stayseerrn

I do agree that it feels much more challenging to find jobs right now. Before, I would be able to have my next position locked down, contract signed, and know my new address with four weeks to go in my current contract. Lately, my recruiter has been telling me, "they don't look for anyone earlier than four weeks out now." So now, I am spending the last two weeks on my assignment trying to get my next one lined up. For the assignment I am on now, it didn't get settled until 10 days before the end of the assignment I was on. Talk about scary!!! But, like other posters have said, the jobs are there. They just might not be in the exact field, area, or on the specific shift you want. I definitely recommend you take up traveling. It was the best decision I ever made. Just be sure not to pigeon hole yourself to one small niche which would limit your job opportunities in a tight market. Oh yeah, the South is undergoing a major budget crunch lately. They have had all kinds of problems with the government health care plans, so a lot of the states are in dire financial straights. Don't be afraid to go for California. There is more to Cali than LA. California usually has jobs because of the state mandated patio staffing ratios, so they always need travelers. Just keep in mind it might not be the exact hospital you want that needs travelers at this time. Best to just settle on an area you like and then choose a hospital from there. Good luck!

Re: Southern California California is really a nice place, especially in the San Diego area. Lots of wonderful things to see and do there. The hospitals are really great as well. When your recruiter is quoting you those $25-27 / hr rates, ask them if that is the blended rate or the base rate. If those figures are the blended rate, then move on. If they are the base rate, then you are in the right ball park. California law requires employers to pay their employess time and a half for every hour worked over 8. Therefore, when you work a 12 hour shift, your last four are paid at time and a half. So, you will often find base rates around the upper $20's with your blended being somewhere in the lower to mid $30's (average of base for the first 8 and time and a half for the last four). That's pretty typical. So, if the base rate is then upper 20's, your on course. If your blended rate is in the upper 20's, you're getting robbed and you need to check with other travel companies.

Am currently in San Francisco Bay Area. Housing stipend is $2000 per month - per my recruiter and what others have told me. Wouldn't recommend taking the stipend in this area. Housing is insanely expensive, so are utilities, and if you are in the city itself, parking is an absolute nightmare (not to mention expensive). Like the previous poster said, you might be able to work out lower wages, for higher stipend. However, I really don't recommend this. In the San Francisco Bay area, the cost of living is so expensive that it could bite you in the backside to cut your hourly wage to get more on the housing. If you come to the Bay Area, take the provided housing. You will be better off.

For my next assignment, I have to work for another nurther agency, but still get paid by current company. Basically, I am a subcontractor of this hospital's nursing agency. We have to go to a classroom orientation at the nursing agency before beginning our shifts at the hospital. When scheduling my classroom time, the lady told me, "we'll just schedule you at the same time as everyone else so that you can get to know your colleagues." I asked her how many there would be, and she told me there would be 10 of us. I asked if they were all going to be in the same department, and she said they were. So, my new facility just hired 10 travelers, starting at the same time, and in the same department. How concerned should I be? Has anyone been in this situation before? Also, any advice on how to make sure this is a positive experience? Any guidance would be appreciated!

