The RN Travelogue

Of course, technically we've stepped away from work entirely, as we've chosen a six month voluntary unemployment period. I prefer to think of it as a hiatus from work altogether. Besides, we plan on resuming being travel nurses upon our arrival from our world trip come next February. We certainly aren't prepared at this point to return to staff nursing, and I highly doubt that five months of wandering around the world is going to make us want to either. There are too many benefits - and too few downfalls - of being travel nurses.

At any rate, we headed out from Tucson earlier this week, having finished up our shifts by last weekend. It was a pretty bittersweet week for us, because seven months in Tucson, despite the furnace blast temperatures of the last two months, brought us some great friends and surprising attachments to our hospitals. We spent the entire week not only finishing up business and preparing for our journey to Colorado, but trying to spend every possibly moment with friends we've made in Tucson.

My unit even bought pizza on what should have been my last night there (I received a call requesting that I come in for an extra shift the next night, which I awkwardly did). That actually really meant a lot to me. In my staff position at the Big D, all I got when I left was the worst eval I hope to ever get and a foot pushing me out the door. They didn't even get me a card there. My unit in Tucson probably didn't think much about buying pizza for me, but it made me feel like I had become a part of the unit in the past six months and not just a warm body, and that was a good feeling. I was actually a little bummed to leave, I've been working in a pretty good unit these six months.

Leaving Tucson itself was a little sad as well. Of course, the last couple of months have been hard, with the temperatures consistently between 105 and 110 every day. It's been hard not being able to do anything outside during the day hours, and all of my hard work running all spring into June have gone to waste as I haven't been able to really get much jogging in. Still, Tucson was good to us. We had a great social scene there, and there is always the environment that has appealed to both of us as well. Jess's parents came earlier in July, and we realized (sadly for the first time) that the best time to be outside was in the early mornings and late evenings. During the few days they spent in Tucson, they saw an amazing number of creatures that I have unsuccessfully looked for, including scorpions, tarantulas, and even a couple of rattlesnakes.

Since their visit, we've been trying to get out and check out the wildlife in the dusk hours, as have our friends Scott and Lindsay, who managed to score a major find, the gila monster, which is a very reclusive and rarely seen lizard. I even went out my last night, at midnight, to try to find some creatures, particularly a rattlesnake. I went into the Sabino Canyon Recreational Area, in the pitch dark, armed with my camera, a flashlight, and a big stick that had been leaning against a sign at the entrance that stated, "Active Mountain Lion Area: Enter At Your Own Risk." I wasn't terribly worried about the lions, most people in Tucson never see one, even those who hike regularly. Still, I hiked for more than an hour, slowly walking up the road peering off into the dark to see some critter, at which I was highly unsuccessful. At some point, I saw movement in the bushes off the road, and became pretty excited until I saw that my quarry was a skunk, which not only do we have in Colorado, but aren't that great of a find anywhere or anytime. Then, up ahead in the hills, I heard a sound that resembled a woman's scream with undertones of a cat sound. I've never heard a mountain lion before, but I've read of the sound they make, and all the descriptions quite accurately fit this particular sound. At any rate, that was pretty much the end of my hike, I turned around and walked as slowly as my eroding courage would allow back to the car. I never did see a rattlesnake in Tucson, which I find to be a tragedy. I also didn't see a mountain lion, which is less of a tragedy.

So, we've left behind Tucson, with its traffic and its mountains, its heat and its unique landscape, and our friends and our hospitals. We're looking at this point to returning to Tucson next February, our vaunted return to the world of employment. So, we didn't feel like our exit was anything permanent, just a spell of time somewhere else doing other things. In a sense, that could be said about our relationship with travel nursing. It's not that we are finished with it, we are just doing something else for awhile.

Keep track of us via our Seven Continent Trip Blog. It's looking to be a good time.

Until next time, be safe.

Posted by aloukonen at 12:29 PM | Permalink | Comments (0) | TrackBacks (0)

It has rained here in Tucson.

That in itself is a pretty amazing experience. Apparently, we are just at the cusp of the monsoon season, however, so for the next month these monsoon rains will be a regular event.

I was in Phoenix earlier this week for a night, so I missed the first monsoon rain. I didn't have to wait long for the next event, though. The day I arrived back in Tucson, it was brilliantly sunny outside, quite hot of course. There was a strange sensation in the air, something called....humidity, I think. I hadn't experienced that for some time now. According to the local news, these monsoon rains need those hot temperatures and sunny, cloudless days to develop the incredibly powerful storms. Cloudy mornings spell a dry afternoon around here.

So, about six in the evening, ominous clouds began building east of Tucson. Darkly bruised and laced with lightning, they came up very quickly, even as the sun continued to shine brightly. By seven, the rain started, and it was very powerful. I wouldn't have expected that sort of rainfall in the desert, it just came in waves, accompanied by wind and lightning.

When it started to let up a little, my friends Scott and Lindsay jumped in my Rav4 and we headed out to check the damaged. Since arriving here, we've noticed the large number of gullies that roads pass through, most containing the warning, "Do Not Enter If Flooded." The sandy washes seem fairly innocuous when empty, so we wanted to see what they looked like with water running through them.

We were impressed. From what we've heard, the half hour of rainfall was a relatively short storm, so potentially the amount of rain one of these storms produces could be quite impressive, as well as considerably more than what was dropped in this particular storm. Still, it was enough to fill the gullies and arroyos, and to go spilling across the roads, giving good reason for the warning signs to exist. Of course, we had to plunge through a few of the flows, although the ones we did were notably low and quite safe, with just enough water to cause some spray.

It should be noted that we are aware of the existence of the Arizona law, the Stupid Motorist Law, which basically dictates that people who deliberately drive through these gullies when there is flowing water, only to be washed off the road, are responsible for the costs of the emergency folks who come to save them. Did this stop us from spraying water around? Hardly.

Until next time, be safe. 

Posted by aloukonen at 04:55 AM | Permalink | Comments (0) | TrackBacks (0)

We have come to a conclusion. After months of worrying about where our road will lead us next, about our next job assignments and where they are, we have finally made up our mind about it all. We are not going to be working at all.

The idea really started to make sense while we were in the midst of a week-long trip to Vancouver in early May. We were hanging out in a place very close to where we had planned on spending our summer - Seattle - and we were starting to see that there wasn't a great chance that we'd be spending any time there this year at all. Job prospects were slim, and we didn't know what we'd do next.

On the other hand, we had been talking about taking a long trip late in the year, probably starting after the assignment that would have followed our present contract. Somewhere during our trip in Vancouver we had a thought about the Trans-Siberian Railway, and suddenly we were thinking, "Why not take the trip now? After all, September or October is the perfect time to take a trip on the TSR."

And so the idea came to be.

So, after coming home, we continued to nurture the idea. We monitored the job situation as well, but probably not as seriously as we had before. By the first part of June, we'd pretty much settled on traveling instead of working. We told our parents about the trip a week ago, and yesterday I told my recruiter that I wouldn't be needing a job come August. We've sent in an application for Jess's new passport (she filled her other one), and as soon as it comes back, we'll be purchasing visas for Russia and China, the two countries we need them for. With that investment, it will be a done deal - we're hittin' the road!

At this point, our plan has sort of congealed into a Round-The-World trip, perhaps even a Seven-Continent Trip, if we manage to find a way to get to Antartica. Our itinerary as it stands at this point:

We'll spend most of August with family, first in Colorado, then South Carolina. We'll fly out of Charlotte around the 25th of August, to Madrid, Spain. We'll wonder around the southern part of Spain for a week or two before heading across by ferry to Morocco, where we'll spend a week. Crossing back to Spain and Madrid, we're thinking of taking an overnight train to Lisbon for a few days in Portugal before flying out of either Lisbon or Madrid to Helsinki, Finland. From there we will take a train in St. Petersburg and then Moscow to catch the TSR. We'll pass through Mongolia on our way to Beijing on this week-long trip. From either Xi'an or Shanghai, we'll fly to Bangkok, Thailand, from which we will embark on a two or three week tour of Southeast Asia (Thailand, Laos, Vietnam, and Cambodia). We'll likely fly from Bangkok to Sydney, and then spend a week or so in eastern Australia. Finally, we'll fly to Buenos Aires, Argentina. From there, we'll head down the coast of Argentina to the southernmost point in Patagonia, where there is a possibility of going to Antartica. We'll head up the other coast by ferry to Chile, where we will visit friends before continuing on to Peru. We'll head back southeast from there, through Bolivia, Paraguay, Uruguay, and possibly a bit of Brazil on our way back to BA. Then we'll head back to Denver.

There, nothing to it. That's the plan, anyhow.

So, we'll see how it all turns out. It sounds better than working, at any rate.

Until next time, be safe.

Posted by aloukonen at 08:13 AM | Permalink | Comments (0) | TrackBacks (0)

We are rapidly approaching our one year anniversary for traveling. We started at the Y up in Connecticut last May, and have been continuously traveling since then, although our time here in Tucson seems to contradict that.

Officially I am in my fourth contract now. There wasn't a distinguishable moment as there has been in the past between this contract and the last. My last day of the previous contract was the 25th of April, so I'm actually even done now with a full week of this contract since I'm "working" right now. It's strange knowing that we are officially in a different contract without having to change hospitals and units. I've been here for fourteen weeks now and feel almost like staff.

I have to say, I've enjoyed my time as a seasonal worker here in Tucson. I like the unit here a lot, and the people are very easy to get along with. Since I've now been here for more than three months, I actually know a lot of them by name and have gotten to know a little about them. It really does make me feel like staff, to have a relationship with my coworkers, rather than a passing knowledge of their name and perhaps a little bit about their work ethic. Don't get me wrong, though, I still steer clear of the politics and that sort of thing that hospitals are rife with. Even after spending half a year here, I don't need that.

I've even spent a little time outside of work with some of my coworkers, as well as Jess's. She is more social, of course, so she actually has befriended several coworkers with whom she spends some time with. My traveler friend Scott here, who also signed another contract through the summer, lives about four doors down, so often I hang out with him, although we went to a little bar near the hospital the other day with some other coworkers. Technically those coworkers were seasonal staff who'd converted from travelers, as travelers don't have job opportunities in this town (or country) much any more. So, they weren't necessarily core staff, although we all work directly for the hospital itself now.

Speaking of little bars open at 8 in the morning, there are two that we know of. Scott and I usually go to one called Bambi, as it's on the way back across town towards our apartment. (By usually, I'm not saying this is a frequent event, usually only if we happen to carpool on the last day of a long stretch and need to celebrate). The Bambi is a darkly lit place, with crusty, slightly pervish old guys who come in every morning to drink their breakfast. The staff is friendly, though, those old guys tell dirty jokes, and they make good Bloody Marys there, so we've grown to appreciate the place. The other joint, which is called The Buffet and Crockpot (because they have a single old crockpot from which they serve cheap hot dogs in the morning), is a more brightly lit facility and upon first glance perhaps a bit more clean, which is to say not a nasty of a dive as the Bambi. However, from our one experience there, I would say that there are more characters in that place than I would have expected. Generally, by calling them "characters," I mean that they are homeless or close to it. Literally, one fellow put his bed (a sleeping bag) under the bar as he sidled up for a drink. We went with the forementioned group of seasonal staff, and one girl was repeatedly hit on by a man who probably was 50 but looked 75 and had no more than three teeth in his head. He even bought our group of six a full round of drinks in order to cully some of her good graces, which is surprising, as he appeared to not be able to afford the facilities to bathe on a regular basis. It was like sitting in the backroom of a carnival tent. I can see how initially it is amusing, but I imagine the charm wears off quickly.

At any rate, our work situation seems to be fairly stable at this point. Jess will convert from a traveler status to a seasonal worker at her hospital the first week in May. She is a little worried that she will be called off frequently when things start to slow down for the summer. I'm not so worried about myself. My hospital is getting a little to the point of desperation, as they are in a hiring freeze and are stuck with the staffing situation as it is. Scott managed to work two overtime shifts on his unit this week, each landing him about $800. I'm considering trying to work some overtime myself, especially if Jess doesn't get to work as much this summer. I'm having a hard motivating myself to do that right now, but when the temperature starts to head north of 100F, that will probably change quickly.

Our plan for August? Good question, because there currently aren't any positions that have opened up. Here's to hoping that the situation improves by then.

Until next time, be safe.

Posted by aloukonen at 02:42 AM | Permalink | Comments (0) | TrackBacks (0)

Today, the 30th of March, marks our first-year anniversary of traveling. Coincidently, it is also our wedding anniversary, interestly enough. But this post is about our year of traveling.

