I could see why nurses get so frustrated and short tempered. You feel like a pill and paper pusher. This is not why I got into nursing. I got into nursing to care for people. to educate them, to help them, to provide compassionate care.

The next day I was back in the ICU, large and in charge. I started out with 2 patients, and quickly was tripled. We ended up moving out 4 admitting and transferring 4 in. I transferred a patient out to another hospital with an OB team. It was chaos. Hell really. Flash pulmonary edema, drips, codes, just…hell. I did not leave until 10:30 that night. It occurred to me that day, that I was in a war zone. We barely have the equipment needed to do our jobs properly. Doctors scream at us, curse at us, even hit us at times. Administration piles it on higher and deeper. I often feel like I am barely keeping my head above water. I have nightmares about work. Administration does not back us, doctors belittle us, and everyone exists in a state of fear. You never know when you will be written up again, who will be fired on a whim, and most people do not know that a better way exists.

So, you ask, why do I stay? I adore the people I work with. My coworkers are lovely. They make me happy to go to work. I love being a nurse, and I feel like I make a difference almost everyday, even in some small way. And right now, I am not in a position to go anywhere else. At least not until things are more settled at home. I am just afraid that this place is stripping me of my passion for nursing. I do not want to become bitter and jaded. I do not want to become cowed into not speaking when things are wrong. If it is shit, it is shit. candy coating it, just makes it candy coated shit. You cannot change what you do not acknowledge.

I am also frustrated by some of my younger coworkers, who have never worked anywhere else. I feel that they have unrealistic expectations. It is always up to the mysterious “they” to fix everything. “They should give us more help” “They should treat us differently” “They should fix these problems”. It is what it is. When the shit is hitting the fan, screaming about it and having a temper tantrum refusing to accept an assignment is not going to solve a thing. Demanding more help when it just is not available won’t make a difference. Yes, it sucks where we work. No question about it. So what are you going to do about it?

These same nurses, do not seem to get involved. I do not see them going to staffing meetings, or nursing congress, or doing anything to try and make things better. In my humble opinion, the only way we will ever have things better, is to be more self directed. For the nurses in the trenches to set the standard and the goals. We need to come together and come up with creative solutions to fix our problems, and present them to administration. This will give us back a sense of control, and in the end be a lot more effective then temper tantrums. Perhaps we will even be able to solve some of our issues. But you know what? If we don’t try, we will never know.

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What a Week

So this week has been overwhelming to say the least. I have felt pulled and torn in multiple directions on a daily basis. It has seemed as though everyone has had a criticism of me this week. I have felt at times as though my very character is being questioned. This is demoralizing beyond belief.

I still work with amazing people. But management and the doctors have been just difficult as hell to work with lately. I am finding that the things I value the most about my nursing are being questioned and criticized. I am a person who gives a crap. I can’t help it. I try to not at times, but it is just contrary to my nature. This week, I was questioned for my dedication to my job- that I shouldn’t be helping people so much that I have to clock out on time. I also shouldn’t speak when the work situation is intolerable.
Later this week, I was told I was too emotionally attached to my patients. This was for trying to report issues going on to the doctor. The long and the short of it, is I realized today that this patient was being discriminated against for being unfunded. Apparently we are only aggressive and proactive with 90 year old people with insurance. If you are young but critically ill without money, you are screwed. Sometimes I feel so impotent at work I want to scream.

At least there is balance of good and bad. I saw some truly amazing and beautiful moments. I was blessed enough to witness a wife holding her husband and saying goodbye. She let him go, even when it was hard. To see the amount of love in that room, was a profound experience. The best that we can hope for in this life, is that someone loves us enough to do that. To be both on the giving and receiving end of that. To love and be loved, to draw our last breaths on this earth while resting in the arms of our loved ones. How someone cannot be moved by that, escapes me.

Yet, I find myself being criticized for being filled with wonder at what an amazing and fragile world we live in. How often to we circle one another, never truly connecting? How often do we hold back, not expressing our love and gratitude for the experiences we have on this earth? Why do we take this all for granted?
I am a sentimental person. I cannot help this. It is who and what I am. But perhaps I need to explore another direction in my life. I feel like I am spinning my wheels and getting nowhere. Life is too short for this.

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Changes In The Air

Well, I had another day at work. I ended up working again with the nurse described in my last post. The day was ok. Crazy as usual. The only different thing was I tried again to discuss these issues and find resolution. I spoke with my managers, and we all had a meeting together. it was an exercise in futility. The interesting thing is, it doesn’t really matter. At this point, I do not care if he changes or not. That is on him. It did clearly illustrate some core values that I have in conflict with my managers. I do not care for their style of management, or lack thereof. The take home point was that I made the decision to move on. I will hopefully continue in a PRN capacity at this hospital, but it is time for a new assignment.