Hello! Fellow Southerner & Pedi nurse here! I know that heading to the "Land of Granola" i.e., California, doesn't sound like much of an appealing idea, but I have actually enjoyed it out here. San Diego has Rady Children's Hospital, and it is a very nice facility. I enjoyed my time there. I understand wanting some nice scenery to enjoy. On that scale, you have to decide what you describe as beautiful scenery. In San Diego, the surrounding canyons are dry and scrubby, but the ocean scenes are nothing short of spectacular. If you go up to La Jolla (a nice city just 2 seconds above San Diego), the rugged cliffs which lead down to the pristine water provide some amazing photographs, especially with the sun setting. Northern California, the San Francisco Bay Area, has Lucille Packard in Palo Alto. The pay isn't the most outstanding, but the hospital is fantastic in reputation and technology. Once travelers get there, they hardly ever leave because they like it so much. Northern California has all kinds of fantastic views. You have the giant Redwoods, Wine Country, the ocean, the San Francisco Bay as the fog rolls in, and not to mention all the interesting shots you can get in the city of San Francisco. Plus, there are a ton of state parks here on the Peninsula and the surrounding Bay Area. Therefore you have all kinds of hiking, biking, and nature trails full of lush green landscape. In fact, I went bike riding yesterday on Sawyer Camp trail and saw two doe run across the path. Not to mention it runs along the county's water reservoir, so everything is kept in pristine condition. You had mentioned Oregon, so I am throwing in this option. Don't foget Seattle. I know what you are thinking - it rains all the time. First of all, it really isn't quite that bad. It does have several dreary days which are overcast, but it makes the sunny skies that much more beautiful. When it does rain, it is a light, soft drizzling - type rain. In the West, they don't have the heavy hail storm, complete with thundering and lightning that we are used to in the South (in fact, I actually miss those). You can't beat Seattle for it's secenery, even in the middle of the city. Seattle is surrounded by water and lakes. Plus it sits in a basin surrounded by the Olympic mountains and Mt Rainier, which seem to have snow topping them 365 days a year. The entire area is so green with tons of trees, hills, and cliffs. The beaches there are different in that they are more pebbles than sand beaches. You see all kinds of driftwood washed ashore which can serve as all kinds of unique angles for shots. The city and its landmarks are quite interesting. There is more than just the Space Needle. Just google Pioneer Square. It is an interesting combination of Early 20th century architecture as well as Native American and Alaskan structures. Okay, enough about the scenery. Great hospital to work at: Children's Hospital and Regional Medical Center. I loved every minute of my assignment there. The people were so nice and wonderful to travelers. Plus I had such amazing cases and patients to care for. Don't miss out on the opportunity to go there. Don't let the stories scare you away. Seattle is one of the best kept travel secrets out there! I am from Tennesse, so I understand the desire to be surrounded by all of the natural beauty of rolling hills, season changes, and great sunrises. However, I am glad I took the plunge and headed out here. And my pictures have been absolutely unforgettable. I can't tell you how many of my friends have said, "I never knew there was more to the West than the beach." Occasionally it can be hard finding pedi travel jobs, so it is good that you have some adult experience as well. Just remember that sometimes you have to take an adult assignment (which I don't really like as well as pedi) in order to be where you want. You can do that while you wait on a pedi assignment to open up. Good luck with your travels!

I am with Preferred Healthcare Staffing. It is owned by American Mobile, so I still get all of the same benefits as American Mobile.

The Bay Area is San Francisco, Oakland, Berkely, San Mateo, Daly City, Redwood City, Fremont, Hayward, with San Jose being the end of the Bay Area. Pretty much, if you look at San Francisco on Google maps, I am referring to the cities which surround the San Francisco Bay. And those who live here have it broken down into different regions. When they refer to the South Bay, they are referring to the cities of San Jose, Mountain View, Sunnyvale. East Bay cities are just like they sound, those along the east side of the San Francisco Bay: Oakland, Berkely, Fremont, Hayward. Another geographic region is the Peninsula. This is referring to cities between San Francisco and those cities just north of the San Jose area. This includes Daly City, South San Francisco, San Mateo, Redwood City, and Palo Alto (depending on who you talk to as some consider that South Bay). Net result is that the Bay Area refers to the cities along the San Francisco Bay.

Set up your triage system based on the ESI 5 level system. It is a nationally recognized standard and helps to sort things out for you. Check the ENA website for all sorts of resources. I know they even have workbooks that your hospital can purchase to help train future staff. Good luck!

