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Travel_RN_0714's Latest Activity

  1. Travel_RN_0714

    The Importance of a Title: Anesthesiologist vs. Nurse Anesthetist

    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.
  2. Travel_RN_0714

    The Importance of a Title: Anesthesiologist vs. Nurse Anesthetist

    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.
  3. Travel_RN_0714

    NOW what?? Terrified...

    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.
  4. Travel_RN_0714

    Want to Travel Nurse, don't know where to start

    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.
  5. Travel_RN_0714


    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
  6. Travel_RN_0714

    On call policies

    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
  7. Travel_RN_0714

    Want to Travel Nurse, don't know where to start

    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.
  8. Travel_RN_0714

    Prophecy Testing

    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.
  9. Travel_RN_0714

    Because It's always been done that way orders

    OK... you're saying that I should make a memorandum of what I'm seeing in regards to consenting patients and hand writing an order from the CRNA which should have been put on the Anesthesia order sheet and instead was written on the surgeons order sheet or.. what are you saying ? I've seen a lot more.. from assessments that were never done and Vital Signs just copied down from the previous days assessment with a time put down where the RN was actually in a surgery and couldn't have assessed that patient.. all kinds of stuff I've seen. They're just writing stuff down in the charts with made up dates and times and it's just so obvious that it was never done. I mean, how can you do an assessment on Thursday at 8 am when you were in a surgery and copy down vital signs verbatim from an assessment that was done on Wednesday at 9 am that was done by a different person. I'm just besides myself as to what I'm seeing.. and don't know what to do.. It's just so rampant and they are doing it just because it's how they do it... just blows my mind. Are you saying that I should cover my butt in case something happens at this hospital and I am involved in a patient safety issue or that the hospital will complain to my agency about me that I was a city nurse and didn't play ball well with their ball ?
  10. Travel_RN_0714

    Because It's always been done that way orders

    That's very good advice. I guess I'll have to just cover my own "ass" and do what I know is best. I don't want to raise a stink and just want to fit in and do what I gotta do and head to my next assignment. I already have been in contact with my agency from day one and relayed my concerns to my supervisor. She agreed with me that I just need to cover myself and that I'm very wise with not just doing it their way. If at any time this hospital asks me to do something that I'm not comfortable with that is not within the normal and customary standards of practice.. that I am allowed to refuse and I should contact her and she will let me speak with the agency DON for clarification. The thing about their policies... I asked the RN "what does your policy state" she doesn't know... has never read them... doesn't know where to find them in case I would want to read a copy of it.... and just blindly does as she was trained. The person who trained her is gone and was placed on "administrative leave" and I'm thinking the way she trained these RN's has something to do with it. I don't want to be a paid representative of the Joint Commission, but do know the right and wrong way of doing things and just have to keep my mouth shut and get on with it... lol All in all, I'm going to take away from this assignment that this is a learning experience for me as an RN.. it will make me a better RN for it.. will test my integrity as a patient advocate and I'll make lemonade out of the lemons they are giving me... what else can I do ? Asking to be re-assigned isn't an option in my book.. I'm being paid the top rate and don't want to hassle of picking up and leaving.
  11. Travel_RN_0714

    Because It's always been done that way orders

    I've been sent on my first traveling assignment to a small rural hospital. The people are very friendly, and the hospital is very small. I've been an RN for 7 years and have worked at 2 large hospitals, one of them being a Medical Center with cardiac cath lab, cancer center, etc. The other one was about the same. I need some help from the Allnurses community and would like some opinions as to a couple of issues. Example 1: I was being shown the admission process for a same day surgery patient. The RN training me has the patient sit down in their room, and hands him/her the consent form for the surgical procedure and the anesthesia consent. Neither are signed by the MD or MDA. The MDA hasn't seen the patient preoperatively and the MD had seen the patient a couple of weeks ago. There is not a current H & P on the chart (RN claims there isn't one needed because it's just a colonoscopy) RN starts to explain the surgical procedure including all the risks and complications and what might happen, etc. I was absolutely floored but just stood there and watched her do it. Same thing with the anesthesia consent. She explained to the patient all about general anesthesia. The patient signed both consents and the RN witnesses "the consent procedure" and signs off on both consents with neither the MD or MDA having signed them. I was always taught and specifically remember the teacher telling us in Nursing School that the RN "NEVER EVER" obtains an informed consent for a surgical procedure and that the duty of obtaining the consent and explaining the surgical procedure rests soley upon the doctor. I talked to the RN that did this in private and she told me she didn't see a problem with it and that they've just always done it that way... the doctor is really nice.. yadda yadda.... I reminded her that she's not a doctor and didn't they tell you in school not to do that ? She said yah.. but. Apparently all the RN's do this at this hospital. I'm uncomfortable explaining procedures to a surgical patient and to work around this am just going to hand the patient the consent ask him/her to read through it and sign it... I plan on adding next to the word "witness" the words "to signature only" which will signify that all I have done is witness that the patient signed this consent. I'll throw it in the chart and let this hospital worry about it. I don't want to raise a stink and be an ass. Just want to do my time here and get out. Example 2: The RN training me is showing me how to look at the pre-operative surgical and anesthesia order set. For the same colonoscopy, it was the standard.. admit patient.. start IV with LR @ 125... yadda yadda. All of a sudden she says " we need to do an accucheck" I'm looking at the surgical order WHICH WAS NOT SIGNED and I'm looking at the anesthesia orders WHICH AREN'T SIGNED as well, and I asked her "how do you know that" She says, she looked up in an H & P, which was 3 months old, that the patient has diabetes and JIM the CRNA (not his real name) says that whenever we see that the patient is diabetic, that we have to do an accucheck. I asked her if Jim was going to put that on his order and she said no.. we just always do it like that. She then takes a pen and writes onto the pre-surgical order "accucheck" I could not believe what I was seeing. I told this RN that I've never seen an RN just write in an order on a surgical pre-operative order sheet without the surgeons approval just based upon the fact that so and so said so. At this point, I told her flat out that I was not going to do an accucheck on this patient without a verbal order from the CRNA and that I was not going to sign that order sheet after she wrote accucheck on there prior to having obtained a legal verbal or written order. I also told her that I was uncomfortable providing patient care if this is the way the rest of the day was going to go. Here is the rub. The RN explains to me that this hospital is so small that it doesn't have to follow JCAHO or joint commision and that it follows the Rural Wisconsin Hospital Co-operative (or something like that) guidelines. She felt I was a big city RN and that "they do things differently" here in the countryside. I responded that she still needs to follow the basic principles of nursing and not provide care to a patient without being ordered to do so either with a verbal order or a signed written order and I didn't care what guidelines she wanted to recite. I was going to follow the basic principle of NURSING 101 that I was taught in college and I'm not going to so much put an ice pack on a patient without being told to do so either verbally or with an official post operative written and signed order and that I"m not risking my RN license that I worked very hard for. What do all of you think about this ? Am I just being a big city nurse, or are these RN's out in the country side way off base and putting themselves at risk by blindly following a set of archaic principles that might have worked 30 years ago ? It seems like everything here is just done by a feel good country way of doing things and I'm used to seeing a written order either on paper or on a computer before taking on a nursing care. I'm at a loss here and would like some opinions.

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