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Joined: Aug 14, '09; Posts: 444 (30% Liked) ; Likes: 357

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  • Apr 22


    Based on true Travel Nursing experiences by Cynthia Hubbard, R.N.

    It was Wednesday when the call came in: "Can you be here by Tuesday?" Moira, the Director of a well- established Home Health and Hospice company up in northern Maine had just phoned me for an interview. It wasn't 10 minutes and I found myself saying with enthusiasm, "Sure!" Never mind I was in Wisconsin, but then, I have always been an optimist.

    "Really???" Hope was evident in her voice. "Wow! That would be great."
    "See you Tuesday, " I replied. I placed a call immediately back to my travel agency per instructions, to let them know that I would accept the assignment. Now I needed housing. I hate apartment living so Janelle in the travel agency's Housing Department was scrambling to find me a single family rental near where I would be working. She phoned to tell me she was waiting for a reply which we found out later - would never come.


    After three hours, Janelle called to say she found a "cute place on a lake with a private deck and everything. I found it on Craig's List," she said happily. She gave me the phone number to the lady who owned the house. She lived upstairs from the studio I would be renting. It was in my price range. Little did I know what I was in for.....As I already had my necessary administrative paperwork done, all except the drug test and a few FAX's to send, all I to do was pack a suitcase....or so I thought.

    The vehicle I drove was a 2000 Plymouth Voyager Van, 15 years old. While it got its' oil changes done religiously, and had new brakes, tires, and insurance, it lacked a tailpipe, one hubcap and had no back seats. Mind you it was great for loading stuff, but as it has crossed the country four times in the last 5 years and been exposed to extreme temperatures, so of course it had some rust. I suddenly wondered if we would really be okay on this trek to "God's Country." I phoned my mechanic to schedule the oil change. It was a tough squeeze but he agreed to do it later that afternoon.

    As there was no internet in my apartment, keeping communication open between the travel agency and myself was a challenge. One is only authorized 2 hours a day of internet at the library unless one brings their own computer. Experience has taught me that using my computer in the library, is an exercise in patience. It could take up to 2 hours just to log on. Some documents such as titers, immunization records, physicals, respirator fittings, etc. needed timely FAXing so I jumped into my car to our apartment manager's office to use their machine. Caroline was behind the desk, hunched down, speaking to a prospective renter on the phone. (I think she had hoped I wouldn't see her.) Her desk piled with papers, she was trying to eat her lunch at the same time. Clearly, she was doing the work of 2 people. I felt guilty for asking for her help, but FAX's sent from her office do not cost anything and I was told in the past that it's ok to ask them to send. She hung up the phone.

    "Hi, Caroline," I said with some mustered up cheerfulness, "How are you?"

    "Busy," she said flatly.

    "I just got offered a travel nurse position up in Maine and I need to send these right away. She loaded the machine. While it was sending, her phone rang. As the pages fed through the FAX, they fell on the floor, gracefully spilling in all directions. I wanted to go behind the desk and help gather them up but renters aren't allowed back there so I helplessly stood while she spoke on the phone while I waited. The Confirmation Page printed. I thanked Caroline very much and headed out the door to the mechanic, 45 minutes up the highway. As I rolled into the garage for the oil change, my phone rang. It was Joe, from the travel nurse company.

    "We never got the FAX," he informed me.

    "But I have a confirmation!"

    "Nope, it's not here. Can you send it again?" Caroline again and I was too far away from town anyway.

    "Wait," I brainstormed. "My church is about a half mile up the street. I'll see if I can use theirs."

    "Ok, just let us know when you are transmitting so we can watch for it."

    "You got it," I said. Throwing the car into reverse, before he got a chance to raise the hood, I left the mechanic with a mental promise I would call him later and re-schedule. As I sailed into the parking lot at church, I prayed I could get this all done before I had to leave for Maine in the morning. Slamming the car door and racing to the entrance I nearly dislocated my shoulder as I grabbed the door handle to the church entrance.

