desta

Re Doctors Without Borders: --I don't think you need a BSN but you will definitely need nursing experience. Surgery, ER, OB/GYN, Peds are a few useful specialties that come to mind, though people with lots of different backgrounds go. They have a huge range of projects including primary health, inpatient, surgery, nutrition, vaccination, community health, L&D, HIV, TB.... the list goes on. --Personal travel & international experience can be a big plus with them, even if it's not specifically medical - they ask about this in the application/interview. --In my experience, knowing other languages is never wasted, but Spanish assignments with Doctors Without Borders are few and far between. French, however, is super useful with them. They will sometimes send you to French immersion once you have worked with them for a while, but if you have languages to begin with it will help your application a lot. --The organization is non-religious and non-political. I suggest making sure that you feel aligned philosophically with the organization that you choose. While missionary nursing and working for non-religious humanitarian orgs share a lot, there can also be significant differences in everything from what they are looking for in candidates to the approach to work in the field. --Doctors Without Borders tends to be more clinical than a lot of other international health orgs but as a nurse you typically would be in a management role. Sometimes you do more direct clinical work, but as a rule you should be prepared to manage people and projects. Of course you still need to know your stuff clinically in order to manage/teach/etc. --I think they will help arrange loan deferment but the actual pay you'll get will not be much. If you want advice - I say get a job in a useful specialty, throw as much as you possibly can at those loans for the next couple of years, maybe try to do a couple short-term things in the meantime for a few weeks at a time to keep yourself motivated, etc., and gain more experience. --MPH - could be a great choice for you. RN/MPH is very marketable in the humanitarian field. BUT could add so much to your loan burden that you would feel too limited to do low-paying work. Timing is essential... --Great advice above from Cheryl. Important to be resourceful, manage stress, be flexible. You will end up using everything you learn. Happy to answer any other questions.. good luck to you.

I worked a travel contract with MedStaff last year, did some international work, and now am back in the States looking for another travel contract. I have been talking with a MedStaff recruiter and she's submitted me for a position. This morning I got a call from a NovaPro recruiter, saying that because I'm an ER nurse and this specialty is in demand, my file had been selected to be shared with NovaPro & CrossCountry. I asked her several questions, and it sounds like the companies are working independently (competing) but they have access to the same database of assignments as well as to a lot of the same nurses. Wondering if anyone can shed some light on this situation. I know it can be helpful to have multiple recruiters looking for assignments for you, but it seems like this is only an advantage if the different recruiters have access to different assignments. Unless NovaPro and MedStaff have significantly different payscales/benefits (?does anyone know if this is the case), it seems sort of pointless to me to be working with two different recruiters at these two sister companies. Thanks much!

no- actually, it wasn't my post... i just tracked you down by looking at your last post or something... and i think i should be getting close to the magic 15 any minute now...

Hey lilwbprincess, Thanks for the PM - I did indeed get it & much appreciated... I just haven't made enough posts yet to send one back. Should be there soon though... I am definitely signing up with more than one agency - all for hedging my bets :) A nursing school classmate also recommended MSN staffing although she only did a couple of shifts with them. Anyway... good luck to both of you. ~Desta

Wow.. thank you everyone... sorry for the delay in responding but somehow I didn't get the alerts that there were responses! 79Tango - I don't think I have posted enough to send PMs or something but as soon as I do I will drop you a line. I am in the ED right now but actually have thought about switching to a more procedural area for a while (like cath lab or endoscopy where you need critical care skills and get to use them but it's a little less hectic than running around after ten or fifteen patients at a time...) Vagabond - thanks for the Am Mobile feedback... I'd heard from a friend in CA that they had cornered the KP market- do you know if that's true in OR as well? dixRN - will definitely check out Delphi...

