NedRN

NedRN's Latest Activity

1. 

   PMHNPs travel contracts?

   NedRN replied to 2015bsngirl's topic in Travel

   Generally, there are travel assignments for every possible healthcare profession (or skill to include all the unlicensed possibilities). The rarer your specialty, the few choices of assignments. On the plus side generally the rarer the specialty, the higher the pay. While large traditional travel nurse companies like Cross Country and American Mobile will have spots, you may do better with specialty companies. These will also handle "travel" for physicians and other advanced practice professionals (to name one that no one may have heard of, physicists)! Instead of travel, Google locum tenens (usually just locum or locums interchangeably in spoken and written language: "She is a locum"). Both these companies and independent recruiters may market you rather than depending on posted assignments. You might start your journey with this link. Expect very good pay, benefits (maybe), and great housing. Advanced practice earn very good profits for the companies and locums are very well treated. A lot of locums (and all physicians) have their own company to do contracts versus being an employee. Differing tax benefits, and could lend itself better to affordable and stable health insurance.
2. 

   TRUSTED HEALTH. New company, no recruiters, is this a good option?

   NedRN replied to NurseKristen82's topic in Travel

   Yes. However you can ask agencies to pass along your available times for an interview.
3. 

   PACU travel nursing? American Mobile feedback?

   NedRN replied to kat_attack_85's topic in Travel

   All that sounds rather scary as I look back on what I wrote, but depending on how you juggle numbers, your equivalent compensation should be above 100K, especially if you stick to better paying states and assignments. So you really can afford to budget 10K a year for insurance.
4. 

   PACU travel nursing? American Mobile feedback?

   NedRN replied to kat_attack_85's topic in Travel

   Health insurance is another big topic. A law that predates the ACA is COBRA which grants any employee to keep their insurance for up to 18 months after leaving their job. You do have to pay the full cost, which is mostly hidden from you as a staff nurse, plus a 2% admin fee for your former employer to handle the paperwork. The premium will come as a shock, good insurance is $800 a month plus (double that if married). You can do the same with a large agency insurance after a job, but it has to be a larger agency (small companies are not subject to COBRA). And the insurance is usually crappy. You can ask the agency's benefits person what the COBRA premium is, but if it is under $500 it is likely a waste of money. If an agency actually has good health insurance, either you pay the entire cost yourself or your compensation is much less. The other thing you can do is get an ACA compliant plan. Your state may have an exchange, if not you can use the federal exchange. Many that use an ACA plan get a government subsidy, but nurses earn too much to qualify. The Trump administration enacted some kind of relatively inexpensive insurance to cover emergencies, but only the very young and healthy should consider it. The underlying cost of ACA plans are pretty much exactly the same as COBRA costs except that some employers really have gold plated plans that can be a lot more. You will get a very different idea of economics as a traveler. No hidden insurance subsidies. If there were, you would get paid much less. But the insurance cost is the same, but your staff job paid you less than they could if not for your benefits. Private health insurance took off in this country when the tax code was interpreted to allow employee benefits to be tax free - no income tax on those benefits, and simple expense deduction for the employer - allowing them to increase your effective compensation without that income tax burden to their employer. Until the cost of healthcare increased so much employers had to implement copays (pretax so still an effective boost to income. If your hospital has a per diem pool, you know that they get a higher hourly in lieu of benefits. You just have to get over the sticker price of good insurance and deal with it. There are some workarounds to getting personal tax benefits to mitigate the cost but they are all messy. You can Google it for yourself.
5. 

   New Traveler with a Husband and 70 lb Lab

   NedRN replied to NurseKristen82's topic in Travel

   Licensing should not be an issue. You can proactively get them when you know you want to work in a state say within a year, or should you not have quite enough time before your 13 weeks are up, it is usually easy to extend a few weeks at your current assignment. Tax home is very important and too big a subject to discuss sufficiently in a single post. I'd recommend reading articles on PanTravelers or TravelTax. That said, maintaining a tax home is financially worthwhile generally (do some math). A significant portion of your compensation such as housing stipends and per diem are paid tax free if you have a tax home. One easy way to get there in an efficient manner is to have a roommate to help pick up expenses and take care of your home base. As long as you keep a room in the house for exclusive use and and return at any time (and at least once a year or so), you are good. To extend that thought, sell your home and buy a home in an income tax free state such as South Dakota (cheap), Texas (also low cost generally), or Florida and establish residency. These three states are also members of the nursing compact which will gain you access to 28 (?) states on just a single license with no additional bureaucracy.
6. 