    Locked! I forgot that the church was also a school and that school was now out for the summer. Frantically I phoned the Pastor. (I had him on Speed-Dial.)

    "Hello," he said cheerfully.

    "Pastor, I've got kind of an emergency.." and explained to him what I needed.

    "May I use your FAX?"

    "Sure! Just tell Amanda what you need. Come to the end of the building and she'll let you in. I'll let her know to open the door."[

    "I breathed a prayer of thanks." Amanda opened the door and said seriously, "You need to send a transmission? We will need to de-activate the alarm, as school is closed for summer and the equipment is rigged to go off if being used without authorization."

    "Wow, so what do we do?" I asked.

    "I'll call them and ask them to de-activate it while we are using it. It shouldn't be a problem."I watched as she contacted the Security folks. "About a half hour I would think," she said to them. I pulled out my paperwork and got my agency on the line to confirm as it was being transmitted.

    "By the way", said Lisa, (H.R. Compliancy Officer at the company), "we also need a copy of your C.P.R. card and proof of car insurance."

    "Great," I thought to myself. "It will mean a trip to the car," as I kept that in the glove box. I glanced sheepishly up at Amanda- she's very tall. "I will need to go out to the parking lot and I'm afraid the door will lock after me."

    "Just prop it open with the child bench outside the door," she suggested. I ran down the hall. We were racing against the clock so I was only thinking about my Team that was waiting for the FAX, the alarm and how much time we had. The bench was within reach. As I held the door open and reached over to pull the bench over, I was shocked to feel how heavy it was and nearly threw my back out in the process. No one mentioned it was made of concrete!

    As I reached the car and threw open the glove box, I saw to my dismay that although I had current coverage, my card had expired. "This just keeps getting better and better," I said to myself ruefully. As I trotted back to the church office and handed her the expired insurance card, I called Joe to let him know that the card is expired, but I could prove coverage.

    "Yeah, we really do need a current card or something from your insurance company," he droned.

    "You'll have it within the hour, I promise." I shot back with a forced smile. To my horror, while Amanda was making copies of my tiny cards to FAX, the alarm went off. We stared at each other. "Really?!" I asked. "Has it been a half hour?" We waited. No phone call.

    "Great," I said chuckling, "Do we wait for the S.W.A.T. Team?" "I don't understand it," Amanda said looking bewildered. "They're supposed to call when it goes off." "Well," I replied, "I'm on a mission. They're gonna have to shoot me first." I started laughing. Amanda didn't think it was funny. The phone finally rang. All was well. I thanked her profusely and she wished me well.

    Another ring...it was my cell: "By the way," (it was Lisa again) "You will need to take a couple of quick tests online. Can you get to the library?" No stress there. I was only 45 minutes in the opposite direction. I said I would get there in about an hour. It was a miracle it went as well as it did. The tests got done, I was packed, mail forwarded and out the door, I went the next morning. I don't think my feet even touched the ground.[

    Travel Day:[

    First stop, the garage. I still needed that oil change and I knew I'd be walking on eggshells with the mechanic, due to the afternoon previous.

    Jeb was in a bad mood, crabby and the only person in the world I know who can make "good morning, " sound like it was a bad thing.[ I pulled in the garage and left the car to wait in the waiting room. About 15 minutes later Jeb approached me scowling, "You might need another one of these." He held out his hand with a broken piece of rubber hose that used to be part of the crankcase apparatus.

    "What are you guys doing? I only wanted an oil change."

    "I'm not breaking stuff on purpose! It just came off. Here, I'll show you. Follow me." I obeyed.

    "Can you tape it for now? I need to get on the road." He showed me a print out of my battery. It didn't look good.

    "Promise me you will get the battery replaced as soon as you get there if not sooner. The tape will hold for now. The oil change is done." I was on the road.....

    The deadline to get there was Tuesday to start work, so my time was limited. Wisconsin, Illinois, Michigan, Ohio, Pennsylvania, New York, New Hampshire and finally, Maine. The scenery was an education in the geography and demographics of our wonderful land. The glorious sunrise of gold, pink white and silver, the rolling green hills flowing of farmlands, bays of blue-silver water, sailboats, colorful gardens, all were reminders America's beauty. I smiled as I anticipated how much fun driving to the northeast would be.

