I've had the pleasure of working in states where there were legally mandated maximum patient ratios. I have worked in states where there was no such thing. What is so important about ratios? Well in order to understand the MASSIVE importance, one must understand the time management of a nurse working on the average Med-Surg floor. I will list a night-shift from start to finish, each time showing the amount of time remaining after a task.

12 hours with ONLY 6 patients (7pm-7am shift)

Oncoming report (30min) = leaves 11:30 hours
Initial “new orders” check (15min) =  leaves 11:15 hours
8pm V/S (30 min) =  leaves 10:45 hours
8:30pm blood sugars (30min) =  leaves 10:15 hours
9pm med-pass  (1hr) =  leaves 9:15 hours
Midnight vital signs (30 min) = leaves 8:45 hours
Midnight medications (30min) = leaves 8:15 hours
30min lunch =  leaves 7:45 hours  (often eaten at the desk while working)
15 min break x2= leaves 7:15 hours (often “skipped” all together)
24hr Chart checks (1 hour) = leaves 6:15 hours
Patient Charting  (1 hour) = leaves 5:15 hours
4AM vital signs (30 min) = leaves 4:45 hours
5:30 blood sugars (30min)= leaves 4:15 hours
6am medication pass (30 min) = leaves 3:45 hours

This leaves 37 minutes of actual care time with each patient.

The above list DOES NOT include any of the following common occurrences which also deduct from the above listed time “patient care time”

1. Missed orders on the chart
2. Head to toe assessments
3. Gathering additional needed medical supplies
4. Phone calls to/from doctors, pharmacy, lab, family
5. Admissions
6. Discharges
7. Wound care
8. Emergency issues
9. Codes
10. Prepping for surgery, radiology, or other diagnostics
11.  Drawing lab samples
12.  Intake/output collection or documentation
13.  Any PRN medication
14.  Any miscellaneous needs such as ice, drinks, snacks, extra pillows/blankets
15.  Changes of linen
16.  Assistance with ambulation
17.  bathroom break for the nurse
18. Covering another ENTIRE group of patients if a nurse goes to lunch or attends an emergency

(MOST NURSES KNOW AT LEAST HALF OF THESE WILL OCCUR DURING EACH SHIFT)

Now imagine the same nurse with the SAME amount of time, trying to care for 7, 8, 9, 10, 11, or 12 patients. (And yes, my max was once 12, and I did work in Lafayette, LA where the average patient load was usually 10:1)

Traveling involes a lot of... well... traveling! There are several steps you can take to make your journey easier and safer. The following are just some of the ways to make your trip safer. I hope others will comment and add any extra useful tips.

Plan your trip - know your route, print your maps, invest in a GPS, buy an updated road atlas. Nothing is worse than going 50+ miles out of your way, before you realize it.

GPS - I know your phone probably has one, but a dedicated GPS for a car doesn't lose cell service or network coverage. They are inexpensive and worth their weight in gold to a traveler! Don't rely on the one on your phone.

Road atlas - Technology is great but a good ole road atlas never needs batteries, is never out of network range, and is an inexpensive backup!

Know your equipment - More than once, I have stopped to help a stranded motorist that had no clue where their tire-jack was located or how to change a tire. I hope everyone reading this will take the time to "trial run" changing their tire at least once. I think all owner's manuals have this information in them just in case you think it will never happen to you.

Road-side emergency kits - Get one and keep it in the car where it can be easily reached! Something that contains a minimum of an LED flashlight, jumper cables, flares, a multi-head screwdriver, pliers, and water container. I would highly recommend adding a can of fix-a-flat, a pair of work-gloves, a couple of bottled waters and energy bars, a multi-tool, and an emergency blanket.

No-contract phone - I recommend a pay-as-you-go emergency "back up phone". Buy one from a national carrier (ATT, verizon, T-mobile, Sprint). Get one from a carrier DIFFERENT than your primary cell carrier. Whats the use of a go-phone that has no service where your primary has no service? You have now doubled the chance of having cell coverage in an emergency.