   PACU travel nursing? American Mobile feedback?

   NedRN replied to kat_attack_85's topic in Travel

   I've never heard of any agency taking a cut from advertised rates, their margin is already baked into a quote. That said, you do have to run some math on the quotes to get a real feel for what they mean. PanTravelers has a free calculator to help you compare quotes. Some of the issues are that much of the quote is free from income taxes, legal if you maintain a tax home. Some agencies will quote "take-home" pay from gross pay which does some of the math for you - similar to what PanTravelers calculator does. Others quote a taxable hourly pay, and lump the non-taxible housing and per diem stipends into a weekly number. If you are not eligible for the tax free money, then the quotes are without meaning to your personal situation. You are considering working for a single agency. This can be a highly effective strategy and reduces paperwork and hassle but I don't recommend it long term. I did this myself for over 4 years for the then largest agency, Cross Country. While I was working for them, it seemed good, I was treated well and had escalating pay (sort of a normal travel progression because as you demonstrate your value as a successful traveler, you get access to better assignments). When that relationship came to a crashing end, it became very clear I could do better in a number of ways. For one thing, the benefits of managing my own career more closely became apparent when I became a "free agent". Pay escalated even faster when I could freely pick assignments from different hospitals and utilize smaller agencies with less overhead (meaning they could run with a lower margin). I also discovered the benefits of maintaining my own professional portfolio, especially written references/evaluations. Agencies do collect these from each assignment, but typically consider them proprietary and do not share with their travelers. Proprietary because if a traveler has them, they can easily move from one agency to another with little friction and pick the best paying agency for particular assignments. That said, working say for the first year for a single agency lowers stress while you learn how everything operates. But my normal recommendation is to talk to lots of agencies and pick maybe three of the ones with recruiters you communicate well with. Then you have a plan B if your first choice goes bad. In fact, my communication with my first recruiter was so bad, I almost bailed before I started. But for several reasons, they were my only choice (in part because I pre-interviewed at a hospital on a holiday I really wanted to travel to and found that they primarily used that agency). So I called them and was able to talk to a recruiter manager and got a new recruiter. The importance of a well fitting recruiter cannot be understated, far more important than the agency brand. "Settling in" to a new assignment can be tough but not too dissimilar from any other job. Sure, there can be cliques and issues with new policies and procedures, expectations, and new medical software to learn. It can be a lot for a new traveler. Thus it is really important to get a traveler friendly assignment well within your clinical abilities the first time or four - be suspicious of high paying assignments in the beginning - high pay should not be your primary initial goal for well fitting assignments. Maintaining a high level of professionalism is super important to successful travel. You have to overcome staff distrust of the skills and teamwork of a new colleague, especially that of a traveler. You do not have the "get out of jail free card" that a staff member will have from even what you might consider innocent remarks. Do not criticize their practices (but don't do anything you consider unsafe either), or compare it to them with other places you have worked, or show them a better way to do things. Instead, work hard, be cheerful, and help others when you can. Staff expects really good performance from travelers who make "twice" as much as they do - we don't other than some crisis assignments - but that is what they believe. Good luck! If you are a good fit for the travel lifestyle, it is a great life!
7. 

   New Traveler with a Husband and 70 lb Lab

   NedRN replied to NurseKristen82's topic in Travel

   So let's get this over with first: there are no best agencies. Nor are agency recruiters your friend. This is a business and if you remember that first, you will do fine. Your ability to communicate with your recruiter is important (all is lost if you don't communicate). So call lots of agencies, and sign up fully with say 3 of them whose recruiters seem trustworthy and don't just make stuff up - lots of calls will help you learn the business and separate out the BSers. Then you will have a plan B and a plan C to cover you if agency A with your preferred assignment falls through. So housing with pets is hard but doable. Expect high non-refundable damage deposits. Try regular housing first (most agencies will provide considerable help) until you find out if the travel nursing is for you. That said, there are a number of travelers who like RVing. It won't save you any money, but it can reduce the hassle of traveling with a pet - RV parks are almost universally pet friendly. However needing a reasonable commute to the hospital can limit your assignment options. Wi-fi can be bad at some parks though, so you may need a mobile hotspot generally and perhaps your husband's job will require reliability. Possibly an iPad a with a SIM card could work for internet needs.
8. 