    It rained in Michigan, quite a lot. Highway traffic was deadly. I prayed for Travel Mercies the whole time. Unfortunately, in every state I hit construction. Still, the delays weren't too bad and I managed to make it to a nice motel by 8 p.m. the same night.

    When I got to Ohio, the highway suddenly closed down without warning compliments of the State Highway Patrol. All traffic was detoured through Sandusky, at the height of the motorcycle gathering of veterans, and a celebration of the anniversary of the end of the Viet Nam war. The colorful flurry of flags that flew, planted in lush lawns, the bands playing, vendors, outdoor cafes in full swing, folks honoring those we lost and those who came home scarred inside or out, made me take pause. To this day, when I see a convoy, I still get choked up.

    The one thing that I thought was a miracle, is that the whole time that I was driving, my blower fan which needed repair, was working beautifully! There wasn't time to fix it and frankly, I hadn't the finances to do so. It was to God's grace to which I give credit. By the time I got to New England, my spirits began to soar. The mountains, mists, colors and lack of billboards made the drive look like a picture postcard. Such graceful and treacherous beauty!It felt as though I was entering another world...

  • Mar 19

    really either is fine. If it were me I would put it on my resume. They don't know it wasn't a short critical need contract. Fast staff sometimes does 4-8 weeks contracts. Strikes are even less. If they ask be honest, but if they don't (probably will not) then your fine.

  • Mar 15

    Well most of us sign the contract with good intention and I don't know about you, but I value my license and integrity and I am not going to work anywhere I feel like my license is in jeopardy or I am being treated like crap by being floated 1-2 times a shift and being paid $40 less than the staff nurses. And one is unaware of these conditions when the contract was signed. And if YOU honor your contract as signed then don't worry about the fines cause you wont have to pay them. I'm not into settling for bad situations and so if I feel like that's what my contract put me in then by all means necessary I'm getting out of it. So, Sorry if it affects you in someway, but if you like your contract and complete it, then it shouldn't affect you!!

  • Mar 15

    I just quit my contract with 7 weeks left on it...I was miserable and my son was at home not with me on assignment and he was starting to rebel agaist his uncle...who he was at home with...I was getting floated everyday and sometimes twice a day...I just hated it and I couldn't take it anymore...so we'll see what the say but it doesn't matter...I'm not going back!!

  • Dec 30 '17

    This is just not something we can help you with. Please discuss this with your wife's providers.

  • Jun 18 '17

    I remember the first time I heard about travel nursing. I thought the idea was awesome. Travel around the country and have adventures.

    I also remember the uneasy feeling I had about it. New hospital and jobs every three months? It sounded crazy.

    I wanted to encourage you to try something new in your career as well as some signs that travel nursing might be for you!

    Go have an adventure! It's pretty freaking awesome!

    -Andrew


  • May 8 '17

    Quote from klone
    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.
    And that is my point - gain the basic experience in a LESS acute area than the ED.
    My family member has had new nurses on med-surg. While I have not been completely comfortable with the situation, I have been able to watch what happened as my family member has not been in a situation that requires critical or emergent nursing and medical care. In the ED there is no time for that; if my family member deteriorates or needs specific care and they need it now, this is not the time for the patient and family member to be hanging around hoping the new nurse will get their act together in time.

  • May 8 '17

    Quote from Rose_Queen
    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.
    I agree with the OP.