Plan ahead but not too far ahead - Being organized is great, but don't OVER plan your trip. If on a multi-day trip, don't book rooms more than a day in advance. One fly in the ointment, such as an overnight repair, could cost you tons in missed reservations, plus the additional costs of new reservations. Most online booking sites have a minimum 24 hour cancelation policy which come with fees. If you travel with a pet, book with pet friendly chains such as "Super 8".

Keep some cash on hand - Ever been told "our debit/credit card machine is having problems"? Don't let THEIR problem cause YOU to be stranded.

Travel in the daytime - It is sometimes tempting to do your long-hauls at night since there is less traffic. There are fewer services at night, some gas stations close at night, and you are less likely to get assistance from a fellow traveler at night.

Have your car checked - If you can't afford a service, at least check your fluids. Most people use "quick-lube" stations to get their oil changed. Most of these offer "between service" check-ups for free. They check and top-off any fluids, check tire pressure, and do a mini-inspection, etc.  Use this to your advantage... you paid for it. If your oil change service doesn't do this... find one that does and give them your business.

Don't trust every good samaritan - People HAVE been attacked by others pretending to be good samaritans. One tip is to stay on the phone with a friend while someone assists. Give your friend the helpers description, what they drive, license plate number if possible. If you CAN'T get a friend on the phone... FAKE IT! You are less likely to be attacked if they think you are in contact with someone. Phones have cameras, sneak a pic of them and their vehicle and text it to a friend or two. Feel free to utter some fake phrases within earshot of the person helping such as "I didn't bring any cash with me"... "Dad can't help, hes on duty at the police station for another hour"... "I called the state troopers but they aren't sure how long it will be before the officer arrives". Also remember, holding the "9" button down, for a few seconds, on a cellphone will automatically dials 9-1-1. They can triangulate your location from your cellphone signal. If someone tries to take your phone, hold the "9" button down and then throw it into the woods, tall grass., or under the car.

Get a roadside assistance plan - Most are inexpensive. Some come with your auto insurance (check your policy). Get their 24/hr number and store it in your phone! Some offer 30-day free trials.... sign up a week before you travel and cancel when you arrive at your destination.

Email your itenerary to a friend - Let someone know where you are going, when you are leaving, where you will be stopping, what route you plan on taking., and that you will be calling them OFTEN. Check-in with them by phone a few times a day and give them updates on where you are, if there are changes in plans, or if your vehicle is not acting right. Even sending a text reading "just passed through Dallas" can help keep you safe by alerting your buddy as to your general location.

Be aware of your surroundings - Most attackers are opportunists, stick with well-lit, crowded stations and rest areas. AGAIN... if this isn't possible, get a friend on the phone. Tell them where you are and why you are stopping BEFORE you get out of the vehicle. Keep them on the line until you are back on the road safely.

Defensive items - Pepper spray, tazers, stunguns, knives and pistols are handy. Even a car key can be used to poke an eye out! It is good to know the laws, but in a life or death situation...DO WHAT YOU HAVE TO DO!  Remember This: It is always better to be judged by 12 jurors than carried by 6 pallbearers!!!

I've been doing the "travel thing" for a loooong time now and have learned many things about packing. I'm starting this thread to pass on things I have learned and in hopes that others will comment and leave their tips for others as well.

Contrary to popular belief... There ARE ways to pack 10 pounds of "crap" into a 5 pound bucket!!!!

Tip 1) Clean all the trash, junk, and non-mandatory items out of your vehicle FIRST!

Tip 2) Evaluate the situation. Do you need 5 coats, 12 pairs of shoes, 10 pairs of lounge pants? Don't OVER pack. DO pack for both summer and winter because you never know if you are going to extend a contract.

