Travel_RN_0714

Keep in mind that the AORN standards/guidelines or whatever term you wish to use are just that. They really are not binding rules and are interpreted differently depending on where you work. With that said, anyone can stand there during intubation and help out as long as they've been shown prior what to do. It's not that difficult to hold cricoid pressure, if it's a rapid sequence induction, and pull out the stylet. A lot of times you don't have to do anything as intubation is with an LMA. I've seen Surgical Techs, Anesthesia Techs, LPN, RN, RNFA, NP, PA, MD, MDA, etc, help out. Pretty sure there is no rule. Hope this helps.

Of course they can. A hospital system isn't going to keep travel staff if they aren't needed and pay them, as well as their regular staff if the patient census is low. Just 2 short years ago Covid hit and impacted my specialty, the Operating Room. Non emergent cases were cancelled nation wide and the Operating Rooms were being converted to Covid rooms because the OR's had ventilators that we use during surgery and were needed to keep Covid patients alive. As a result travel contracts for Operating Room RN's were cancelled all across the United States. For the first time in my decades long career, I was unemployed from April until September as the Operating Rooms were for Emergent cases only and most hospitals had enough permanent staff to cover that need. I had friends that were driving to their new destination and had their contract/agreement/assignment cancelled on them. It's the same thing now. Hospital systems filled a staffing shortage with travel nurses. Covid is on the decline, and like it or not, the travel RN is going to be the first one to get let go.

Well Ned, thanks for the free legal advice. However, I happen to like my recruiter and the hospital that I'm at. I'm not going to shame him or the travel agency I'm currently with. I feel he was being honest with me and it's not him or the travel agency, it's the huge multi-state hospital system that lowered the bill rate and I can understand the hospital system's dilemma as well as my travel agencies point of view. With Covid cases dropping, they simply don't need travel staff and aren't going to pay the sky high Covid rates. I'm just happy that they didn't cancel my assignment/agreement/contract or whatever it's labeled. I'm not going to switch hospitals over something like this as it's hit or miss that I'll find a place that I enjoy going to. I've been to some hospitals that are very nasty to their travel staff. Leaving my staffing agency over something like this isn't an option either, as we all know the onboarding process when changing agencies is a pain. Uploading all of your documentation, retaking the dreaded Prophecy exams, etc. My post here was actually to inform other travelers of what has happened to me and ask if anyone else was having this happen to them. But again, thanks for your advice.

I signed an extension that was to begin mid-April at a hospital that's quite nice to work at. In my current "contract", I'm making a pretty good Covid pay rate and extended at a lower pay rate as we all knew that these high pay rates weren't going to last. I signed my extension 2 weeks ago and just 2 days ago, my recruiter messaged me that the hospital system has re-evaluated their needs and rates and is dropping the bill rate across the board, Nation Wide. He went on to tell me that it's not just this hospital system that's doing it, it's happening all across the Nation. Rates are dropping and going back to the pre-Covid bill rates. He sent me a revised "contract" to sign with the new, even lower pay rates. He said I can either accept the new lower rate, or I can decline, and he would find me an assignment somewhere else. The new bill rate will not impact the current contract that I'm in, however the hospital system is not accepting any extensions that haven't started without re-negotiating to the newest lower bill rate he sent to me 2 days ago. Here's the thing he explained to me during a lengthy phone conversation yesterday, that I didn't realize. As travelers, we aren't signing a legally binding contact. We are signing a "travel assignment" and we are workers "at will". If a hospital system finds that they need to reduce staffing, or adjust their bill rates, they can do so and the travel agencies really have no recourse. The hospital systems dictate the bill rate to the travel agencies and that's that. The agencies can't do anything about it as they aren't going to tell their huge money making hospital system clients no, because there are a dozen travel agencies ready to take that hospital system's business. When I asked him why none of this is in the agreements that I sign, he told me that the travel agencies sign the "Master Agreement" with the hospital system and that is between them. My agency then sends me an agreement that is between them and myself. My recruiter went on to tell me that it stinks that the hospital system agreed to an extension at a set rate and then wants to back out of it, but that they can do it. I can't sue them or do anything about it. All I can do is say no and he'll find me an assignment elsewhere. I went back and looked at the various "contracts" that I've signed the past years, and yes, none of them really say the word "contract" in them. They all speak of the "assignment" and yadda yadda. It's all an illusion and very vague. Soo... is this happening to anyone else, and what are your thoughts about signing a "contract" and then having the hospital system back out of it?

Talk about sloppy practice. CRNA's like you and your arrogance is what's wrong with the medical profession. If you ever tried moving a patient to the end of the surgical day over an IV start, some of the Orthopedic Surgeons I've worked with would chew you a new a**. Nice story, but I don't believe you for one second.

