Travel Nurse: A Trip To Silver Springs, Florida

The weather in Florida is certainly interesting. One day it can be 80 degrees outside and not a cloud in the sky. The next day it can be 40 degrees and raining. In fact, one day last week started out 70 degrees and raining and ended up 25 degrees and clear. I have learned that anytime I leave the house I need to bring an umbrella; cloudy or not. Right now it is clear and cold.

Recently we took a little time off for what my husband calls a "mini-vacation." We pulled our boys out of school for a couple of days and took a short 2 1/2 hour trip southeast of Tallahassee to Silver Springs, Florida. My husband and I decided some time ago that when we get a chance to give our kids a little "hands on" experience with life (i.e. nature, history, etc.) that pulling them out of school for a couple days is a small price to pay.

Take a look at what I mean by "hands on" experience. Reading it in a book is fine if that is the best you can do. But holding it in your hands can make a lifelong impression.

Silver Springs has several different glass bottom boat rides you can take the kids on. The water is so clear and the fish so big it is almost unbelievable. You can see the kids in this picture looking through the glass bottom of the boat at a school of fish. I think the tour guide called them Bluegills.
The tour guide said that a number of old Tarzan movies were filmed at the springs, as well as some James Bond and other movies.

Across the parking lot from Silver Springs is a water park. It was closed for the winter. The kids were a little disappointed about not going swimming so we found a hotel with one of those indoor heated pools and swam until we were all prunes.

What a fun "mini-vacation."

Travel Nurse: A Cycling Near-Tragedy

Last night I had a patient who competes nationally in bicycling competitions. I'm not sure what types of competitions he enters as I don't know much about the cycling world; other than Lance Armstrong owned the Tour de France before he retired and that the French hate American cyclists.

He had been biking without a helmet down one of the roads running through a local college campus when he was T-boned by a car going about 35 mph. His body went over the hood of the car, ricocheted off the windshield, over the roof of the car and onto the pavement. He said he recalled everything up until he hit the pavement. When he finally came to, there was a crowd gathered around him and blood was gushing from a deep cut extending about six inches from the side of his right eye upward to the edge of his hairline. The impact had almost taken his eyesight. His bike was about 40 feet away lying in a mangled clump of titanium.

All night he kept saying that if he had rotated just a few more inches while in the air he could have lost his eyesight or suffered sever brain damage. He said he never rides a bike without a helmet, but thought this one time as he rode on campus he would be alright.

All things considered, he was lucky. Very lucky.

Travel Nurse: Contract Items You Need To Address

I have received quite a few e-mails lately wanting to know some of the nuts and bolts of signing up with a travel nurse agency. Apparently quite of few of you are worried about taking a travel nurse job in a new state, moving and then finding out that your hourly pay or your hours are not guaranteed and you are not able to make ends meet. A legitimate concern indeed. I debated between either addressing the e-mails I have received or writing about our recent visit to Wakulla Springs, Florida in today’s post. The e-mails won. I will recount the Wakulla Springs trip later this week when I get another chance to write.

Before I start any new travel assignment, I make sure I have a written (not a verbal) contract with my agency. It has been my experience that promises made over the telephone between me and the agency don’t mean much until they are reduced to writing. Agencies experience personnel changes and the person who made the verbal promise may no longer work for the agency when it comes time to enforce the promise. Also, people’s memories become foggy when you try to get them to honor verbal promises they no longer want to honor.

The following is a list of items you need to address in your written contract:
1) Is there a provision in the contract guaranteeing my assignment? The concern here is that you move to your new assignment and the position is no longer available at the facility. Your agency should then be responsible for finding you another similar assignment in the same area or paying you until they find an available assignment.

2) Are my hours and pay rate guaranteed? You do not want to get to your new assignment and find out that the pay you think you are going to receive only applies if you work as a charge nurse on the night shift when you were supposed to be working as a regular floor nurse on days. Also, because you will likely be receiving a higher pay rate than the other nurses, facilities would generally rather send you home first when the census is low. Make sure your contract contains guaranteed hours.

3) How often will I be paid? You will likely not have much control over whether you are paid every two weeks or every month as agencies pay you when they are paid from the facility. However, you do not want your agency to hold on to your funds once they have been paid by the facility. I personally have never run into this problem, but you never know.

4) Will I be paid by my agency or the facility? I personally prefer to be paid by my agency. It creates more consistency for me as I travel from one assignment to another. If there is a problem with my check I know who I need to contact.

5) If I am going to a large metropolitan facility, will I have to pay for parking? This may not seem like much, but some facilities seem to try to make a living off charging their employees for parking and other related items.

I think the above addresses the specific e-mails I have received. Other items you may want to address in your contract are: Will I be paid via direct deposit or bank check?; and what items will be deducted from my paycheck? If I think of any others I will try to include them in a future post.