So I spoke with my agency and there is something opening up in Edinburg exactly when I need it to. Everything seems to be falling into place. I will be interviewing hopefully today for that. Orientation week will be challenging as I am working the last week of my contract here and need to start there, but I am confident I will work it out. I may not sleep, but I will work it out.

I also went and chopped more of my hair off. It is a little shorter than I wanted, but it looks cute. My hair though is almost a metaphor for my life right now- I needed to get rid of the dead ends, and it will grow back. It had become damaged and hard to manage, but I was afraid to let it go. No more. I absolutely will not live in any kind of fear. I am the one who has to live with my hair, and myself. I cannot have it to please others. It is mine and belongs to me, just as my life and profession does. My new path of eating is also going well. It has been hard to find anytime to exercise, as my work schedule has been completely insane, but at least the food is on the right track. my daily calorie count has been between 1200-1500 calories pretty consistently. I need to watch and keep up with my water intake. when we get super busy at work that tends to drop off and I notice a difference. I also need a new scale, mine is possessed or something and give me a different reading every time.

I guess though ultimately I am feeling like things are changing for the better. I feel like I have found the “secret” so to speak, at least for me. I must stay in the moment, positive, embracing all things, and loving myself. Taking that care that I give to others and applying it to myself. I deserve to be treated with respect and care, I deserve to be happy healthy and whole. Because I am awesome, and the only person who can deny me that is myself.

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Where to Next

ok, so I am going to Rogers, Arkansas next. its a short term 8 week assignment. should be interesting. I will be on day shift, yay! I have not had regular day shift work in forever. I am very excited about that. lots of overtime available too. it will be interesting to see what adaptations I need to make for my schedule doing days. I am thinking more of a two on 1 off sort of thing. I will be working a PCU/Tele floor. the pay is good, and there are other travelers there. I spoke with the manager on the phone, they seem to be having the same issues most hospitals are having these days. lots of new grads, not so many experienced nurses. the poor new grads are overwhelmed. I wonder what is happening to everyone else? and it is odd I must say to be considered ‘experienced’ with 12 years as an RN. I remember when that both seemed ancient, but having done it, it doesn’t seem like that long anymore! below are some links to info about the hospital and the town.

http://www.northwesthealth.com/Pages/home.aspx  I will be going to the Springdale Location.

wiki- http://en.wikipedia.org/wiki/Rogers,_Arkansas I have never been to Arkansas before! will be interesting!

wiki- http://en.wikipedia.org/wiki/Springdale,_Arkansas  i think this is where the hospital itself is located.

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Nursing Travel Agencies I have encountered

ok, so the agency I am with right now is Liquid Agents. this is not a commercial for them, I swear. I was referred to this agency by word of mouth from a nurse who was working cath lab at my old hospital. He said he had been working with them for quite a while and was very happy with them. he gave me the website address, explained to me a little bit about how he got paid, and how it was working for him. I went to their website and completed an application, but also started looking at some other agencies as well. The other ones I spoke with were American Mobile, and On Assignment Staffing. I filled out some forms for some others online, but they never got back in touch with me. On Assignment I contacted online, but someone I knew also worked with them on occasion.

a summary of my experiences and why I chose who I did:

On Assignment- very aggressive recruiter- seemed young and inexperienced, not a nurse by trade at all. pluses- was trying to get me work quickly- minus- not the best pay package, and something turned me off in a very used car salesman sort of way. the recruiter was always ‘reaching out to you” and “wanted to check to see if you had a chance to reach out to the hospital”. it gave me the creeps. I also felt like he was just submitting me for anything and everything, without a real thought as to my worth or my specialties. no real overtime pay, nothing remotely resembling time and a half. the people they said were going to call me did not call me, and when they would tell me to contact someone for an interview I had difficulty getting return phone calls. the only one who did was for something that was not an appropriate assignment for my area of expertise.

American Mobile– professional, prompt in their response. not very high on the payscale, and it feels like a machine. I think these are the big dogs in the industry, but do seem to lack some of the “personal touch” that I like. I got along ok with the recruiter, but she did not seem to remember me from one conversation to the next, and the payscale especially for OT was not up to par. If they were to offer me something that paid enough, I would consider working with them.