I've worked with them all. MDA's, CRNA's and AA's. I'm usually there when the "anesthesia provider" interviews the patient just before going to surgery and virtually all of them never use their title and simply say... Hi.. I'm so and so from the anesthesia department.

Guess I'd be terrified as well. I'm bothered by your use of opioids for 4 years and wonder why as a health professional you don't realize it's not in your best interest given all of the news about opioid use that you wouldn't seek an alternative. That with admitted use of TCH leads me to think you have a problem. I also wonder who is prescribing this for you for the past 4 years. I'm sorry, but I find it hard to have sympathy for you.

I forgot to mention another few things to look at when comparing agencies and their contracts. What the agency charges you for a "missed shift" fee. Usually it's about the cost of the daily meals and per diems rate, however some agencies hammer you when you miss a shift and charge an awful fee anywhere from $160 - 300 per day that you miss. Some break it down to: If you miss 0-4 hours, it's a certain fee, if you miss 4-8 hours, it's another and if you miss more than 8 hours, it's yet another fee. Some agencies charge a missed hours fee, usually between $15-17 per hour that you miss which I feel is the fairest way that I've personally seen. Some agencies, for instance in the OR where I work and the hospital is closed on a holiday, still charge you for a missed shift. Some agencies take this into account that it's not your fault the OR is closed for the holiday and don't ding you for those days because you still have to eat and pay for your lodging. It's sad when the hospital schedules you for call on a holiday and you're actually working and your agency won't pay you for your meals and per diems. Even worse when you're on call for a holiday and you never get called in. These certain agencies will tell you that "we can't bill them if they are closed on the holiday" I know this isn't true because some agencies do pay the meals and per diems if the OR is closed for a holiday. It's just another way of some agencies ripping you off so they can make more money. If you decided to have your agency pay for your apartment and you don't take the per diems stipend, make sure they take out the "missed shift" language. I've found that getting a good contract that is fair to the traveling nurse can sometimes be a challenge. Just make sure to remember that "you are the one that makes the agency money and without you they wouldn't make any money." Don't be afraid to have any language you object to taken out of the contract. Such as " the hospital can call you off for X amount of shifts or hours" and take out the language that you can be forced to "float" to other hospitals or departments. I also make sure the contract states the actual hours I will be working for instance 6:30 am to 3 pm and not just "day shift" Also if you are taking call have the language say every 4th or 5th weekend instead of "once a month" Any and all days or shifts off should be spelled out as well. I've sent back a contract to certain recruiters several times until they get the language exactly how I want it to read, otherwise, refuse to sign it. Also, It doesn't matter what the person tells you during the phone call interview for a hospital contract, as a lot of times the person that does the actual scheduling of shifts and call has a disconnect from the person doing the interview. What matters is what is in black and white on the four corners of your contract. I hope all of this helps you and any other RN that is interested in being a travel RN.

Gosh, I haven't worked at a hospital with and actual RNFA in years. I've only worked in Wisconsin and Minnesota but there was only one hospital out of the 19 that I've worked at that had an RNFA. Not sure about the rest of the country. Most places that I've personally worked at have a PA that works with specifically with their surgeon, or that surgeons group (such as an orthopedic or neuro group) that will help during the surgery and close the incision. Other places have the SA (surgical assistant) that has more training than a ST (surgical technologist) and they assist the surgeon and help close the incision. My .02

From what I've experienced, most OR departments do expect you to take call as a staff member. For travelers, some do want the traveler to take call and some don't require it. For various reasons. With that said, I was at one hospital where if you were 55 or older you didn't have to take call, and another one had some type of policy where if you had worked there for a certain amount of years.... I want to say 20... you didn't have to take call anymore. Other factors, such as if your work status is part time, or if you are a specialty coordinator you don't have to take call. Some hospitals have a dedicated "on call" team where they work 7 days on and 7 days off. They don't work during the day and are salaried. Usually their shift is from 3 pm to 7 am and all weekend. So, if they aren't called in, they still are getting paid. Just my .02