At any rate, it has been a packed year. I tallied up the states that I have visited since March 30th. Last year at this time, I took a flight to Memphis, TN, to visit my sister. That was the first trip of the year, as by that point I had resigned from my position at the Big D. Since that trip, which also took me into Mississippi, Jess and I have visited 30 states. She has a couple more than that, actually, because she took trips to Florida and Nevada, trips that I wasn't invited on.

So, thirty states in twelve months. That seems pretty impressive to me. And, we managed to slip in a backpacking trip to China during that year period as well.

It's hard to estimate the miles that we traveled, but we did purchase a new car in May, 2008, and we already have over 21,000 miles on it. Those miles don't include the 2000+ mile Southwestern US trip we made in a rented car, or other instances where we drove other vehicles.

We managed to live in three different states this last year, not including our time here in Arizona. We survived the scary first assignment, and now, watching the approach of the end of our third assignment by the May, the idea of traveling seems much less intimidating. There is still that unsettled feeling walking into a unit you've never visited before to start working, as well as that bittersweet sensation of leaving an assignment and a location that you've grown to appreciate, and friends you've had lots of good times with over that remarkably short period of three months. But our confidence in ourselves has grown greatly in the last year.

And then there's that great traveler idea, the idea of Three Months. Anything can be tolerated for three months, that is the mantra you understand when you take a position. By the end of that period of time, you find yourself thinking, "Wow, that went by quickly," and even regretting the short span of time that you have to spend in a place. But that is the essence of traveling, that if you don't continue to move on, if you become comfortable and settle in to a place, then you've ceased to work for the sense of adventure, of newness, of challenge that brought you into this odd choice of a career in the first place.

We've seen now that traveling isn't for everyone. We've met travelers who couldn't handle the loneliness, who couldn't keep their issues at bay enough to hang onto jobs, or who just didn't like it. We have seen travelers start and travelers stop. For us, so far at least, staff positions are for the birds. If you can handle the lifestyle, then there is nothing better than the money you make doing this, or the freedom from the politics and the anchors that come with most or all of staff jobs. There's nothing like the idea that you can live anywhere in the States, and be paid to do so. It'd be hard to give up this lifestyle.

So, happy anniversary to Jess and I as travelers! Here's to hoping to continue this lifestyle until we find something better, something that makes us happier.

Until next time, be safe.

Posted by aloukonen at 05:34 AM | Permalink | Comments (0) | TrackBacks (0)

Jess and I are a little worried about our circumstances in the upcoming months. That is because our contracts will end by the first week of May. After that, our future is currently undecided.

Last year at this point in a contract, we were already making a decision about where to go for our next assignment. We had already gone through our choices and come up with a likely choice. The next step would be to have an interview, which we would have done within the next two or three weeks (we only have a month and a half left on our contracts here in Tucson). That is not the case today.

Granted, our economy is in a tailspin, and we count ourselves lucky that we even have jobs at this point and are even able to save up money. The word on the street is that travel nursing positions are few and far between, that a lot of travel nurses are hanging up their travel scrubs to take staff jobs to ride out this recession/depression (let's be honest, how crappy must it be to call it a depression?). We know of a few nurses here in Tucson that apparently are heading back to North Carolina to take staff positions.

I never thought that I would see a situation where there were so few travel positions. Indeed, a lot of hospitals (including my current employer) have installed a hiring freeze, and aren't even taking on new staff nurses. It's turned into a game of seeing who can last the longest. Hospitals can hold off on hiring new nurses for as long as they dare, but the fact is that nursing drives patient care, and when the ranks of the nursing staff reaches a point where patient care is compromised, then there is no choice but to hire new nurses. Some places, like the floors here at my hospital, are increasing the patient load from 4:1 to 5:1, but that is about as far as they can go. At some point, managers have to break down and hire more nurses, budgets be damned.

On the other hand, the real question for travelers is who can afford to wait it out. There's always the potential for a month or two or more in between assignments. Competition for positions is fierce, as entire states post only a few jobs here and there, or none at all. Hospitals suddenly are finding that they can be ridiculously picky. I've heard of hospitals having requirements like two years of traveling experience, or to have the state license in hand even before bothering to apply. This latter requirement is annoying. For example, Jess and I applied for our Washington licenses recently, as we've heard it takes 8-10 weeks to get it. It cost us $325 for the two of us, and ICU jobs are extremely rare in Washington right now, not to mention PICU jobs. But we can't even apply for positions that come up without the license. So, we take the risk of not even getting a job in Washington, but we had to pay over $300 for that chance.

Also stewing in our minds is the fact that we can't really apply for any Washington positions in the near future. First, we haven't gotten our licenses yet, and also, the jobs are only posting three weeks from their start dates. That makes this game of chicken all the more daunting. We've tried to compensate by having a backup plan, but that's no guaranetee. We are trying to secure assurances for extensions here at our current positions. I've been told that I would be able to get an new 13-week contract, but Jess's PICU essentially cranks down to a skeleton crew during the summer months, and there's considerable doubt that she would be able to renew.

Our second backup plan is to drive to Sacremento and pick up some California licenses, which can be obtained in a day. California, despite being the state in the most trouble these days, is the only state that appears to be reliably hiring. There seem to be plenty of jobs in the San Diego and LA areas. It's another possibility.

In the meantime, we just have to wait. It's still too early to know what will be avaible by mid-April. Perhaps this recession will start to lift a little, hospitals will unfreeze their hiring, and positions will begin to reappear. Perhaps we have nothing to worry about. Still, it's uncomfortable waiting around to see what might happen.

Posted by aloukonen at 02:06 AM | Permalink | Comments (0) | TrackBacks (0)

Tonight is my first nightshift in a very long time. I did a four night stretch up in Madison, but before that, I hadn't worked nights since being at the Y in Connecticut in early August. So, it's a little strange to be up at this point (0230).

It's also hard to believe that I have been at this hospital already a month. I've decided to call this hospital the Thorn, in honor of the mulitude of cactus that surrounds Tucson. In one sense, it seems like I've been here for a long time, at least in Tucson, because I was here for three weeks before I started working. On the other hand, the last month has flown by, and now there is only two months left on this contract.

Nights here are pretty dull, I'd have to say. There isn't a whole lot going on. That might be because it is a Sunday night, but really it's a little slow. I have a stable double, so I've just puttered between the two of them getting things done. That's a relief from my last shift, where I took care of a patient who'd been in this unit for months. He ended up coding on me, and ultimately didn't survive. I felt pretty lousy about that yesterday, because it seemed like there should have been warning signs that I could have picked up on and didn't. In fact, he looked bad all day, and we (as a team) were dealing with that, but in the end, I guess no one realized how quickly he was going south. I ended up leaving feeling like there was something that I could have done differently, and that made me feel pretty bad about the situation.

At any rate, it's a little bit of a relief to just have a dull double tonight. My first month here has been a little stressful for me. Mostly, I psyched myself out a little about working in a CT-ICU, which is a first for me. I had myself imagining that I would be taking fresh hearts, straight out of the OR. As it turns out, that hasn't been the case, I've actually been taking care of the kind of patients that I'm fairly accustomed to. But then I've also been taking some pretty difficult pairs, to prove to the crew here that I'm up for it. It's been fun, but a little stressful as well.

Anyhow, working nights is nice because it allows me to consider our next assignment. Jess and I put in our applications for our Washington state licenses, which turned out to be very expensive ($330 between the two of us). It'd be great to head up to Seattle come May. The issue is that the market for traveler jobs is very tight right now. There are some jobs posting, but they are posting only a couple of weeks before the start date, and they are being snapped up quickly. My hope is that if we have our licenses when the time comes to get an assignment, we will be in good positions to take any jobs that open up.

If that doesn't work out, it's quite possible that we could end up renewing here in Tucson. My manager has offered to extend my contract for another 13 weeks (and a staff job if I want it). I told her that we hadn't made up our minds yet, and it seems like the offer will be there for awhile. This hospital is in a complete hiring freeze, so they like having me around, and I was told that they'd make an exception to hire an experienced ICU nurse. Still, if we took an extension, we'd be here in Tucson well into the summer, which could be brutal. It wouldn't be my first choice, but we may take the offer if Jess can get an extension and there are no jobs opening up in Seattle. That, of course depends on whether Jess can get an extension in the hospital that she is working in, which is smaller and has a less dependable patient population, particularly in the summer here.

Actually, I'm calling tomorrow to a couple of big hospitals in the Seattle area to see if they are hiring seasonal staff. That may be our redemption, if the traveler routes are all dried up. We are going to try every tool in our bag on this assignment, because the economy isn't so friendly towards us these days. I've heard a lot of stories about travelers having difficulty finding positions. I hope that doesn't stay the trend for long.

Until next time, be safe.

Posted by aloukonen at 05:52 AM | Permalink | Comments (0) | TrackBacks (0)

Well, I've survived the first two weeks of work, and they haven't fired me yet. Quite the contrary, apparently they seem to like me.

Really, the worst part was the first week. I had three full eight-hour days of orientation, and let me say that although being paid was a good thing, it almost wasn't worth the pain of those three days. My friend Scott, a colleague from the Big D who came here for his travel assignment only to be cancelled three weeks in and then rehired in the same unit as a seasonal worker, was in the orientation class with me. We figured out how much we were making for every minute that we suffered through the class, and that was enough to survive the experience. Rarely do people have to suffer such excruciating boredom, and even more rarely do they live to tell the tale.

At any rate, the three days finally ended, and then I was working on my own. My first two patients were quite easy, neither cardiac patients really. They had cardiac history, but they had respiratory issues that kept them in the unit, so it was like working in a MICU. That day went quite well; I even walked one of the patients several times in the hallway so that the boss could see that I was working.

Ah, then this week came along. It wasn't a bad week, by any stretch, it was just really busy. Perhaps the trauma unit up in Madison was a little more busy, but this unit is busy as well. Of course, working in a cardiac unit, there are a lot of patients that I'm not allowed to take care of. These are the patients that have all of the cardiac equipment, such as the LVADs, RVADs, BIVADS, Tandem Heart machines, balloon pumps, those sorts of things that require completion of a competency course and test just to even think about taking care of them. So, I end up getting the patients who have been in the unit for a long time. These are patients that I'm very familiar with, and comfortable taking care of, even with their cardiac histories.

Then again, sometimes these patients can be incredibly busy. My first day taking care of the particular double that I kept all three days, one patient was extubated and reintubated (the breathing tube was taken out and replaced later) during the course of the shift. This isn't normally a big issue, but when you are not familiar with all of the protocols surrounding such events for a particular unit, it becomes more stressful. I kept pretty busy that day.

The next day was only busier. The doctors decided that the patient who had been extubated the previous day needed to have a trachestomy, so we did that, at the bedside. It was really interesting to watch, but it set me back four hours, since they proceeded to replace all of the central IVs as the patient was already paralyzed anyhow. I ran around madly all day, my only comfort being that the boss was there and actually felt sorry for me, thinking that I would have a bad opinion of the place. Really, it was quite the opposite, I really like being that busy, I like all the activity and bustle and cool stuff going on around me. Plus, they let me be the stand-in anesthesiologist, and were even going to let me extubate the patient as soon as they cut the hole in the trachea (the tube in their mouth was being replaced by a tube in their throat), but the attending nixed that idea when she found out. Too bad…

I really ran that day. I only got to use the restroom twice in the 12-hour shift—at the beginning and at the end. I ate lunch at 5:30 in the afternoon, basically devouring a plateful of food in ten minutes. It was fun, though. Even better, I started to see a trend emerge around me. I started to notice that there are a lot of really smart folks on the unit, including the doctors, the PAs, and the nurses. They are a sharp bunch. Plus, they really back each other up. I'm not even a part of the group, and there were people asking me the whole day if I needed anything. I felt pretty inefficient, as I do the first week of any assignment until I start to get a real good feel for the place, but unlike at the Swiss Cheese up in Madison, they backed me up and I wasn't worried. It's a good thing when a unit cares enough for their patients that they wouldn't put them at risk by allowing someone to become overwhelmed.

The third day was much less busy, all the hard work had been done already in the previous two days, I was more in a holding pattern. These are long-term patients, once you've done the busy work, then you can ride that gravy-train for a long time. But the best part of the day was that the unit educator came around and offered to put me through their equipment classes. So, hopefully I'll be able to go through all the classes about the devices in use here. Apparently, the co-inventor of the artificial heart is on staff at this hospital, so it is a good place to learn about heart devices. This is turning out to be a big educational event for me.

Hopefully, it will stay that way.

Until next time, be safe.

Posted by aloukonen at 09:06 AM | Permalink | Comments (0) | TrackBacks (0)

Granted, part of that time was planned; we purposely didn't work at all in December. Still, it's nice to finally be pulling in an income. I assure you, Jess is more than enthusiastic about me starting as well. We are both tiring of my role as house-husband for that last three weeks.

