Travel Nursing: What’s That About?

“Oh, you’re a travel nurse? What’s that?”

That is typically how people or my patients respond when I first mention I’m a traveling nurse. At least once, I experience the following exchange with one of my patients while on assignment:

“So how long have you worked at XYZ Hospital?”

“To be honest, only a few weeks. I’ve been a nurse much longer than that – don’t worry. I’m actually a traveling nurse, so I’ll only be here a few months. You’re in great hands though because the people here are wonderful.”

From there, it sparks people’s interest. Some claim that they could tell that I “wasn’t from around here” or “[they] couldn’t tell because you blend right in” or “[they] knew it because of your accent” or “Wait, but, you don’t even have a New Jersey accent” or a combination of the above. Eventually, the conversation moves away from me and moves towards what travel nursing entails. Below is typically how I would explain it, with further details.

What is Travel Nursing?

I usually tell them that travel nursing is like the “band-aid” of nurse staffing issues. When a hospital has a problem with fully staffing a unit or units, they often utilize contract workers for temporary positions until they can resolve the shortage. Per Diem (or in-house, as needed) positions won’t entirely be sufficient because many times they aren’t required to work as much as the hospital might need in their particular situation. They also can’t force staff to work overtime to meet their needs. Travelers offer that little time-out to alleviate the pressure. We are nurses that bounce from place to place in order to meet the needs of the facilities and the communities they serve for a period of time.

When Do Facilities Need Travel Nurses?

Most times, there’s no crisis on the horizon. When someone retires or transfers, they have to fill that position of the retiree. If they have trouble doing so, and the unit was already tight, they might go ahead and get some help in the meantime until a qualified candidate comes along. When they find that qualified candidate (full-time), it takes some time to train him/her (up to 6 months). During this orientation period, you generally tie up two nurses, the nurse doing the training and the trainee. Orientation periods for traveling nurses are usually much briefer, and in my experience, last no more than one week. As a result, a traveling nurse carries a smaller opportunity cost than a full-time candidate, resulting in a more reasonable “quick fix” in tight staffing situations.

Other times, these facilities have good staffing, but there has been a sudden rise in a number of patients staying at the hospital. This is most common in the winter months due to the flu and the colder weather making those with respiratory issues more susceptible to becoming sick. These contracts can be a little longer due to the patient surplus, rather than staffing inadequacies. For example, if they hire a full-time candidate for a temporary problem, then the hospital could be wasting time and resources because, at this point, the hospital will be overstaffed once the winter is over.

How Does a Nurse Find the Right Facility?

That’s a great question. The facility has identified that they require a number of nurses to meet their needs. Now they need to find those nurses. This is where staffing agencies come in.

Staffing agencies work as middlemen for both the facility and the nurse. They put nurses who are in need of jobs in front of hospitals in need of nurses. They are very important in this whole process. These agencies do a lot of behind the scenes work. They maintain relationships with facilities and their staffing personnel, ensure credentials are up to date, manage payroll, find viable positions, help with housing (if needed), and many more things. Sometimes, facilities have exclusive relationships with companies called vendors. If the vendors are unable to adequately staff the needs with their own nurses, they will open up the contract to other companies in order to fill the need. The relationships of all the parties in the process are shown below:

Capture 1.PNG

I recommend you find an agency and recruiter you are comfortable with and that meshes well with your values and personality.  It’s not uncommon to work with more than one agency at a time while you’re looking for a job, however. Sometimes the agency you’ve worked with doesn’t have access to the contract that you really want. In those cases, it’s important to have eyes out there looking for potential jobs for you. That’s not to say there’s no loyalty, but this is your livelihood. Some recruiters will try to make you feel bad for working for someone else on a contract, but that’s all the more reason to leave. Nothing in these work relationships should ever be driven by personal reasons. As long as you are transparent with all parties involved and professional, then there should be no reason to worry. Remember: YOU are your greatest asset.

How Does Pay Work?

Remember back to when we discussed that the facilities reach out to these agencies and vendors? They also name what they’re willing to pay in regards to specialty, experience, and availability. When the agencies receive these pay rates, they reach out to their nurses and let them know what these facilities are offering in exchange for their care. If it’s a good fit, then the contract is drafted and signed. When thinking about contracts, it’s important to remember that the Facility/Agency contract and Agency/Nurse contract are different entities. When it comes to pay, the facility pays the agency, then the agency pays the traveler, following a similar pattern to the relationship pictured earlier. However, since these agencies offer their services, there’s obviously a portion that is deducted as a service fee. Some companies structure it in a way that is a percentage of the total contract and others set it up as a flat fee for a contract, regardless the size of the total package.

Some new travelers tend to get upset about these cuts, stating things like “But I’m the one who is making them their money. I’m the one on the unit. I’m the nurse. I should get all of it.” In reality, that’s just being greedy, and without the help of these agencies, we wouldn’t have jobs. Also, think back to the services they provide. They offer a service and deliver their service. As far as I’m concerned, what’s fair is fair. I understand that there are profits that the company must make and goals to meet. As long as I take home my fair share, it’s more than fine with me. I understand that there are many people involved long before I ever step foot in the hospital. Just to name a few, there are recruiters, managers, compliance coordinators, salespersons, and things like rent and utilities. It’s very important to understand that it’s very much a mutual relationship where we both benefit.

From the bit that gets taken out by the agency (and possibly vendor), the rest is for the nurse (and government in taxes). The goal is to have the least amount of taxable income possible so that you can take home as much as possible and pay the least taxes as legally possible. There are a lot of tax implications (and I am not a CPA), but the basic rule of thumb is that you need to have duplicated expenses of living at home and on the road in order to receive tax-free stipends (please see TravelTax.com for more).

To better illustrate, please see the image below:

pie chart

Please keep in mind that this is a VERY rough estimate and that there are many variables, including contract specifics, the business model of agency, presence of vendor, qualification of tax-free stipends, etc.  I promise to go in more depth on the breakdown of pay in later posts.

Key Points

  • Travel Nurses aid in the management of staffing issues in temporary positions
  • The Nurse/Agency relationship is important when landing a contract
  • Facility pays the agency who in turn pays the traveler

Why Do I Travel?

Behind everything we do there is a why that gets us out of bed in the morning and fuels our passions. This why gives us our destination, but it is our responsibility to create the path to get there. Many times, like in a coloring book maze, it is easier to start at the endpoint and work backward to until we reach the starting point. The why gives us our mission, but it does not name for us the tasks. It defines what we truly want (spending more time with family, traveling the world, etc.). It allows us to refocus on the things we do and ensure they align with the goals we set and, eventually, meet. Our why will change many times throughout our lives as we also grow and change. In our pursuit of achieving these things we have set out to do, it also might be beneficial to have sub-goals along the way so that we do not become discouraged by failure.

Imagine, for example, you and your friend want to run a marathon. On your first day of training, you decide to run 26 miles. On your friend’s first day of training, she decides to run 5 miles, then eventually move up to 10 miles, 15 miles, and so on. Who do you think will likely be more successful? It will likely be your friend because they set smaller, more realistic goals in order to reach their overall goal of running the 26 miles. There are countless models for success when training for marathons. Many of which people have created, tweaked and adapted to their personal preferences. Much like this, I saw a life in travel nursing as a model that I could use to my advantage.

For me, my overarching why is to be the very best form of myself possible. As a result, I identified areas of my life which are important and needed to be improved upon. Self-worth is the sense of value as a person. For me, my profession in nursing is how I contribute to society in terms of my job, but I am also very fortunate because I have the opportunity to impact others on more levels than just showing up and punching my time-card. I have a responsibility to do more than that. Maybe it’s this pressure that I place upon myself and one that no one else expects of me, but nonetheless, this pressure is still present because I feel if I have not made someone else’s situation better, then I have made it worse by not improving it. Therefore, my nursing practice was something that I wished to enhance. I also understand that you are your most important asset. Without your health, you have nothing. So, my personal health – physical, emotional, mental – became a focus for my betterment. In much the same way that I needed personal health, I knew that financial health is important to provide for myself and loved ones. Lastly, I wanted a broader appreciation for various cultures, climates, thoughts, people, and places in order to better understand others and their viewpoints. In all, these aspects of my life have funneled into my goal of being the best I can be and helped me make my decision to become a travel nurse.

Nursing Practice

I got my start in nursing as a pediatric home care nurse. Everything was 1:1, mostly neurological issues (i.e. cerebral palsy, seizure disorders), and I loved it. The pay wasn’t great, but the kids were. They made going into work enjoyable and that helped me fall in love with nursing. They were all full of life and it was my pleasure to help them thrive the best they could. I spent my first six months as a nurse in this setting, focusing on my nursing skills – medication administration, g-tube care, airway management, etc. After I got the hang of things, I felt it was time to move into a new space in order to challenge myself. I eventually landed in a telemetry unit of a community hospital.

On telemetry, I was faced with a new set of challenges. I now had to learn to manage multiple patients with a whole new set of diagnoses. I needed to hone in on facility protocols and procedures to provide more safety to my patients and uniformity throughout the hospital. I needed to learn how to work as a part of a team, the art of delegation, and to coordinate with physicians, therapists, dietitians, social workers, case managers, and discharge planners. Through this opportunity, I was excited to learn as much as I could. The more I could learn, the better. I attended classes related to caring for our patient population. I pursued national certifications as soon as I could in order to better my practice. However, after awhile, it felt as though I was stalling out in my progression. I loved the people I worked with and the patients I was taking care of, but, in a sense, I wasn’t feeling fulfilled. Not to say that I was peaking or anything, but I knew that I was reaching the ceiling as far as possibilities were concerned unless I wanted to transfer. But, that also wasn’t what I wanted. It’s not that I wanted higher acuity patients or more of a management or quality-based role. I wanted patients of similar acuity with new and different problems. I knew that as painful as it was for me to do and leave my work family, I needed to leave the community hospital setting and branch out into new areas to acquire new experience. After speaking with multiple colleagues who had worked as travelers or were currently on assignment and doing hours and hours of research, I knew that the benefits would be worth the risk.

Now, as a traveler, I’m able to take my experience and apply it to new settings. I soon learned that nursing is nursing no matter where you go. Whether you’re floating to a new unit or it’s your first day in a new facility, your nursing care remains top-tier despite having different tools and systems at your disposal. I became even more confident in my skills and assessments. My clinical judgment became even more important, especially when I hadn’t quite committed protocol to memory or gotten the hang of a new charting system. I realized that ultimately you are your most significant asset and important tool. All of your new patient interactions build upon ones you’ve had previously. In a way, the patients you take care of today extend their thanks to those who allowed you to care for them yesterday as they’ve enabled you to care for them better. I, for one, am truly grateful for these experiences.

On day one of traveling, I found out that I would be caring for patients on telemetry, but on a neuro unit. To be honest, this startled me a bit as it was not something I was expecting. However, I knew that this new patient population would help improve my practice because I was expanding my knowledge base. On this unit, I took care of patients with hemorrhagic strokes, neurological and spinal surgeries, craniotomies, halos, and more. All of which I would have never really seen at my home community hospital. At other facilities, I’ve taken care of VATS patients, those with specific cancers, and some post-trauma. Again, had I not traveled, I may not have had the opportunity to care for these patients and increase my level of comfort.

Financial Position

A driving force of many things leads straight to the wallet or pocketbook. As many of you reading this, in order to fund my nursing school, I had to take out loans. (Granted, I probably didn’t have to accrue as much debt as I did by going to an out-of-state private university, but that’s another story for another day.) Of course, as a teenager with no credit, my family had to help as cosigners, but I was determined to tackle the balance on my own. With more than $120,000 in the hole after my college career, I knew my journey had just begun.

As stated previously, I started in home care and worked as much as I could. Many times working multiple shifts, six to seven days per week. No matter how much I worked, it didn’t seem to help bring that massive number down. I continued to live like a poor college student and budget meticulously. As I earned more money, I dumped it all into my loans.

When I got the hospital position, I continued to work both jobs as much as possible. The increased pay rate at the hospital helped, but I knew there was still room to grow. Luckily, the facility had a way to increase your pay rate through national certifications and clinical ladder progression. I saw this as a way to increase my pay, improve care for my patients, and elevate the organization. It was a win-win-win. However, after speaking with a few travelers at my facility and doing some research, I knew that travel nursing would be that extra boost needed to jumpstart my future.

Travel nursing has many financial benefits, including high pay rates and tax advantages. Of course, “high pay” is relative to the area and the level of need for the facility, but if you can live economically and budget, you will typically come out ahead. High pay paired with the tax-free stipends for housing and meals, leads you to keep more of the money you make. (I will go into this further on future blogs). As a personal example, after my first year traveling, close to 50% more money hit my bank account after taxes while working close to half the amount that I had been per week while taking off nearly a month entirely. Of course, there are additional expenses required when traveling, but if you maintain your tax-free eligibility and do your research into the area, you almost always come out ahead.

Well-Being

Too much of something, even if it’s good, is typically not so good. Just think of peanut butter. There’s that fine line between “OMG this is amazing” and “My stomach is killing me, I’ve had too much.” As mentioned earlier, I had been working a lot. I believe 27 days in a row and 70-80 hour weeks was when I realized that I needed a change. I was 25 years old and was burning myself out. I was a machine. Wake up, workout, go to work, try to have a social life, sleep, repeat. It got to the point where even in my dreams, I was at work. The more I worked, the more money I made, but it ultimately didn’t seem worth it. I was drained all the time, struggled to be with friends and family, and when payday came, more and more money was coming out of my checks for taxes. There was a positive correlation between work put in and money out, sure. But overall, it just didn’t seem worth it. It was also obvious that I was ignoring my health. I couldn’t cut corners at work so I would cut corners at home. I stopped working out as much, stopped preparing food to bring to work and instead grabbed something from the cafeteria or fast food place.