Also, one final bit of advice, read through your travel nurse contract and make sure the above items are in there. Do not assume that because you have discussed an item the item is addressed in the contract. If you have a question as to where the item is located in your contract bring it up with your agency contact. More often than not she can show you where the item is addressed or add it if it has not been added.

Travel Nurse: Code Blue

My last day of orientation ended in a whirlwind last night: I swiped my badge to clock out, got in the elevator, pushed the button for the parking garage, heard the words "Code Blue" over the speaker system, stuck my hand between the elevator doors just before they closed completely, jumped out of the elevator, joined a dozen other nurses running down the hall towards the coding patient and ran into the patient's room. When I got into the patient's room I saw several other nurses going into the bathroom.

I walked into the bathroom where the patient, a 350 pound woman, had apparently been sitting on the toilet when she began bleeding out of her femoral artery in her left groin. There were already four or five nurses working on her. I later found out that several days earlier she had had "an uncomplicated" heart catheterization procedure. Uncomplicated, that is, until she passed out on the toilet and nearly died.

I helped start IV fluids for the patient and hooked them up to her heplock. It took six people to lift the patient off the toilet and put her back on her bed. As we did so, one of the nurses kept a ball of gauze pressed against the slit in the patient's groin to keep the blood from coming out. I then backed away from the scene and watched as the cardiovascular surgeon climbed on top of the patient and while straddling her, pried open the slit in her groin with his hands and pressed directly on the artery. The patient and the doctor were then whisked out of the room, down the hall and into the elevator toward the operating room.

As I walked out of the hospital I thought to myself how consistent nursing is no matter where I have worked. In every hospital I have worked in there have been good days and bad days. Days where not much happened, and days, like today, where all heck breaks loose at the end of the shift and you have to react as quickly as you can. But in every hospital I have worked in "Code" always means "this is important, pay attention and react," "Code Brown" means "someone has dropped anchor on themselves" and "Stat" always means "move your butt right now."

Orientation is definitely over.

Travel Nurse: Do Agencies Pay for Relocation?

A reader recently sent me an e-mail regarding whether travel nurse agencies will pay to relocate a nurse. I have received several similar e-mails in the past. As this may be a subject more of you are interested in, the following is the e-mail and my reply:

The E-Mail
"I have a question, if you'd be so kind. once you sign a contract with a agency, how do you get to the destination? does the agency pay for you to get to your assignment or do you? I live in texas, if I take an assignment in California, who pays for the travel out there?
Thanks
[Reader]"

My Response
[Reader], thanks for your e-mail. Some agencies will pay for the move or at least give you an alotment that you can spend towards the move. The amount depends upon the distance of the move. Some will even hire the moving company for you.

It has been my experience that if you do elect to have the agency move you they will lower your sign-on bonus or your monthly pay. I usually choose to move myself and keep the bonus and have a higher hourly pay rate.

I suspect there are quite a few other potential travel nurses who have the same question. I will probably post about it in the near future.

Amy Robbins, RN, BSN"

Disclaimer
One of my purposes in writing this blog is to provide information to readers who are thinking about becoming travel nurses. When I first became a travel nurse the fear of the unknown was almost too much for me. I am, however, glad I took the plunge as it has allowed me to visit places and see things that I would not have otherwise been able to.

I have used several nursing agencies during my time as a travel nurse, but have intentionally omitted their names on this blog. Why? Because I have decided not to endorse any specific agency over another. Nor do I allow people to publish comments on my blog endorsing an agency.

This blog absolutely endorses travel nursing, but has refrained from endorsing any specific travel nursing agency.

Travel Nurse: Not the Ideal Start

What a weekend. Headache, nausea, vomiting. And that was just me. I don't know if it was the anticipation of starting a new job or what, but Saturday night around 9:30 p.m. a migraine headache started pounding the back of my head..."Somebody turn down the T.V. and turn off those lights!"... Shortly after the headache began came the nausea which crescendoed into an all out vomit-fest that lasted about an hour. The nausea and vomiting eventually subsided but the headache lasted until the wee hours of the night which meant I got about 2 solid hours of sleep before waking up and getting ready for the first day of my new travel nurse assignment.

I was a walking zombie all day long. Fortunately, I was just orienting and didn't have any patients... "Sorry about giving you that Estrogen shot, Mr. Jones"... I am now a little concerned about the doubtless whisperings that will come out of today... "Have you seen the new brain dead travel nurse"...Thank goodness I don't have to go back in until tomorrow.

Travel Nurse: Grand Rounds 3.14

When my husband convinced me to start blogging about my travel nurse experiences he gave me a few words of advice that I didn't quite believe at first. He said that blogging is not like running a website where a person visits a site, buys something or downloads information and then leaves with no real attachment. He said bloggers, real bloggers, establish a connection (be it intellectual, emotional, psychological, etc.) with their readers. It made me wonder whether I was ready to take the leap from becoming a blog reader to a blog writer. You see, as solely a blog reader I was someone who could take shots at blogs I didn't like, enjoy the ones I did and not open myself up to criticism about my writing. As a blog writer...well, things are different. Suffice it to say that I'm not quite as critical of other blogs as I used to be.