I've kept the house very, very clean. The sheets were washed more times since we arrived in Tucson than the three months in Madison. Zuri has been a wreck, since every time we clean she assumes that we are getting ready to move again. She isn't used to that much cleaning activity, so she has been pouting more than usual. That could be because she misses my parents' dog, with whom she spent December and became good friends with. Perhaps all my cleaning is just the icing on the cake.

At any rate, I've also kept busy running and hiking. I joined a nearby library, where I got a bunch of books on Arizona, as well as loads of CDs that I've been burning on my computer. I joined a photography meet-up group and actually attended a meeting, which I was never able to do in Madison or New Haven. So, my time hasn't been wasted.

However, the fun times have come to and end, or rather, they've been cut back to normal. The vacation is over. I'm currently sitting in a computer class, which is nothing if not boring and excruciating. The trick is being able to type without any clicking sounds and being able to make the instructor think you're actually paying attention. It's more difficult today; there are only three of us in the class. I have to be particularly subtle.

On Friday, I will spend my first shift on the floor. I'm working in a CVICU, so it will have a lot of cardiac. That's a little worrisome to me, but I'll survive. I'll be suffering this weekend, as I will have to be up by 5:30. These last three weeks, I've been getting up between 8 and 10, which has become my routine. Even worse, I'll be working seven out of eight days, so it will be relentless. That's probably good, to get me back into the habit of being up really early. The first few days will be painful, though.

One thing that I don't like at all about Tucson is its traffic situation. They wanted to preserve the small town feeling of this city, which is utterly ridiculous for a city of over 600,000 legal inhabitants (we are just up the road from Nogales, Mexico, so not all Tucson residents are documented). So, they didn't put in any freeways within the city. This means the roads are clogged most of the day and night, there are stoplights one after another, and it takes forever to get anywhere (this morning it took me 45 minutes to go 11 miles). I'm not fond of that at all. Any city over 500,000 should at least have a beltline going around it. From our apartment, it takes us 30 minutes just to get to the only nearby interstate.

I do like being around the friends I had starting in Tucson back in December. One couple is living just a few doors down from us in the same apartment complex. We have seen quite a bit of each other in the last three weeks, hiking, playing Wii, that sort of thing. They even kept Zuri for us last weekend when we headed to San Diego for a couple of nights; they like her enough we thought there might be fisticuffs trying to get her back.

Scott is a travel RN, and this was his first assignment. It hasn't gone as he anticipated, though. Given the economic situation, it was an unfortunate time for him to start. Three weeks into his contract, they told him that they were cutting his contract short, and gave him 30 days. Eventually he worked out a deal to take a seasonal worker position, the same kind as the position I've taken. He even stayed in his original unit. However, since he no longer worked for our travel agency, he had to move into another apartment, which ended up being in a nearby building. He had to pay a bunch of rental related fees, go through all of the hospital related orientation crap, and take a week off. It was a huge pain, and not really the best way to start out being a travel nurse. Still, he suffered though it well; this probably won't be his last assignment.

Speaking of the economic situation, this has been a very educational experience for us. We now know that travel nursing isn't immune to the downturn. Hospitals still need us, they just don't want to pay for us. We are a little concerned already about job positions come May, after my assignment is done here. Jess is even considering interviewing for adult units, to give us much more selection. Currently, there are very few PICU jobs out there, although that could change by May. On the other hand, we now have another tool to find jobs, the option of working as seasonal travelers. This may develop as a new trend as hospitals cut costs by hiring travelers directly instead of through agencies. It's good to know that this is a possibility, and even more. For example, we may find it's more lucrative to hire on as seasonal travelers, as hospitals may pay us more if they don't have to pay an agency. Of course, that means we would lose out on the benefits of the agency, for example the housing and tax perks. Still, having more tools in the toolbox is always a better thing.

Anyhow, I'm very excited to be starting. I feel like this will be a very educational experience, and I'm getting a little stir-crazy waiting to get working. Strangely, I am quite eager to get started, rather than sad to leaving behind a two-month hiatus from working. I never thought I'd be in that frame of mind. Hmm.

Until next time, be safe.

Posted by aloukonen at 03:38 PM | Permalink | Comments (0) | TrackBacks (0)

On the job front, I managed to do quite well with my interview in the CCU and scored a job offer for a seasonal position. Actually, it turns out to be much more cardiac than I had thought, as it is a full-blown CT-ICU. They have all kinds of fresh heart and lung transplants as well as any cardiac surgery and ailment that you can shake a stick at. I had to be a little vague with my interview in regards to my previous experience with cardiac, as I've seen alot more cardiac than I've actually been involved with. At any rate, this is another big, fun hospital, and I am going to get a ton of new experience, to put on my skills checklist ;)

As a seasonal worker, I'll have a 13-week contract like any other travel assignment, and the pay is similar, including the fact that I'll receive a monthly living stipend. However, I'll be working directly for the hospital. That will be a new change. The bad news is that I don't start for another week and a half, until January 26th.

Of course, Jess is quite happy with that development. Right now we are just on her income, so things are tighter than we have come to expect in the past eight months. We have to watch our cash much more closely, eat out less, and hang out at home more. Actually, that's working well in my favor. I'm doing well with the Chickenfoot Weight Loss Challenge (loser eats a nasty chickenfoot we brought back from China). I now have 11 days that I have had some sort of exercise, for at least a half hour. I've been running, working out, hiking excessively, those sorts of things.

Also, my friend Scott has a Wii, so in a way, I've been playing tennis as well.

My weight hasn't dropped that much; I'm down seven pounds from weigh-in (we ate tons of chicken wings and beer the night before, so that weight was a little skewed). The more important part is, I feel a lot better than I have for awhile. I feel healthier, mostly in part because I'm getting plenty of exercise and I'm watching my diet much more closely. Being unemployed isn't all that bad. So is being in a state where physical exercise is much more common, in comparison to being up in Madison, Wisconsin.

I'm also getting plenty of photography time. I take my camera on all of my hikes, and today alone I added four new galleries of Tucson pictures. One of them is a compilation of photos where I've converted them into B&W or some other color scheme, which turned out very pleasing to me. Desert pictures usually are good for color conversion. I also really like the Slideshow option that I put in, I even find myself just watching the pictures rather than having to click through them. All new galleries in the past 5 or 6 months have had slideshows to go along with them. Here are links to Tucson B&W gallery as well as the Tucson Assignment page:

Tucson B&W Photos

Tucson Assignment

I even went to a Photography Meet-Up, where I went to meet a bunch of photographers. It was more about networking than about being informative, but I found out about a couple of other photography clubs in town that I need to check out. It's nice to have a little time to concentrate on photography for a change. It'd be great for that part of my life to move out of the hobby category and more into the money-making category!

Until next time, be safe.

Posted by aloukonen at 04:17 AM | Permalink | Comments (0) | TrackBacks (0)

In fact, it's been over a month since I last updated the blog. First, as I mentioned in the previous entry, my website was banned in mainland China, so I couldn't do anything like write on the blog while I was there. Then, we returned to the US on December 18, and went head-on into the Christmas season. We stayed a few days with my folks in Colorado before flying to South Carolina for Christmas. Then we headed back to Colorado for a few more days before embarking to head down south here to Tucson.

As it turns out, my job situation has been quite interesting, if that is the right way to put it. Two days before we headed off to China, I received a phone call from my recruiter at Cross Country, who informed me that because of "low census" issues in the unit I was to start in when we arrived in January, my contract had been cancelled. This came as quite the shock, of course, as there was not enough time to look for additional work before we left for China. The whole issue of "low census" is ridiculous, as well. There are no shortages of patients in any hospitals. The reality of the situation is that December is the fiscal end of the year for many hospitals, and this year is exacerbated by the rapidly declining economy. Basically, canceling my contract was an easy to cut an expense, despite the poor business practices involved as well as the thrashing of the idea of a signed contract.

At any rate, I wasn't terribly worried about it. Jess still had her contract, and being that jobs are suddenly quite scarce, we decided that it was prudent to go ahead to Tucson. I decided I would try very hard to find a position, or at least pick up per diem work in order to supplement Jess's income. Honestly, while it might seem a little naive, I actually felt pretty certain that I would be able to talk to the manager in the unit that I had originally been contracted to work at, and something would work out so that I could end up working there.

Then, right before we headed south, I received word that my friend Scott had his contract cancelled halfway through, meaning that he'd already started working. We talked, and came to the conclusion that he would probably have a job regardless of the cut as soon as December ended. Sure enough, on January 1st, the manager in his unit approached him about signing on as a "seasonal" worker. This is a new concept to me. Essentially, it means that he was hired in at roughly the same pay rate that he'd been at before, perhaps even a little better. The difference is that as a seasonal worker, he'll be working directly for the hospital instead of through the travel agency. My guess is that this is a much cheaper way to hire staff for the hospitals, which apparently are struggling nationwide with their budgets. Obviously, he jumped at the chance.

As for myself, I did speak with the manager, and after a couple of days of talking with her people, she called me to let me know they didn't have a position available for me. So much for my ideas of working in that unit. I was a little disappointed about that, but it lit a fire under me, and I went to three hospitals here in Tucson to talk about getting a job. As it turns out, I have an interview tomorro with a cardiac unit in that same hospital, for a "seasonal" position.

Isn't it interesting the jargon they use? There has to be a more honest way of putting it. Instead of "low census," they should just tell you that they are out of money and you are a luxury they can't afford. Instead of hiring people for a "seasonal position," they should just tell you that they are too cheap to continue using the travel companies that have provided them with numerous workers, and they are going to screw them by going around them to poach their own staff. For example, if I take a position at this hospital, which I obviously would for financial reasons, I would be poached from Cross Country, because those folks introduced me to this hospital. It's like taking a girl to the dance and watching her make out with someone else.

Good thing Jess is getting the free housing. Hopefully the interview will go well, and I will be back to work within a week at the longest. I'm getting a little itchy about being out of work.

Not to say that I haven't made the best of my week off since we arrived here last Saturday. Besides looking for jobs, which isn't all that time consuming (how many times can you talk to a human resources drone?), I've been concentrating on burning off the ten-to-fifteen pounds I packed on in Madison eating all that cheese and drinking microbrews. I've been lifting weights. I've run three days this week; one day I ran over four miles, although that was an accident as I got a little lost and ended up running longer than I anticipated. Jess and I have taken several hikes so far, including a 15-mile hike that we took today. That too wasn't exactly planned; it was one of those situations where you feel pretty good so you keep going, and then you celebrate reaching that distant 7.5 mile point like you would if you just finished a 7.5 mile hike. Then you realize you are in the middle of nowhere, and it's a 7.5 mile hike back to your car. Yeah, I can't walk tonight.

I actually started a contest with my friend Scott called the Chicken Foot Weight Loss Challenge. Basically, I brought back this nasty chicken foot treat from China, and the person who loses the least percentage of weight between the two of us has to eat that foot. It won't be pretty. We weighed in on Thursday. Sort of ironically, we went out for all-you-can-eat wings the night before and stuffed ourselves sick with wings and beer. I won't tell you what I weighed the next morning, but I anticipate losing at least 20 pounds.

So, wish me luck on my interview. Hopefully the next time I post an entry, I will have a job. Jess will be particularly happy about that. As for myself, it's not that bad being unemployed.

Until next time, be safe.

Posted by aloukonen at 03:25 AM | Permalink | Comments (0) | TrackBacks (0)

Posted by aloukonen at 12:09 AM | Permalink | Comments (0) | TrackBacks (0)

After today's shift, I am down to the last ten shifts of this contract. I have one more shift left this week, then there are only three weeks left. It's hard to believe, but this contract is nearly finished. Soon, I'll have to change the subtitle of this blog, since we are no longer new travel nurses, having two assignments under our belts.

Speaking of which, we have already taken our next assignment, in Tucson, Arizona. This will be a very exciting assignment for me. I am a little disappointed about this assignment in that there weren't any male travelers here with the exception of one. I'd hoped to have some other guys to hang out with, since after all, there is a limit to the time that I can stand to spend in the company of women (no offense). I've ended up spending a lot of time by myself, fishing and whatnot, which I have enjoyed, but it would have been nice to have spent some time hanging out with some guys.

On the other hand, at the MICU that I accepted an assignment at in Tucson, there is already a couple who I used to work with at the Big D. Even better, a good friend of mine from the Big D is starting his first assignment as a traveler in that unit, so there will be four of us. Then, Jess and I have our good friends Scott and Amna in Phoenix, where an old high school friend of mine also lives. So, I'll be back in the company of people I know. I won't know what to do with myself, I'll have to take trips alone into the desert to get that solitary feeling back.