   ER or ICU - Which opens more doors for a travel RN?

   NedRN replied to Birdsofprey's topic in Travel

   Love ED? Do it! Let me help you with some rationalizations. You can do your own research at a big agency like Cross Country, but ED has more assignments than ICU. In addition, there are a wider range of hospitals to choose from, from tiny rural hospitals to large inner city teaching hospitals. ICU tends to be larger hospitals. In the broad scheme of things, ED often has ICU holds, so you will learn ICU basics as well. ICUs also tend to be fragmented in terms of patient population. There are medical, surgical, neuro, CV, and adult/pediatric ICUs. Out of nursing school, I interviewed at a transplant unit (including ICU) where they followed all transplant patient no matter the admission reason. They all have specific skills and training needed and you need to have a good fit both ways to work at a specific ICU in a specific hospital. No matter your skills and experience background you can find steady work as an ICU traveler - just pointing out that unlike ED, you cannot count on the number of ICU postings versus ED as you won't be qualified for all of them. Yes, larger EDs are streamed by acuity and sometimes subspecialty. Pediatric ED is a big one, and neuro versus cardiac may have their own pods and assigned nurses. For some counterpoint, ED is more entry level nursing than ICU. Generally, higher trained nurses get higher pay because of supply and demand basic economic rules that apply to travel (no so much staff). So generally speaking, ICU pays better than ED for travel assignments. There are more crisis assignments in ICU that pay much better available versus similar ED assignments. Specialties such as CVICU can pay really big bucks at times. I cannot tell you what the difference in pay might be as that depends on your path. I can make a good guess that you will make 10% more a year as an ICU traveler than an ED traveler apple to apple assignment choice. Is that enough to blow out your personal preference? I'd suggest no. As an experienced ED nurse, you will have lots of options down the line. ICU will be an easier segue later (although your current experience is super for going into the ICU now). ED skills translate directly to PACU as you generally recover your own procedure patients - which is a great place to work if you suffer burnout later. Good luck, but I don't think there are any bad choices here.
9. 

   Married/Engaged Travel Nurses! I need your advice

   NedRN replied to TheSiriP's topic in Travel

   So old conversation but OP said just one year of travel with, I would assume, meetups every three months or sooner. That’s a lot less time than many military deployments. A very minor stress test versus what is certain to happen later in a relationship. Travel nurses are insensitive and burnt out? Strongly disagree with that vast generalization. You may be projecting your own personal situation.
10. 

    Asking for more money

    NedRN replied to bluescrubs's topic in Travel

    You can always ask for a dollar or two more for extending or a renewal bonus ($500 is a dollar an hour). That should be pretty easy. Shop around first and see what others are paying for a similar job. Be prepared to walk. Sure, for critical need employees, vendor managers can raise pay. You are not one of those.
11. 

    Travel nurse housing wishlist

    NedRN replied to MC44's topic in Travel

    Fully furnished ideally would include cookware and utensils. Some sort of coffee maker for most. I bring my own, but I think only a small number of travelers do. Some travelers prefer long term hotels where everything is furnished. Historically, about 1 in 10 assignments fail to complete, however that includes some number that never started. Best is a month to month contract to minimize traveler financial difficulties. Pets are a big problem for those that have them, as well as landlords. Going to guess no more than 20% of travelers have them. Those that have them (and don't travel by RV - the easy way out), are used to large non-refundable pet deposits. In the beginning, an agency recruiter did everything. Now most agencies outsource many services, including housing. It would be far more difficult to let some 400 travel nurse agencies know about your property (not to mention allied health and advanced practice/physician agencies, and students/residents) versus just listing your property on a service. The big names I know of are Furnished Finders, Travelers Haven, and Med Temp Housing - used both by agencies and directly by travelers.
12. 

