CrazyGoonRN 11,224 Views
Joined Aug 14, '09.
Posts: 442 (30% Liked)
And I bet families of patients going into Med/Surg (or the ICU, or L&D, or OR) feel the same way. I've never met a patient who said "Yes, I TOTALLY want a brand new inexperienced nurse taking care of me!" But yet, new grads can't become experienced nurses without...experience.
I think it says more about how nursing schools are teaching. Med/surg is a specialty of its own; to say that everyone needs to start there kind of seems to disrespect that status. However, schools need to have students prepared at the basic level of functioning; instead, it seems that nursing grads need to be taught how to be a nurse after graduation, regardless of the specialty in which they work.
We have several new grads in our ER. I'm starting to think that most nurses should have at least a year on a more general ward before learning a specialty.
I'm seeing some clueless mistakes, and lack of basic skill in pt care. That includes things like how to clean a pt and roll and change bedding. Basics about IV med administration, dose calculations, prioritizing, and realities of inpatient care. They have no idea how the rest of the hospital functions.
On top of that, some of them seem to harbor elitist attitudes, as if they are already big hotshots. Yet, they themselves seem to lack the above mentioned skills.
So I did some digging and wanted to give a real life exam. I'm single and no dependents, under 30, and a non smoker. I looked into Anthem Blue Cross Blue Shield because they have a national network. The agency I'm speaking with also uses them so it was easier to compare value. My recruiter crunched some numbers based on two available contracts and gave me multiple scenarios for each.
For vision, dental, and health I'm looking at $455/month out of pocket to have my own plan based on the choices I felt were best for me. There were 21 options for medical, 3 dental, and one vision. The agency will also give me $400/month to have my own insurance. This will be added to the housing stipend so it's tax free (provided it's not over the fed limit for housing in the area). Or an increased $2-3 hourly wage if taking provided housing. So we're looking at $55 out of pocket expense (maybe slightly more or less depending on taxes and overtime with the hourly rate option)
If I take agency insurance vision/dental/medical, I will pay $110, $190, or $278 per month out of pocket (pretax) depending on the medical plan (only three options here and no choice in dental and vision). Insurance starts on Day 1 as long as paperwork is submitted 5 days before assignment starts. And you're covered for 30 days between assignments (they'll charge you out of your next couple checks). BUT NOTE: Another company I looked at, you're not covered until DAY 90!! So pay attention to this. Also, I'm not how much it would cost to put these plans on COBRA but let's just add $400 to your monthly rate. So $510, $590, or $678 completely out of pocket.
The biggest differences were deductibles when you'd have to pay out of pocket for the big expenses but it really doesn't seem to matter once I crunch some numbers (I didn't do the lowest cost plan because it doesn't seem comparable to what I picked):
Personal plan - 3500 deductible, $5700 annual max, 25% coinsurance (meaning how much of the remaining bill you have to pay after deductible, up until you hit the annual max). A outpatient services bill of $2000 will cost $2000. A $1500 ER bill will cost $1500. A hospital admission costing $8000 will cost $4626
Agency plan Mid cost - $1000 deductible, $6350 annual max, 70% coinsurance (plus additional $500 copay for admission and $200 for ER visit). A outpatient services bill of $2000 will cost $1700. A $1500 ER bill will cost $1410. A hospital admission costing $8000 will cost $6050
Agency plan highest cost - $700 deductible, $6350 annual max, and 80% coinsurance (plus additional $500 copay for admission and $200 for ER visit). A outpatient services bill of $2000 will cost $1740. A $1500 ER bill will cost $1380. A hospital admission costing $8000 will actually cause you to tap out at your annual max of $6350.
I think in this case, my own plan makes more sense to me. Obviously, monthly cost could change if companies aren't offering anything in return for carry my own insurance or you change agencies and insurance often. But it's really just preference. I think I'd rather have my own insurance, not have to worry about a waiting periods if switching companies, etc. I also don't want to have to figure out a new network every couple months. Sometime the lowest cost isn't the most important thing.