It's really a good situation that we already have our assignments, though, since we're going to be gone for the first half of December in China. I had been a little worried about trying to secure assignments while being out of the country, but it doesn't seem like it will be an issue. We'll come back from China on the 18th, divide our time around Christmas between our respective families, and be in Arizona by the 3rd or 4th of January so that we can start on the 5th.

So, it's just a waiting game at this point here in Madison. We are experiencing what I imagine is a typical feeling for travelers. We've made our next arrangements, now all that is left is finishing up our assignments here and heading out. I know we felt the same way in Connecticut, once we'd taken our assignments here. Once we signed our contracts, we could have packed our bags and headed out. We feel the same way, like we could bid farewell to the Swiss Cheese and Madison in general and head south to a warmer climate. It's not that we are so sick of being here, but that we are eager for the next adventure. Once you know the next segment, it's hard not to look forward to it, which has the risk of decreasing the enjoyment of the current circumstances.

Our arrangement in Tucson will be a little different than our first two assignments. Primarily, we've taken jobs at two different hospitals, both of which are large teaching facilities that are only four miles apart. That will be new for us. Also, Jess will be working day shifts, while I will be working nights. I think it will pretty much work out for us, though, because we've learned a few tricks. We made sure that our contracts stated explicitly that we would have the last weekend of every month during our contract off, meaning Friday through Sunday. That way we at least have one weekend off together. Hopefully, it will also mean that our schedules will resemble each other more, unlike this current assignment where we have worked opposite days. Starting the month with the same days will hopefully set the tone for the rest of the month.

We will also have a tax home. This is absolutely essential for travelers, I can't believe that we have completed two assignments without it. That means that we have a "permanent home" for tax purposes, which provides us with up to five thousand or more dollars each a year in tax breaks. Fortunately, the rules of these tax homes are vague, so we can easily qualify. That means more money in our pockets.

Tomorrow we are heading for a two-day trip to Chicago. Since our last day trip, I've been looking forward to spending a night in the city. There is a jazz club that I really want to visit. Also, it is election night, so that will make it even more interesting. I'll put up a post about our trip, as well as the inevitable picture gallery on my website. I also have three other photo galleries ready to post, so keep updated.

Until next time, be safe.

Posted by aloukonen at 12:47 AM | Permalink | Comments (0) | TrackBacks (0)

JCAHO is truly the blight of the medical system. They are actually a private organization, smiled upon by the government, which came up with a "provision that hospitals accredited by JCAH are "deemed" to be in compliance" back in the fifties. In essence, they are an accrediting organization that's been around for more than a century. Nowadays, they come through the hospitals, looking for the piddleliest little things to ding hospitals with. By ding, I mean bring multi-thousand dollar fines against. Each hospital apparently gets its own list of wrongdoings, there's no consistency that I've noticed. Here at the Swiss Cheese, one of their issues are saline syringes. Even though there is no needle involved, and even though we are talking about sterile saltwater, apparently these saline syringes are too dangerous to be left to the meddling hands of patients and their families. These people might try to squirt someone in the eye.

Another thing that they are tremendously focused on are two points on our admission paperwork: whether patients are suicidal and whether they want to quit smoking. Focused is not a strong enough term, they are downright anal about these two essential parts of patient care. I've had several conversations with the managers on my unit about making sure that these questions get filled out. It's hard for me to remember to complete these parts, because I'm noncompliant with making this an issue. Hey, if you want to smoke, go ahead, it keeps jobs available for me when you get lung cancer. And suicide? Don't get me started on why people seem to be so unsuccessful with that.

Anyhow, there was a false alarm on Monday. Word gets out when JCAHO is in the house, meaning they are somewhere in the hospital making some employees miserable (and suicidal), while at the same time interrupting the much less important patient care. It's been rumored since we arrived in August that JCAHO was coming, so there has been this palpable tension building everywhere, as managers throughout the hospital develop hypertension and stress ulcers. Well, word came that the dreaded JCAHO goons were finally in house. That set off a frenzy of action, none of it remotely involved with patient care.

Of course, I was taking care of a patient who had been admitted over the weekend completely unresponsive. A spur of the moment decision to get a CT scan turned out to be very helpful, it showed that he'd had a horrific stroke, and one side of his brain was completely whited out. That explained why he didn't follow any commands at least. At any rate, the opportunity to ask him if he was ready to give up smoking or if he was suicidal never arose for me, on the three days I cared for him. I could have asked his family, but they never showed up. Unfortunately, the fact that I hadn't asked him those two essential questions meant that I had to face the manager.

It wasn't that she showed up to talk to me, after not even saying hello for weeks, just to point out that these two questions were incomplete on the admission form. It was plain enough to her when she saw the patient why I couldn't just ask him. It wasn't even that obviously this man had smoked his last cigarette, and that he was already on a different train to the afterlife. It was that she wanted me to call his family to ask them whether this man was suicidal or ready to quit smoking.

That's what really stunned me.

I'm getting good at my poker face, I've been working on it a lot here. In my head, I was heaping scorn onto her head like hot coals. I had all sorts of witty comments which I silently rebuked her with. But outwardly I was cool as Wisconsin nowadays, and put forth my best lie.

"I'll get right on it."

Later she sent the charge nurse to remind me that these questions still were unanswered. The poor girl was almost too sheepish to tell me, so I was nice to her. I didn't tell her that there was absolutely no way that I would stoop to such levels to follow such stupidity. Can you imagine that conversation?

"Hello. This is Bob's nurse. I am so sorry about the news about his stroke. But listen, I have a question for you. Do you think he is ready to give up smoking? How about suicide? Has he talked about wanting to kill himself recently?"

If she wants those questions answered, she'll just have to use the phone in her office to give that family a call.

That is what JCAHO does for our medical system, a private organization operating with government approval to hold hospitals hostage under the threat of massive fines for such total, complete pig patooey. No wonder we pay more per capita for our healthcare than any other country and yet so many get so little from it. 'Cause, God forbid someone steal some saline syringes, we need a massive organization to keep an eye on that.

Until next time, be safe.

Posted by aloukonen at 02:19 PM | Permalink | Comments (0) | TrackBacks (0)

After we finished our assignment at the Y, the plan was to go to work up at Dartmouth in New Hampshire. Seeing that we ended up in Wisconsin, obviously that didn't work out as expected. A large part of why that didn't work out was because I had very little Neuro ICU experience. At the Big D, the only neuro issues I encountered were the crazy crackheads, and I didn't see any more neuro at the Y. So, while it was true that I didn't have true neuro experience, it wasn't my fault.

Well, working here at the Swiss Cheese has changed that.

The most obvious difference between the unit that I work at here in Wisconsin and all of my previous experience is that this is a trauma unit. Then there is the fact that this is Wisconsin, the state of flaccid attention to the relationship between motor vehicles on the melons that sit on our shoulders. Wisconsin has an odd oxymoron, emphasis on the last part of that word. People here have survived for the most part because of a governmental acceptance of lack of common sense.

See, in New York City, where there are multitudes more people and hence more vehicles, people tend to be very careful walking or biking in the road. This is because there is no law that gives pedestrians the apparent complete right of safe passage. I'm guessing that the officials in New York City assume that if you walk out into traffic and don't look, then it's your own fault that you get creamed by a bus. Ask me, I got a closer look than comfortable at the front of a bus there.

People don't have the same respect here. They assume that if they walk out in front of you, then you will be courteous enough to stop. Fair enough when the person driving sees them and has time to stop, but poor decision making at night when they are wearing dark clothing. Or when they are walking in the middle of the lane on a windy country highway. Or any number of other instances when it's just plain dumb to walk out into traffic. I've had to start taking a different route home from work, away from the university and its students, who apparently aren't enlightened enough to stay out of traffic.

Then there are the two-wheelers, a subject I've touched on before. There is a huge culture of mopeds and motorcycles here, followed by a huge culture of ignoring the obvious fact that the skull is poor protection against the hard concrete of the road at any speed. I've been going down the main drag in Madison at 6:30 am, to see a moped weaving amongst traffic, driven by some young girl with no helmet on. Am I supposed to feel badly for them when they show up a hour later in the ICU with a big, fat, swollen head?

It all pretty much stupefies me. There apparently is a sense of entitlement here, government sanctioned to boot, that has people thinking that it is ok to not protect their own lives on the road with cars. To me, it's a no-brainer; I'll pass on the sense of entitlement and stay alive, because when people get hit, they may have been protected by the law, but it didn't do much to protect their bodies. The person at the wheel of the car might be at fault according to this state's law, but all they get is a dent in their hood. Crazy.

Rant aside, my point is that my unit gets a lot of neuro patients. There is a neuro ICU in the hospital, but often these guys come in with all sorts of traumatic injuries, and neuro takes a backseat to the medical aspect of their care. After all, what use is the head when their body is dead? It sucks for these folks, but it has worked out pretty good for me, because I'm lapping up the neuro experience like there's no tomorrow.

This week has been particularly useful to me. I guess before on the rare occasion that I actually had a neuro patient (like the time that I got floated to the neuro ICU), I've just pretty much gone through the motions of doing the neuro checks and whatnot. Mostly, that means I look at the charting that the nurse before me did, then go do an exam that covers all of the checks that they'd done. Well, this week has been all about practice. Almost all of my patients have had some degree of brain injuries.

Two of them have had craniotomies, which is where they've taken out a piece of the skull to relieve pressure in the head, leaving the bone out until the swelling has resolved. This means that these two patients had an area of their head where there was no skull. Of course I had to feel that area, push on it a little bit. Yes, yes, softly! Geez. That was pretty interesting. I had to do my bi-hourly neuro checks, so I actually learned how to do them, and what to look for. A couple of my patients were really banged up, so I got some trauma mixed in there, with some fancy terminology to toss out at unsuspecting interns and new nurses. Even better, I had not one but two ventriculostomies, one each for Monday and Tuesday.

Essentially, these are drains that help decompress the pressure in the skull. They are the first line in surgical defense to do so, meaning that the person will require a craniotomy if it doesn't work. They are also a monitoring device, allowing us to measure the ICP, the intracranial pressure. They're fairly easy to deal with once you've become accustomed to them, but there are a lot of rules and stipulations that are involved, as well as measurements I'd never heard of before. Of course, I acted real nonchalant about it, using the classic traveler line: "Oh, I've never used the equipment this hospital uses. Do you mind running me through the equipment?" Hey, it beats sneaking off to look it all up on Google after report. Not to say I didn't do that too.

One of the big issues that Dartmouth had pointed out with my application is that I hadn't ever had a patient with a ventriculostomy. Well, the skills checklist has been updated, and I continue to heap scorn on the dungpile that is Dartmouth.

Oh, get this. One of my patients was a biker dude, you could tell by the cattleyard's worth of leather when his family came in. This guy will probably be sucking his meals through a straw the rest of his life, but guess what was on the cover of the guest book his family brought in for friends to write condolences? A big, chrome Harley, no helmet in sight. I didn't get upset, he had a ventric. Sweet!

My other ventric was a kid in his late teens who was doing some wicked trick on a skateboard and didn't make the landing quite right. I mean, he made the landing, but on his head. I guess having four wheels under you doesn't mean you shouldn't wear a helmet. Seriously, if he'd been protecting his melon, he would have had a stiff neck and a skinned elbow.

Anyhow, it was quite an educational two days for me. I even got floated for eight hours to the Burn Unit, which was crazy. They'd just gotten a fresh burn in when I arrived, which was fairly gruesome. It was very interesting to see, though, and I stepped right in to get involved. They even loaned me a pair of the unit scrubs to wear, so I looked like I was one of the group. My single patient wasn't a burn patient, but was instead, of course, a neuro patient.

Until next time, be safe.

Posted by aloukonen at 12:56 AM | Permalink | Comments (0) | TrackBacks (0)

I just finished four night shifts in a row. They were the first night shifts I've worked at this hospital, and possibly the last. I didn't see any night shifts on the upcoming tentative schedule, although the tentative schedule might just be that and change.

The first night was a little rough. Since I haven't stayed up all night (or really past 1 am) since leaving Connecticut, it took me a little to get used to it. That was the hardest 3 AM that I have had in a long time. The next night was easier, my body had gotten back into the late night routine.

I fell in with the night crew pretty easily. By nature, night shift folks tend to be fairly independent, dark in humor (bordering on obscene), and fairly judgmental and grumpy, at least until they have gotten a chance to know you. Coming into a unit and getting people to trust you is a different process for day shift and night shift. A lot of day shift folks tend to be Type A personalities, meaning that they are very much about doing procedures just like the nursing manuals tell you how to. I tend to think that these people are so rigid in the proper procedure because they literally have an audience--they have the doctors, the families, the management, and here in the Trauma Unit at the Swiss Cheese, the eICU Big Brother cameras monitoring their every move. It creates a feeling of paranoia, having so many observers, so it's little wonder that they do things by the book, even by the paragraph, the sentence, the letter.