Well, picking out an agency can be an involved process. You're going to get all kinds of recommendations as to which one is the best, etc. I've been traveling for about 9 years, dozens of contracts and have used several agencies. I have no preference to any one agency. It comes down to which one can get you a contract and how much they are going to pay. Some contracts are nice, some are awful. It used to be that a hospital would put out a need and most of the agencies all had the same hospital need and it would just be deciding which one had the best rate of pay for hourly and per diems. Now, the mid level vender management companies have taken over and they take their fee off of the top before your travel agency gets their cut and you finally get what's left over. When I look for a new assignment, I put out a feeler to several companies at the same time. For my last contract I was working with 4 agencies at the same time. Each agency has the same contracts for a hospital as the others and each agency has their "direct bill" contracts where the others don't have them. Some mid level management companies work with certain travel agencies and vice versa as some travel agencies don't want to get gouged by the percentage that mid level management companies take off the top of what the hospital pays out for a traveling RN. Best advice is to find an agency that has health insurance from day one. Some agencies don't give you health insurance until the first day of the month after you start your contract. Also, the agency should be giving you a travel stipend, usually $400-500. Most agencies all offer the usual health insurance benefits, 401K, etc. Also make sure the agency is going to pay you the max rate for your meals and housing according to the GAO website for the zip code where the hospital is that you will be assigned to. Being a travel RN isn't the glamourous lifestyle that people think it is. While it is a rewarding career and I enjoy it, bottom line is that travel agencies are in business to make money off of you. The less they pay you the more your agency recruiter is going to make in commissions. You would be surprised as to the difference once agency vs. another will have in regards to what they will pay you. Contact several agencies, don't let them know you are working with other agencies and see what they are going to pay you. Before going on to any agency website and signing up and filling out stuff make sure you get a quote on: travel stipend, hourly rate of pay (taxed), meals and per diems rate, cost of health insurance (is it day one) etc. You'll also be surprised how much one company vs. the next charges for health insurance. Some are reasonable, some are outrageous. If the agency isn't willing to let you know what the rate of pay for a certain assignment is, just contact another one. Hope this helps and good luck.

Just had to retake 4 of the Prophecy exams. I'm a traveling RN and every once in a while a certain travel agency will use these awful exams. I had to do the 3 basic RN core competency exams and the dreaded RN Pharmacology exam. The Core exams weren't that bad. As one other person suggested, if you get stuck , just open up another browser window and look it up. I didn't look at the study guides at all. However the Pharmacology exam is a beast, especially if you haven't done any drip rates, dosage calculations and conversion factors such as myself since nursing school, over 15 years ago. Do yourself a favor as some others have suggested and study up for a bit, there are some websites with practice tests on the math part. Familiarize yourself with what the study guide says that Prophecy has for the Pharmacology exam. I had a sheet of paper so I could remember what I answered for each question in case I had to retake the exam. If you fail it, you do get to see which ones you missed so you can figure out the correct answer for your retest, but write down the answers that you selected for the first test, so you don't get them wrong by accident if you have to retest. I studied up for a couple of hours and passed with an 83% with 47 seconds left on the timer. I dislike the Pharmacology exam as much as the next guy, but it can be done.

Are you taking drugs or what ? He stated that he was "staying with family for free and keeping the housing stipend" Where did you read that he was "minimizing housing costs by staying with family" ? I read that he was bragging that he was staying with family for free and keeping the "tax free" stipend. Not a smart thing to do. At any rate, It's NOT consistent with IRS rules and if ever audited, you'd better be able to show that you duplicated your living expenses... hence, keeping receipts that show you paid for your housing with your "tax free" stipend and not stating that I'm living with family for free and keeping all the money. I don't know where you are getting your information from but the tax free stipend isn't there to cover reimbursements from your employer. You get paid a weekly tax free amount according to the IRS/GAO guidelines and are expected to pay for your meals and housing with that "tax free" money. There is no reimbursement. You get tax free money to pay for your lodging and if there is ever a question, you'd better be able to prove that you used that money to pay for your housing while away on a travel assignment. It's guys like you that play around with the rules that will ruin this for everyone else.

Thanks... it's the ALPHA personality.

We are discussing the standard mileage deduction... not business expenses such as a taxi or parking garage. You keep throwing all of this into the mix and it has nothing to do with the mileage of your daily commute to and from the hospital as a travel nurse on a 13 week assignment. It's not the same as a business trip. You used the term "home" as if a commute from a motel or apartment when somebody is on a 13 week travel assignment isn't their temporary home. Been to several traveling nurse conventions and the classes that go with that about what you can and can't claim. I was told that you can only claim the mileage that it takes for you to get to your travel assignment from wherever you live and the mileage to get back after your 13 week assignment. The miles that it takes each and every day to go from the motel or apartment to the hospital and back again is your daily "commute" and not deductible. And just for clarification, I am referring to my personal vehicle. Not a rental, not a taxi, no parking garage fees and all of the other stuff you threw into the mix that are "BUSINESS EXPENSES" A 13 week travel assignment is not a business trip. You make me laugh when you tell me to go to a CPA. Been there and done that. I have 2 Brothers in law that are CPA's. both of them have no clue how the travel nurse thing works and how the tax free meals and lodging stipend works any more than going to the guy sitting behind the desk at H&R Block. However, both of them agreed that the daily commute to and from work, regardless if you are at home or at a motel away from home is not allowable.