Tip 3) Ditch cardboard boxes and get plastic totes. They are more protective, last longer, more stackable, and your stuff won't smell like bananas or beer when you unpack! You might even consider color coding them for clothes (blue for winter clothes, red for summer). Get the size that fits your vehicle best (smaller for cars, larger for truck/SUV)

Tip 4) Invest in "vacuume sealer" bags. They will help protect your items and allow you to pack 4 times the clothing in the given space. Be sure to throw in a couple of scented dryer sheets before sealing and compacting the bags.

Tip 5) If you use a suitcase, learn to military roll your clothes. You can research how-to on the internet or youtube.

Tip 6) If it cost less than a dollar but is bigger than your fist, don't pack it. Just buy one when you get where you are going.

Tup 7) Consider not packing plates/bowls/glasses/silverware. These items can be purchased at the local "dollar store". However, if you are considering "entertaining", by all mean pack the good china!

Tip 8) Don't pack the kitchen pantry. Pack a few snacks and a small drink cooler. Buy groceries when you get there.

Tip 9) If you drive a truck, invest in a cheap tarp and cargo net to cover your stuff.

Tip 10) If you rent u-haul trailers, and are making a long term career traveling, consider purchasing your own trailer. It will pay for itself in time. (especially if you travel long distances)

Tip 11) If you are packing any electronics, wrap them with any extra towels, sheets, and blankets that you intend to take with you.

Tip 12) Test-lift your boxes. Heaviest boxes go on bottom, lighter boxes go on top. Also remember, odds are you will be unloading these alone. Don't pack more than you can lift into one box. Balance out the weight into the lighter boxes if you have to.

Tip 13) Although this shouldn't be the case when "going" to an assignment, if you find yourself returning home but have more stuff than you have space..... prioritize and ship items home if necessary.

Tip 14) Even if you ignore all other tips, remember this one.....

Have a "last in, first out" box! This is the box that you load into your vehicle last, so that it is the first one unloaded into the new apartment. By the time you have made your trip, odds are that you are tired and may not feel like unloading or unpacking immediately. This box is like a small "survival kit". It contains items you probably will need early access to, even though you don't want to unpack. Only YOU know what you really need. I'm listing what is in mine as an exaple. 1 roll of toilet paper, 3 soup-in-a-cup/ramen, 1 towel, 1 washcloth, 1 plastic bowl, 1 boiler, 2 spork/napkin packs from a fast food chain, 3 bottled waters, 2 cans of dog food (I travel with a pet), 3 solo cups, travel-size shampoo, soap, razor, deodorant, 1 baseball cap, 1 pair of lounge pants, 1 set of scrubs+underwear+socks, 1 camping bedroll, travel pillow, extra cellphone charger.

***THINGS TO CONSIDER

1) Don't pack groceries to travel to/from your destination. A couple of packs of cookies, ramen noodles, or snacks are ok. DON'T pack the entire kitchen pantry. It adds weight which uses more fuel and also takes up packing space. Buy groceries when you get where you are going.

2) Stop buying groceries about a month before leaving a contract. It is ok to buy staple items, but forgo anything more than totally necessary. Whatever you have left over before moving... offer to another traveler or give to a foodbank.

3) Don't buy fuel with credit cards. Gas is high enough, there is no sense in paying interest on it. Yes, it may be easier to keep up with the cost that way... but so is an envelope marked "Receipts for gas" in your glovebox. Remember... A $2 cash advance fee on $100 is cheaper than 21% interest on $100.

4) Buy all your travel snacks at walmart BEFORE leaving on the trip. It is way cheaper than the convenience store. Consider a small cooler for a 6-pack of drinks or waters.

5) Do you REALLY need to stay in Hilton just to sleep for 8 hours? Research hotels on the route for a safe and inexpensive place to sleep.

***REWARD CARDS (I suggest having an extra keychain in the glovebox for nothing but reward cards)

6) If you prefer 1 or 2 hotel chains when you travel, sign up for their rewards programs and earn you some free nights!