But if you're looking to save money monthly, there are other cheaper options. If it looks like if you're facing paying a high deductible, crap probably hit the fan and they all start to balance out in the end. (Sorry if a number or two from my math may be off. But I think the point is clear)
If you have a tax home (which enables tax free stipends if you work away from home), then you are required to file a resident income tax return in your home state. However, your work state always gets first crack at income taxes, and if your agency is paying you correctly, you will have paid income taxes in your work state. You are also required to file in every state worked (except a few states that do not have income tax).
While I cannot speak to how Turbotax does with multiple states, the process of doing them yourself is pretty easy. First do your 1040 or have Turbotax do it (FreeTaxUSA online is similar to the Turbotax question process, and is well, free for IRS returns). Then go online, and do each state's non-resident income tax return. They pretty much just flow from your 1040, and the amount of money earned in that state. Do your home state tax return last. It will credit you for taxes paid to those other states.
Returns are due today (or must be postmarked today if you have to file a paper return)! I did four tax returns a week ago in about two hours (after a couple months procrastinating), so it is doable.
I am having trouble with remembering the differences between right & left heart failure as far as symptoms. Is peripheral edema a manifestion of both? Any mnemonic help? TIA.
you may visit the georgia board of nursing's website at www.sos.ga.gov/plb/rn, click on "application downloads" and choose instructions for out of state applicant fingerprint background check. this will provide clear information regarding the necessary steps to obtain a background check without traveling to the state of georgia.
I did alot of research and sifted through alot of recruiters. I'm now signed up at a grand total of 8 agencies. But I can tell you of that 8 I regularly use only 3. Why? Because I require 3 things. Prompt communication (if I text or email during business hours on a weekday I expect a response in no more than a couple of course), the best pay package, and don't mess up my paycheck. I've found only a few recruiters who can do this for me consistently.
So no, I don't think you have unrealistic expectations. And my superstar recruiter may seem lackluster to you. It's all very individual. I'd recommend you join some travel nursing facebook groups. They are lively and lots of support for newbies. Try The Gypsy Nurse oNE first.
Tip one: There is no perfect company. There is better and worse.
Tip two: A lot of your experience depends on the recruiter. If you sign up with recruiter A and there is disconnect between you two, then you can be switched to recruiter B. Usually just takes an email or phone call to their manager. Keep it short as the reason for the switch. MOVE ON, if they will not meet your request.
Tip three: Sign up with 4 agencies minimal. That means have active profiles ready to go. If you get canceled or terminated you have three other agencies that can possibly cook up something for you quick.
Big question: What companies should I look into? Depends if you want to fatten the pockets of investors or mom and pops, lol Seriously...
*Bigger companies are going to have more volume and desirable locations. You know them they invest highly in advertising...Cross Country, Aya and American Mobile. These companies are the main vendor for many hospitals. That means other agencies have to pay them a small percentage. A nurse can work directly with these large companies. Working directly does not mean the RN will get more money. Bigger companies have many different departments you have to deal with.
*Rapid response companies like Faststaff and Healthsource Global are going to be limited locations and not as desirable. Taxable hourly is a high rate and the two listed will provide housing. Blue Force and Cru 48 will seldom provide housing.
(Rapid Response means a nurse can start in 1-2 weeks. Critical emergent needs of the hospital.)
*Smaller agencies might be limited to just 1-2 states but, they have less overhead cost. Less overhead means more money for the RN..
**Ask some of the mid size or smaller agencies do they have direct contracts through the hospital. This usually means more money for you the RN.
For those who have traveled please chime in why you work with XZY company.
One hour to never! It would be reasonable to give up after 3/4 days and broaden your search. Try to follow up and find out what the problem is (usually hospital HR in most cases) because it is possible there is something in your profile that makes you unqualified for the position submitted, or some negative they didn't like. Once in a while, you get useful intel from your failures.