On the other hand, in order to get the night shift people to trust you, it is a little more straightforward. You just have to demonstrate that you are capable of handling yourself, that you can do your thing without having to get help every five minutes. Again, there is a strong sense of independence on night shift, the lights come down, the doctors scurry off to their holes, the families (hopefully) drift off to sleep in the waiting room, and management, well, they aren't there and that is what really matters. So, you need to demonstrate that you can get all your work done, walk around to ask if anyone needs any help, and still spend at least fifteen minutes of every hour reading CNN news. Then the night shift people trust you.

It was actually unexpectedly busy this last weekend. There was a big university home game on Saturday, meaning there were throngs of drunken students everywhere, so we had some MVAs (motor vehicle accidents), some car surfers, lots of lacs (lacerations), and a fair amount of blood and broken limbs. Then there was an alcoholic who was going through withdrawals, and the best way to get people to like you is to step in with your cuffs rolled up and say, "Hey, if there's a type of patient I can handle, it is these drunks." I guess my time in Connecticut at the Y didn't go to waste, for they gave me at least one drunk per shift. At least one.

And this guy was a cherry. He was literally drowning in secretions, could barely breath much less talk, but that didn't stop him from using his last few breaths to call us f-ing $@%@% and @$@%## and @%%##%. He could barely summon the strength to inhale, but he could still pinch and punch and even try to bite my finger. I've said it a million times, but Propofol (and ET tubes) are proof that God loves us (that, and beer, of course, but that's proof more that God wants us to be happy).

Good times.

In more exciting news, I just purchased tickets to China for December. We are flying to Hong Kong on December 4, will spend a few days on the island, then hopefully spend a little more than a week in mainland China before flying back to the States on the 18th. That depends on our success in getting visas, but luck has it that we are a two and a half hour drive from the Chinese consulate in Chicago, so with another $260, we should be good to go. I managed to get the tickets for $1100 after taxes and fees, which I find to be quite a deal, especially given that tickets for identical dates to Sydney, Australia, are going for $1500 (recently down from $2000).

Anyone want to backpack in China for two weeks? It's gonna be fun.

Until next time, be safe.

Posted by aloukonen at 09:16 PM | Permalink | Comments (0) | TrackBacks (0)

I was pretty happy that they gave me some time off from work. Usually, when you are negotiating your contract, you request dates that you want to have off. It's in the contract then, they can't make you work those dates. Somehow, it didn't occur to me that I might want my 30th birthday off, or any time around it. I did email the scheduling person on the unit for an informal request, but there weren't any guarantees. Fortunately, she turned out to be a kind person and gave me five days off.

This will be something that Jess and I will have to work on more vigorously in the future. It's one of the things that you learn as a travel nurse, usually mid-assignment, and then you have to wait until the next assignment to take advantage of it. We didn't request any long weekends off together, so that will certainly have to be remedied next time, so that we have a better schedule.

I've been gradually getting more and more comfortable here at the Swiss Cheese. I've become familiar with the unit now, so it doesn't take me nearly as long as it did in the beginning. I did have an unfortunate experience, however, right after my first entry about this particular hospital.

Just to refresh, I had the worst orientation I've ever had. My one orientation day was before my computer training, and the entire day was spent either coding my one patient or trying to keep him from coding again. I had no idea where to even find the med cart for my next shift, much less how to find all the equipment and supplies. That's another thing to remember for the future--I will demand another orientation day (I should have gotten two anyhow) if my first day sucks.

So, the next shift just kicked my butt. I had two very busy patients, and I ran from room to room, trying to keep my head above water. I couldn't expect much help, it was a terrible day for everyone, they were running around themselves. I survived, however, and even managed to get all my work done. Tired but satisfied, I left, and didn't think much more about that day, considering it my true orientation day. That following weekend, I actually had a really good weekend, and was starting to feel good about the place, I was just starting to like it. Beware of such feelings.

I also worked that following Monday, a week after that frenetic day. This particular day was going well, I was helping people out, I got three nice IV placements, people were laughing and joking with me. I was feeling pretty good. Then, the manager of the floor comes and finds me, asking me for a moment to talk. No problem, I thought.

Once in her office, the needle that popped my bubble came out straight out. "Aaron, we've had a family complaint about you," she started right in.

Oh, yeah?

"Remember last week? Well, the wife of your patient said you made her feel uncomfortable."

Really? How?

"Oh, for nothing wrong. She came and told us that a traveler named Aaron had taken care of her husband, and he had seemed very disorganized. She said that you'd turned her husband by yourself, and that you didn't spend enough time in the room explaining to her what was going on with her husband. She's a nurse, too, and she said she just felt very uncomfortable about you."

Oh. Well, I'm sorry about that. (Note to self: never tell any family member, especially one who purportedly has experience in the medical world, that you're a traveler, until you really trust them. Which is never. There is no benefit to telling them, and they will use it against you if they want. Plus, would I have had this meeting if this lady had thought I was staff? )

"Oh, and since you're in here, we had one of our E-ICU nurses stop by with a complaint."

(In this unit, being the technologically advanced unit that it is, they have cameras that can watch you do all your work, and occasionally a voice comes on and asks questions and makes, um, suggestions. ICU nurses and doctors are the ones watching you. Talk about Big Brother. It's awesome.)

"Yes, apparently that day your patient's O2 sats were 89%, and you weren't doing anything about it. In fact, you appeared to be priming a tube feed bags. When she asked you (via the camera speaker) if you needed help, you simply said that he was doing fine. She thought that tube feeds must be more important to you than respiratory status."

(Apparently the wrong answer to give. I'm from the respiratory world, though, and for me, an O2 sat of 89% is just fine, especially with someone with chronic lung disease. True, I was aware of the sat reading, but I wasn't alarmed, and I was continuing to monitor it while I did other work

By this point, I was starting to see a pattern develop here. I wasn't going to get anywhere from trying to defend myself, so I simply puckered up and starting kissing. At the Big D, I always scorned those who sucked up to management, but I'm getting pretty good at it as a traveler. Two big lessons I've been practicing hard here: kissing butt and flying under the radar. The kissing butt part comes in when you don't succeed at flying under the radar, which is evidently not my strongpoint.

Anyhow, this meeting turned out to be one about how I had not done anything necessarily wrong, but by the exacting standards of this unit, I hadn't done things necessarily right either. I did point out that I had gotten a terrible orientation, that I really didn't get an orientation at all, which she admitted to be true. Then I told her that I had not gotten a lunch that day, it had been that busy, and that I couldn't find anyone to help me out when I needed it. I didn't point out that I'm not the type to sit in the room and hold the wife's hand and console her. Hey, your husband smoked his whole life, what did you think was going to happen? I'm a tough love kind of guy.

What I really got out of this meeting was that they have their eye on me here, much more than at the Y. This place is very confident in their superiority over any other place, that much is transmitted in most interactions with management I've had. That makes flying under the radar all the more important.

Either that, or getting better at brown nosing. I helped withdraw on a patient last week (we extubated the patient from the ventilator, which resulted in his death a half hour later). I made sure that I handed out a lot of hugs and condolences to the family. Normally I would have anyhow, I felt very bad for them, and they were very nice people. Given the recent meeting, this time I made sure to give out the hugs in the hallway.

Despite this less than pleasant interaction, I have been starting to enjoy my time here. I stay very busy, which isn't a bad thing. I have been able to listen to the doctors talk about some very interesting diseases and treatments. Also, since this is the major trauma unit of the hospital, I've personally taken care to two patients who I was able to read about or watch on the local news from incidences of the previous evening. That's pretty fun.

Besides, when I start to get comfortable with a place, I start to let my personality out a little, and a little of my humor. I've kept it on a tight rein here, but it's nice to be able to start to converse with people, to talk to the staff and have a little fun. Of course, my true humor will never make an appearance here, well maybe on my last day…

Until next time, be safe.

Posted by aloukonen at 10:09 AM | Permalink | Comments (0) | TrackBacks (0)

It's been awhile since I've written, and for good reason. Working days has been a new experience for me.

I guess I figured that the difficult learning curve of my new unit was mostly related to the fact that I didn't know where things were found and how procedures were done in the unit. This is the first day/week (depending on the hospital) scourge of any new assignment. So, I expected to be at a loss the first couple of days, floundering around, trying to keep my head above water and perform some patient care at the same time. Then I realized something: it was less that I couldn't find anything, from saline syringes to triple lumen kits, and more that I haven't worked a day shift in a very long time. That made all the difference.

To put it bluntly, day shifts are difficult and ugly at best, and more commonly hellish. For someone like me, who prides myself in being as efficient (some might call it lazy) as possible, someone who tries very hard to get my work objectives accomplished with minimal to moderate exertion by cutting out the extraneous chores (e.g. climbing the notorious "clinical ladder"), working days is akin to slave labor. It's brutal.

Not only is there all the same work one would expect on night shifts, there is loads more of it. First, you get the pleasure of dealing with the packs of anonymous doctors parading around for the multiple rounds they make (every discipline, such as renal, cardiac, etc, does their own rounds on their patients, and any patient might belong to a large number of specialties). This means that every time you finally almost get caught up, another group of doctors comes up and asks a bunch of questions that you have no answers for, if you even were aware that your patient had a cardiac or renal issue, and that means you get to look a little stupid all over again. They all also write their own orders that may or may not be agreed upon with the unit team, which also rounds several times.

Next are families. I can understand the stress and frustration that runs in the veins of the families of the ill. That being said, families are the most irritating aspect of healthcare. Working night shifts, I had limited exposure to families, thanks to the 9 pm visiting hour limit. Now, they hound me, the mothers, the wives, all of them, like hens, clucking questions about their poor family member, telling me what one doctor on the weekend had told them (FYI doctors on the weekend will tell you anything, because come Monday, they won't be there to back it up), asking me, why oh why their husband who smoked 50 years has such difficulty being weaned off of the ventilator.

One such mother kept stopping me yesterday all throughout the afternoon with them same questions: why weren't we weaning? Why weren't we extubating? Why was he still under sedation? Finally, I needed to have her talk to a doctor, so I brought her to the fellow, who I didn't know but as a fellow, I expected some degree of intelligence. That turned out to be a dramatic mistake. She agreed with the mom to just turn off the sedation, in this case Propofol, which is a powerful, short acting drug but was running at a very high rate. I tried to explain to the doctor that this particular patient had failed a weaning test earlier in the day, perhaps she would want to talk to a respiratory therapist? Nah, she said, all patients need to be taken off sedation daily anyhow, and it looked like a good time for this patient (this is not true, but that's a whole different entry). By then, I was approaching the point of being hopelessly behind, so I decided fine, I'll show her what happens when you turn off the sedation on a patient not ready to be extubated. To make short a traumatically long story, it was a horrible experience for me, the patient, and hopefully the family, who all sheepishly hit the road right after the patient went completely crazy. The sedation came right back on, in addition to multiple doses of other meds to bring him under control and get his heart rate down from 165.

I really wanted to scorn that doctor, but as a traveler, I just had to smile and try not to look evil, as in better luck next time, fortunately the patient is still alive. Even when they are obviously incompetent, it is hard to say anything to them, because you don't want to step on any toes. Being a traveler means absolutely needing to fly under the radar. You also have to know which doctors you can never, ever ask a question or direct family inquiries to.

At any rate, these day shifts have been thrashing me like a dry field of corn (hey, it's everywhere up here). Even staying up all night working doesn't make me as tired as I am when I come home from working a day shift. Sometimes, I feel like I just finished 12 hours of Thai style caning, a beating that lasts all day. Days like yesterday, I work frenetically, I eat my lunch in ten minutes at 5 in the afternoon, I go from one chore to another constantly, and still I feel like I'm an hour or so behind. Mid-afternoon yesterday, I actually had a single hour where no meds were due for either of my patients; I must have celebrated too long, because the next thing I knew, I was an hour behind on meds for both of my patients. Days shifts are brutal, and now that I know my way around the unit pretty well, I can't even use that as an excuse anymore.

On the other hand, working day shifts does tend to be a very educational experience. It is interesting to listen to rounds, to hear what all of the patient's issues are (most of which are left out of the nurses reports), to hear a little education about treatment of all the conditions found in the ICU. It actually is very interesting, at least on the occasion that I can break from from the work to spend ten minutes listening to the rounds. I do like that aspect of days. Plus, it's nice to come home, go to bed, then wake up in the morning of a day off and not be completely exhausted. That is a nice change.

As it turns out, I have seen my tentative schedule through most of October, although the final version won't be out until next week. I'm working almost all days, except for a single four-shift stretch where I work nights. So, I guess I'll have to get used to the hustle and bustle.