7) Reward cards work well for fuel stops also. Consider  reward cards for national "interstate-chains" such as Love's or Flying J. 

8) Grocery store reward cards. Have one for your prefered store at your destination. (You don't have to give your real info to get them... for the phone number give local area code and 867-5309... like the song)

***OTHER THINGS TO CONSIDER

9) Mind the shopping sprees! Odds are, anything you buy other than food will have to be packed up when you leave. If you were tight for space when you came... just imagine how much tighter it will be when you leave!

10) Most travel companies will deposit into more than one account. Have a percentage of your liking deposited directly into a savings account. Do this from the start and you will never miss it!

 
Something just came to mind and I thought I would throw it out there for you.......

I was once asked by a recruiter... Are you a smoker? The facility wanted to know.

What's that about? I smelled discrimination all over it. Of course I was a smoker at the time and funds were getting low, so I lied by saying "No."

I didn't say anything to the recruiter, but the question really rubbed me the wrong way. Thats a bit like asking "Are you overweight?" or "Do you have high cholesterol?" or even "What color are you?"

Has anyone else ran in to a situation like this? 

more...

This blog is mostly for the new and relatively new travelers.

I have heard "The hospital is doing away with all the travelers" at every facility I have ever worked. Yes, EVERY facility. New travelers often bolt for the next traveler they see to spread the word, once they hear this. Experienced travelers usually just grin and go on about their business.


Yes, it is 100% true that all hospitals with travelers are trying to "phase out" travelers. Fear not. If you think about it a little it often becomes clear. Why WOULDN'T a hospital want their own full time staff instead of travelers? It is more beneficial to the hospitals.

Often it is a "catch 22" situation. The more travelers a hospital has, the more the hospital wants to phase them out. However, the more travelers they have, the LESS likely they are to BE phased out.

I have actually seen a hospital try to put this in motion. One hospital in Louisiana where I was employed decided that they were going to quit using travelers "cold turkey". The memo was sent out that after a given date, no contracts would be renewed and no new travelers would be accepted.  Since the hospitals practice was to hire travelers on large groups every 6 weeks, this caused a large predicament. 50% of the contracts would end on the same day and the remaining 50% would end in 6 weeks. So basically all contract personnel would be gone in a period of 6 weeks and 1 day.
          When the first group left, staffing became REALLY bad. Travelers often had to float between 3 different floors in a 12/hr shift. Workloads increased, stress increased, and call-ins increased by staff and travelers alike.  By the time the next "drop date" arrived, all the travelers were MORE than ready to get out of there.
          The hospitals staffing turned horrible. It even made the news paper about the staff shortage in the facility. The hospitals then put their "secretive plan" into motion. Their brilliant idea was to form their own internal "agency", to staff the traveler openings. The one thing they never considered was the number of regular staff that would also leave due to the almost doubled workload and declining working conditions. The hospital had to condense floors due to staffing issues.
          The internal agency failed miserably. No one would apply because current staffing was horrible. The current staff became even MORE pissed off because their hospital was trying to hire new nurses at higher rates than the senior nursing staff members made, and current staff members were told they had to be employed elsewhere for 6 months before they could apply through the hospitals internal agency.
          Long-story-short; Within 3 weeks the hospital contacted the agencies to have them call us all and ask if any of us would return to the facility. I never did and I don't know anyone else that did. I did speak to a staff member friend that said by the time the issues were fixed that they had many more travelers than ever did before they decided to halt the contracts.   Moral of the story.... If ants are biting your fingers, you don't chop your arm off at the shoulder to get rid of the ants.

Always remember, it is the shortage of medical personnel that makes traveling possible. If we are being phased out then there wouldn't be new agencies succeeding every day.

I may not see it in my lifetime, but I feel that medical personnel will go the way of "free agents" in professional sports.
"If they want us, they will have to meet OUR criteria" not the other way around.
          