    Regardless of whether people agree on the status of med-surg as a specialty, I think the point is that basic nursing training on a med-surg unit does provide good training in the fundamentals of nursing care that one will use in a number of other units/specialties, and provides a good knowledge base that is applicable to other nursing areas. In the ADN program where I received my clinical training approximately 20 years ago, I completed several clinical rotations on med-surg units: oncology (2 half semester rotations), student work experience, and preceptorship; ortho/neuro (one half semester rotation); general med-surg (one half semester rotation). We provided total care from the second week of classes. Along with patient assessments, and monitoring patients, once we were checked off on skills in skills lab, we could perform those skills in clinicals' with our instructor present for the first time (for certain skills, such as IV meds, we had to have our instructor present whenever we performed the skill throughout the program). We learned how to bathe, move, transfer patients, make occupied beds, and provide incontinence care. We had a chance to work on developing time management, charting, working with other team members, and team leadership. I found everything I learned on my med-surg rotations relevant on all of my other clinical rotations: rehab; L&D; ICU step-down; pediatrics; psych; geriatrics. My med-surg training formed the basis of my nursing training. I was exposed to a large variety of diagnoses and medical problems, and a variety of patient ages.


    Today, it seems as though many nursing students are barely trained to provide hands on nursing care any more. I have read numerous accounts of the lack of clinical training students have received, but I have never really read good explanations for the reasons why nursing training has changed so much. I remember when nurses who were hired into the ER/ICU were mostly experienced nurses. I don't really understand why facilities hire new nurses into specialties such as the ER, when the nurses can't even function at a basic level.

  • May 8 '17

    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.

    Thoughts?

  • May 2 '17

    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)

  • May 2 '17

    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.

  • May 1 '17

    Quote from sports2245
    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.
    No. Peripheral edema is NOT a manifestation of both types of heart failure. It is a manifestation of right-sided heart failure.

    Heart failure is a gradual progressive condition. It starts and proceeds as follows:
    1. left-sided heart failure
      • ineffective left ventricular contractile function
        • increased workload and end-diastolic volume enlarge the left ventricle
      • pumping ability of the left ventricle fails, cardiac output falls
        • right ventricle becomes stressed because it's pumping against greater pulmonary vascular resistance and left ventricle pressure
      • blood backs up into left atrium and then into lungs
        • diminished function allows blood to pool in the ventricle and atrium and back up into the pulmonary veins and capillaries
        • rising capillary pressure pushes sodium and water into interstitial spaces
        • fluid in the extremities moves into the systemic circulation
      • Signs and symptoms
        • dyspnea
        • orthopnea
        • paroxysmal nocturnal dyspnea
        • reduced sympathetic stimulation while sleeping
        • pulmonary congestion
        • tachycardia
        • S3
        • S4
        • Cool, pale skin
        • restlessness
    2. right-sided heart failure
      • ineffective right ventricular contractile function
        • stressed right ventricle enlarges with the formation of stretched tissue
      • blood backs up into right atrium and peripheral circulation
        • blood pools in the right ventricle and right atrium
        • backed-up blood also distends the visceral veins
      • patient gains weight and develops peripheral edema
        • rising capillary pressure forces excess fluid from the capillaries into the interstitial space
      • Signs and symptoms
        • jugular vein distention
        • positive hepatojugular reflux
        • hepatomegaly
    3. systolic dysfunction
      • left ventricle can't pump enough blood out to systemic circulation
      • blood backs up into pulmonary circulation and pressure increases in pulmonary venous system
      • cardiac output falls; weakness and fatigue occur
    4. diastolic dysfunction
      • ability of left ventricle to relax and fill during diastole is reduced and stroke volume falls
      • high volumes needed in ventricles to maintain cardiac output
    The above information comes from Pathophysiology: A 2-in-1 Reference for Nurses, pages 182-185.

    Two terms connected with heart failure are preload and afterload. End-diastolic stretch is known as preload; afterload is the stress or tension that develops in the ventricular wall during systole. You need to develop a good understanding of heart failure, preload and afterload and how they all relate because all this information is at the basis of understanding the nursing diagnosis of Decreased Cardiac Output. Students are always asking what nursing diagnosis to use with certain medical diagnoses. Decreased Cardiac Output is used for any of the heart failures including congestive heart failure.

  • Apr 24 '17

    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.

  • Mar 29 '17

    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.

  • Mar 21 '17

    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.


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