My husband also said that bloggers have their own community pecking orders complete with Wise Grandparent, Sarcastic Uncle, Alcoholic Best Friend, Court Jester and Wet-Behind-the-Ears Newbie. Two guesses on where this blog falls into those categories (hint: Newbie).

Grand Rounds 3.14
One of the blogs that definitely falls in the medical blog heirarchy under Wise Grandparent is Blogborygmi written by Nick Genes. Nick has recently posted his self described "collection of the best posts in medical blogging" known as Grand Rounds 3.14. Nick's latest edition of Grand Rounds reminds me a little of Einstein's publication of the Theory of Relativity. No, the post doesn't provide any monumental breakthrough in science...but hear me out.

It is my understanding that when Einstein published his Theory of Relativity, he did so first as a footnote to a larger thesis he had been working on. When the scientific community pored over his thesis they found the obscure footnote and began to question him on it. From an obscure little footnote came one of the most important incites of our time.

On a smaller scale, Nick provides an incite into the medical blog community that may get lost in the pomp and circumstance of his Grand Rounds awards. He says that "Bloggers talk to each other enough, reading and commenting on posts so frequently, that when one of them disappears, it feels like we're losing a friend." This may be the most important statement in his entire post. For those of you who only read blogs, it is up to you to find the incite in his statement. I hate to end this post so abruptly, but it is late and I start my new travel nurse assignment tomorrow.

Travel Nurse: Three Shots In One Day

Let me start with a quick Bon Jovi remake: "Shots in the arm and your to blame. Darlin' you give nurses a bad name." Okay, so most of you post 80's teenagers may not know who Jon Bon Jovi is but some of us still remember having his picture pinned to the inside of our locker doors.

So why the 80's music flashback? My travel nurse agency called yesterday to tell me that I needed to get updated tetanus, influenza and PPD (tuberculosis) shots before I can start my new assignment. What a bummer. Although I can administer shots with the best of them, I do not do quite as well when it is my time to be stuck.

My visit to the employee health clinic at the hospital this afternoon was no picnic. The nurse was rude and seemed to take pleasure in sticking me three times in the arm. On the bright side, after my hospital visit our family went to a local petting zoo in Tallahassee. The zoo is located beside a large marshy lake that reminds me of pictures of the Everglades I have seen. There were alligators, bears, panthers and a number of other animals the kids were allowed to pet.

My first shift in Tallahassee is scheduled for this weekend and I actually look forward to it.

Travel Nurse: Florida Tornado Victim

Several years ago I started keeping a journal of my travel nursing experiences. Last night I decided to read back through some of my entries from last year and one incident in particular caught my attention. The names and places of the incident have been omitted to protect patient confidentiality, but all of the other facts are as I experienced them.

Patient with Multiple Contusions, Lacerations and Fractures
One evening while working on an orthopedic (bone related) floor a young man was brought into the unit with multiple contusions (bruises), lacerations (cuts) and fractures (broken bones). He had been stabilized in the Emergency Room after many hours of work by doctors and nurses before being transferred to my floor.

The young man had broken four ribs, one arm, one leg in two places and had a head injury. He was also clearly experiencing psychological pain from what had happened to him. My first thought was “why would anybody ride a motorcycle without a helmet?” But this was no motorcycle accident. In fact, it probably would have been better had the man actually been in a motorcycle accident.

No, this man had experienced what it is like first hand to be sucked into a tornado.

“It Was Just Like Being Flushed Down The Toilet”
Two nights before I had him as a patient, the young man, his sister, his niece and nephew were sitting in their mobile home watching TV when they heard a noise outside. He said the noise sounded “like a train engine barreling down” on them. The family jumped off the couch where they were sitting and began running toward the bathtub. He, his niece and his nephew made it to the tub before the tornado began ripping their mobile home to pieces.

The young man said that he watched from the tub as the ceiling of the mobile home was ripped off and his sister was sucked out and disappeared into the dark. He then tried to cling to his niece as she was pulled out of the tub. He was unable to hold onto her and she too was sucked out. The last thing he recalled was feeling extreme pressure pushing and pulling on his body and then he was pulled out of the tub into a swirling funnel.

When the rescue team finally found him many hours later he was laying in a ditch several hundred yards away from where the mobile home had been and a portion of the mobile home was on top of him. His sister and niece had been killed. I am not sure of the status of his nephew. The last I heard the nephew was still in intensive care.

In all of my years as a travel nurse, I don’t think I have ever taken care of a patient who has gone through anything as surreal sounding as what this patient experienced.