Anyhow, there is something going on here in the Swiss Cheese that has not just been my observation. Again, perhaps it is a day shift phenomenon, perhaps not. There is a certain edge about this place. I'm not going to make a general statement about the hospital or even unit as a whole, but I have gotten the sense that some of the staff here have a certain sense of arrogance about their work and the way they do that work, which in turn is dangerous for travelers. These are the types who would think nothing of writing you up for anything, which at the very least creates bad juju with the management and could even lead to termination in a surprisingly short time. Thus, the art of flying under the radar is that much more important, especially in a place like this. Most of the travelers I have talked to have noticed the same thing; it's like we can sense it in the air: Danger!

Well, that might be a little dramatic, but it pays to watch yourself very carefully. Honestly, that tidbit is passed between all travelers here at this hospital.

Until next time, be safe.

Posted by aloukonen at 04:50 PM | Permalink | Comments (0) | TrackBacks (0)

I'd planned on calling the hospital of our current assignment the Cheese. Having arrived, I've decided to amend the name to the Swiss Cheese. That is because while this hospital has less than 500 beds (half the number of beds at either the Big D or the Y), the facility itself is enormous and very spread out. In fact, it's been called a honeycomb design during orientation, so given the cheesy nature of Wisconsin, I think Swiss is appropriate.

Currently I am sitting in a computer class for the computer charting system for the hospital. Naturally, it is fascinating, and I can barely tear myself away from it to write this entry. The thing about changing hospitals on a frequent basis is that you get to learn a whole new computer system nearly every time. Yea! Most systems seem like they seek to be counter-intuitive, as though they want to encourage the computer-illiterate nurses over the age of 45 to retire early. Here at the Swiss Cheese, technology is top priority. Everything is cutting edge here, from the monitors and pumps to little handheld scanners for meds. Seems like it could be handy, but on the other hand, sometimes simpler is better; replacing a single check on a paper with a complicated handheld device isn't necessarily the best thing to do.

This is actually my fourth and final day of orientation. Monday and Tuesday were hospital orientation, an experience that never fails to be painful and generally useless. Eight hours of sitting through non-applicable policies and boasting about the facility are eight hours that can never be redeemed nor retrieved. Yesterday was my single orientation shift on the unit, which I will talk about in a minute. Today, of course, is the computer training day, eight hours of following the tourist bike tour policy--that is, everyone goes the speed of the slowest user. There are plenty of older nurses in here who struggle each and every time they try to check their email. We won't be getting out early today.

Yesterday was an quite the day. It seems that each time a traveler starts on a new unit, the experience is different than the previous time. When I started at the Y, I only had an eight hour shift to get oriented to the unit. It turned out ok: I was shown all of the areas, given all the codes, given a general tour of the unit so that I could find my way around and could find supplies. That was pretty much what I expected from my orientation here. Tsk, tsk, perhaps not.

So, I was paired with a nurse who was taking a 1:1 assignment. The patient was a young man who was wheelchair bound. He had been crossing the street and was hit by a car, and ended up with all sorts of contusions and fractures. The assignment was supposed to settle out within an hour or so and then I would get the needed tours and information. By 9 am, it was apparent that there was not going to be any settling out with this patient. From his fractures, he developed a wicked case of ARDS (complete lung failure and multiple complications), with massive pulmonary edema. To make matters worse, he had internal bleeding from his pelvis fractures, requiring nearly continuous blood product infusion. We simply could not oxygenate the man; we had him on 100% O2, and his PEEP up to 20 (for those who don't know what that means, think of a bike tire that you keep inflating far beyond the safe recommendations--his lungs were the bike tire). I'm pretty sure that a PEEP of 20 is far out of the protocols, and in the end, we popped both of his lungs and had to emergently place bilateral chest tubes. There were several points during the shift that he came very close to death (e.g. when his O2 sats dropped to 40%, or when his PaO2 came back at 28 on 100% FiO2 or when he starting erupting pink froth from his endotracheal tube). We managed to pull him back from the brink, although it seems likely he suffered an anoxic brain injury from the long episodes of oxygen deprivation.

Needless to say, I didn't get a tour. At some point, during a lull in chaos, I was shown where they keep their supplies, where the meds are kept, and the men's locker--the important things. It wasn't very detailed, for sure, and there were vast parts of the introduction that I didn't get. For example, I have no idea what the unit's MAR (the medication administration record, one of the absolute essentials of nursing daily life) looks like, or how to do routine chores like order blood products. On the other hand, I did get to know my room very well, as in where all the various machinery and supplies can be found. I also got to see how they did certain procedures in this unit, such as place triple lumen IVs and chest tubes. We even put a Swan-Ganz catheter in this poor man, and practiced a little taking measurements.

I even got to play around with their technology a bit. Each room has a computer inside which has a screen that can be removed and carried around, and controlled by a touch screen. Labs and meds can be viewed this way. They have a setup to continuously watch cardiac output using the arterial line, which I hadn't seen before. All in all, it made the Big D look pretty old-fashioned, and the Y looks straight-up archaic in comparison. I think that when some hospitals like the Swiss Cheese upgrade to new equipment, they put their old equipment in storage for 5-10 years, then send it to the Y. Or ship the equipment off to Afghanistan for a couple of years before bringing it back to give to the Y.

At any rate, I won't know how effective my "orientation" to the unit was or how much more I need until my next shift. I have the weekend off, so I won't know until Monday. I don't think it will be a big issue; the staff on the unit is very friendly and open, and they are far too concerned for patient safety and well-being to let a nurse drown out of spite or disregard. That bodes well for me. I've been around nurses before who'd rather let the patient die than help you out. I didn't see any of those types yet at the Swiss Cheese. It's all about being willing to look a little dumb and have to ask questions whenever needed. That, and have a computer nearby to Google anything you don't know and don't feel comfortable asking. Which is a frequent thing, at least for me. Thank God for Google, if He didn't inspire it, he certainly owns stock in the company.

Finally, a strange event. As I stood waiting in the conference room for morning report to begin, I turned to find a familiar face looking at me. I didn't know if I was yet awake (I'm working all AM shifts), it was a bit surprising, but there before me was a nurse I worked with until late 2006 at the Big D. She has been traveling around the States, and actually is settling down after her assignment here at the Swiss Cheese. It was pretty remarkable meeting her, at this hospital of all places. We've also met travelers who know and have worked with traveler friends of mine in Colorado. A small world indeed.

Until next time, be safe.

Posted by aloukonen at 12:59 PM | Permalink | Comments (0) | TrackBacks (0)

It's been awhile since I've written an entry, and for good reason. Let's see, the last entry, I was in a hotel room having just finished our journey into Wisconsin. The plan at that point was to head north for a week of camping in the wilds of northern Wisconsin, maybe pick up a few more states by going through Minnesota and the Dakotas.

As it turned out, that wasn't to be. My grandfather was ailing, so the next morning, after being in Madison less than 24 hours, Jess and I loaded up and started the 15-hour drive down to Longmont, CO. We arrived by noon the next day. It perhaps wasn't the best circumstances to be in Colorado, but it was great to see my family, and we even managed to see a few friends one afternoon. Ultimately, my grandfather passed away, and we headed back to Madison Friday after the funeral. We pulled into Madison early Saturday afternoon, in time to arrive at the apartment complex and sign the papers for our new apartment. Our total mileage since leaving New Haven, CT: 3600 miles on the Rav4, which we drove to Colorado.

The apartment we had in New Haven was pretty nice, with a loft and two-story windows. It was pretty generic, though, with no real character. Our apartment here in Madison (called The Madison Apartments) really made that obvious; it is beautiful. For a one-bedroom apartment, it is huge, at 1500 square feet. It has a very large kitchen, with tons of counter space, which is a big plus for me. It is just a really nice place, quite easily the nicest place we've ever lived in. We even have a garage space right below us for one of our cars. This place would have cost a fortune in monthly rent in Connecticut, but according to The Madison's website, it only costs $1150 a month, which might actually be expensive for Wisconsin. Of course, we don't have to worry about that at all; we don't even pay utilities. Heck, with the stipend we receive as two travelers in the same place, we actually get paid to live here.

Since this is our second assignment, we already had a lot of the essentials of traveler household goods (pots & pans, dishes, etc.). That, of course, didn't stop us from blowing some serious cash at Target buying "essentials."  Jess has been using my shampoo, which actually bills itself as men's shampoo, for about six months now, which is not my fault in the least (she's just too lazy to buy her own). So, she splurged and bought herself not only shampoo but conditioner as well. As for myself, since I have had a hard time finding a barber that I trust since leaving NC in May (for which I haven't looked too hard), I haven't gotten a haircut for several months. I had to buy some pomade (think of George Clooney's character's use of Dapper Dan pomade in Oh, Brother, Where Art Thou?) to hold back my hair from my eyes. I've had marginal results; I look like a cross between a greaser and an old perv. I guess there is the ugly phase of growing one's hair out; that phase has lasted about a month so far for me.

We spent Sunday touring Madison. It's actually a nice college city. The university here is huge, with 41,000 students. The campus sits on the shore of one of Madison's three big lakes, which is really nice now, but probably sucks in mid-winter when the -40 degree winds blow in across the lake. Fortunately, school will be in session, so all the students will get to enjoy that. Bikes and mopeds are very popular in Madison (again, at least before the winter freeze comes); there are loads of bike paths, and I've seen more mopeds in the last week than ever before. Strangely, literally no one, whether on bike, moped, or motorcycle, wears a helmet. No one. On the main drag through town, the bike lane lies between the car lanes and the bus lane, so there is plenty of potential for MVA collisions. Sure enough, they have quite the active neuro ICU in town. Yet, the throngs of bikers in the morning all ride along with their hair blowing freely in the breeze, and there doesn't seem to be much encouragement to change that, from my limited time in Madison.

We walked all around the downtown area, which sits right next to the campus. There are a lot of the interesting little shops that sell things that college students find funny (I'm still young enough I usually see the humor as well). Apparently school was starting Monday, because that Sunday afternoon, all the students and their parents were coming into town. It's a little funny to watch parents drop off their kids, not just watching the mothers sobbing as they walk away from their kids, but also the looks of impending doom that cross the faces of most fathers. They've spent the better part of the last two decades trying to establish a sense of morality in their kids, only to drop them off in a gleefully decadent environment. In one store, I watched several dads looking over items that I can't even mention because I don't want my own mom knowing what I was looking at. Their looks of dawning horror is priceless. The glimmer in their children's eyes is also priceless. It's wonderful to watch.

There are also a lot of great restaurants in the area. It's nice to see a lot of ethnic food choices. We ended up eating at a Mediterranean restaurant, which was next to several ethnic restaurants, including one from East Africa, which sounded good. Even more exciting, Wisconsin seems to have caught some of Colorado's enthusiasm for microbreweries. There are lots of local brews to sample, and we've both added almost ten beers to our beer lists. There are even a couple of breweries right here in Madison, which makes a short trip for the necessary beer pilgrimages. One of our favorite brands up here is Leinenkugel's, which has several great beers.

So, we're warming up to Madison just fine. It's a different experience from New England, for sure, but that is the essence of travel nursing, to enjoy a multitude of different experiences in different environments. I think we'll like it just fine.

Until next time, be safe.

Posted by aloukonen at 08:44 AM | Permalink | Comments (0) | TrackBacks (0)

Last weekend was pretty chill, we just relaxed and stayed in the area. Mostly we prepared for our trip. On Monday, we finally headed out from Connecticut. We had a rough start, we were supposed to be on the road by 11 in the morning, but the cards seemed stacked against us. We ran into obstacle after obstacle, the most annoying being my urine drug screen. I choked, I couldn't seem to perform, and couldn't produce enough urine to satisfy the requirements for the drug screen. Long story short, I ended up having to have new forms shipped to Wisconsin and only finished the test today. At any rate, we finally headed out of town mid-afternoon.

Our first objective was the Catskills, where we planned on camping a few nights. Again, the odds were against us, we arrived only to find rainstorms all throughout the area. After long consideration, we ended up at a campsite just outside of the Catskills, planning to head out the next morning if it was raining (the forecast was for a nearly constant rain the next day). We woke up to a brilliant morning, and despite occasional threatening clouds, the day was perfect. We toured around Woodstock, the town made famous for the '69 concert, and found that it has become a commercialized hippie town. We drove throughout the area, which is beautiful, looking at the lakes and the big hills, covered in forests. In the afternoon, we hiked a little in the park. It wasn't the most scenic place I've been, but it was quite relaxing.