The whole ADN vs. BSN debate will rage on as long as both types of entry into the field exist. Here is the bottom line: a piece of paper does not determine whether you are a good nurse. Going through a BSN program does not automatically make you a nurse superior to an ADN. Only advantage to a BSN is that it might open other opportunities down the road. But, it does not sound as if you are ready to head back just yet. Give yourself some time. If you feel as if you are ready, and wanting to go back, then do so. Also, remember, you don't have to do the whole BSN full time like a traditional student. You can take one class at a time if you want. That way, you don't have to feel overwhelmed with the amount of work you will coping with. Good luck with your decision!

Computerized charting has been both a godsend and a curse for med rec. It is a god send because most computer charting systems retain info from previous visits and d/c rx from the most recent ER visit. However, it is also you worst nightmare. Some computerized systems are systemwide. Which sounds great until you try to figure out which dose of coumadin the patient is on now after the doctor has been spending the last 6 months adjusting it. Computerized charting helps keep a list of meds a patient has been taking, but it doesn't easily filter out what are the current meds and dosages. My favorite stand-by is to have the patient bring all of their current medications with them. That way I can input the data based on their current intake and not have to sort through multiple computer screens to figure out what they are on right now. But unfortunately, I am finiding out that it is the ER who is having to do most of the med rec. In fact, I have had residents tell me that they cannot proceed with writing the patient's admit orders until I get a complete list of their medications. This of course, contributes to the pt being boarded in the ER longer. But, that is a whole different talk show. Net result, best bet is to have the pt bring their medication bottles with them.

Yes, have been travelling for two years. I love it. Have been in the Bay Area for most of it.

Congrats on emabrking on this great and exciting phase of your career. Starting your first travel assignment can be quite intimidating, but remember, you are a nurse. You have many years of experience, so nursing is not new to you. The only thing that is new to you is your location. Just relax and enjoy this new experience. A couple of quick hints: 1.) Explore your surroundings. Be sure to check out area festivals, parks, music, etc. Also, your co-workers might have a great insight into where is a good place to have fun. Just ask them where is a good place to go. Some of them might even ask you to join them on an outing. 2.) Get the phrase, "well back home we..." out of your vocabulary. I have seen more travelers **** off staff by saying that. Needless to say, they had a horrible experience after that. Part of travelling is learning how other people deliver care across the country. 3.) Be flexible. You never know what new adventure lies ahead. If you aren't flexible, then you might miss something great. Just relax and enjoy the ride. Welcome to a great adventure!

Have you had a chance to check out the thread entitled "Helpful tips for the Travel Nurse" which was started by diary, dairy? It is a really great forum, and most of us who are already travelers have been posting there. There is a lot of great info there. You do need to have at least 1 year of experience in your specialty. I would highly recommend at least 2. When you present to these hospitals, you usually only get about 2-3 days of orientation. One day being actual classroom-type, hospital based orientation. The other day is usually on your unit dedicated to showing you how to function on the unit, i.e. where things are and the specific idiosyncratic policies that hospital has. You are still expected to provide patient care, only you have someone who is specifically available to you at all times to be your resource. You don't get a shadow day where you don't have to do anything. You have to start immediately. So, you need to feel comfortable in your field before you begin to travel. Definitely check out that the thread on this bulletin board about helpful tips. You'll find lots of good info there.

Sorry the previous post was long, but I have one more to add. I am currently in the Bay Area, and have been here since 12/2007. Was here before from 8/2006 - 2/2007, and I really love the area!!! Therefore, I have kind of had an opportunity to get a feel for the area and what other nurses have been talking about as far as their scale. Have also had an opportunity to do a little investigating myself. Hope these help.