You know, Karen, I was typing my response and one thought kept crossing my mind. Since my colleagues have done such a fabulous job already, I have chose not to defend my career choice against your inaccurate statements and just post the one thought.
If you are so anti-traveler, why are you lurking in a travelers forum.
As a side note, maybe you could use that time and put it to good use, like actually educating yourself on the facts that accompany traveling.
Also, we dont see the money that hospitals "shell out" for us. We dont make that much more. We dont get vacation pay, sick days or even 100% paid benefits. We go sometimes months without seeing our friends and family. So when you get "sick and tired of paying these high fees", just remember what we give up and live without just to help in your staffing crisis!
John Hopkins is notorious for cancelling travel contracts. I did not get cancelled when I worked there but about 4 travel nurses were cancelled the same time that I started. And I know that someone got on about not talking about the " nurses attitudes" but it is because of these staff nurses that some of these nurses were cancelled.
Just a word of advice ANYWHERE you go, document, document, document. And I am not talking about regular chart documentation.
Document on their procedures (if it is something different than you are used to) and who told you and the date.
I work with Open Heart patients, in one hospital a nurse orienting me told me that they do not check potassium levels on day 2 even if the pt has a couple of PVCs on the monitor. I wrote it in my little book that I carry every where I go along with her name and the date that she told me. Guess what, when she realized that I was writing down her name she re-canted what she said. Once these staff nurses see that you are knowledgeable about your stuff, they will just respect you.
Even recently, I received a patient who was in recent Afib and the resident decided to stop the amiodarone drip. Mind you, the pt was still in Afib. I mentioned this to her about 3 times in 30 mins. and she adamantly told me that she doesn't want the pt on the drip. Well, I charted on the patient's chart the number of times that the MD was made aware. I also told the charge nurse and made it known to the supervisor. People may think that I may have gone overboard but guess what, I am here for my patients and mind you my pt was finally put back on the drip and broke the Afib 2 hours after. And the attending came in the morning abd read my notes and thanked me for taking care of his patient.
Just remember you have to be on top of your game as a travel nurse
Here's my two cents worth: I worked there as a Travel RN and extended my stay twice - I worked in the ICU and loved it - everyone worked together and I felt like part of the family. I would work there tomorrow if I could.
The long lived what seems to be country wide rivalry between EMTs and Long Tern Care Nurses is an obvious one. Long into social media, you see EMT pages posting ridiculing memes about long term care facilities and the pooor nursing care provided. Visit and EMS forum, and you'll see threads doing the same.
As a former EMT, now LTC Nurse, I've come up with a list things that I do believe every LTC Nurse wished EMTs understood.
1. There's a big difference in quality of care when patient ratios are 2:1 rather than 1:40 plus. When an LTC Nurse doesn't know the answer to a question off the top of his/her head, doesn't know the events leading up to the emergency, I doesn't mean that they are lazy or incompetent, when you have 40 demanding residents, to give medications too, and loads of charting and other work to do, as a charge nurse, you will not know every detail about every resident every minute of the shift. Imagine getting to the hospital to give report on 1 patient and having 40 patients in the back of your ambulance.
2. We don't make the rules. Sometimes as EMTs you may think that just because a patient fell and has no S/S of head injury that the transport isn't necessary, but a doctors order is a doctors order. If a residents primary care physician orders an ER eval, then that's fina. There's nothing you can say that's gonna change the fact that my resident is going to the hospital. As a licensed nurse, I will not be standing in front of my state board at a hearing, having to explain why i refused to carry out a physicians order. I once told an EMT who was being difficult and causing a scene in the hallway, asking why we were sending a resident out for such a small not in his head, in such stormy conditions outside, " Because I'm not putting my license on the line by tellling Dr. Brown (not real name) that I am not sending his patient to the hospital, but you are more than welcome to do so,".
EMTs and Nurses play a very vital but very different part of healthcare today. And I do think that if we could be a little more understanding of each other's roles, responsibilities, obligations, and limitations, the ride for the resident from the LTC Facilty to the local ED may be a little less rocky.
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