We camped again Tuesday night, cooking our meal over our campfire, and roasting marshmellows. As nice as it was, we had to hit the road on Wednesday, heading down south through New York into Pennsylvania. We stayed that night in a little town called Somerset, after about a 420 mile drive. Thursday was our longest drive, more than 460 miles, over seven hours in all of driving. That day we crossed five states, three of which were new to me (lifers). We arrived tired but upbeat in Coldwater, MI, as the day had at least been as easy of driving as it had been long in length. We figured the worst was behind us. Today, though, that was proven wrong. We had a much shorter route, maybe 360 miles, but it swung us around Chicago. Even though we were in the outer suburbs, the traffic was atrocious, in particular the truck traffic. There were hundreds of trucks, as many trucks as other vehicles, it seemed. There was nearly constant construction, so the lanes were all very tight, and usually there were only two lanes. It was common to be completely boxed in by aggressive truckers, one on all sides except the side with the concrete barrier a foot to the left. This continued all the way to Madison, and it was almost too much after already having gone more than 1000 miles.

Incredibly, nearly all of the interstate roads that we took were tollroads. I am just not familiar nor comfortable with this concept. After all, a hefty portion of the $4 per gallon we spend on gas goes to our roadways; why do we need to pay additional tolls as we travel across the States? In Pennsylvania alone we each spent $10 on one road; altogether we probably paid $50 each in tolls. That's just too much. Besides, the condition of the toll roads was despicable for the most part, so what were we paying for? I have nothing good to say about it, it is simply highway robbery.

So, we were very happy to arrive here in Madison this afternoon. We found our storage spot, and dropped off the majority of our belongings. I went and finished my drug screen, drinking lots of Coke and water so that I was almost screaming for my little cup and a bathroom. We checked into a surprisingly ghetto Econo Lodge, I thought we'd left that all behind us in Connecticut.

We haven't seen much of Madison yet, we didn't even go downtown to check out the hospital. We just dropped into the hotel and haven't left yet, except to walk to a burrito place next door for dinner. Zuri, our dog, is simply mystified by all these changes. She is an adaptable dog, and was excellent in the car for the trip, but she is very nervous, she doesn't understand what is going on.

As I said, we are here a week early, as orientation doesn't happen until the 25th. That means we have a week to burn. Fortunately we were able to store most of our stuff and Jess's car, so the plan seems to be that we will be heading out of town again tomorrow, looking for fun places in Wisconsin (or Minnesota, or Canada) to camp out for a few days. We were too tired and frazzled today to really come up with a plan, I sort of doubt we'll have a plan by tomorrow when we have to check out at 11.

As for our trip, it was a long one for sure. From the time we left Connecticut, I put a little more than 1350 miles on the Rav4. That doesn't count the driving we did in the Catskills on Tuesday, which we did in Jess's Camry. Our Rav4, which we just purchased in the beginning of May, already has more than 7000 miles on it. Starting with Connecticut, we passed through nine states, four of which are lifers. That brings our state total since April to 25 states. There are only nine states that I have not been to yet.

We were talking over lunch the other day about it. We spend a lot more time fooling around as travel nurses than actually working. Compounded with the fact that our jobs, our assignments, are simply that and nothing more (no politics, no gossiping, no committees, no clinical ladders), it makes the time we spend fooling around even more significant. To quote Kurt Vonnegut, "I tell you, we are here on Earth to fart around, and don't let anybody tell you different."

Now, I think that's pretty sweet.

Until next time, be safe.

Posted by aloukonen at 11:55 PM | Permalink | Comments (0) | TrackBacks (0)

Jess and I are both here tonight at the Y, working our last shift. It's a strange feeling. It's a little sad, but also a very satisfying feeling, as we have completed our first contract.

It has been quite difficult to really be motivated about doing too much tonight. After all, how are they going to tell me that they didn't like how I charted tonight or that they didn't like the fact that I didn't bath my patients since I won't be coming back after tonight (don't have a tiffy, I'm charting and bathing)? The act of actually coming to work tonight was almost too much for me.

People seem genuinely sad to see me leave. I've talked about my plans for the rest of the year with several people, and as the day crew headed out the door, they all wished me the best. I feel like they saw me as one of the staff here, as a part of their group. I have been given plenty of warm farewells this evening. On the other hand, I had a rather uncomfortable conversation with my bosses prior to leaving yesterday morning.

I stopped into their office to tell them that I've had a great experience here, that I was treated very well, and that I'm grateful. The dumbstruck look on their faces told me something was not right. There apparently had been no communication between my unit's management and the HR department here at the Y, which is technically the department that hired me. Back a month or so ago, when one of my bosses told me in another awkward setting that I had been re-signed, she took it that the arrangements would be made, and that I'd be staying. I wrote a entry about that.

Yet, we never received any sort of contract offer from the HR department. There was never any discussion or negotiations about trying to get us to stay. Of course, we were considering leaving anyhow; being renewed with the Y was a backup plan all along. Taking the job in Wisconsin was just another part of the process, and we assumed that the HR department would communicate back to our managers in our units that we wouldn't be staying.

At least Jess's manager heard that she was leaving, and had a conversation about it with her that mostly involved a half-hearted effort to get her to stay. My managers went as far as putting me up on the next schedule, which starts this approaching Sunday. They had no reasons to believe that I wouldn't be returning. I guess I could have been more forthright about my plans, but then I worked all nights here at the Y and never really spoke with them much except a nod in the mornings in passing.

Needless to say, it was a rather awkward moment. I could see that they were picturing the scrambling that they were doing in their heads about the new schedule issue. However, we moved on past it; I was a little excessive in my praise that I gave the unit, trying to erase the unease in the room with a little brown-nosing. They told me that they were very sorry to see me go, and that they wished that they would have been involved in the hiring process.

I didn't tell them, naturally, that they really, really would have had made it worth our whiles (i.e. a very big bonus) to convince us to stay. And they would have had to have done it a month ago, before we signed our names on contracts.

Other than that, my last moments here at the Y have been good. I have an easy patient load tonight, obvious from the fact that I am writing a long entry here. They didn't even give me a crazy patient or an alcoholic, which there are plenty of both on the unit right now. I guess they want me to go out of here with a last good memory.

It wasn't needed, though, as I have had a good experience here. It has been a very nice three months. So long, my friends at the Y.

Until next time, be safe.

Posted by aloukonen at 02:31 AM | Permalink | Comments (0) | TrackBacks (0)

Tomorrow night is the beginning of the end for our assignment at the Y. We will work three nights in a row, and then on Thursday morning, I will walk out of the lobby of the Y for the last time of this assignment, and likely ever. It will be quite the bittersweet experience.

There are reasons that I am happy, perhaps even relieved, to be leaving. Primarily, once I have made up my mind to do something, then the period before it happens feels like a waiting period. The papers have been signed, housing has been found, the job in Wisconsin is secure, and all that waits is for us to make the 1000 mile drive there. This is also our first travel assignment, so there is the relief, and satisfaction, of having completed what seemed like such a hurdle at first.

Along the same thought, I feel like we have really tapped this place out. The only trip that we haven't made is to Montreal through Vermont and New Hampshire (although we passed through a part of NH on our way to Maine). We have been all over New England, and enjoyed it immensely. Somehow, I feel that if we stayed here, we might start to get into a rut, to stagnate, because we have done everything we had planned on doing. Perhaps if we had signed another contract for the fall, we would have ended up less time exploring and more time sitting around. When we arrive in Wisconsin, on the other hand, being in an area of the US that I have very little time in (I'll be visiting five states I have never been to before), there will suddenly be a whole new area to explore. In comparison, for example, we just spent the night in a hostel in NYC, which was my fourth time in the city and Jess's fifth. We have crisscrossed this region several times. So, I don't feel like we're going to leave New England with any regrets about what we might not have done or places we might not have visited. Besides, it's not as though we can't come back to the area for future assignments (which we most likely will).

Also, I can't say that New Haven has been the most terrific place to live. Sure, it's a wonderfully central location, accessible to every point in New England we have wanted to visit. As for a city, it has the ocean access for fishing and so on. It has history and some interesting parts. But there are a lot of dodgy neighborhoods in this city, and there have been several incidents that have occurred in such neighborhoods that seem more likely to happen in Detroit or the Queens than in civilized Connecticut. And don't even get me started on Hartford, that giant ghetto of a city. Not to mention that people drive like maniacs in this state, and that gasoline is more expensive here than in all but seven states in the entire US. (It was the fourth most expensive at its peak average of $4.40 a gallon).

Nonetheless, our experience at the Y has been excellent. I don't think that we could have had much better experiences really. I think that we were very flexible--we both floated as necessary, put up with the assignments we were given without complaint, and so on. This is essential to the travel nurse experience, I think. Our units seemed to appreciate us for having a positive attitude, and that we were willing to fill the needs that they had. Some travel nurses are less inclined to do so, and that certainly causes friction with their relationships on the unit. It wasn't that we were constantly putting up with the worst experiences, either, they were generally kind to us. Jess ended up being floated a lot more than me (sometimes three times in a shift), but she found that actually doing so was to her benefit. After all, what all are you expected to accomplish in a four hour period, besides keeping a warm body next to the patient and of course keeping that patient alive? Certainly no baths or thorough charting.

Of course, our perspectives on nursing in general have seemed to change quite a lot since starting as well. We were much more inclined before traveling to be wrapped up in all the intricacies of the job--the politics, the need to take care of super-sick patients, the "climbing of the clinical ladder," as it was known at the Big D. I won't ever forget, coming back from Africa, despising the unappreciative patients and families that typify Americans, when I was trying to organize some sort of Big D nursing initiative for nurses to go abroad to perhaps Kenya (perhaps just so I could go back myself), and my efforts were being interpreted by the management as climbing that stupid clinical ladder. I didn't bother telling them I was planning on quitting within a year, so much for the ladder.

Since starting to travel, on the other hand, our lives have taken on a different focus. We still strive to be good nurses, no one wants to be a bad nurse who wipes out patients and gets fired, but we don't seem to have any desire to be the "best" nurse, by any stretch of the imagination. More now than even before, I am really interested in work only because it pays really well and it allows me four days a week (oh, believe me, no more overtime in my schedule book) to get out there, explore my world, and play. If I could get by without working, if the money came regardless if I showed up to work or not, I wouldn't be donning my scrubs and heading out to spend another 12-hour shift through the darkness of the night in the depressing company of yet another drunk who is being involuntarily dried out.

Even better is the detachment that we have come to cherish from the establishment of the hospital. No more are we obliged to have any particular emotion towards the management of our units, simply because it is the collective emotion of the unit. No more are we inclined to join committees and spend hours of our precious time off pouring energy into unit projects (ok, that was Jess, I never joined any committee, and I only went to one unit meeting in three years at the Big D, only to regret it later as being an infamously wasted hour of my life). Of course, I've already mocked the notion of working overtime; it's no longer necessary to choose between saving money and having a great time and lifestyle, as we make enough to do both.

In short, our focus has shifted from living to work, as we did at the Big D, to working to live, which we do now. Our focus is what we do on the four days spent outside the hospital, not the three days we spend inside.

That's not a bad way to live. To yet again paraphrase, this traveling gig is pretty sweet.

Until next time, be safe.

Posted by aloukonen at 01:20 PM | Permalink | Comments (0) | TrackBacks (0)

So, three weeks from now, we will officially be finished, on Thursday, August 7. Our tour of duty at the Y will have come to an end, and we will moving on to the next assignment.

It's a little strange really. I think that I'll miss this hospital, and this unit, but then again, once a decision has been made about going somewhere different, it just seems like a waiting game, getting ready to go. I feel very comfortable here, and it actually seems like I've been here longer than 10 weeks, a lot longer. I guess I caught on to the flow of the place early on, and have found my place here. In fact, there are several people leaving for various reasons in August, and I found myself considering going to their goodbye parties. I don't even know these people, and somehow I feel entitled to go eat their cake and drink their beer. Not that that is something different for me.

It's been a long five days of addiction for me. Every shift, I've had drunks and druggies. Hardcore folks, too, not just college students on a binge. I've had the serious drunks, and the crazy crackheads. I was thinking they were punishing me, but then I realized the whole unit is full of these folks. I guess they come out of the woodworks this time of year. It is, after all, a good time of year to smoke crack.

I did have an interesting patient this week, my one-day reprise from the junkies. He was a gentleman who had worked in coal mines in Jamaica. He has steadily declined since arriving on our unit. From my perspective, his case was poorly managed by the team here; he would have been put on an oscillating ventilator long ago at the Big D, and at one point, an attending purposely gave him a cuff leak on his vent to "blow off a little extra CO2" (sorry for the medical jargon for non-medies). Anyhow, it was all pretty ridiculous, I think the attending was planning on writing a paper about it, and wanted some data. When they finally did oscillate him (a huge rarity here), he died immediately. Guess it was a little too late. Still, the shift that I was pretty interesting. It was very intellectual, and very busy. He wasn't an alcoholic, either, which spoke volumes for him.