San Francisco is a great, but tough, market. First of all, trying to get a job in the actual city is a challenge. Nurses who work in a San Francisco hospital can now get PTO (including travellers). Therefore, once most travellers get there, they rarely leave. The housing is outrageously expensive. I agree with a previous post which stated that you are better off taking the company provided housing, and not the stipend. Pay here is kind of tricky. Many recruiters will quote you a pay rate that sounds like $37-$40 per hour. What you need to ask the recruiter is if that is the blended pay rate, or is that the base pay rate? In other words, I have worked an assignment where I get a base pay of $32/hr for the first 8 hours. Then for hours 9-12, you get paid time and a half, which is $48/hr. If you average out the two different rates, you get about $37/hr for a 12 hour shift. So, be very sure when your recruiter quotes you a rate if that is the base or the blended rate. Otherwise, you will be very shocked when you get your first check. I did work one hospital here in the Bay Area where the base was $26.50 (great hospital, but didn't know that was at the low end of the spectrum). So, when a recruiter gives you a quote of a pay rate, ask if that is the blended or the base rate. Most base rates are anywhere from $26 to $34, with the average base at right around $30. The $34 one is rapidly filling their positions with actual staff, so they are not renewing their travelers. Basically, look for something around the $30 mark for your base, and you should be on par with the rest of the area. For per diem pay, it depends on what route you take. A couple of the nursing agencies pay you $40/hr, but the agency reported that you only have to pay taxes on about $25/hr of it. Not quite sure how that worked out. Needless to say, only worked a couple of shifts through them as I was kind of nervous about the tax issue. For hospitals, of course, the pay rate is more than going through a staffing agency. But, you will be locked into that one hospital, and they require a minimum amount of hours per week or per month. Whereas with some staffing agencies, they don't have a minimum amount of time you have to give them. Per diem hospital pay works out somewhere between $55-$65 per hour. My current hospital pays about $56/hr, but they are really nice and flexible with my schedule. They understand that I am a traveller and don't have a lot of days I can give up to them. For me, money is important, but for a per diem job, it is more important that the hospital be flexible with my schedule. Also, I agree with the previous poster about looking at the cities around the Bay Area. San Mateo, Redwood City, South San Francisco, Berkely, Daly City, even Palo Alto are good options for the Bay Area. You won't be living in the City itself, but you will be no more than 30 minutes by car, or you can take the BART in. Just because there is not an opening in the City itself, don't miss out on the Bay Area. Just pick one of the cities in the area, and then you'll get to experience all that the Bay Area has to offer. And the earlier post was right - be sure to bring a jacket!!!! Don't forget your bike as well. Lots of great paths to ride up here, both road and mountain.

I travel with two small dogs and have had no problem doing so. Of course I did have to pay a pet deposit, but my company lets me keep rolling it over from apartment to apartment. That way, I don't have to keep shelling out the new pet deposit every time I go to a new assignment. Some apartments require a monthly pet ret, but the company will divide it up over both of your checks each month. Dog parks are great things, and my dogs really love it. Plus, they are a great way to meet people and get all the ins on good vets, pet stores, etc. I don't travel without my kids. I just told my recruiter on the front end that I don't travel without them. I haven't been denied a job because I am travelling with my dogs. You shouldn't have a problem with taking a dog. Just be wary that some apartment complexes place weight and / or breed restrictions on dogs. That may be your only set back when finding a place to live. Otherwise, no problems at all bringing your dog.

Hi neurorn6, At first, I too wanted to stay in the South - close to my friends and family. Unfortunately, it is very difficult to get an assignment in the South. There are multiple reasons why - one of which being budgetary issues. The pay rates in general are lower, and the poverty rates in most Southern areas are higher. Therefore, many hospitals have fewer resources to pay for travelers. California has several travel positions because of the mandated patient:nurse ratios. Therefore, they have no choice but to hire the travel nurses to help meet the ratios which are a part of state law. While picking up and travelling from the South out to California is scary and daunting, it is the best place to get your feet wet while travelling. After time, maybe a position might open up closer to your home. You never know. Just be wary that it is difficult to get jobs in some of the Southern states. So, don't be afraid to broaden your search radius.