Friend or Foe? in one word... BOTH!  I have been benefited by contracts and also "screwed" by something as simple as how it was worded.

Contracts actually started in the phone interview. The phone interview is often the only time to ask for things you want before the contract is drawn-up. Need a holiday off? Only work a certain shift? Want to find out what the weekend work policy is? Now is the time to ask questions, make requests, and negotiate. Then relay the info to your recruiter of what you discussed/agreed in the contract.

WARNING... Never let anyone tell you "well thats between you and the hospital, we don't put that on contracts." Anyone that tells you this is basically saying "I don't care what YOU want".   HELLO... That contract is also between YOU and the HOSPITAL and thats where all agreements should go! All agreements need to be in WRITING. Verbal agreements don't mean squat. Even if verbal contracts are binding in that state, you're not gonna hang around long enough to mitigate the fact that you were "told" you could have Christmas off.

RECORD your phone interviews. I have had hospitals tell me one thing and try to do another, always telling me "I never said that." Not many people keep spy equipment on hand so I suggest using spoofcard.com It is basically a calling card service that gives you voice prompts in the beginning that allows you to record your conversation. Its cheap and you can get instant access. In no way do I vouch for how legal this may be in your state. However, 99% of the time just hearing their own voice in a recorded conversation is sufficient enough to get your point across.

WORDING... Its not always the big things that cause confusion. It could be as simple as the words "and" or "or". I was once contracted to a facility and told I would be working three 12hr shifts from 7p/7a. Somehow on my paperwork it stated "eve/nights". I had a sleazy floor manager that used this to her advantage when she got in a pinch. She actually scheduled me 3-11 five nights a week for the remainder of the contract. I tried to negotiate through my company.... but I was bound by a signed contract. Now I make sure they state "7P-7A."
           "As stated per hospital's policy" is NOT a set agreement. It is another statement that can be left open to interpretation. One unit may have different policies than another. So if you agree to "every other weekend" in your interview, make sure it "STATES THAT" in your contract. You may get to the hospital and be told "In times of need our policy states that we may require nurses to work every weekend".

HOUSING... Most contracts state "Adequate housing."  Who's definition of adequate? Yours or theirs? What is "adequate" anyway? Don't think this is pertinent? Try spending 2 weeks, of 95 degree weather, in an apartment with a broken A/C!  I always make sure that I have the phrase "Adequate heated, air-conditioned, and safe housing" in my contracts now. Most up-standing companies will help you out in a bad situation by putting you in a hotel until things are fixed, but there is always exceptions to the rules (I USED to be an "exception magnet")

BONUSES... If a contract states "Bonus of $2500.00 to be paid upon completion of contract and all requirements". Then you better be 100% sure you know what all those requirements are! Don't screw yourself out of $2500 just because you took 1 sick-day, or had to leave 4hrs early due to sickness.  (please read the blog on this website called "BONUS or BOGUS?")

PAY RATE... First things first! Find out if the hospital pays their employees time-and-a-half or double-time for holidays or if they also pay time-and-a half for weekends and have that put in your contract. If not, you may look like a "cheaper" way to staff during the holidays which puts you 1st in line to work (unless you have arranged holidays already in your contract) 
                      Second.... Holidays. Which ones are recognized? Some only recognize the biggies such as Christmas, Thanksgiving, and New Years Eve. However, some recognize the smaller ones also. MAKE SURE YOUR CONTRACT MATCHES THE HOSPITALS POLICY or you won't be receiving those extra funds!
                      Third.... Watch out for sleazy agency practices. The number one phrase that should cause you to hang up a telephone on an agency is.... You will be making $35/hr. "THE WAY WE DO THIS IS" (thats your warning sign)!!!! The way we do this is, we give you a base pay of $8/hr and we pay you $27/hr per diem. THIS WILL SCREW YOU IN MORE WAYS THAN ONE! $8 + $27 may seem the same as $35 but it's NOT! Sure, they tell you that you will come out ahead because you are taxed differently(or not taxed) on the per diem. But look at it this way.... Lets say you worked 48 hours one week. at a normal rate of $35/hr you make $1820.  If you work the same 48 hours at the $8+$27 rate you will make $1712. Why because you are only paid overtime on the $8 and NOT the $27 per diem.     
                       The other way it screws you is...... you and the company are only paying taxes on the $8/hr. You might be saving a little on taxes up front but SO ARE THEY. They aren't paying SS, Medicare, or any other deduction on anything other than the $8/hr. 
                        And waiting for you behind door number 3................. TAXES. Boy oh boy.... Just wait till Uncle Sam gets ahold of you! You will be trying to find some VERY creative deductions! You'll be trying to get social security numbers on 13 hamsters to get out of that IRS payment!!!!