When I started traveling, I stopped working as much. My first contract was for 36 hours a week, and the facility didn’t really like to pay for overtime, so that was it. No more, no less. At first, I didn’t know what to do with all my free time, but I soon learned how to use my time productively in other ways rather than working. I got back to the gym, meal prepping, playing basketball. Hell, it was southern California in the summer – there was plenty to do. I noticed my stress levels drastically decreasing and was able to think much more clearly when I wasn’t constantly on the clock. As an added bonus, in California, the mandatory ratios for patients to nurses was significantly lower than what I was accustomed to in New Jersey. I now had 3 to 4 patient at a time whereas I used to have up to 7. There are also scheduled breaks which I could have only dreamed of. When drafting a contract, you can put your required time off so you can go on that vacation you scheduled, and if you’re feeling a little lazy, you can take a break between assignments. This all just made work more pleasant which definitely impacted my life in a positive way. With the combination of working less often and more desirable work conditions, I was able to make some much-needed tweaks to my work-life balance and get my health back in order.

Cultural Experience

Everyone back home is just like me. If I had to guess, I’d say 98% of my town is at least one of the following: Irish, Italian, Roman Catholic, white, or Republican. And, I might be lowballing that number too. I value people’s differences. When everyone and everything is the same, it’s boring. I love to learn about people and new places. I got my first real taste of differences in people when I went away to college. Again, much of the physical make-up was the same having gone to school in the North East, but at least people were from different places. I found myself fascinated with everyone’s hometowns, what crazy words or phrases they’d say, or their accents. Like seriously, who calls a water fountain a “bubbler”? Also listening to a kid from Boston go on and on about how Tom Brady is one of the most important people to ever walk the planet followed quickly by a New Yorker who thinks otherwise was quite entertaining. Although this was all great, I knew I wanted more exposure to the world and to explore away from my comfortable little corner of it.

I’ve spent the last year working in Los Angeles, and it was a shock from the start – I still can’t tell if I’m impatient or everyone is just slow. In all seriousness, being immersed in this city, which is basically a bunch of mini-cities that grew in together, has been wonderful. I’ve gotten to learn about many cultures, enjoy their food, and stare blankly and nod when they speak to me in their language. Korean BBQ  – they supply the food and skillet, and you cook it. Taco trucks on the street with everything in Spanish. My barber is an Armenian guy who speaks some English but not enough to have a real conversation and I know absolutely no Armenian. We don’t really speak except for exchanging hellos and me saying “number two on the sides, trim the top,” followed by our good-byes. However, I value these conversations because as I sit in the barbershop and get my hair cut, I’m able to absorb a little of their culture even though I don’t understand what they’re saying. I’ve also been able to practice some of my Spanish, which is something I’ve always wanted to do for myself but also for the comfort of my patients. I still follow my little script, “Hola. Me llamo Tomás. Soy enfermero. Yo hablo español un pequito,” but I’m able to actually communicate a bit more which is always nice.

Key Points

  • Travel nursing allows me to improve my nursing practice, world exposure, and financial and personal health.
  • You can expand your nursing experience in different settings using previously acquired skills.
  • Less money out in taxes means more money for you thanks to tax-free housing and meal stipends for those that qualify.
  • Take that vacation without having to worry if your PTO will be approved.
  • Explore new places and be immersed in their culture while on assignment.

Why I Canceled My ANA Membership

Today, I wanted to explain why I recently canceled my membership to the American Nurses Association.

If I were to tell you that this action has nothing to do with the midterm election, I’d be lying.

It’s taken me a little over a month since the election to publish something, initially because it didn’t affect me directly and I thought I might just let it go. However, after thinking more about it, I feel it’s something I need to get out there in the open.

I’m just going to come out and say it: I was unimpressed by the response that the ANA produced with the defeat of Massachusetts’ Ballot Question #1.

For those of you not familiar, the ballot question dealt with staffing ratios for nurses. Had the question received enough support, staffing ratios would be mandated by government and a timeline would be set for these actions to take place.

The ballot question was proposed by a different, much smaller, Massachusetts-based nursing association; and, after reading the proposed implications of the measure, I think it might have been a bit ambitious, especially in terms of the timeline and individual ratios at some levels of care. However, is it really appropriate to be “pleased” in our colleagues’ failures?

To highlight,

  • One patient per nurse if caring for a patient under anesthesia; in critical care or intensive care units (two patients in stable condition); caring for active labor patients; patients with intermittent auscultation for fetal assessment, and patients with medical or obstetrical complications; caring for a patient during birth and up to two hours after birth; caring for a baby during birth and up to two hours after birth.
  • Two patients per nurse if caring for post-anesthesia patients; caring for urgent non-stable patients; caring for babies in intermediate care or continuing care units.
  • Three patients per nurse if in step-down or intermediate care units; caring for urgent stable patients.
  • Four patients per nurse if caring for pediatric patients; in medical, surgical, and telemetry units; in observational and outpatient units; in units not otherwise listed above.
  • Five patients per nurse if caring for non-urgent stable patients; caring for psychiatric patients; in rehabilitation units.
  • Six patients per nurse if caring for uncomplicated mothers or babies postpartum;
    caring for well-baby patients.
  • Penalties for noncompliance include per day and per violation fines.
  • Law would go into effect January 1, 2019.

In its proposed state, maybe the measure shouldn’t have passed based on barriers in implementation, including the quick turnaround period, and some tweaking needed in the ratio specifications. However, I agree with what it aims to accomplish at its core. Overall, this measure attempted to guarantee a degree of certainty when deeming what’s appropriate for safe nurse staffing. This seems to be the opposite stance that ANA is taking.

According to the ANA, they have been a “strong advocate for appropriate nurse staffing in all health care settings,” but they do not support nurse-patient ratios. In turn, they have outlined what they believe the recipe for success is when it comes to staffing in their publication, Principles of Nurse Staffing.

To summarize,

“ANA’s Principles underscores that:

  • nurse staffing is more than numbers
  • one size does not fit all
  • nurses’ experience, as well as other components of the staffing mix, along with patient acuity, workflow such as volume of admissions, transfers, and discharges, and available resources in the delivery of care, all impact the determination of what is appropriate staffing at any given time
  • patient care needs are fluid – and vary between hospitals, among units in a hospital and across shifts
  • nurses work as a team; flexibility and teamwork are essential to effectively meet the ever-changing needs of patients.”

This all seems great. It’s something that you might learn about in your Nursing Theory class, right alongside Maslow and Nightingale, but let’s take a realistic approach and actually read between the lines.

Nurse Staffing is More Than Numbers

Technically, this isn’t wrong. Nurse staffing is much more than numbers. It involves a lot of prayers, hopes, and disappointment too. Prayers that you have enough nurses on the schedule today so they don’t pull someone to another unit and load up your assignment from the start of your shift, essentially making their problem yours. Hopes that the house supervisor won’t change your unit “guidelines” and give you an additional admission or transfer and chastise you for speaking up, claiming you’re not a team player. And, disappointment knowing that you, your colleagues, and your patients don’t have nearly the amount of support you all deserve or require.

One Size Does Not Fit All

The nurse-patient ratio should act as a minimum requirement for support. They do not need to be rigid in the sense that you can’t have more nurses available on the unit. You just can’t have any less than is required. Some might just say, “Fine. We’ll just make the ratios big and let the hospitals decide anyway.” But then what’s the point? They have to serve a purpose and be impactful in order to protect the well-being of nurses and the livelihood of the medically vulnerable they care for.

Nurses’ Experience…Acuity…Workflow…and Available Resources…All Impact the Determination of What is Appropriate Staffing…

This one has a lot bundled into one. It’s like the swiss-army knife of bullet points. I should probably address each portion separately.

I would agree that a nurse’s experience has a positive correlation to the quality of care a patient receives in many cases. However, I don’t think it’s necessarily appropriate to say that because a particular nurse has seen some stuff in their day that they should have any sort of impact on the number of nurses required. Although, I can understand grouping them with more inexperienced nurses to serve as a resource or mentor to balance the experience on the floor. What good is having an experienced nurse as that resource figure if they’re too busy to help you because they’re drowning in their patient load themselves?

Acuity might be the most straightforward of all these points. Sicker patients need nurses who have fewer patients. This leads to more patient care hours for them. Ratios are typically structured in this fashion with the level of care as the grouping factor. In a more macro approach, generally, ICU patients are sicker than step-down patients who are sicker than telemetry patients and so on. Of course, when using a magnifying glass and zooming in on the different levels of care and patient groups, there will also be variations in acuity, but to a smaller extent. I feel as though the levels of care are an appropriate benchmark for assigning degrees of acuity.

The workflow of a unit (admissions, discharges, and transfers) has to a lot to deal with access to hospitals, the unit’s level of care, the patient population, etc. As a nurse, you may have found yourself working on a floor where you felt pushed to your limits and then well beyond them. It seemed that at the very moment someone was discharged, there was another patient there to take their place. If you’ve never worked on a unit like this, you’ve been blessed by the nursing gods. Yes, there are times where extra support and resources would alleviate the pressure from a busy unit where many people are coming and going. However, I can’t think of a moment where a unit that wasn’t as busy in terms of turnover of patients would require less nursing staff to do their normal nursing tasks (outside of those ADT functions). In times where the patient census isn’t high, I can understand the need to allow people to leave early to save costs and avoid being overstaffed, but not at the expense of patient care.

Patient Care Needs Are Fluid…

Okay…so a father with a heart attack in a rural community needs less patient care hours or attention than that same father if he were to have lived in the suburbs or city? Patients have needs and must be to be cared for – period. If I have seven telemetry patients and work a 12-hour shift, each of my patients can only possibly get 1.7 hours of face time and care from me (if I’m spreading the love equally). That amount of time jumps to 2.4 hours if I have 5 patients, and all the way up to 3 hours if I have 4 patients. Yes, at night, patients sleep (or you hope so at least), but medical emergencies don’t care what time it is. If that father’s heart decides to give up at 2 AM, we tend to it. We compress his chest until that life-saving attempt is done. We don’t have the liberty to say, “Sorry, we’re understaffed tonight. We’ll get to it when we can.”

Nurses Work As A Team…

To a nurse, when “teamwork” and “flexibility” are used in the same sentence, they’re onto you. They know that means, against all odds and lack of resources and breaks and staff, find a way to make it work. Yes, teamwork is necessary when working alongside your fellow nurses at the bedside in terms of safety and to provide excellent care. It is also important when coordinating with other disciplines (e.g. physicians, pharmacists, therapists, social workers) to improve patient outcomes and formulating safe plans for care and discharge. But, don’t take my willingness and ability to adapt and hold me hostage with it.

Now that I’ve actually taken the time to think and respond to these points, I think I get it. I think I understand where their stance stems from. Nurses have fought a long battle to gain respect as a profession. A battle that has been complicated by the treatment of women in this country in a profession that is historically female-dominated. There’s a reluctance to forfeit some of the autonomy in the decision-making process for how we, educated professional nurses, go about performing our jobs and the amount of work we are capable of handling.

There’s a statement of independence but, I also see dollar signs. It also comes down to money.

A teacher of mine once said, “Whenever a decision is made, always look to the pocketbook.”

I believe that many of the principles noted above appear to be sugarcoating the truth as well in an attempt to fabricate a facade of empowerment. Maybe I’m just being cynical here, but then again, maybe not.

Many of those individuals who are forming the official opinions and at the helm of the association are very far removed from the bedside. It makes sense that their viewpoints would more likely align with the administration and the hospitals they operate. I believe there needs to be an understanding that the daily reality of those nurses forming policies and systems are very different from those at the bedside – the frontline of nursing.

I understand that nurses are a large expense for hospitals in their operations, and essentially with a ratio, this expense would increase by nearly double in some levels of care. It comes down to the fact that if ratios were to be implemented, hospitals would be required to employ more nurses which will take away from the hospital’s profits. Facilities don’t want to pay for more nurses. Hell, they don’t even want to pay the ones they have on staff now it seems at times.

Looking back to November of this year and the mid-term election, the major supporter in shooting down the measure and the proposed ratios, with over $25 million in contributions (over double that of those who supported the measure), was the Massachusetts Health and Hospital Association, which contains many of the hospitals in the state – no surprise here.

If it were left up to the ANA, hospitals would be able to determine what they feel is appropriate staffing with input from nurses, many of which I’m sure will be long-removed from the bedside.

Regrettably, nurses do need the support of government and its citizens because their facilities and health systems are failing them. It would be wonderful if hospitals could be left to self-govern and make decisions that would do more than benefit their bottom line. However, that’s just not the case. As things stand now, the conditions imposed on nurses are forcing burnout, mental breakdowns, and ultimately causing great nurses to leave the bedside. Meanwhile, the ANA stands to the side, promoting a utopian healthcare system of hopes and dreams rather than something that is objective, quantifiable, and enforceable.

Nurses should have the desire to further their education as a personal calling or advance their career. Unfortunately, instead of a personal calling away from the bedside to something different, it’s more of a sprint away from the lack of support, unrealistic patient assignments, and constant fear of making mistakes from being spread too thin.

Ask just about any nurse in a graduate program for their motivations in enrolling. Yes, many will cite something along the lines of “better pay” or “more autonomy” or “this was always my plan from the beginning of nursing school”. However, I will guarantee that the overwhelming majority will state “I needed to get away from bedside” as their primary motivation, or at the very least, a very strong contributing factor.

Please don’t twist my words here. I am not shaming those who advance their careers and the profession by pursuing higher education and climbing the professional ladder. However, I would rather this not be the only way that many find themselves with the possibility of retaining any sense of sanity and remaining in the field of nursing.

Things need to change if nursing has any chance of being a healthy profession.

It’s fairly evident that this change will not come without the help of the laws protecting nurses and their patients. Having worked in states with and without mandated ratios, I believe that these ratios are useful tools in promoting the safety of patients and the wellbeing of nurses: physically, emotionally, and professionally.

For this to work, it’s pretty obvious that change will need to be somewhat significant. Health systems and hospitals will need to become leaner in their operations along with some tweaks in their business models. However, this isn’t a discussion about that. I don’t pretend to know all of the answers. Nevertheless, I think at least one of them is a mandated nurse to patient ratio, which will help keep our nurses willing to work at the bedside, enhance the safety of patients and nurses, and will allow nurses to give all of our patients the time, attention, dignity, and care they deserve.