Am currently in the Bay Area & absolutely ADORE it. Have been here before & have been back for the last 9 months. When it comes to San Francisco, my advice is to take the provided housing. The cost of living in the Bay Area is INSANE (we all did cartwheels when cheap gas went down from $4.60/gal to $4.14/gal)!!!! Trying to find your own apartment, furnish it, and pay for all of your utilities in San Francisco would eat up all of your pay. Per my recruiter, the average stipend for the Bay Area is about $2000. Keep in mind, that my current apartment (in a quiet San Francisco suburb) rents for $1900 and is only approx 650sq ft. When it comes to San Francisco, definitely come. It is not to be missed! However, take the provided housing, not the housing allowance. Oh yeah, San Francisco recently enacted a standard which states that ALL employees, including travelers, now qualify for PTO. Therefore, it has been quite difficult to get assignments there because travelers who are already there do not want to leave an assignment which provides a benefit we hardly ever get. Don't be discouraged if there is nothing actually inside the city of San Francisco. So, if you want to be in the San Francisco area, consider some of the other cities such as San Mateo, Redwood City, Palo Alto, Daly City, South San Francisco, even Oakland or Berkely. That way, you are close to the City (i.e. San Francisco), but still have a job. From most of these other areas, you are at the most, a 30 minute car ride away, or you can take BART (amazing public transporation which connects most of the Bay Area to San Francisco) anywhere you want to go. Just don't limit yourself to the city of San Francisco itself. Look at the smaller cities around the Bay, and you will enjoy your travel just as much as being in the City.

Worked in an ER which saw 70,000 to 80,000 pts a year. So, we had plenty of days where we reached the 300 pts a day mark. How did we handle triage? We had three triage nurses at all times, unless the waiting room was caught up. If the triages were current, then one of the triage nurses would go to the back and work as a float nurse to help expediate pt flow in the back. This ER also used EMT/Paramedics, so this was an invaluable asset. In triage the EMT (or paramedic - I will use EMT from this point just for expediency purposes) does several things. First, they can help the secretary get pts registered in the computer, but they are able to keep an eye and ear out for "high risk" or emergent pts. If they see someone who falls into that category, then they can immediately start on that pts vital signs and notify the triage nurses that they are starting the vitals on a high risk pt. Then after the vitals are done, the nurse looks at the vital signs, gets the triage info and then can direct the EMT to perform an initial intervention such as an EKG, or assist the pt to a room in the back (if one is available). EMTs can also get the vital sign portion of the triage initiated while pts are waiting on the nurse to obtain their history. If the EMT has an out of range VS, or something of concern, then they can alert the triage RN. Basically, our key to running multiple pts through triage is a bare minimum of 2 triage RNs, with 3 the preferred staffing, and an EMT to help keep an eye on the waiting room, facilitate pt flow through triage, and alerting the triage RNs of any high risk pts.

It's a hard thing to balance. You still need to show your pts compassion, but yet you can't let it consume you. You need to be able to step back from the situation. Being in the ER were exposed to one of the highest rates of workplace violence (I think psych units had the highest), so you have to learn to distance yourself a bit. So, you must keep a sense of humor about you, and support your co-workers. They are the ones who will keep you sane. And don't take anything personally. That's probably the most important aspect.