If ANYONE has other tips about contracts, other less-than-nice practices by agency or hospital, PLEASE, PLEASE, PLEASE post so that others may be aware also.

If you have been around traveling very long, you have noticed that travelers are not always welcomed with open arms. Lets face it, If you had invested several years at a job, and Joe Schmo walked through the doors and is immediately making way more money doing the same work, you might be a little "irked" too. I've dealt with this a few times and seen how others deal with it also. So how is one to cope with the situation? There is not a single "perfect" answer.

I usually approach the situations differently depending on location and staff attitude. As a "Southerner" from L.A. (thats Lower Alabama) I ALWAYS try to use a little southern hospitality or country charm. An intelligent  southern accent will get you a million miles in California and up north... notice I said INTELLIGENT southern accent.

The indians had it figured out. Many cultures adopted the practice of bearing gifts when first contacting a different culture. If I am starting at a facility in the south, I usually bring home made "Lace" cookies, or some other baked good. It's just "good country manners".  If you have ever seen any movies based in "the south," there are usually the "welcome wagon ladies". Those 3 beehive hairdo women, all gathered at the newcomer's door with cakes, pies, and cookies in hand. It's not just a gag folks...  My mom is like that (minus the beehive).

If I am working in a northern state, I tend to stay away from the baked goods, but still offer a "taste of the south". My favorite gifts to give are coffee mugs with a sampler bag of Community coffee and a small bottle of Tabasco sauce with a small straw ribbon tied around the neck of the bottle.
      Community coffee and Tabasco sauce is a "staple" item in most Louisiana households. The items can be found at communitycoffee.com and Tabasco.com, the coffee mugs can be bought at any chain retailer.

I have also ran into a few die-hard haters that go out of their way to make the traveler feel unwelcome. One charge nurse that I worked with intentionally gave me the worst patients every single time we worked together. I finally got fed up and confronted her. When I asked "why?" her response was "Well you make more money so you should have to take the harder patients". I quickly corrected her by explaining that I wasn't paid more to work harder. I was paid more because I have to drive across country, be away from my family, and go to a new place where I don't know a single soul, to work with such kind individuals as HER! I often follow with this question... "If you had to work with someone that treated you the way you're treating me, wouldn't YOU want more money???

For others that have an issue about the pay difference... I usually tell them I can get them an application to my company. When I get the "well I have kids" response I tell them "well being flexible and relocatable on short notice is part of why we get paid what we do". This helps put things in a little better perspective.

Sometimes it is not the pay that is an issue. We have all met the "lower end" of the traveler spectrum. That person that travels because, lets face it, that can't hold a job in one place very long anyway. This person seems to have worked at every facility across the U.S. and has left a "bad taste" in the staffs proverbial mouth. I do my best to not only separate myself from these people, but prove that I am their total opposite.

Last but not least (and back on the pay issue)... Yes, we all like earning that check that is usually way above average staff pay, and our bonuses, and our perks. It REALLY is in your best interest NOT to mention pay rates or anything else of that nature. If cornered about it, I usually shave several dollars off of the real answer.


Now YOU tell of your experiences and how you deal with these things !