After its celebration of defeat for the measure in Massachusetts and the subjective staffing principles it promotes, it becomes apparent that the ANA and I do not see eye to eye, nor do I feel that they have the best interests of the majority of nurses it represents at heart. And, like a Shark on ABC’s “Shark Tank,” “For this reason, I’m out.”

One Thing That Every Nurse Should Have

You’re probably thinking a stethoscope or a pen, but it’s something much more boring and important than that: professional liability insurance.

Disclaimer: In keeping with the theme of this post, I am not providing legal advice.

In an age where people will sue if you look at them the wrong way, insurance is more important than ever. Professional liability insurance adds a layer of protection that could save your career and financial well-being. For the same price as an evening out at the bar or dinner with friends, you can have professional liability insurance for the year. This can potentially protect you from hundreds of thousands of dollars in legal action, court and lawyer fees, and save your license from carrying blemishes.

My employer says that they carry a professional liability insurance policy. Aren’t I covered?

Yes, but let’s take a look deeper. Many health systems have their own liability insurance policies that cover everyone who works at the facility, but it’s definitely beneficial to have a personal policy as well. The incentive for hospitals is to settle if a case is ever brought against them. This usually keeps their name out of the news, the problem goes away, and they often don’t have to admit fault. However, if ever a case were to be brought up in which would require something to be reported to the nursing board, you run the risk of having your license reported as well because you are included in the case that was settled. If you have your own policy, you will have more individualized protection, the incentive of which aimed at protecting you and your integrity.

Travelers, nursing students, and new hires are often the first to be thrown under the bus if something goes wrong. You definitely want to have that extra bit of security, knowing that your interests are being safeguarded in the unfortunate case that you’re involved in a legal matter.

It’s alarming when I find that some of my colleagues do not have professional liability insurance – many of which because they don’t know it exists. The reason being, I have seen the benefits of the protection, having encountered a number of nurses who have had cases brought against them, whether that be individually or as part of a group, where their licenses remain unblemished and they endured no financial hardships as a result of the proceedings.

For me, the goal is to never have use the service, but it’s comforting to know that they’ll have my back if push comes to shove. That sense of comfort is well worth the price (my annual premium is a little over $150). If you are a contractor or self-employed, your rates may be higher. There are other factors that play into determining your risk-factor and your premiums, but ultimately that’s up to their underwriters.

For those interested in acquiring professional liability insurance (and I hope you are after reading this), it’ll only take a quick phone call. The company I use is Nurses Service Organization, or NSO. Check out them out NSO.com.

I am not receiving any kick backs or referral fees for this recommendation. This is simply the company I use. Feel free to shop around, but I’ve had good experiences with them.

Navigating New Traveler Orientation

Congratulations on accepting and starting your new assignment!

Whether this is your first or your fiftieth assignment, there will be some nerves when starting somewhere new. Much of this has to do with the uncertainty of things and needing to assimilate rather quickly. Having just finished orientation for my new assignment (yay!), I have a little bit of a refresher on these feelings and some insight on how things unfold during orientation. Below are some tips on how to best approach your new traveler orientation.

1. Get Your Mind Right

Go in with expectation that no one will have any answers for you. Every answer you get is more than you expected to have received. Yes, this a bit of a hyperbole, but you need to understand that everyone you talk to has a very specific job to do, and they probably don’t have the answers to your questions, which are probably unrelated to their area of expertise.

You need to remain flexible and patient as information reveals itself as time goes on. If you’ve reached the end of orientation and still have questions about getting paid, log-ins, or schedule, then ask away. Everything else can probably be resolved down the road (i.e. when you’re on the unit, a different class).

2. Expect a Short Orientation

Remember, the incentive for hospitals to use travelers stems from a traveler’s ability to have a near-immediate impact on the staffing situation of a facility despite minimal on-boarding time and training. As a traveler, you are expected to be a quick fix and fill the holes in their schedules as soon as possible. For this reason, it is not uncommon to have a three-day orientation, most of which is classroom-based, discussing policies, culture, and charting systems.

Depending on how the facility chooses to prioritize material, you may only be given a brief unit orientation (i.e. one half-day). Again, everything is up to the discretion of the facility, and you may get lucky and have a bit longer orientation. However, in my experience, one week is usually plenty as long as you understand that you can’t possibly know everything and will often need to learn on-the-fly during your shifts.

3. Start to Make Allies

Orientation is a good place to begin making friends, but more importantly allies. You’ll probably need these people to make scheduling trades with down the road. It’ll also be nice to have a buddy when you’re first let loose on the unit. Having a familiar face when starting at a new place on day one can make all the difference! For more tips on how to make friends and create allies with permanent staffers, be sure to check out Closing the Gap Between You and the Permanent Staff.

Conclusion

Before you leave orientation, you should have a grasp of the following concepts:

  • How to clock in/out
  • Scheduling
    • When and where your schedule will be posted
    • How to pick up extra shifts
  • Computer log-ins
  • Documentation basics
  • Basic overview of nursing policies
  • Dress code
  • Where to report for your shifts
  • Parking

Anything else is really going to be overkill and make you crazy if you worry about it. You already know how to be a nurse (and a good one at that), the rest is just “fitting in” to this particular system. Again, just take your time, be patient, and enjoy getting paid to sit and listen to someone talk for a few hours.

Best of luck on your new assignment!

Top 5 Travel Nurse Questions

This is a crosspost from my youtube channel where I briefly talk about the five questions people frequently ask me in regards to travel nursing. 

1. What is a travel nurse?

A travel nurse is like a contractor or a substitute teacher where you’re only there for a short period of time. You do all the functions of a nurse, but you move from hospital to hospital throughout your assignments.

Read more: Travel Nursing: What’s That About?

2. How long is an assignment?

Length of assignments varies depending on your contract and the needs of the facility. However, the standard length is typically 13 weeks or 3 months. Of course, it can be shorter or longer, and many times you have the option to extend.

3. Do you have a choice as to where they send you?

Yes, of course. You are in complete control of where you work. Recruiters can suggest openings that they have available, but you absolutely have the final say. It’s not like the military where you get stationed somewhere. You work alongside your recruiter to help form your wishlist and you choose from any availability they have.

4. How does housing work?

There are two options here.

  1. The first is to accept the company housing where they’ll most likely put you up in an extended stay or leased apartment that they have available. This will come out of your paycheck and will offer you less flexibility to move in and move out dates, but it’s a lot less stressful than finding a place on your own.
  2. Your other option is to take the housing stipends and put that towards your rent. You can find short-term rentals on Craigslist, Facebook Housing Groups, Airbnb, FurnishedFinder, VRBO, or at local apartment complexes. You’ll usually come out ahead financially when you take this option. As a rule of thumb, try not to spend more than one week’s salary on housing.

Read more: Finding Housing as a Travel Nurse

5. What do I do for taxes?

I use a CPA that specializes in traveling healthcare providers. They send me a pdf to fill out prior to our phone conference. When I’m done filling it out, I set up my appointment. We have our phone call, which takes an hour or so. Then they do the rest and will send me some stuff to sign when they’re all done. I’ve used them since I started traveling. I’d definitely suggest checking them out at TravelTax.com. They have a ton of resources; just try your best not to get overwhelmed!

 

 

Patients Say The Darndest Things

As nurses, we all have those stories that stick with us. Usually, on the verge of tears whether it be from laughter or from sadness, there are instances in your career that, for whatever reason, make their imprint in your memory. Below are some of the stories that I won’t soon forget (and also because I jotted them down in my notes app).

Alexa

I’m doing my evening rounds, making sure that everyone is tucked in and clean before the night shift arrives at 23:00. I walk into a patient’s room, and just as I do, the patient, laying in bed with eyes closed, asks, “Alexa what time is it?”

In the doorway, I respond, “9:45 pm.”

He opens his eyes, horrified, and states, “You’re not Alexa. You’re a human. Alexa is a robot and can tell you anything you want to know. She plays music too. My son made her.”

“Well, you got me there. Good night, sir.”

Swedish Lady

I had worked four days in a row, and somehow didn’t get floated AND got to keep my patients for all four days (woo!). One of my patients was this elderly Swedish lady with an adorable accent. We had been talking over the course of my time with her. She’d tell me about all her immigration to the US and how beautiful Europe was, and how I should visit one day.

While we were chatting after dinner, she had dozed off, so I turned out some of the lights and continued to tidy up the room. Then, from the hallway, someone had started to talk as they passed the door and woke her up, definitely disorienting her.

She turns her head towards the door and looks frantic. She whispers assertively, “You need to go. I heard something in the other room. My husband is home. I’ve never been unfaithful.”

I try to reorient her and tell her that she’s in the hospital and that her husband is at home. She keeps her head on a swivel until she finally exclaims, “It’s too late – get under the bed!”

Potty Break

This elderly woman needs help getting to the bathroom, and I am the only one available. She’s completely oriented, but definitely has seen better days as her mobility has deteriorated a bit, especially in her acutely ill state. She’s definitely too weak to be walking by herself, and maybe even with assistance, but she’s set on making it to the toilet. So, we muster up some strength and begin our trek to the bathroom.

As I help her into the bathroom, she’s shaky and definitely becoming more unsteady. She’s very appreciative for taking to time and energy to grant her wish. However, when we get into the bathroom and she’s about to sit down, she realizes that she can’t stay standing and pull down her underwear at the same time since she’s supporting herself with both arms, one on the side rail and the other on my arm.

She bashfully asks for help, and, of course, I obliged. Then she starts laughing uncontrollably, to the point where she almost loses her balance. I ask what’s so funny? At this point, I’m confused because this is a pretty regular scenario for me. However, she responds through the tears of laughter, “Sorry. Sorry. I don’t mean to laugh. You’re just really good at this and your handsome. I’m just laughing as I think about how many ladies have dropped their panties for you.”

I don’t think my face could have gotten any redder.

Starting an IV

This older woman accidentally pulled her IV out as she was putting on her sweater. I had offered to help her nurse out and put a new one in because she was a little swamped. The patient agrees, but makes me aware that she’s very much afraid of needles and will pass out if she watches. I told her that she can distract herself with the TV or something, and that should didn’t need to watch.

I grabbed all the supplies and proceeded to put in the IV. It was a pretty easy stick, and I didn’t have much trouble at all. As I’m working on securing the dressing, she peeks out of the corner of her eye, and says, “I know you’re never supposed to ask a man this, but is it in yet? I don’t even feel it.”

Registration

This happened when I was still in nursing school, and working in the ED registering patients and verifying their insurance.

One lady was brought in by ambulance from her nursing home. She had fallen and needed to go for surgery. I go back to her room to see if I can get a head start on her registration prior to surgery, but as I enter the room, she beckons me over and says, “There’s room enough in this bed for two, you know?”

“No, I didn’t know. That’s news to me. Thanks for your time. Someone will be in to assist you soon.”

Five Guys

This one isn’t so much a specific patient, but more so their families and other team members unfamiliar with your floor. It just cracks me up every time.

Basically, if they know the nurse they are looking for is a male by their name, and you happen to be male, they come to you so certain that you MUST be the person they’re looking for, even if there happen to be five other guys working in your unit that shift.

Again, nothing specific here, just a laughable moment that I’m sure some of you might be able to relate to a bit.

What are some of your favorite stories? Please share. I’d love to hear them!

An Epic Tale: Making Your Patient List Work For You

Throughout my travels, I’ve come across many facilities, each with their different method of documentation. Some still use paper charts. Some use electronic medical records (EMRs). Some use a combination of paper charts and EMRs in a hybrid fashion.

Whatever the current state of the system in place, it seems that the trend is moving towards technology and EMRs. Reimbursement from insurance companies, safety, and the widespread access of an electronic record seem to be the rationales at the forefront of this shift. It’s something that we, as healthcare professionals, need to embrace because it’s not going away anytime soon.

One of the benefits of traveling is that you get to see what tools and processes other facilities use to handle similar issues. A huge tool in healthcare as mentioned earlier is the EMR, my favorite by far being Epic. To me, Epic seems to be the quickest to pick up and has the best flow to facilitate your workday. Epic is an EMR that is all built on the same database enabling seamless communication and functionality. It’s also pretty popular around the US which helps when moving around to different facilities because you’ll already be familiar with the system they’re using.

Although it is the same program, Epic allows for a great deal of customization based on the needs of the healthcare system which might take a little bit of time to adjust to when using a new facility’s version. However, it’s usually just a change in color schemes, how things are organized, and varying layouts. Moreover, the appearance may be different, but the overall functionality will remain consistent.

Probably my favorite feature in Epic that I use as an inpatient nurse is the patient list. It’s probably the first thing you learn when you go through training, but there’s tons of customization that you can do here that I don’t think many people take advantage of. Having just worked an Epic conversion (the health system was changing from their previous program to Epic), I’ve seen this many times over the last couple weeks.

The reasons why it’s so important to customize your lists and make them your own is because it saves time when navigating the chart, highlights all your important items given your patient population and role, and helps keep you organized when giving and receiving report.

Since I was just helping others adapt to the program and it’s fresh on my brain, I figured I’d share my preferences as an inpatient nurse on a telemetry unit for you to use as a template and tweak to your needs.

I tend to organize my list in a way that resembles an SBAR report style and then I’ll fill in my assessment in the blank areas. Remember that some of the headers may not be available at your facility based on the version they use or the options they’ve selected. Do your best to find them if they’re named something different or use a substitute for something similar if you like.

Also, remember that this is the list I use while working the floor as a staff nurse. You might find it useful to tweak some of the things listed below if you have a different role (e.g. charge nurse, break relief).