I agree with JoJo. The ER is about addressing the chief complaint. Your assessments are ABCs and chief complaint specific. Not every pt on every assessment needs a complete head to toe assessment. Lung sounds assessment with each and every assessment is not important unless they are a CHF or difficulty breathing pt. The important thing is to notice their lip & nail bed color, their ability to speak, and the effort with which they are trying to breathe or speak. If all of those are fine, then you don't have to listen to lung sounds each time. Same principle for CV assessment (of course, this does not apply if you are dealing with heart issues or possible perfusion issues). Point is, most of your ER interventions and assessments are going to be specifically focused on the pt's complaint. After you do your first "make sure everyone is breathing" round, again very limited and brief assessment, then work with your most critical pt first. They are always the top priority. The old addage of "if you are breathing and have a pluse, then you're waiting" is true for most ERs. Now if while you are doing your "everyone breathing round?" and you see someone critical (i.e. respiratory distress, weird rhythm on the monitor, abnormal VS readings on the monitor), stay with that patient until they are stabilized. After they are stabilized, then move on. If you are unsure of what is the top priority in your patients, buddy up with a good preceptor or senior nurse who can help you pick out which patient should be your top priority. Again, this is where knowing your facility's standards and protocols will become a great help. Some facilities have strict protocols regarding the time frame in which antibiotics are to be administered (i.e. one hour from order written, or four hours withing presentation), and of course, there are the national core measures for things like pneumonia, STEMI, DVTs, etc. Therefore, the timeline for execution of orders is crucial. So, if you don't have an "obviously sick" person, then look for those who are protocols which have distinct timeframes for orders to be completed. Also, standing protocols are your new best friend. It feels weird at first using them, as you almost feel like you are flying without a net. However, a large majority of ER use treatment protocols for things such as chest pain, abd pain, vag bleeding, ODs, resp distress. Try to find out your facility's policies and use them - RELIGIOUSLY. They really help expedite pt flow, which is a huge pt satisfaction issue. It makes the pt feel like we are really working towards getting things accomplished for them. Plus, it makes your life easier and keeps you from having all of your patients get seen at one time by the docs, them write all of your orders at once, and then spend the next four hours in hell trying to get them all executed. Protocols really help you stay ahead of the game. And if the facility has standardized protocols, using them does not constitute going beyond your scope of practice. The protocols are, typically, written by both the physicians and nurses of the ER who have agreed upon which orders to be executed and under what situations. Okay, long rant to agree with JoJo. Keep your assessments to ABC, Chief Complaint. Focus on your most critical pt first. Use standardized protocols like there's no tomorrow! And lastly, relax, take a deep breath and try not to focus on the minutia of everthing. While there is great importance in the details, sometimes Emergency Medicine is looking at the minutia, but focusing more on the overall big picture of the pt. Good luck!

Ditto!

TNCC is an intense course, but that is its intent. The course material appears daunting, but can be worked through quite easily. There are study materials and scenarios in the textbook. Review those before you go to class, but especially review those before the exam. One important thing to keep in mind is ABCDEFGHI, and always stick to it in that exact order. That will get you through the skill stations without any worries and will help you better answer your exam questions. Good luck, and I look forward to reading your post about passing the course! :typing

I would like to start a thread here as a means of keeping a list of places we have traveled and would recommend to others. So please post what places you have enjoyed working at and a little bit of what you liked best. Thanks! :thankya: 1. Seattle Children's in Seattle. GREAT staff. Lots of interesting patients. Hospital is busy, but not too busy. Plus the city is amazing with tons of stuff to do, no matter your interests. 2. San Mateo Medical Center, San Mateo, CA. The staff is what makes this hospital. County hospital, so lots of indigent patients, as well as ones being cleared for jail. It can be kinda busy and make you tired at the end of the day. However, the staff are so friendly and the Bay Area is so fabulous. You are close to San Francisco, like 30 minutes by car at the most, and yet still don't have to be in the middle of city traffic and congestion.

No LPNs in the ED in at my home base hospital. This is due to limitations passed in the nurse practice act for RNs and LPNs. Since LPNs cannot do initial assessments, give IVP meds, access central lines or implanted access devices (which I think was a facility preference there), or give blood, this severely limited the roles in which an LPN could function in an ED. So, our management offered to pay for the LPNs to go back to school to get their RN or they had to leave the unit. This was no indication of the capability or lack of experience by the LPNs on the unit, the decision came as a result of the way the nurse practice act had defined the roles of an RN and an LPN. Because we had such valuable and knowledgeable LPNs on our unit (one which had worked in the hospital for ten years, 5 of which in the ED) the manager got the hospital to pay for them to go back to school.