Hi all, I'm basically looking for the same kind of info afa & veronica were seeking - I am relocating to Portland (may be temp, may be longer term, not sure yet) and am just looking for names of agencies (travel or local agency staffing) in the area. I've made contact with a recruiter from MedStaff already, but want to try to hedge my bets if possible with a couple of other options. I'm also in ER (most recently) and community health before that. Any leads much appreciated.. Thanks :) Desta

Hey RNyogi, Just found your post - I am heading out to Portland for a few months & am looking for travel/staffing agencies that actually do placements in that area. Also thinking about drifting southward to California at some point. Just curious if you ever found any that you would recommend... Thanks! -Desta

I'm planning a cross country move to Portland for family reasons and will be looking for travel contracts or per diem work in the Portland area starting in January. I am lucky in that I have a place to land housing wise and am not totally committed to the area long term, just need to be there for the time being, so not looking for full time at present. And I have several years' experience, including a solid 2 in my current specialty (ED). OR licensing process is well on the way. I've been reading up on the posts here - sounds like the job market is pretty slow. I am looking for some information to help me target my search. So - I have connected with American Mobile and it sounds like they offer many more contracts in California (the recruiter was even trying to push me that way on the phone!) Thinking that it might be better to target my applications (and time/energy) to agencies that actually provide travel nurses to Portland area hospitals. Would really appreciate any info on which are placing nurses around Portland. Also, local staffing -wise, I've put in an application with MedStaff, which I heard about via word of mouth. I also found mention of Advantage Nurse Staffing and Integrated Healthcare Solutions offering per diem/temp work in the area here on this board. Wondering if anyone has experiences with these agencies or recommendations. Many thanks in advance!

bigboy - see the link i posted for sammi earlier in the thread - the internship program takes BSN and ADN new grads up to those w/ a year of hospital experience (as far as i know). thedit- i can only speak for vns in manhattan - there was a separate IV infusion team/program which only did infusions, but on the regular actue/longterm care teams there were no infusion responsibilities that i know of. i had one patient with a picc line in 4 years. occasionally got patients with a peg tube, ostomy, trach, bipap machine, LVAD, etc., and had a fair number of sq/im injections. a lot of times the patient or family were responsible for doing the treatments or site care independently. in my own practice the technical skills i usedthe most were head to toe physical assessment (obviously) and wound care - all different types/sites, wound vac, etc. in the home, i spent a lot of time dealing with functional/psychosocial/environmental/care management issues both in terms of assessment and interventions as opposed to tasks/technical skills.

bklyn - i agree w/ you that homecare isn't easy, by any means, and i didn't mean to give the impression that it was!! it's a distinct area of practice that requires specialized skills and knowledge, and is much less controlled than a clinical setting. you have so much responsibility because you are the only one there. and you are right that safety can be an issue when we are on our own out there. but... based on the original post, it sounds like sammi is planning to test the waters a bit before making the switch, so i think she would be going in w/ her eyes open. and i do think that, although it has its own pitfalls and stressors, homecare also offers some things like flexibility, an opportunity to interact with patients in a different and often meaningful way, and the chance to have a more autonomous practice than bedside nursing. as for the paperwork - personally i didn't think recerts (assessments that have to be done every 9 weeks to reevaluate the patient's need for continued services) were much different from a regular visit note - i always documented a full assessment for every visit anyway, so it was just a few extra questions about functional status. but you are right, there are some other paper forms, which i wasn't really thinking about (admission forms, a few forms for medicare/medicaid, and for home health aide placement/continuation). it also depends on whether you are in longterm (much heavier paperwork load) or acute care... i'm not sure what the hospice or mch paperworkload is like. but in the hospital, you have to document everything too.... but... it's just a different workflow, and figuring out what works for you in terms of when/where you get it done. one other time burden that's coming to mind - in homecare, you also spend a lot of coordination time on the phone - calling doctors, social workers, the pharmacy, therapists, ordering supplies and placing services, or getting in touch with family members/caregivers who don't live with the patient. so that can add up too. as for why i left - i did have a positive experience and felt i was treated well as an employee, but after 4 years i felt i'd learned what i could, and needed a new setting to expand my skills and get some fresh energy. i chose to leave not because it was unbearable, but because my learning curve had flattened out and there were other things i wanted to learn/experience in nursing. it was just time for a change, plain and simple. i will say that the main thing that became a real negative for me over time was feeling isolated from other clinicians - although i loved the independence (the positive flip side!), part of my decision to move on was being ready for a change to an environment where i can learn from watching others practice and have more direct and immediate collaboration, rather than having the bulk of my contact with physicians and other nurses be by phone. but.. if someone is sick of the floor, maybe that person would also like a break from co-workers!!! it's just so much about the individual's personality and whether community/homecare agrees with her or not, as well as the timing - what's perfect at one time in your life/practice may not work at all at some other point. sammi, one more thing - i don't know if you're aware but there is a new-grad program at vns through which you get extra support & guidance for the first year. i think they take nurses (with both associates and bachelors degrees) who have up to a year's hospital experience. that might be a possibility for you as well. http://www.vnsny.org/careers/positions-by-specialty/home-health-nursing-internships/