Top to bottom indicates columns left to right

(*) = Optional

  • Unit (*) – shows unit, beneficial if you’re rounding on patients in multiple units
  • Room/Bed
  • Patient Name + Age + Sex OR Name/Age/Sex – either separate columns or as a combination
  • Code Status – (e.g. full, DNR)
  • Allergies – lists patient allergies
  • Isolation – (e.g. contact, airborne, droplet)
  • MRN – medical record number
  • Chief Complaint (CC) – usually what patient says is their reason for coming to the hospital
  • Problem – pulls in problems from problem list
  • Diagnosis – reason for admission
  • Med Due AND/OR Med Overdue – flag appears when a medication is due or overdue, respectively
  • New Orders – flag appears when a new order has been written for a patient
  • Treatment Team OR Attending – shows all those responsible for the care of the patient, may list phone numbers or pagers
  • Diet – (e.g. NPO, clear liquids, regular)
  • Insulin Meds (*) – nice for tracking the patients who need blood sugars at meal times
  • Foley (*) – Foley catheter in place
  • Telemetry (*) – requires cardiac monitoring
  • Level of Care (*) – (e.g. med-surg, tele, ICU, step-down)
  • Current Level of Function (CLOF) – beneficial for seeing how well your patients move (e.g. bed bound, ambulatory)
  • Fall Risk – indicates patients at risk for falling (although everyone is a fall risk…)
  • Braden Score – shows latest score, indicates patients at risk for skin breakdown
  • MEWS (*) – last Modified Early Warning Score, shows risk for sepsis, beneficial to RRT nurses or general
  • K (*) – shows most recent potassium level, beneficial on tele floors
  • Mg (*) – shows most recent mag level, beneficial on tele floors
  • Hgb (*) – shows most recent hemoglobin level, beneficial for just about any population

 

Here’s a little preview of what your final product might look like:

Inpatient Med/Surg Floor Nurse
Capture

As nurses, we’re flexible. Constantly adapting to the newest equipment, medical regimens, protocols, etc. Technology is no different. Be sure to go with the path of progress and avoid resisting change for the sake of “this is how we’ve always done it.” Allow it to facilitate your daily workflow so you can spend more time doing what you love: caring for others!

See More with Travel Nursing: Road Trip from California to New Jersey

After about five years of grinding to pay back student loans, I figured it was about time to enjoy the summer for a change. In addition to wanting to scale back a little in terms of work, I also had some weddings to attend back home as well, so I decided to take the summer off from traveling and drive from California back home to New Jersey.

Preface

The trip started in Orange County, California, where I had been staying with my girlfriend and her family. They were kind enough to let me visit while I got my life in order, and I am very grateful since April and May were busy months (which is probably an understatement).

Just so you can see what I mean, I’ll give you the highlights: I moved out of my Airbnb since they had put the house on the market, move into a hotel for a few days, moved out of the hotel, flew home on a preplanned trip, flew back to work, moved in with a coworker for a week as they were in the process of moving out, packed up again, finished my assignment, drove to Orange County from the Bay Area with my car packed floor to ceiling, flew to Minnesota for a three-week assignment, and flew back to Orange County to prepare for my road trip home.

Now, that I’m out of breath from explaining the chaos, let’s recap on the trip home.

Day 1

Venice Beach, Los Angeles, CA

This was an easy day. After finishing packing up my car, I drove north from Orange County to Venice Beach where my traveling buddies were currently on assignment. I wanted to check in with them before I headed home, and also to get some beach time in. We ended up brunching pretty hard and met some new friends in the process.

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This day was mostly a reunion and enjoying each other’s company because I hadn’t seen them in a few months after they moved from San Francisco.

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Day 2

Venice Beach, Los Angeles, CA

We walked around for a good part of the morning in Venice. It was a sleepy Monday morning, so it was pretty mild on the beach. Nothing too crazy here. Just some performers setting up and early bird tourists.

After a nice morning walk along the beach and canal, we got lunch. Soon after, I was off to the east side of town to visit my friends from college and my old neighborhood when I used to live in LA.

Los Feliz, Los Angeles, CA

I arrived late-afternoon to my buddies’ apartment, everyone just getting home from work. We spent the rest of the evening catching up and hitting up one of our favorite taco stands, Tacos Tu Madre. One of my favorite parts of LA has to be the Mexican food. It’s everywhere, and it’s so good.

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Day 3

Los Feliz, Los Angeles, CA

img_6848We woke up early to catch a sunrise hike up to the Wisdom Tree. This was one of those impromptu, right before getting into bed super late ideas. I was totally down though because I love the trails at Griffth Park. There are so many different paths you can go depending on the time you have available and your skill. It was definitely nice to get a good start on the day too.

This particular trail is a little steep, but the views at the end make it well worth it. During the daytime hours, it can be quite crowded at times, so it’s not as easy to take in the whole experience once you’re at the top. However, since we left pretty early, we just about had the whole place to ourselves.

We did the hike, but there wasn’t that much of a sunrise because it was so foggy as we rose in elevation. It was pretty eery, to be honest. Despite the weather, it was still nice to get out there on the trails.

By contrast, without the fog, the views should look something like this:

wisdom tree view

credit for image above: twenty talk

When we came back, breakfast was obviously next on the agenda. House of Pies is a nice dinner not too far down the road, so it was nice to eat up after a long morning.

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The rest of the day consisted of meeting up with other friends and hitting up some of our favorite hangouts. We ended up spending most of the night at Spitz where they have game nights, great beer, and döner (Turkish kebab). It was a nice end to a good visit with great friends.

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Day 4

Grand Canyon, AZ

The trip started pretty early because I knew I had about a seven-hour drive ahead of me. I ended up getting to the south rim of the canyon just after noon. Of course, I would get there when it’s hottest. I guess I didn’t factor that into my plan. However, the views made the heat so worth it.

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When I first rolled up, there were TONS of people. More than I expected, but as I got further from the parking lots, the volume of people decreased.

I guess I’ll let the canyon speak for itself, but I was totally caught off guard with its beauty despite seeing hundreds of pictures before, learning about it in grade school, and getting a lifetime supply of Arizona t-shirts from my grandma when she lived there over the years (thanks Gram). I did overhear a passerby say that it looks like a giant cinnamon roll, and I can’t say that I totally disagree.

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Some tips I can suggest for your trip (please learn from my mistakes):

  1. Bring sunscreen with a high SPF and make sure it’s accessible – we can’t have you burning up.
  2. Bring a refillable water bottle (make sure it starts out full) – there are some refilling stations along the way, but not too many so you may want to bring more than one actually.
  3. Utilize the bus tour – there are some viewpoints that are just too far too far to walk to given the heat (plus, there’s AC).
  4. Don’t bring snacks that can melt because they sure will – bring high-calorie snacks though because you’ll be doing lots of walking.
  5. Take breaks and photos whenever you can – don’t be afraid to ask others to take your photos, although you might be surprised at how many people don’t speak English as their first language (“photo please” along with the camera charade gesture usually does the trick).

I lasted somewhere around five hours before I had to call it quits due to the heat and the hiking. I wish I had more time here to explore some more, but it just gives me a reason to come back. After my day was done at the canyon, I drove about an hour and a half to my hotel, showered up, got dinner at a pub, and watched the NBA Finals. Not a bad end to a memorable day!

Day 5

Meteor Crater, AZ & Petrified Forest, AZ

What a LONG day! I was definitely a little too ambitious with the planning for this one. My initial goal was to see the meteor crash site and Petrified Forest on the way to Denver. However, I got a little caught up in walking around both places, so I never quite got all the way to Denver. I had to stop about an hour and a half away because it was getting late and dangerous to drive.

Anyway, first stop was the Meteor Crater, and this was pretty cool. According to the tour, which you should totally do, it’s the best-preserved crater due to it being in the desert. You really only need an hour at this place to get the full experience. Anything longer than that, and you’ll be overdoing it.

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When I was told about the crater, my friend had told me to not look at pictures prior to going because it would be that much more impressive (sorry for ruining that for you – see it anyway!).

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After about an hour, I made my way east towards the Petrified Forest National Park. The drive wasn’t too bad. In fact, it was nice that the viewpoints were all drivable, meaning you didn’t have to walk all that much if you didn’t want to. The AC in the car was definitely a game-changer.

The first part of my journey through the National Park was the Painted Desert, which was really cool. The sand was all different colors and looked like a layered cake. I know that doesn’t do it all justice, but seeing the colors change as you drive through the park, it was mesmerizing at some points.

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By the time I got to the portion of the park with the petrified forests, I realized that I was running quite late, so I cut that part a bit short. However, it was nice to reflect a little on the beauty of it all.

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After leaving the park, it was a mad dash to attempt to make up some lost time as the day had gotten away from me. During this phase of the trip, I ended up encountering a motorcycle disguised as a chariot along with its driver.

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Luckily for me, there was also a nice sunset while driving through New Mexico.

Day 6

Denver, CO

After a late night of driving, I ended up sleeping in a bit. A few days in the sun in addition to some long days driving had really taken its toll on me. There was only a short drive to Denver from where I had stopped along the way.

In Denver, there was really no agenda. My only plan was to meet up with a buddy from college who was living in town. He was free so he was willing to show me around for the morning and early afternoon. We walked around town for a little and grabbed lunch before making our way to Red Rocks Park where we went on a hike.

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The air was was definitely thinner than anything I was used to so there was quite a bit of huffing and puffing going on. Below is the video from some of our hike together.

After returning from the hike, we said our goodbyes and went our own ways. The rest of the day was devoted to hitting up multiple happy hours, trying some good food, and trying some local brews.

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Day 7

The Open Plains

After waking up in Denver, I decided to spend the morning there, and grab one last meal. If you’ve never been, I’ll let you know that it’s a very big foodie town. Everything is amazing so I wanted one more crack at it.

After leaving Denver, just after noon, I set my aims on Kansas City, which was about a nine-hour drive. There wasn’t a whole lot in between, but something about the plains and rolling hills, in some parts, were very soothing. There wasn’t much traffic, so it was just driving and listening to podcasts while enjoying the scenery.

I ended up getting to Kansas City somewhere around ten, and since I hate eaten my weight in beef jerky on the way, I wasn’t too hungry. I just found a hotel that seemed upstanding enough and went to sleep.

Day 8

Kansas City, MO & St. Louis, MO

I really didn’t know what Kansas City had to offer other than BBQ, the Chiefs, and the Royals. After looking on Yelp for some attractions, I realized that there wasn’t too many that interested me, so I decided that the BBQ was the best choice. I got some recommendations from a friend, and it was some of the best BBQ I’ve ever had. Truly melt in your mouth type of stuff.

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After lunch, I made my way towards St. Louis where some friends were on a travel assignment. To be honest, I wasn’t sure that I was going to stop there in order to make better time on the road. However, I ended up seeing the iconic arch from the freeway and decided that it’d be worth it.

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As I was going to meet up with my friend for dinner, these two homeless guys approached me, asking for money so they can buy dinner. Instead, I offered to buy them dinner. There was a St. Louis Bread Company (Panera Bread everywhere else) nearby and got them what they had requested. I felt that it was only right since I had been eating so well on this trip. I bring this up not for praise, but because our interaction had such an impact on me at that moment, causing me to reflect quite a bit.

At dinner, it was nice to meet up with a friend and enjoy another BBQ meal on the day.

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After dinner, the day of driving wasn’t done just yet. I tried to get as far as I could under the circumstances of having a food baby and rainstorms incoming. With the rain incoming, it looked like the rest of the trip might be washed out with about fifteen hours of driving left.

Day 9

Homeward Bound

I made my way pretty far into Ohio before calling it quits the night before, so that really helped set up for a much more bearable driving day on this day. The rain was still setting in so, to me, there wasn’t much reason to stop if I couldn’t get out and enjoy the weather. I decided just to power through the last ten or so hours. I made it home just as my family was getting ready for bed. When I walked through the door, my mom was going to see who was coming through the door so late. At first, it was as if she saw a ghost, but that soon turned into pure excitement which obviously made me happy to know I was missed. It was nice to be able to surprise them a couple of days early for sure.

Check out some more footage from my trip below

Other Notes

  • All of my belongings were in the trunk or in the back seat under a blanket. I made sure that no one could really see that there was stuff in there to be stolen.
  • I never booked my hotels in advance, which allowed me more flexibility in deciding where to go and when.

Top 3 Reasons to Start Travel Nursing

Everyone has their reasons for embarking on a new career path. The beauty of nursing is that it can take you in so many directions, not just geographically, but also professionally (e.g. job title and responsibilities). Your nursing license has the flexibility to adjust, transform, and mold to your needs and gives you the option to remain active, vibrant, and fluid throughout the profession. Travel nursing is a huge tool at your disposal for creating this environment of growth for yourself.

Many claim that the main hurdle preventing them from starting a career in travel nursing is that it never seems like “the right time”. If you ever seek the advice of self-help “gurus”, they’ll always say that “the right time” is now, if not yesterday, last week, or last year. Whereas, if you ask me, I’d agree in saying that there’s never a “right time”. Change is scary, and stability is comfortable. However, no growth comes from your comfort zone. It’s definitely easier to come up with a million excuses or alternative plans that indirectly act as stalling tactics for a much-needed change, and I get that. I stalled for nearly a year before I said, “Let’s do it – now is as good a time as ever;” drafted my resignation letter; and signed my first contract. For me, that realization and the subsequent transition into the travel nurse world have been the most liberating experiences imaginable.

I understand that it can be quite intimidating to shift into this lifestyle. I understand that it can remove you from all that you’ve known – your family, your friends, your hometown, your facility, your unit, your coworkers, your favorite pizza place, etc. I understand, too, that in some cases, it is truly not a period in your life where this degree of flexibility is feasible due to various obligations. However, let’s look at some of the circumstances that make starting a career as a travel nurse both practical and enticing.

1. Travel More

The desire to travel is probably the most popular reason for pursuing a career in travel nursing (shocker – I know). Traveling allows you to become well-rounded and immersed in other cultures, ways of life, and landscapes. When you couple that wanderlust with a way to fund your adventures, travel nursing becomes a no-brainer.

When choosing assignments far away from home, your new environment can serve as a “vacation” with the ability to make money 3-5 times per week, depending on contract requirements. Often, nurses with low seniority at their permanent job may find themselves frustrated when not getting their requested vacation time off and opt to go per diem or start travel nursing for more flexibility.

As a side note: you have the ability to request days off prior to signing a travel contract and can also space out time between assignments to allow for trips and breaks.

2. Permanently Relocate

Life has the ability to pull us in different geographic locations. Sometimes, it’s to be closer to family. Sometimes, it’s to follow a significant other’s job. Sometimes, it’s to avoid subjecting yourself to bad weather (I’m looking at you winters in the northeast). Whatever the reason, occasionally, you need to move.