    Transition from Telemetry to Travel LTAC assignment

    NedRN replied to emmyloo85's topic in Travel

    There have been similar comments here as well, specifically saying if I recall correctly that the acuity can be similar to a medical ICU but with a higher patient load. Probably better to stay in your lane for a first assignment. I think the risk is too high compared to the potential rewards of training or total failure. I would only do it if it was a goal of yours to work in such a setting, but even there you will be better served by working a year or two as a staff nurse in an LTAC: proper orientation and training and extremely low risk of failure.
13. 

    Travel Nursing

    NedRN replied to DJ Thompson's topic in Travel

    You have to pay your dues. Bad idea to go into ICU traveling with zero experience even if possible. And even if possible, believe me, you don't want to take that assignment from hell that they would take someone unqualified. Attitude reboot would be best. My first job was in Baltimore in 1992. Spent just under 3 years there at $15 an hour. Every year, I got a small merit raise, and then one more small raise to catch me up to new grad pay. I had just enough money saved after that time to buy a ten year old car to go traveling with (I'd highly recommend a better cash reserve). It was like a fifth career for me and the lowest paying by far. But I knew it would pay well eventually. Working in much of the South, including NC, kind of sucks pay wise. I knew that going in, but I was a new grad in a mild recession and had to take my search nationwide after I struck out in my school state of California (where new grads even in 1992 made $30+). But clinically it was great. Teaching hospital, I rotated through all the specialties in the operating room, floated for a while, and joined the open heart team. Stayed extra to make sure I was confident in my skills, and tested them by doing agency at a couple other hospitals. So I would recommend staying, and even a third year if it gets you into your goal of ICU. Having solid skills and confidence will really help you when you are thrown into a new hospital with new everything with little orientation and a maddening EMR. You will have plenty of stress without worrying about your clinical skills - and there will likely be updates to your clinical skills on every single travel assignment. So you really want to want to travel, for the lifestyle, and the continuing learning curve clinically and culturally. Not for the money. Hopefully the pandemic is over by the time you are ready to travel and those ridiculously high paying assignments will be gone allowing future travelers to make more rational decisions.
14. 

    Travel Nurses!!

    NedRN replied to citylights91's topic in Travel

    One thing I treasure the most at a facility is a list of staff and physician names. Most units have an internal contact sheet so that secretaries or staffing can contract staff by phone. Mind you, I work in the operating room where such resources take on extra value in that I have to enter everyone's names into the case record. Still, such a resource can assist in learning your peer's names, right down the important staff such as housekeepers. I save such lists to remind myself of the people I worked with, and often travelers come back to the same facility so that list helps get them off to a fast start on repeats. Door codes are probably best done on personal cheat notes that can be destroyed once they have entered a traveler's memory (even better is to upgrade tech and use ID badges). Seems to me that publishing code lists causes security concerns, especially to places like locker rooms and med rooms. It's a shame, but I think every facility suffers from theft and even after incidents fail to change security codes. I would also poll your existing travelers. They can tell you what they struggled with initially. Consider exit interviews if you are interested enhancing workplace culture, pt flow, and so on - travelers have seen many ways of doing things and cross pollination is good for healthcare (yet it is really hard to have an impact during the course of assignment). Many issues are unique to a facility or unit. Online, we would just be able to tell you of issues we have faced at other facilities and may not be relevant to you.
15. 

    Decreased pay mid contract...options?

    NedRN replied to clickhand's topic in Travel

    That sounds good. It is highly likely that the hospital insisted on the right to change crisis rates to regular bill rates once staffing normalized with the agency or vendor manager. The agency protected themselves, but should have highlighted this issue prior to you signing the contract. You might have been able to take a different well paying contract that, well had a contract that they cannot change at any time. Even if it paid less, you might have made more overall. One thought here is that going with a rapid response company would have avoided this. Lots of agencies started filling Covid contracts but perhaps just suspending regular bill rates and adding an escape clause in the traveler contract. A rapid response agency wouldn't be in that position. Hindsight, and possibly not so relevant going forward. But always a new way to fool travelers with no financial consequences.
16. 

    Decreased pay mid contract...options?

    NedRN replied to clickhand's topic in Travel

    What a worthless contract! Frankly, it sounds like you have zero rights. I've not seen a renegotiation clause before, nor would I sign one. That just opens the door to promising anything for one week bait and switch. Sounds like your options include quitting or staying. Very possible if you quit that there are contractual penalties you may owe. On the plus side, you did get great pay for 7 weeks.