Liquid Agents– these were the first people to call me back. My recruiter is Jessica, and she is a delight to work with. she actually seems like a real person, and she is easy to deal with. everything was clearly spelled out in my contract, and she was very flexible with working with my needs. I had originally been looking for some local travel, but she had this great opportunity come up and submitted me for it. it fell into place like a dream, and I got hired right away. the pay is excellent, and she was more than patient to go over all my pay options for the contract. it was spelled out exactly what was what, how I would get paid, and which options I could select. everyone is pushing this tax incentive thing. I personally like it, it works well for me. I take a housing and travel allowance that is tax free, and find my own housing. my taxable rate is far less, which is what saves me on OT. this company actually is giving me an OT bonus, on top of the “time and a half” of the lower hourly rate. they are not keeping that for themselves, which is what I think in truth many of the agencies do. I do not have a problem with them making money- they find me the jobs and take care of a lot of hassle for me. but I am the one who is bringing home the bacon so to speak. I am the one working gobs of shift, representing the company, doing a good job and bringing them more business. I should be the one getting the lion’s share. I am a good nurse, experienced, flexible, and I know what I am worth. I am not desperate for work, and I will always have a job. I feel like I have a very good understanding with this agency, in that we work together so we both can be happy. and if I am happy, they will be happy- because I will bring them more business with those hospitals and recruit more nurses to work for them.

I will make another post more in detail about the pay thing, and how it works exactly with the different pay options most agencies do. this post is just to detail my experiences, it is not meant to be for or against any particular agency. I went with who I did bottom line because of the money and clarity of the offer. I wanted short term assignments, and they offered that as well. I am getting ready for my second 8 week assignment, so we will see if the shine is still there!

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Leaving Yuma

well, I am completing my first travel assignment here in Yuma, AZ. I have learned a lot here for my first experience with this. pro’s and cons, and feel like I will be able to tackle my next assignment with even more confidence. I have met a lot of new people, made some new friends, and really have enjoyed myself immensely. I would say the best thing I have done, was in getting to know people. this has been an outstanding experience for that. if I had to break it down into top 10 things I have learned it would be the following.
1. Research Your Surroundings. I discovered after I had already been here for a while and had spent quite a bit of money on a rental car, that the cabs are ridiculously cheap. I could have saved myself 500 dollars my first 3 weeks here.

2. Don’t be afraid to be unconventional and take risks. I rented a motel room for the first week I was here, then met someone in orientation who needed a roomate. it has been an awesome experience. not only have I saved money, but I have made a really great friend. If I stuck to the traditional route of provided housing or keeping to myself, this would not have been nearly so financially lucrative, nor would I have developed this friendship.

3. Search out your transportation options way in advance. I lost money coming out here because it was kind of last minute, and the travel options were limited. if I had researched things a little more, I would have found out I could fly into a major city and take a shuttle to my location, saving me time and money.
4. Portable Internet. This is a must. everything is online now, and while I brought my laptop and I have my iphone, I did not have real internet access for most of this trip. I assumed I would have it in the apartment, but it was more challenging to get. I ended up getting something through my phone company that is portable and I can hook up to 5 wireless things into it. for 50 bucks a month, it can’t be beat.
5. Travel Light. I have too much crap with me. I have to buy another suitcase to take the stuff with me home that I have now. its really not necessary. half of the clothes I brought with me I have not used, and there are things I wish I had.
6. Have Distractions. its very lonely being away from your family and friends when you travel. you don’t notice it on the days you work, but on your days off, you have to find things to do. its especially hard working night shift, because you feel like such a zombie on your days off.
7. Talk to your neighbors and co-workers. I have gained a lot of tips and information by networking with people. just by being open and friendly, I have learned new things and gotten great tips on local stuff. anything from where to eat, to what to do on your day off. the local people can help you, and the other travelers can offer pointers.
8. Be Flexible. I have floated all over the hospital, and had as much work as I want. I try to be all about what I CAN do, not what I WON’T do. it has put me in good standing in the facility, and really helped me financially.
9. Be Goal Oriented. I have to remember why I am here and what I am doing this for. I make small little goals- get through this week, earn x amount of money…it makes the time go by faster and makes it much easier to adapt.
10. RELAX. this is about the experience, the journey, the adventure of being somewhere new. just roll with it. it is fun being somewhere I don’t know! yes, some people call it being “lost”…I call it exploring. you have to have the right personality for travel nursing, and you have to be flexible. nothing is perfect, no place is perfect. if it was, they wouldn’t need travelers. but its exciting, and its temporary. so if it sucks, it will end eventually. and it is all about what I make it.

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