If you’ve ever had to try to find a job long-distance, you know that this can be a challenge. It’s hard enough to get a callback when you live down the street. If your resume says that you’re out of town, you might never get that opportunity to interview, no matter how qualified you are.

Travel nursing in your target location gives you some time to scope out the area, see where you might want to live, research where you might want to work, have an in-person interview without having to fly in, and even give you an opportunity to have an “on-the-job interview” (i.e. getting a permanent job offer after completing an assignment if you find it’s a good fit).

3. You’re “Over It”

This is going to mean something different for everyone. Obviously, no job is perfect and nurses are quite resilient, but everyone has their “tipping point” where enough is enough. These don’t always have to be negative. For example, you might feel that you’ve learned all you can at your small community hospital and want a change of pace as you look for a larger teaching hospital to pursue. Other times, certain issues can run you down and cause you to resent your current situation. Whether it be the job politics, struggling to get that 2% raise come evaluation time, or something else more personal, you feel it in your bones that it’s time to move on and wish to avoid staying in one place for too long.

Closing the Gap Between You and the Permanent Staff

So there’s a little backstory to this post. Someone contacted me through LinkedIn to participate in a study that aimed to understand how nurses with different employment statuses communicate in their work environments. I usually don’t respond to LinkedIn messages, but I figured “why not?” As I’m fielding questions and offering responses over the phone, the wheels in my head were turning and got me thinking about the topic. It wasn’t so much a “light bulb” moment as it was a “well, duh!” moment. Of course there are some distinct barriers that are present when temporary and permanent interact, at least initially.

During my time as a traveler, I must have subconsciously identified and addressed these barriers because I never really thought about it before that phone interview. Although the phone interview only lasted an hour, I found myself thinking about the topic for quite a while and think I finally have a handle on it.

This goes without saying, but every unit is going to be different because they are staffed with individuals with varying cultures, personalities, ethnicities, and have different challenges to traverse. Based on the makeup of the staff, you will find that time it takes to “break the ice” varies. Sometimes, you can stroll in and have the run of the town. Other times, you’ll find yourself on the set of “Mean Girls” and “you can’t sit with [them].” Despite these varying degrees of acceptance, there are some common obstacles which will be present no matter where you travel.

What Do You Mean, “Obstacles and Barriers?”

When I say obstacles or barriers, I mean anything that could portray an “us vs. you” mentality. In other words, anything that could inhibit the cohesion or chemistry of your new unit. Our goal is to remove this frame of mind as soon as possible when arriving on assignment and working to prevent this from forming as the assignment goes on. Below, you’ll find some strategies to address these.

Put Yourself in Their Shoes

The first thing we need to understand is the reasoning that you were hired on as a traveler. Of course you’re a great, qualified nurse, but more importantly, the hospital sought to fill this position because of a need. It could be that the census was super high, they were understaffed, or possibly a combination of both. As you can imagine, this probably doesn’t lead to the most ideal working environment for staff. They’re most likely stressed, burnt out, and frustrated.

If the reason you were brought on is a staffing issue (e.g. unable to retain nurses), you could be viewed as a short-term fix instead of a long-term solution (i.e. hiring new permanent staff). Furthermore, there could be some element of resentment there as well. This isn’t the case all the time though. Other times, people are genuinely thrilled to have some help, even if it is only a temporary relief. Regardless of each individual’s stance, your goal is to convey that you are there to help and contribute to a positive work environment; you are their ally.

Alleviate Their Fears About You

Let’s face it – you’re an unknown element in a very familiar place. You’ll likely get the impression that they’re feeling you out, seeing what makes you tick, and observing your work flow – and you’d be right in thinking that this is happening.

I’ve already touched on the topic of being the new guy in a previous post. The highlights from that post are listed below, but it’s definitely worth it to read the whole thing.

1) Be Approachable – smile, make a good first impression

2) Show Gratitude – chances are you’ll require some help when you’re getting started. Be generous with your thanks. Take the time to thank those who helped you in the moment.

3) Ask Once – show that you’re paying attention and try to figure things out first before asking for help.

4) Prove Your Worth – bring all of your skills and past experiences to the table. However, do not dwell on how you’ve done things in the past if it does not align with your new facility’s protocols. One thing people hate hearing is how they SHOULD be doing something because you did it that way somewhere else. Tips and tricks are welcomed, but stay away from lecturing people or trying to change the way they do things.

5) Be a Team Player – buy into the thought that this is your unit while on assignment, help your colleagues

6) Do Your Due Diligence – just as you are being observed, try to figure out those you can count on when you’re in a bind.

Show Them That You’re One of the Good Ones

This barrier presents itself when the staff have had bad experiences with travelers in the past or think you’re not invested in them or their unit because you’ll “come and go.” It’s similar to when you’re starting a new relationship with your boyfriend or girlfriend and they have trust issues with you because of something their previous partner did. To continue with the dating example, it could also be a situation where your love interest doesn’t want to make anything official because “this could only wind up being a summer fling.” It’s not necessarily fair, but it’s something we have to navigate from time to time.

Sometimes, it’s hard to blame them. The fear of abandonment is something that a lot of people have difficulty coping with. To make matters worse, I’ve also had run-ins with nurses who barely do the minimum required, are toxic, and have an apathetic mindset because they’re only on assignment for X number of weeks more. I like to refer to these people as those who “have to travel.” These are ones who need to keep moving in order to avoid getting in trouble or those who simply abuse their welcome. Unfortunately, the staff might have encountered one of these types of travelers as well.

By contrast, you have to show them that you’re someone who “likes to travel.” You’re someone who enjoys seeing different parts of the world and exploring. You’re someone who wants to get to know new people and learn about different cultures. You’re a nurse who is a problem solver, not a problem creator. You’re a nurse who likes to see new and different approaches to solving similar issues. You need to show them that you’re different because you’re a nurse who is willing to do their fair share and consider this unit and city their new home for as long as your contract outlines.

Always Look to the Pocketbook

The last and most obvious barrier is money. Pay packages are going to vary. That’s the truth of the matter. It all depends on the contract, city, season, severity of need, specialty, etc. Sometimes, travelers get paid more than permanent staff. Sometimes, the opposite is true. It all depends on the situation. If you’re in a desirable location or vacation spot, you could find yourself making significantly less than your permanent staff counterparts and that’s okay because the assignment in Hawaii or San Diego is definitely worth it. However, what’s important to note is that traveler base rates are almost never on par with those on permanent staff, but because the bulk of traveler paychecks can be in non-taxed stipends, travelers can come out ahead by keeping more of their check.

For whatever reason, there’s a lot of misinformation about how much travelers make and I’ve seen some permanent staff nurses act on this. For example, they’ll drop a heavy patient assignment in your lap and follow it up with the reasoning that it’s because “you make more money than us, so you’ll have to earn it.” If this is the mentality of your new unit, make sure it’s addressed promptly and professionally because it’s something that you can’t allow to fly. You’ll need to advocate for yourself and your patients. The load should be distributed evenly so that it’s a safe and fair shift for everyone. Again, this behavior is more on the extreme end of things and will not be present at many assignments. However, I felt it was necessary to inform you that it may be an unfortunate roadblock at some locations.

On the more common side of things, a question might be asked while sitting at the nursing station which goes something like, “You’re a traveler, so you guys get paid a lot, huh? Do you mind if I ask how much?” If you don’t want to talk about finances – and that’s okay because some people don’t – then you can politely decline. If that’s not something that’s awkward for you and you don’t mind having that discussion, go for it. Whatever you decide, just make sure you are respectful. The pay structure for travelers and permanent staff is very different, so you might also find that they’re more interested in learning about how you find housing, etc. instead of a line by line breakdown of your paycheck. If you have trouble explaining or need some help guiding the conversation, be sure to check out the post “How Pay Works”.

Conclusion

I’m sure there are a few other universal barriers that could be at fault here, but these are the ones that I’ve revisited over and over as I’ve brainstormed the issue and chatted with other travelers. If you’re looking to coast during your assignment and avoid the cold shoulder, you’ll definitely want to implement some of these strategies and address any obstacles that might stand in your way.

What other barriers or obstacles can you think of?

5 Mottos That Guide My Nursing Practice

There are tons of things that contribute to your experience as a nurse. Collectively, they are what makes you unique and provides the backbone to your success in the profession. The countless hours in nursing school, busting your butt on the unit each shift, and everything in between brought you to this point in your career. Hopefully, we’re able to refresh and think back to the key points and lessons that have brought us success time and time again and continue to reproduce these outcomes moving forward. A technique that I use is having short expressions that I say to myself or to others as encouragement, to recharge, and to maintain a positive frame of mind. Below are some of the sayings that I use the most because they resonate well with me.

1. “Nursing is Nursing Wherever You Go.”

If you’ve read some of my other posts, you might have seen this written before. As a traveler, this applies to just about everything that comes with the territory: arriving at a new hospital, floating to a different floor, using a charting system for the first time, etc. It all comes down to your skills and taking care of patients. You always have your experience and judgment to fall back on. Those are aspects of nursing that are universal. I refer back to this one to alleviate the stress that comes with “being a new kid in a new school.”

2. “Work to Be Ahead Now So That You’re Only a Little Behind Later.”

Some days, you can never seem to catch up. No matter how hard you try to fight the current, it seems to just pull you back under. You don’t have time to think or breathe or pee or anything. Your work gets done almost out of desperation and in an attempt to do 15 hours worth of work in only 12 hours. Other days, there can be a bit of a lull (don’t you dare say the Q-word) and it seems like you have to force yourself from the chair at the nursing station because it’s such a rare luxury. This phrase mostly applies to these types of days because, as you may know, if there’s a lull, it doesn’t last long. I try to work to be ahead of the impending rush where all of a sudden the ED admits patients on rapid fire or everyone is trying to be discharged at the same time or the call bells are lighting up more than a Christmas tree. It also serves as a reminder that if your work is done, then you can help others, and, in turn, they may be able to help you later on as well if you become swamped.

3. “This is Somebody’s (Mom/Dad/Brother/etc.).”

This is probably self-explanatory. However, this is my goal mentality when caring for patients. It’s a variant of the “Golden Rule” – “do unto others as you would have them do unto you.” I try to care for everyone as I would care for my family members because they’re someone’s loved one. On days where I have needy, combative, and verbally abusive patients, I need to remind myself of this one a little bit more than I might like.

4. “No Good Deed Goes Unpunished.”

I’m a little bit superstitious, and this motto follows me outside the nursing world as well. For whatever reason, it seems that I always find myself in a pickle when doing someone a favor or trying to do the right thing. Maybe it’s because I lower my guard or have different expectations or assume that karma will take over. Whatever the reason is, I say this in an effort to keep my guard up, lower my expectations, and stay vigilant. Examples of this include coming in on your day off to help but end up having a bad assignment and exhausting day or assisting another nurse and then one of your patients has an issue. It’s just an extra coat of mental armor that I use to keep me on point.

5. “All You Can Do is Your Best.”

There’s only so much you can do with the resources (e.g. time, staff, equipment) you are given. Hopefully, the resources that you’ve been given are enough to get the job done satisfactorily, but if not, you need to try your best to do what you can with what you have. We can stretch and bend and try to move mountains, but, at some point, something has to give. This saying works two-fold: 1) it holds me accountable to actually do my best and not just saying that I am and 2) it allows me to maintain my integrity because I know that I’ve done everything in my power and that I’ve left it all out there.

 

Do you have any mottos that you use in your nursing practice?

I’d love to hear about them. Please comment below so I can check them out.

7 Steps to Getting Your Finances in Order

Personal finance is definitely not the most exciting thing to learn about, however, once understood, is very rewarding and affects us all. Nurses have the opportunity to make great money, especially travel nurses. Healthcare is a steady field (unfortunately, there are always sick people) combined with licensed work (RN; not everyone is qualified) makes for a situation where salaries are very favorable. However, the problem is that not all of us have a business or finance background, and personal finance is not something that is taught in high school (although it should). Furthermore, we are left to learn on the fly and/or hopefully have had parents/family/mentors who have modeled good behaviors around money.

It is actually not unrealistic to make well over six figures when traveling, but the key is to be efficient with this money and keep the money you make. After all, no one wants to be making $100,000 a year and living paycheck to paycheck.

My fascination with personal finance stems from my seemingly crippling debt upon nursing school graduation. I HATE to feel like I owe anyone anything, so the fact that I could be indebted to Sallie Mae for years and years had me very anxious, to say the least. I also wanted to set myself on a good track for retirement because I definitely don’t want to work forever. Below are some of the first steps you should take to get your finances in order. Resources will be provided at the bottom for further reading.

1. Stop, Assess, Make a Budget

Essentially, there are only two ways to have more money. They are very simple.

  1. Make more money
  2. Spend less money

To a point, you can’t make any more money due to the limitations set out in front of you (e.g. wage cap, no overtime, not enough hours in the day). In nursing, we mostly work with hourly rates, meaning we trade hours for dollars. Sometimes, I use this analogy to see if it’s worth it to pick up that extra shift when I know that all I’ll be doing is catching up on some TV series.

When it comes to spending less money, it can be difficult but will have a much larger impact. It always seems like we can spend money much faster than we can make it, so by this logic it only makes sense to focus on this aspect more. You don’t have to totally cut out the frills (e.g. eating out, entertainment) nor does it have to be immediate. It may feel less of a struggle if this process is done gradually. A tactful way to do this is with a budget.

There are some great tools out there that help with this. The one that I’m most familiar with and have been using for about five years is Mint.com. Mint is free, has the ability to create and tweak budgets, and allows the synchronizing of all of your accounts so that you have a better picture of your overall financial situation and don’t need to input any transactions. Other options include YouNeedaBudget.com (YNAB) or Personal Capital.

Once you have a good idea of where your money is coming and going, you have the ability set goals and will have a better financial foundation.

While we’re in the mode of getting our finances in order, it might be wise to also check an estimate of your FICO credit score: Discover Credit Scorecard, Mint, Credit Karma, etc.