hi sammi... so, i have just left vns, about a month ago, and am starting a new job. but my info should still be pretty current!! i would say the average caseload is 5-7 patients/daily. i have heard of nurses being pushed to see up to 8-10, but that was never my experience. the paperwork is all done on a laptop computer that you carry with you. once you learn your way around the computer system, it's pretty straightforward to do a note. the length of time varies according to how much you do during the visit. avg time - maybe 20-30 mins? longer when you're new, but you'll definitely get faster!! i had a great experience at vns b/c i had a really good manager and a good team. we had a lot of great teamwork, support, and i really respected my manager and colleagues. i think people's experiences vary a lot though. i've met people on other teams who were just as happy, and also have met people that weren't as happy. i'm sure you'd get a sense while interviewing of whether your new supervisor would be someone you'd want to have supervising you!! the patient population vns serves is very sick and very needy. i found that i had to play so many different roles - nurse, social worker, surrogate family member, case manager.... etc etc etc. when you are doing per diem work, you might be more in and out, with very specific goals (like wound care, an insulin prefill, etc) for each visit, but as a staff nurse/coordinator of care you are really involved with every aspect of your patients' lives. the union and benefits are very good. pay is pretty good too, about equivalent to what i'm making in my new hospital position. hope that helps... good luck w/ your transition, and let me know if i can give you any other info. ~desta

re the original question - (loved)- i think tuition reimbursement starts either 3 or 6 mos after your start date - i know a nurse i started with was taking NP classes right away and i think she was reimbursed. you can get reimbursement both for nursing and public health coursework that is leading to a degree. re nats' question - VNS staff nurses are usually RNs, although occasionally LPNs are hired. partners in care is affiliated with VNS and employs home health aides. they have the 1199 union, which i believe reimburses for LPN or RN courses (but i'm not 100% sure). i don't know re CNA training. good luck!

hi sammi, i've been at VNS in manhattan for 4 years - just got our updated rates for this year - i'm not sure the exact starting salary - but, it should be upper 60s, with the educational & experiential differential should be 70K +/-. hope that helps....

I went straight from a BSN program to home care in NYC, and had a friend who did something similar in the Boston area. My agency had a program for new grads -- both bachelors and associates degree RNs, but unfortunately I don't know anything re LPNs. Don't know how common it is for home health agencies to accept new grads, but I thought I'd comment on the experience... I went through an extended orientation/internship -technically lasted a year but we were pretty much independent by 6 mos. I feel I was well-prepared for what I needed to do my job well. Though a lot of people do think that you have to have hospital experience first, I'm sure my agency is not the only one out there willing to train new grads. And... despite having gotten some flak from some other nurses in the agency who did their two years of med-surg time .. I know my patients are getting safe and excellent care. Three quarters of the nurses on my team were also new grads and every one of them is a terrific nurse. My only words of caution - if you are not sure that you want to be doing homecare long term (although it sounds like you do!) perhaps some hospital experience wouldn't hurt. It's tough to go in the other direction. I've found that despite spending 3 years in a reputable agency some hospital nurse recruiters seem to consider me not to have any experience. Also - as a new professional developing my own practice, I did feel that I missed out on being able to work directly with other, more experienced nurses and having the opportunities to learn from observing their practice. Plus, having the experience with higher-acuity patients certainly wouldn't hurt your practice in the community. But if you are totally sure, then go for it!! An open-minded manager will recognize your years of life experience and commitment to the field for the incredible advantages that they are.

if you're working in manhattan and want to live in manhattan, you could consider uptown neighborhoods - harlem, washington heights & inwood - it is definitely possible to share a 2br for 800-1000, and if you are willing to go to 3 i've heard of people having rents as low as $500 (not many of these -- the starving musician types seem to be the ones that ferret them out!) good luck!