2. Start an Emergency Fund

Travel nursing can be rewarding and exciting. However, it also has the potential to be nervewracking and unstable, especially when you’re coming down to the last minute to secure a new assignment. A way to combat these feelings of anxiety and promote strong financial health, it’s important to build an emergency fund so that you are secure in the worst case scenarios.

Emergency funds usually consist of anywhere between three to six months required expenses. This is why budgeting is an important first step (so that we know how much money we need to live). If you have high-interest debt like those from credit cards, it’s beneficial to save only one month of expenses and pay off those debts first, then proceed to save for the three-to-six-month fund. It’s also important to avoid carrying a balance on your credit cards. This fund will act as your “get out of jail free card” if you run into unplanned expenses because you won’t have to put any expenses that you can’t afford on your credit card. A credit card is NOT an emergency fund.  Just to clarify: you can use credit cards, just don’t carry a balance past your due date because the interest can really be crippling.

When creating your fund, it’s important to have it available (i.e. cash). In order to have it accessible and separate from your other finances, it might be beneficial to start another account. A good option is Ally Bank, an online bank that has favorable interest rates on savings accounts. You can also set up recurring account transfers so that you can continue to fund your account automatically.

3. Enroll in Your Company’s Retirement Plan

There are many advantages to enrolling in your company’s retirement plan. The first being that it reduces your tax liability by siphoning money from your paychecks before taxes. Of course, there are specific rules to each product, but the general guidelines are that you should keep this money in the plan until retirement age. The longer your money has to grow in the market the better. If you withdraw funds early, you are bound to pay penalties and interest on the borrowed amounts.

Another perk that may be available to you is an employer matched contribution. This is essentially free money. Basically, your employer says has the opportunity to contribute to your retirement as well. For example, the 401(k) plan may be structured in a way that your employer offers 50% matching of the first 6% of your contributions meaning that you automatically have a 50% return right from the start! Sometimes there are vesting periods which basically refer to the length of time necessary to be with an employer in order to keep the contributions made by the employer. The contributions made by you are always yours though!

A great deal of power with retirement plans comes directly from the employer match. Make sure you are saving the required percentage to receive the maximum match amount by checking your plan information. If there’s no employer match with your plan, it might still be wise to use a small percentage (2-4%) any way to allow the compounded interest and the market work for you. If you change companies between assignments, there’s always the opportunity to “roll over” your old retirement plan into your new one as well.

4. Pay Down Your Debts

The debts we are most concerned about here are those greater than 4%. Obviously, the higher the interest rate is the greater the concern and more immediate the response. The goal is to use the remaining portion of your income as allocated in your budget to make the minimum payments on all of your loans and dump the remaining amount into the loan with the highest interest rate. When that loan is paid off, then you will use the money that you had budgeted to pay that loan and dump it into the loan with the next highest interest rate and so on. This is called the “avalanche method.” Another method exists where you attack the smallest loan amount in order to reduce the numbers of loans, called the “snowball method.” However, this method is will end up costing you more in the long run. A good website to help you formulate a plan/schedule is unbury.us.

In order to relieve the burden of interest, it would probably be a good idea to see if you can refinance your loans with a different servicer in order to reduce your interest rate and possibly consolidate your loans. When refinancing my school loans, I was able to refinance from an average weighted interest of nearly 8.5% down to 5.49%. 

5. Contribute to an Individual Retirement Account (IRA)

After we’ve got a handle on our debts (which may take a while), the next step is to contribute to an IRA for the current tax year. You can also contribute for the previous tax year if it’s between January 1st and April 15th. Our goal here is to save up to 15% of your gross income until reaching the annual limit of $5,500.

There are two types of IRAs: Traditional and Roth. The main difference between these is when you pay the taxes on the money. Traditional IRAs have you pay the taxes when you start withdrawing the money during retirement. Meanwhile, Roth IRAs have you pay the taxes up front but do not require that you pay taxes on the money during retirement. You may need to do a little bit more research to see which product best fits your specific situation.

6. Save More for Retirement

When it comes to retirement, we want to save somewhere in the ballpark of 15-20% of our gross income before moving on to other goals. As much as I love nursing, I know my body won’t be able to do it forever so it’s important for me to know that my financial ducks are in a row when it’s time for me to throw in the towel.

After we’ve funded an IRA, we can circle back and increase our 401(k) contributions to exceed only that of our employer match and up to the limit ($18,500 in 2018) as our budget allows. Remember that this must be done from payroll deductions and cannot be funded with outside money.

7. Save for Other Goals

Think about what’s important to you and save for it. Vacations? A downpayment on a house? Early retirement? Take a few months off during the year? A new car? Whatever it is, it basically comes down to two options that we can pursue here: 1) early retirement or 2) more immediate goals.

The way that you save will depend on these goals. If it’s more short-term or under a five-year time frame, you’ll need to have the money accessible (i.e. savings accounts, CDs, or I Bonds). If your goal is further out than five years, then you can accept a bit more risk and can use a balanced index fund or a fund that uses a balance of stocks and bonds (percentage of stocks is usually 100 – [your age]).

Conclusion

This will obviously not all happen overnight and will take some time to get rolling. The important part is that you have a plan and have taken steps to improve your financial situation. Keep pushing forward and take time every once in a while to revisit your progress and make adjustments as time goes on. As you progress, also make sure you watch out for “lifestyle inflation” and use your money wisely as to not waste your hard-earned dollars.

For more information on the topic, the following may help:

Rich Dad Poor Dad by Robert Kiyosaki

Set For Life by Scott Trench

 

The above guidelines have been adapted from a number of sources including reddit.com/r/personalfinance

Nursing Advocacy: Keeping Yourself Intact

One of the core responsibilities of a nurse to his or her patients is advocacy. Nurses are expected to go to bat for their patients, acting as a liaison while addressing concerns with doctors, physician assistants, and advanced practice registered nurses as they arise and sometimes even before these issues come to light. This is often easier for bedside nurses to accomplish because they have more one-on-one time with their patients and are able to dive deeper into the aspects of their care that matter most to them. Essentially, it’s the duty of the nurse, equipped with this knowledge, to defend the integrity of patients’ and their wishes, preferences, and beliefs while engaged in conversations with other members of the care team and, oftentimes, families for when patients are unable to voice their own concerns and where an advanced directive or POLST is available. Many facilities have implemented multidisciplinary rounds, which seems to create a more transparent and facilitated environment for advocacy where many aspects of the healthcare team are able to construct, assess, and/or revise plans and goals that are patient-centered and collaborative. These have shown to have improved outcomes for patients, which of course is the goal for healthcare in general.

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What about advocacy for nurses? Who is there telling everyone what you need or that you need to zoom out and take a break? Sometimes there isn’t that person, so you need to be your own advocate as well. For something so imperative to nursing fundamentals, nurses often forget to speak up for themselves as they are caught in their selfless frame of mind? Nurses need to care for themselves if they are ever to care for others, and sometimes this means speaking up or toning it down. If you’ve ever been on an airplane, you’ve heard the phrase, “Please put on your oxygen mask before helping those around you.” As a nurse, you need to ensure that you are satisfying the needs that make you human. Looking below at Maslow’s Hierarchy of Needs, you’ll see that the foundation of human needs are physiological and safety in nature. This means that calling the doctor for your patient who hasn’t urinated in eight hours is okay, but you should probably address the fact that you haven’t gone to the bathroom at all during your twelve-hour shift as well.

maslow-hierachy-of-needs(1)

This is not an attempt to tell you how to live your life or bring you back on a trip down memory lane through nursing school theory. It’s simply a plea that you look out for yourself (as a nurse and a human being) so that you prevent burnout and are able to better care for your patients. Without further delay from rambling, let’s dive into some of the topics that travel nurses might need to address most regularly.

Patient Assignments

This is probably the biggest ticket item on most traveler nurse complaints. Many nurses claim that the assignments can be skewed to favor permanent staff, where travelers receive all or most of the “heavy” patients  (e.g. tracheostomies, isolations, total cares, the confused old lady who bites – you get the drift) or are left open for admissions. Sometimes, this is true. It depends on the culture of the unit. This is also not the case in other instances. Sometimes, travelers are given the easier patients in lieu of more complex patients, especially on the more specialized units where they might not trust the traveler to know the protocols or care considerations for that type of patient. Regardless of your situation, you need to speak up if you are uncomfortable with your assignment. As the saying goes, “the squeaky wheel gets the grease” and in this case, you want to make sure you’re doing so respectfully, addressing any concerns you may have to ensure that you, your patients, and your license are safe.

Contracts

A lot goes into securing a contract. There are many details that need to be ironed out, and the traveler needs to examine an assignment’s  details (e.g. pay, location, facility, shift, duration) and make efforts to prioritize their needs. A good recruiter will take your preferences and advocate for you as well. However, oftentimes, there can be “too many hands in the pot” and communication and output suffer. This is when it’s important to check in to make sure that everything is going according to plan. Also, if you have in inside track to those who are processing the contract on the hospital end (i.e. knowing the staffing coordinator and/or nurse manager when signing an extension), it may be reasonable to confirm that things are coming along and press the issue if things have not come together just yet.

Housing

For whatever reason, this topic seems to have somewhat of a charged aura around it. While browsing Facebook groups that attempt to put travelers and landlords in touch for the purpose of short-term leases, it seems to be an all-on attack of landlords who list their properties in these venues because the travelers feel as though they are being taken advantage of. Is this true? Probably not. Should you do your research to ensure that you aren’t getting taken advantage of? Absolutely. It’s important to know that you got a fair deal that is mutually beneficial. The landlord has a tenant and the traveler has a place to stay. The landlord’s expenses of homeownership are accounted for and the price is at market value. Of course, there are details that would increase or decrease rent like whole place vs. private room vs. shared space, downtown vs. outskirts, parking vs. no parking, utilities included vs. utilities not included, vs. furnished vs. unfurnished, etc. Again, it’s all about priorities, speaking up for what you need in a respectful way, and negotiating if necessary. Remember, no one is forcing you to stay in one particular place, so make sure it’s a good fit before you sign anything and if it’s not, move on; and keep a good relationship with the landlord when you do sign a lease so that issues can be addressed at a later time as well.

Personal Life

Travel nursing can be an adjustment. It’s important to find the balance to take care of yourself. In order to do that, sometimes you need to put yourself first and think about what it is you truly need. For example, it might be the first time you’ve worked on night shift and need to figure out your sleep schedule. Others in your life should be respectful of that, and if they aren’t or just simply don’t get it, you might need to explain what you need from them in order to get your rest. Make sure you’re consuming a healthy diet as well. This might be another struggle if you share a kitchen or don’t have access to the tools or facilities you’re used to. However, you need to make conscious efforts to make things work in this situation. Since you’re traveling away from home, your support network might be lacking in terms of proximity. In this case, technology is our friend. Text messaging, FaceTime, Skype, etc. have made being away from the ones we love just a bit more bearable. Use these tools to your advantage and possibly schedule some time to video chat and catch up with those special people. Try your best to form relationships with those in your travel location as well whether it be at the gym, work, park, hiking trail, or cafe as it will add much more to your experience and well-being.

2017: Year In Review

The end of 2017 marks the first full calendar year that I’ve been a travel nurse and about a year and a half in total. It’s crazy to think that this much time has passed, but here we are; another year older and another year wiser.  It’s been a wild ride at times, but all in all, it’s been a very rewarding experience. It also marks six months since starting this blog, which has come with its own unique challenges and kinks to work through. A lot has happened in terms of personal growth and life milestones. I’ve met some truly incredible people, been to wonderful places, and really tried to put myself out there. With anything that occurs over a span of time, it’s often beneficial to evaluate its impact and processes at certain checkpoints, and I see no better checkpoint than the year’s end. For this reason, I think it’s important to take some time, step back, and reflect. The following entry will, in essence, be a reflection of my experiences and a collection of my aspirations in an effort to keep myself accountable and examine my journey thus far.

Locations

Disclaimer: I do not pretend to be an expert in the following geographic locations. These are merely my impressions from the time I have spent living in these areas.

Since traveling, I have only worked in California (outside of the occasional per diem shift when back home in New Jersey on a trip). The reasons for this rest heavily on the facts that the pay rates are typically higher than other areas of the US and because the weather is just so much better than back home. This year, I split time between two of California’s biggest metro areas, Los Angeles and San Francisco. As anyone who has ever been there can attest, these two areas are nothing alike. Each is very unique and has its own character. The layout, the architecture, the weather, the people, the food, the industry, the landscape, the traffic, the attitude – all different. It has been great to uncover their personality, the things that make them noteworthy and evoke their distinctiveness. It’s been a pleasure to experience these two wonderful cities for more than just a short trip or weekend outing.

usa

california

tumblr_mu9n0y6sjH1svtp5bo1_1280The layout of Los Angeles can be best described as a bunch of smaller towns and communities that grew into one another to form a much larger city (about 503 square miles). Each neighborhood can be quite different from the next. Some of these areas are defined by ethnic groups, others by their industry, and others by a way of life. However, the overarching theme of the city is entertainment. After all, Hollywood is written in the hills and the “Walk of Fame” strolls along the pavement. The weather in Southern California is great. If you can imagine that day in late spring or early fall with no humidity and that’s about 75F where you say to yourself, “Wow, I wish the weather was like this every day,” you’ve just stepped into the weather in LA nearly year-round. For this reason, you sometimes forget what time of year it is and never get to tap into some of the heavier sections of your closet. Without competition, the worst part of Los Angeles is the traffic. It can be crippling at times. You need to map out your day in such a way as to avoid peak times and fully commit to your plan in order to prevent spending hours and hours in your car to drive only a few miles.

Bayarea_mapBy contrast, San Francisco is in Northern California and much less sprawling (about 47 square miles). San Francisco is within what’s known as the Bay Area, consisting of cities like Oakland, San Jose, and Berkley. I stayed a few miles east of the city where housing costs were drastically lower and my commute was much shorter. The Bay Area has very nice weather as well, but unlike Southern California, it will rain from time to time. Also, the autumns and winters are more like autumns and winters, but very much tolerable. The culture of SF is much different than that of SoCal. From my observations, it seemed like more of an international city where there were more tourists or those living there are first-generation immigrants. There is a strong influence from the technology industry and that is very evident. The city also has more of an accepting demeanor to it in terms of a “live and let live” mentality. Food is also a huge aspect of the culture there, so you’re always bound to find something yummy to try on Yelp. In terms of getting around the city, it’s a lot more bearable because they have a rail system, BART (Bay Area Rapid Transit), that you can use to get into and around SF from surrounding suburbs and cities. For those areas that the BART does not go within the city, an Uber or Lyft ride shouldn’t break the bank.

Personal Growth

Moving to a new place 3000 miles away from home is quite an undertaking. I guess I never realized how isolating that can be at times and the seemingly neverending FOMO (“Fear Of Missing Out”). It’s definitely not something that I’d consider easy, but, with time, it gets easier. I’ve gotten much better at staying in touch with friends and family, although it’s still something that I need to work on.

Luckily, I did not make the journey alone and have had the company of my girlfriend and fraternity brothers while in Los Angeles. It was great to have familiar faces in an unfamiliar place. We were able to explore together and enjoy some of what the city had to offer. In LA, I had my own apartment, which was a first for me. With that came its own challenges like furnishing and dealing with landlords. However, it allowed me to be on my own and learn to navigate through adulthood and make it up as I went along. Although I considered myself independent before, I really was now confronted with the necessity to become self-sufficient. Chores around the apartment, cooking meals, shopping, etc. It’s a huge difference from when you WANTED to do for yourself and when you NEEDED to do for yourself. It helped to align priorities and allowed me to appreciate those who had helped me before.

In the Bay Area, I did not initially have the well-defined support system that I had in SoCal. My girlfriend was unable to continue on my journey because she transitioned from a job that allowed her to work remotely into one that did not offer this luxury, and obviously my buddies needed to stay in LA to pursue their dreams in Hollywood. Out of fear that I’d be lonely by myself, I decided on staying in an Airbnb close to work where I had a private room in a home. My stay has been incredible so far (I’m still here as I write this). It’s offered a sense of belonging that I’m not sure would be present if I had decided to stay in a place by myself. The family has really welcomed me into their home, and I’m truly grateful for that. This living situation has been an interesting cultural experience as well since the father is from England, the mother is from Malaysia, Mandarin is frequently spoken in the home, and they offer me so many foods that I’ve never tried before (and LOVE). They also have two young children who are full of life and have made missing my princess of a niece much more bearable. In terms of making friends, I had to put myself out there a little more – trying apps like Bumble and MeetUp – but nothing besides work friends ever came to be. Fortunately, they’re great people and I enjoy their company in and out of work. In addition, I was able to link up with some travelers who I had worked with in LA who also happened to migrate north as well. I feel so blessed to have developed such a strong support network that I can turn to if needed.

Career

My contracts have taken me from a cardiac unit to orthopedics to chemo to a step-down unit and much more. As a traveler, you’re often first to float, and I have learned to really enjoy it. I love the variation. I appreciate the opportunity to grow as a professional and become more well-rounded in the process. One phrase that has really stuck with me is “nursing is nursing wherever you go,” and I find this to be so true, especially when you can bounce around from place to place. I’ve met some incredible colleagues, some of whom I remain in constant contact with and others I follow on social media where I can see updates in their lives as they wander into my newsfeed. Others, however, are on the opposite side of the spectrum: those I never care to work alongside or speak with if I don’t have to which is what inspired my post on dealing with toxic co-workers. Despite these few bad eggs, I’d say that the overwhelming majority of experiences at work have been positive, I’m learning every day, and incorporating new techniques into my practice.

I’m pretty happy where I stand at this point in my career. The ability to keep things fresh has allowed me to block boredom and indifference. I believe that traveling in this capacity has kept me entrenched in the nursing profession. However, when I do stop traveling, I believe the only reason would be due to the desire to pursue the opportunity to enter the ICU, which I’d need to come on as a permanent staff nurse and be trained at a facility.

Work-Life Balance

My work-life balance and overall health have improved greatly in 2017. Thankfully, I no longer feel the need to work close to eighty-hour weeks between multiple jobs to get ahead financially. In fact, I’ve worked much less than ever before and have made more than previously as a permanent staff nurse at home. Taking lucrative contracts have obviously helped in this way. But that’s the joy of travel nursing. It puts you in the driver’s seat and you can prioritize what matters most to you. For some, it’s the money. For others, it’s the location. For me, it was a little combination of both. I was able to take a HUGE chunk out of my school loans this year and still remain afloat financially without the need for overtime, a second job, or biting my nails from anxiety. I’m able to enjoy life and not always be on the clock, converting my time into a paycheck. The financial security has allowed me to live the way I want, see the world outside of my little suburban bubble in New Jersey, and be healthy – both physically and mentally.

Finances are something that no one ever talks about despite everyone having them. People can talk about the most polarizing topics pretty openly on social media and over dinner, but once it comes to the pocketbook, they shy away. I will not go into great depths here, but I just wanted to share what might be possible for you if you decide to start traveling and create a budget while sticking to sound personal finance strategies. Below you can see two graphs that represent take-home (after tax) money that actually reached my bank account.

yeartoyear take home

monthy takehome annotated

 

Blog

This blog started as a means to assist those getting started with travel nursing, mostly friends, former classmates, and coworkers. It offered me an outlet to share all the things I’ve learned after analyzing and reanalyzing and then overanalyzing the leap into a new career path. The aim was to write about more general things that would apply to many people who might just be starting to look into things. I will not deny that there are plenty of resources out there that can help get someone pointed in the right direction, but it pained me to see that many of them had hidden agendas or were backed by predatory agencies out there trying to gobble up the newbies. That’s why I try so hard to make things here very objective and unbiased in terms of employers. In some ways, this blog allows me to cope with being away from home in a positive way and allows people the chance to have insight into my life without necessarily reaching out. It also serves as a sort of therapy. I get to write about things that I might be personally struggling with and work myself through these situations, like finding housing or being the new guy. Just as a photograph captures one’s appearance at a given time, one’s thoughts and state of mind are captured through their writing. Hopefully, this blog will ultimately act as a breadcrumb trail throughout my career as a travel nurse and showcase the growth that I wish to undergo as a nurse, man, and writer.

Goals for 2018

  • Write at least two blog posts per month
  • Travel outside the U.S. at least once
  • Buy a home in New Jersey
  • Volunteer in developing country and/or disaster event
  • Improve my working proficiency in Spanish

Finding Housing as a Travel Nurse

I hope this doesn’t come as a shock to you, but a big part of travel nursing is the travel part. Meaning that you’ll be away from home, or at least not within a reasonable commutable distance. So a big question presents itself: “Where will I stay?” Don’t freak out! You have plenty of options, each with their own pros and cons to consider. As you’ll find, no one method is good for everyone or in all scenarios. It’s really not one-size-fits-all. There are a lot of different factors that must be taken into account, and it’s often best to evaluate these methods of securing housing on a case by case basis while weighing in your personal preferences and comfort levels. The following will serve as a starting point as you examine job postings, surrounding cities and towns, and housing options.

Do Your Research

Before we can start looking for housing, it’s often best to do a quick search of the area in which you’d like to stay. Typically, this will be close to the facility for which you are having your profile submitted. I tend to like to live within a fifteen-minute commute to work. Other people might prefer to walk or bike so they might need to be a little closer. Still, others might not care about the commute and would rather live in a separate area altogether. Finding your goal area is a synthesis of personal preference and taking the logistics of the housing marketing into account.

I usually do my search prior to considering a contract and then again once I accept a contract in an actual attempt to pursue housing. The reason that I do this before I consider a contract is because I’d rather not waste my efforts in finding a job that’ll force me to stay in an unsafe or undesirable area. First, I do a quick search and find it on Google Maps so that I know where the location is, geographically. You can also zoom in and see neighboring cities, major roadways, and amenities. Another useful feature with Google Maps is your ability to see traffic and commute times at various times of the day by choosing “Directions” and “depart at”/”arrive by” options. If you plan on going to a traffic-plagued city like Los Angeles, this will prove useful since a few miles can often mean hours in the car if you leave at the wrong time. Once I understand the layout of the area pretty well, I look to see how these cities and towns stack up to one another.

If I were giving advice to someone traveling to my hometown, I’d be able to tell them where they should stay, what areas to steer clear of, etc. However, it would be impractical to think that I’d be able to do that in a place I’m unfamiliar with, never having been there before. Luckily for us, there’s this pretty cool website, AreaVibes, that uses various metrics (i.e. Amenities, Cost of Living, Crime, Education, Employment, Housing, Weather) to reach an overall rating or Livability Score. Once you search for a particular town or city, it’ll also populate some other demographics about the town and provide the surrounding towns’ grades as well.

areavibesmetricsareavibesmap

Again, you need to decide what’s most important to you and reflect on your priorities when analyzing the area. For me, low crime is most important, especially being in an unfamiliar place. Things that I don’t necessarily put emphasis on in terms of these metrics are education (I don’t have kids), employment (I’m going there for purpose of work), and cost of living/housing (usually accounted for in my contract via stipends). Therefore, after examining my priorities, I typically like to stay in an area that is safe, reasonably priced in relation to surrounding areas, and a short drive to work (in this order from highest to lowest priority). Although sometimes overlooked, it’s very important to think about the area that you’ll be staying and if it’ll be a good fit.

Housing Package vs. Stipends

I originally wasn’t going to dive into this, but I feel like it’d be a question left unanswered if I didn’t address it, even if it’s not 100% on-topic.

Basically, you almost always come out ahead if you take the stipends as opposed to the housing package. When you opt into the housing package, your agency will set aside a piece of your weekly pay as a budget to cover the cost of housing, which typically isn’t the greatest and leaves you with little to no flexibility and less money in your pocket. Having your agency take care of the housing aspect, although more care-free, is not the best option and you should take the stipends.

For more on stipends and pay breakdown, read my previous post here.

Housing Options

Here, I’ll address some of the different options you have in terms of choosing where to live while on assignment. As mentioned earlier, there are plenty of pros and cons to each method of acquiring a place to stay, and we will examine those in this section. Remember that it is up to each individual to decide what is best for them given their comfortability and preference. The following order is based on how difficult I feel it is to pursue each option from least to most difficult.

Family-Owned

This is obviously not something available to everyone in every situation in every part of the country, but it happens. Sometimes, the reason you take an assignment is to because how close it’d bring you to family in that area. I’ve encountered some travelers you have stayed with family while on assignment to save money and to rekindle relationships that may have been neglected as a result of distance and time away. I’ve also seen instances where matches are made through mutual friends where someone has a guest room available. Depending on the situation, these arrangements may or may not be for the duration of your contract based on personal preference and logistics of course. Just make sure that you pay some sort of rent (may not have to be fair-market, call TravelTax for more questions specific to your situation) so that you continue to duplicate expenses and remain eligible for tax-free stipends. Also, ensure that guidelines are set in place to create a positive environment and foster healthy relationships.

Extended Stays/Hotels

Always an option and, luckily, they’re just about everywhere. Some use these as their primary plan for housing and others may only use this option in a bind (i.e. before/after assignment, in the interim while finding other housing). Oftentimes, when an agency places you in housing at your request (forgoing the stipends), this will be your likely situation (which is why I suggest taking the stipends – if worst comes to worst, you can always do this yourself with a quick google search and save yourself quite a few dollars in the process). If you can get past the impersonal feel and don’t have a lot of stuff, it can be a viable option. Remember that these are furnished so you won’t need a ton of things to make them complete. However, many don’t have full kitchens with ovens which may be a letdown to those who like to cook. As a result, be sure to minimize dining out costs as much as possible so they don’t creep up and suck away your whole paycheck. When comparing these options, do your research – examine prices and make sure they work with your budget. See if there are any corporate discounts through your agency or reduced rates for consecutive/long-term stays. Also, enroll in their loyalty rewards program and you might find yourself with some free stays down the line!

Short-Term Lease

Finding apartments that do short-term leases can be hit or miss; many complexes will only do contracts that are one year or longer (keep in mind: to remain eligible for tax-free stipends, you can’t stay in any one metro area for longer than 12 months in a 24 month period – see “RETURNING TO THE SAME AREA”). You’ll need to do some work finding a few through internet searches and phone calls. However, if you can find a complex willing to work with you, they can be a great option. Depending on how long your lease is, it may force your hand, however, in terms of subsequent contracts in an effort to not break your lease or commute long distances. If you plan on staying in an area for a while though, this takes the headache out of moving around. If you plan on staying in an area but don’t have a contract with the hospital for the entire duration, you might want to situate yourself in the middle of a couple prospective hospitals so that you are equidistance and can easily take an assignment throughout the city if necessary. Also, remember that this option might cost a bit of money upfront to get it rolling because you have a security deposit and may need to provide the furniture if your unit is unfurnished. Depending on the complex, you may need to go out and secure your utilities, including internet and cable as well.

Airbnb

A solid option from top to bottom that allows for quite a bit of flexibility and offers a lot of variety. I’ll come right out and say that some cities do not allow Airbnb or companies similar to operate, which is why this is not higher on the list. However, if you find yourself in one of those cities that are not affected by these rules, you have a lot at your disposal. For those not familiar with Airbnb, it is a service that allows “hosts” to offer up space in a room, an entire room, or an entire house/apartment to those willing to stay there for a fee. Users create a profile and have reviews/ratings based on stays. Payment is all done through Airbnb’s portal so there is never any direct exchange of money among hosts and guest. Many use this service for vacations as an alternative to hotels and resorts in an effort to have a more authentic experience of the area. Many hosts also have their spaces with the eligibility to book for long periods of time which works great in the case of travel nursing.

airbnb.PNG

As you can see above, you can choose the time period (allow for some time before and after your assignment for travel and packing), the number of guests, room type (i.e. shared room, private room, or entire house/apartment), and price. There are also other filters (e.g. on-site laundry, wifi, kitchen) that you can use to help find the best fit. Again, this all comes down to preference and how private you wish your living space to be and what amenities you wish to have. If this is something that you may try, I suggest using this service on some getaways and getting some reviews on your profile so you have a solid track record and hosts are more comfortable with booking your long-term stay.

Craigslist

I’ll be honest in saying that this is not one that I’ve personally had success with, but countless others I know have made it work. Craigslist acts as a forum for people to list classified ads and have discussions.  One of those ad types includes housing for rent.

craigslist

All you have to do is search for the location specific to where you are looking to be placed (at the top) and then search through the housing section. I would start in the sections where people are offering their listings (i.e. “apts / housing,” “rooms / shared,” and “sublets / temporary”) first as you’ll most likely get the ball rolling faster. However, if you can’t find anything that meets your needs, then you can always post an ad requesting a place to stay in the respective sections (i.e. “housing wanted” and “rooms wanted”).

Once you dive in, Craiglist will allow you to further filter potential listings by distance, price, bedrooms, bathrooms, square feet, availability, etc. You will most likely have plenty to choose from. However, you must be cautious when trusting people over the internet. Unlike Airbnb, payments are not overseen by an objective third party. For safety’s sake and in an attempt to prevent yourself from getting scammed, please do your due diligence and heed notice to Craigslist’s safety tips.

RV

Traveling with an RV is a unique circumstance because it allows you to forgo trying to find housing, packing, unpacking, etc. Instead, your goal is to find an RV park where you can unload. In order to do this, you obviously first need an RV, which will cost you around $35,000 used. This can seem like a huge cost, but figure that it’s also the bulk of your rent upfront (there will be some fees at the RV park). It’s also important to note that RVs depreciate in value like a car would, not appreciate like a home typically would. Also, in order to qualify for stipends, you need to have another permanent residence in addition to the RV. Many RV parks also have a limit on how old the RV can be to stay in their park. This is definitely not a path for everyone, but it’s definitely something to think about when deciding to embark on your adventures as it gives you a lot of flexibility on the road. For more information on RVs in general and for travel nurses who use RVs, there are many groups on Facebook that you can ask more specific questions on how to get involved and pursue this avenue!

Conclusion

Housing is an important step in the pursuit of the travel nursing career, but it doesn’t have to be a scary one! Everyone has their own preferences, and it’s okay to use a variety of methods for acquiring housing throughout your time on the road as you evolve as a traveler and after seeing what works for you. Just take your time and do your research when it comes to evaluating locations and contracts to assure they’re a good fit and you’re bound to have an experience of a lifetime!

See More with Travel Nursing: Getaway to Jackson Hole, Wyoming

One of the great things about travel nursing is the flexibility that comes along with it, specifically in terms of scheduling. Each facility is different when it comes to how they produce work schedules (e.g. self-scheduling, repeating two-week schedules, filling in the gaps based on need), but once you know how they operate, you can use these to your advantage to make the most of your adventures. In addition, you can also use techniques specific to travelers in order to plan trips and getaways, including negotiating time-off during your contract when submitting for a position or planning trips before start dates/after end dates. I feel like this is much more superior than the alternative of rarely getting all of your vacation time approved while working as permanent staff or having to put in 30 years in order to have seniority and get the time-off you request. Recently, I was able to use these strategies and the power of trading shifts with coworkers to make it home for my sister’s wedding AND take the trip of a lifetime the following week!

Below, I’d like to share my experiences that I had in Jackson Hole, Wyoming, which would not have been possible if it weren’t for the flexibility that travel nursing allows me.

Backstory

A good friend from college, Shane, moved out to Jackson from Boston after college to pursue his love of skiing and the outdoors. He had been telling me to visit since he moved there over two years ago. I wanted to, but I just could never get the time off when I worked as permanent staff. Besides getting the time off, another obstacle is the relatively expensive airfare into Jackson due to only having a small airport and high demand to fly in. Until recently, I never knew my schedule in far enough advance to buy a ticket for a reasonable price due to the restrictions of staffing and scheduling. However, at my current assignment, they use a two-week rotating schedule, so I’m able to better plan out my time as opposed to waiting until just a few weeks out when the prices for airfare get jacked up. With that, I was able to book my flight and head out for a five-day adventure.

Day 1

After taking my flight from San Francisco to Denver and then connecting to Jackson, I was finally able to see what I had been missing for all these years (after I woke up from my nap of course). I could already begin to see the natural beauty of this place from the window of the airplane. It was unlike any other place that I have seen. The mountain range just erupts from the flat plains seemingly without warning. This first impression left me wanting to explore even more.

Upon arrival, Shane’s cousin, Aidan, who happened to also be visiting as well, picked me up from the airport around noon. Shane was stuck at work until later that evening, so it was just the out-of-towners for the afternoon. We dropped my stuff off at Shane’s place and then proceeded to hit the road. Aidan had flown in the night before, so he also had the morning to check out the town. While there, he got to chatting with some locals who gave recommendations of some key places to see. With this in mind, we set out.

To be honest, I don’t think we had as much of as a gameplan as we thought, but sometimes that makes the experience even better. To start, it was just us in the truck, admiring the incredible views as we drove along. Neither of us had ever seen such a beautiful place before. This was evident by our eyes being glued out the window and lots of pointing and “wows.” Much of the land was flat and untouched with grand mountain ranges in the distance. It took a little bit to gather ourselves and come to terms with the fact that we were there and not browsing a Natural Geographic magazine.

I’ll be sharing some pictures and videos from the trip. You can click on them to enlarge the album. Just keep in mind that these were all shot from my refurbished iPhone 5 from 2013, and that I desperately need an upgrade. Santa, I hope you’re reading this!

 

The first stop was Gros Ventre Road (pronounced “GROW-SHON”). From here, we just drove until we found a place to park and then explored the area, doing our best to remember the way we came. We did this for a few hours. As far as I’m concerned, we might as well have been on a different planet because I had never seen such a breathtaking place before in my life. 

We might have gotten a little lost. I’m not sure. However, to our fortune, we stumbled upon a cool spot with an abandoned cabin overlooking the mountains. All I could think was how great it must have been to wake up to that view every day.

 

Not too far from this spot were these other abandoned cabins. Actually, maybe they all weren’t abandoned and we were just trespassing because as we were leaving, some guys were riding up and turned down the path. Who knows? Maybe just some more adventurers.

On our way to find the main road, we found a Mormon ghost town. Apparently, it was a pretty sizeable community back in the day, but now there’s only have a few buildings (i.e. barns, homes) left standing. All of which were boarded up and locked so we couldn’t go inside. Pretty cool to see and read about on the placards, nonetheless. (There are tours that can take you around on a bus to see these communities for $100+ but obviously, you don’t need to spend the money to explore the land on your own)

After a good bit of driving, we found our way back to the main road. I mean, there are worse places to get lost. And if you don’t really know where you’re headed, are you even lost? Anyways, we headed toward Grand Teton National Park. It was starting to get late, and the sun was beginning to set, so we knew we had to make moves to squeeze in as much daylight as possible. We decided to explore String Lake and Jenny Lake. We even did a short hike (maybe a mile or so) through the forest and watched the sunset behind the mountains.

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Jackson’s Antler Arches in Town Square at Sunset

The sun had just about gone down and we were trying to avoid finding our way back at night, so we head back to town to meet up with Shane for drinks. Aidan’s friend from college, Shayna, also met up with us. Shane and Shayna (both locals) seemed pretty impressed with how much we got to see that afternoon. We caught up for a little bit, then shipped it back to Shane’s for dinner where we had an antelope steak waiting for us. I had never had game meat before. Most likely due to not having the opportunity to try it, but also because I’ve heard from people that they don’t care for game meats. I was willing to try it because “when in Wyoming…”, and I’m glad I did! Very tasty! Shortly after dinner, we began to wind down because we had to be up pretty early for a sunrise hike.

Day 2

I’ll be honest, I wasn’t looking forward to getting up so early after having just explored all day following two airplane rides and a few days in a row at work prior to that, BUT the excitement of getting out there in the wilderness made it a little more bearable (no pun intended). This trip was also multi-purpose since it was elk hunting season, so Shane brought his gear so that he could show us the process and effort that goes into it all. I had never been hunting before so this was a first for me, and I was interested in the culture surrounding it. As I was learning, I was very pleased to find that there are very strict controls and laws in place for conversation purposes.

As we made our way up the hills/mountains (not really sure where one stops and the other begins), you could definitely feel the change in the altitude. The air was thinner and oxygen was harder to come by. It probably also didn’t help that we were lugging big packs and I was breaking in brand new hiking boots. For a large part of the climb up, it was dark so we navigated by headlamps. Just as the sun began to peak over the horizon, we luckily had made it to somewhat of a clearing to see the sunrise. That was a pretty cool scene to see so we sat there for a little bit (I used this as a moment to question why I let myself skip my cardio at the gym and catch my breath).

The rest of the hike was also very scenic. We also found TONS of signs of elk, but no elk. We must have just been missing them by a few minutes the whole time. I was okay with not having seen any because it was still a different experience than I was used to and it was great to get out there and start our day. For me, it was a successful trip.

We managed to make our way back to the car and set off on home. We showered up and relaxed the rest of the afternoon after grabbing some lunch. That night, Shane’s house had hosted a dinner party. It was a great way to meet a bunch of people and try new foods again. This time, we had duck, which I’ve had before (prepared differently), and goose, which was surprisingly very similar to a beef steak. I also met a guy who rode his motorcycle through North and South America and much of Europe for the past year, which seemed like an awesome experience. Nothing much more to this day. Just some drinks and good food.

Day 3

This was Yellowstone Day. I was super excited for this one. I had heard great things about this place, and I knew they all can’t be wrong. It was about an hour and a half ride from Jackson to the south entrance, which wasn’t bad at all. When we got there, it wasn’t too crowded, which was pleasant. Apparently, during the summer months, the park gets swamped by countless tourists and the experience can be overwhelming and frustrating, according to Shane. We were lucky due to the timing of our trip being in late October. It’s considered the off-season for this area which is fine by me!

We saw a good amount of wildlife on the ride in, including this “little” buffalo below:

We walked around the hot springs as we would come upon them. There were quite a few. We didn’t go to “Old Faithful” because the timing was off. We had just missed it. But that didn’t stop us from checking out all the other springs that Yellowstone had to offer!

Since it was pretty cold out, it was hard to get pictures of some of the geysers due to the steam. It felt really good to be in the steam though. Just like walking out of a hot shower. (Just don’t go diving in because you’ll melt)

On our way out, we decided to leave through the west entrance so that we pass through new scenery (i.e. Idaho and Montana). However, there was some construction going on so we had some time to kill until they’d let cars through. We decided to explore until the path was clear. We ended up taking what I think is a cool picture after a long fought battle with some rocks to prop up my phone and the self-timer.

Yellowstone National Park
Left to Right: Shane, Aidan, Tom

We were finally able to pass and began to make our way home, but not before stumbling upon of elk and some more buffalo on the way out.

 

 

On our way home, we passed through Montana and Idaho – both very beautiful as well. The skies seem endless. I don’t necessarily like going on car rides, but when you have those views, it’s really hard to complain. The ride home was somewhere in the neighborhood of two to two and a half hours. All things considered, I think we made pretty good time. Once we got to town, we went out for dinner and drinks. We each got and different meat and shared it because we couldn’t decide on one (and because Aidan ordered the last elk steak). We ended up having buffalo, elk, and fried chicken (super exotic, I know). After dinner, we hit the downtown for a fun Friday night to cap off a pretty well-rounded day.

Day 4

It was all aboard the struggle bus to start the day. We might have had a little bit too much fun the night before, but it wasn’t before too long that we were back on our feet again. Sadly, Aidan was set to fly out so we got an early breakfast, said our goodbyes, and explored the town. The town was on the busier side, especially for an offseason. I guess it was your typical town square with quite a few souvenir shops, jewelers, and restaurants. I ended up finding a hat that I really liked to remind me of the trip.

After our outing, we hit up the hot springs. These ones were safe to go in, unlike the ones in Yellowstone. They were located right on the side of the river bank. The pools were encircled by rocks in order to keep the warm water in and the colder river water out (I hope I’m explaining this well enough. I don’t have a picture because I left my phone in the car). It was so relaxing, and just what we needed after a pretty eventful couple of days. The warm water in the pools would migrate throughout the pools so it was a constant shuffle in order to balance the temperature; you would be warm but not to the point where it’d feel like you were “boiling in a pot of macaroni” (how I described it that day). I ended up taking a dip in the cold river just outside our pool, and that sure woke me up. A lot colder than I thought it’d be, but glad to say I did it.

Night Sky
Photo by Shawn Paone

From the hot springs, we drove back home, showered off the sulfur smell from the springs, and got ready for a concert/Halloween costume party downtown. The night was great, the band was super talented, and we had a nice time. When we got home and started towards the door, I looked up at the night sky. I guess I hadn’t taken much notice of it since I had been there. At first, it looked like any other clear night that I’ve seen before. However, I began to stare a little longer. As my eyes began to adjust to the darkness, the sky lit up! There were so many stars. More stars than I knew that we could see from Earth. Having only lived in metropolitan areas before, I guess the light pollution has always drowned out their brilliance. Luckily for me, in this moment, that was no longer an issue. Never before have I felt so insignificant. Maybe that’s not the right word. I’m not sure how else to describe it though. I found myself gazing upwards in awe until my neck got sore, but eventually, I found my way inside and into bed.

Day 5

The dreaded flight back to reality…but not before a five-hour layover in Denver. I did manage to get my one last peek at the scenery as I got on the plane though as my going away present (I thought I was recording longer but I guess I didn’t hit the recording button). I really don’t think I could ever get used to this view. I know I’ll be back soon!

Conclusion

Lots of great experiences from this trip: five new foods (antelope, duck, goose, buffalo, elk), three states (Wyoming, Montana, Idaho), two national parks (Grand Tetons, Yellowstone), hunting, hot springs, catching up with old friends and meeting new ones too! Thanks to the flexibility of travel nursing, I was able to make this memorable trip happen. I’m not done exploring this place yet though! I’m already working on filing my license for endorsement in Wyoming – just in case something pops up at the little hospital in town!