Tonight is my last night for almost a week, fortunately. Tomorrow, Jess and I head up to Acadia National Park in Maine. We're camping for the weekend. It's going to be a great trip. As rustic as the campground it, there apparently is wireless internet, so maybe I'll post something from the bush.

Until next time, be safe.

Posted by aloukonen at 02:15 AM | Permalink | Comments (0) | TrackBacks (0)

I was pretty optimistic about getting the assignment after the interview. Sure enough, our recruiter called the next day and said an offer had been made. There were just details on the contract to iron out. Then today, we spoke with our recruiter at length about the contract and hammered out our details. I did get an assignment in the surgical/trauma/medical ICU at the hospital I'll call the Cheese, and Jess landed herself in the PICU there. I've always heard so much about how negotiating is so important for travelers. Perhaps we just have a very good recruiter who helps max out our incentives, but negotiating never really seemed to play that much of a part in this contract.

For example, there wasn't really any room for negotiation on our wage, which will be $38/hr. I asked for shift differentials, but it wasn't even an option. Our recruiter offered the max on the travel benefit, which will score us $500 each to travel to this assignment (which is 1095 miles away from our currennt location). Our housing stipend may have been an area where I could have negotiated a little, but they offered one of us $1050, which taken with the $3 increase in hourly wage from what we make now, will actually be hundreds of dollars more monthly than what we make at the Y (where we get a $1600 housing stipend). I just didn't know how much to push for or when to push for it, especially after doing the math. So, we'll be making a fair amount more money, living in a state where gas prices average 40 cents less than here in Connecticut, which means that all cost of living expenses will drop as well.

At any rate, we got a pretty good deal. We don't know our living situation yet, which will be interesting, but it has turned out well so far. Jess and I both work until the 6th of August, and we will have until the 18th before we start. Personally, I would like to drive up to Madison, WI, then fly down and spend six days or so in Colorado before starting. That will have to be intricately planned, of course. Time will be tight.

In the meantime, I'm trying to think of what I'd like to see before we head out of New England for this year. We are planning a trip to Acadia Nat'l Park in Maine in a couple of weeks. There are also two weeks in this contract where Jess and I will literally have opposite schedules, so I am thinking that for one of the stretches that I have off by myself, I want to drive along the coast of Rhode Island up to Cape Cod, for the million photographical moments that would offer. I also wouldn't mind spending a day each in Hartford, Providence, and New York. Those can be quick day trips for when Jess is working. I am going to try to max out our last month in Connecticut without spending too much money.

At any rate, I had quite the interesting patient last night. He's a young guy, but a severe alcoholic, drinking several 40s (big bottles of beer) and a pint of Jack every day. Apparently he became fed up with his boozy lifestyle and decided to stop cold-turkey, not the best idea when your daily alcohol requirement is enough to knock down a mule. So, his girlfriend comes home and finds him seizing on the floor. Once he recovered enough to hold a can, he downed a six-pack of beer, just to stave off another seizure attack (actually pretty smart of him), got himself on a bus, and rode it to the ER. Suffice to say, he didn't fit in well with the staff on a floor unit, kicking and punching and swearing, so he ended up in my care, in four-point restraints and a restraint vest, on 15 mg of Ativan per hour, with liberal PRN doses of Ativan and Fentanyl (which was developed as a horse tranquilizer). For non-medical folks, our usual dose to sedate people is 2 mg, once. If you gave someone 15 mg, usually they would stop breathing. Not this guy, though. He still managed to talk a lot of smack through the night. Funny thing, though, I heard from another traveler about this crazy guy she'd transferred to my unit the night before, and I thought to myself, "I bet I get that guy." I hate when I'm right.

Until next time, be safe.

Posted by aloukonen at 02:44 PM | Permalink | Comments (0) | TrackBacks (0)

We had our CrossCountry interview for the job in Wisconsin today. That means that CrossCountry is the exclusive agency that brings in travelers to this particular hospital; travelers from other agencies might come in, but only when their companies subcontract through CrossCountry. We didn't have an interview with the managers of the units that we would be going to, but instead with the location manager at CrossCountry. That went well enough; it sounds like the hospital is very, very nice, and has a strong emphasis on good staffing methods. The reason that they are hiring travelers is because they are changing to a computerized charting system, and will be pulling off nurses to train them. That's where we step in to fill the gaps.

Problem is, there was talk again about neuro and trauma experience in this hospital. Again, this is a 400-bed hospital, and its ICUs are not as segregated as a 1000-bed hospital like the Y or the Big D. Having just been buzzed badly on the Dartmouth job, I'm a little skittish about these demands, that I have neuro experience. I'm not holding my breath; if it happens, it happens, I am not going to get all excited about it yet. Jess is getting pretty excited about the prospect, though. She wants to get on the road again. Actually, she did get a phone call from the manager of the PICU at this hospital, which turned out to be a pseudo-interview. That really got her excited about heading towards the Midwest.

I've started to come around a little about possibly living in Wisconsin. Apparently it isn't just flat and windy like I've imagined. There apparently are an abundance of lakes and hills, and lots of trees. Perhaps the fall wouldn't be as spectacular as in New England, but from what I've heard, there is a distinct changing of seasons. It also gets really cold there, probably by the start of November, so we quite possibly could be seeing snow in our three-month stint. Still, it sounds like a reasonable gig, and the hospital itself is appealing. Plus, it's very close to both Chicago and Milwaukee, and we can knock out four, even five states that I've never visited before (Ohio, W. Virginia, Michigan, Wisconsin, and maybe even N. Dakota if we get really bored). Perhaps it will work out. Perhaps I even want it to work out.

In the meantime, another stint at the Y is still a possibility, they made a point of changing my schedule so that I have a long weekend off with Jess, sending me an email so that I'd know that they made the change. Surprising? Maybe, or maybe they want us to stay. Strangely, if we don't end up doing another contract, I might even miss this place a little, it's been good to us. New England's not going anywhere, though, we can always come back.

Until next time, be safe.

Posted by aloukonen at 01:37 AM | Permalink | Comments (0) | TrackBacks (0)

So, although it just doesn't seem possible, a few days before July, here we are trying to get into our next assignment. This has proved to be an interesting ordeal already. We'd come to the conclusion that while we have been very pleased with the Y, it would be nice to have a change of scenery and head up to New Hampshire. Well, that fell through, and not in just the casual, oh-well sort of way that such things can fall through. Since it has indeed fallen through and there is no need to hide the name, we were interested in Dartmouth, which is a 350-bed teaching hospital in Lebanon, NH, associated with the school there. It's really in the middle of nowhere, but that would have been fine, as the outdoor surroundings would have allowed plenty of hiking and biking and camping, a change from the urban life. Once we settled on going there, I was focused on it and couldn't have imagined being turned down, especially by a small hospital urgently needing nurses.

Our recruiter requested evals from our current managers, which took an exceptionally long time to obtain. Even before they were submitted, my manager stopped me the other morning in the conference room to tell me that they'd already re-signed Jess and I. I was taken aback, I didn't see that coming, and didn't know really what to say. I must have looked a little stunned, because someone in the background said, "Well, don't act too happy!" At that time, Dartmouth was certain in my mind, so I thanked her and got out of the situation. Apparently they'd caught wind of our eval requests and were trying to head us off from leaving, which is a compliment of sorts.

Later that day, our evals came through and were sent on to Dartmouth. I received an unexpected call from our recruiter late in the afternoon, bearing bad news. Apparently, Dartmouth turned me down cold. They weren't interested in an interview or more information. They didn't care that I had 3 1/2 years experience in 1000-bed hospitals. They decided I didn't have enough neuro and trauma experience, and that was that. I didn't even get a chance to talk to them, they just weren't interested. So much for Dartmouth.

It was pretty insulting, really. Surely I would have more experience than all the new grads they have to hire at the end of August. I felt pretty disheartened by it; were they having a bad day, or PMS? Does my skills checklist suck that bad? I've moved on, and am not really that sure why I was so insulted, I just know that I felt pretty angry about it, as well as disappointed. Ironically, a nurse we had directed towards applying for the job to did get an interview and accepted, and is heading up there soon, for $41.50 an hour. Nice. Rub it in.

So, we're still looking for the job. There is a job in Wisconsin for $38 an hour. I am not sure I want to go to Wisconsin, though. I've been looking forward to being in New England for the fall. Apparently the Y wants us to re-sign, so that is always an option, and probably the best one at this time. I wouldn't mind staying for sure, our units have been great, and we would still be in New England for the fall.

Then today, after my terribly busy night, somehow I managed to have all my meds done, all my orders finished, and the patient and room looking clean for the most part, not an easy task considering the pile of orders I had to dig through. The patient had stabilized and turned around. Of course, I had much help from my neighbors (another reason to stay at the Y), especially with my abandoned patient, but it felt good to leave that mess in decent order. Then the nurse I gave report to, a seasoned nurse who has been working there for a long time, asked me whether I was going to sign another contract. She told me that I was the best traveler they've had in a long time, which had me stammering again. While I doubt that everyone in the unit would agree with that statement, it was the kind of compliment that I needed, a boost in a time that I been having some doubts. I was very grateful for that.

Until next time, be safe.

Posted by aloukonen at 02:12 AM | Permalink | Comments (0) | TrackBacks (0)

This also applies to the clinical aspect of travel nursing. Obviously, all facilities have their own way of doing things. The most mundane chore can be done a thousand different ways. Last night, a thoroughly exciting and enjoyable night, only highlighted that aspect of this lifestyle for me.

I've been caring for the same woman for the past three nights. She has a lot of cardiac history on top of being generally unhealthy for a 51-year old woman. Turns out that they find (by way of a cardiac catheterization ) that she has a large lesion in one of her major coronary arteries. Essentially, she needs cardiac surgery, a CABG, big time stuff. But literally during the four hours that included the cardiac cath, she became severely septic. So, in the days that I've been taking care of her, she's become progressively more ill, which I hope isn't an indication of my nursing care (it's not--she was already intubated and very sick, more so than anyone knew at the time). Two nights ago, I had a busy night with her, she was very sick and required constant care; I basically walked into the unit to find her on the verge of coding, and it didn't let up until about 2 am. I was happy to have been involved, I am getting tired of the baby-sitting assignments I've been getting, so it was nice to use my brain. I didn't expect to get her last night, though, as she needs a balloon pump and should be heading off to the cardiac ICU for management of her heart failure.

To my great surprise, I walked through the door to find her still in the MICU, as my assignment. Even more interesting, although certainly not surprising, was that the team had placed a Swan-Ganz catheter. For non-medical folks, this is a big deal nowadays, where few MICU patients get them; you have to delve into the cardiac realm to find them. Of course, it's been about a year since I've managed one, so it was great to get this one, so that I could get refreshed in all the measurements and implications involved. I spent the better part of the first half of the shift getting familiarized with the catheter; it all came back quickly enough. It was surprising, however, to get this type of a patient as a traveler. It is an opportunity units usually reserve for their staff so that they will get the valuable experience. I think the only reason I ended up with this patient last night was because I'd taken care of her for a couple of nights prior.

That was interesting enough, but my learning experience wasn't over. She was severely malnourished, and they had started TPN (IV nutrition). However, they really wanted to feed her via the GI system, so they needed to put in a nasojejunal tube (a feeding tube from the nose that bypasses the stomach and empties directly into the intestines, to prevent reflux of fluids into the lungs from the stomach). At the Big D, they'd send these patients down to the radiology department to have it guided in. Not at the Y, it's the nurses job here. The day nurse had placed one, but it was coiled in the stomach and needed to be replaced, so I got the honor of trying it out. It seemed rather basic, even though I'd never done it before, and have used up all my asking tokens with the Swan, I had to rough it with just some literature. Needless to say, I didn't get it after a couple of tries, but not because I was doing it wrong, she was just a hard person to sink a NJ into. Others tried and failed.

She also had some interesting cardiac issues all night. The breathing tube was irritating her throat, making her cough whenever she was awake (I didn't allow that much--for the first time since I got up here, I've had the orders to give proper sedation, as they don't believe in sedating their intubated patients). The problem with her coughing was that she had a vagal response each time and dropped her heartrate from the 90s to the 30s. There was little I could do about that except send her into Happyland where coughing wasn't allowed, but she also had an occasional irregular heartrate slightly resembling atrial fibrillation, so the doctor wanted an EKG.

Again, at the Big D, there are techs who do the EKGs. Not at the Y, it's up to the nurses. So, there I was, by this point completely unwilling to ask another question, I'd even used up next week's tokens as well. This is fairly rudimentary, not exactly rocket science, so it didn't take long to figure out. But hey, if you've never done something, it is still a new experience when you do it.

Anyhow, it was a pretty good night. I handled myself well, I think. I had to ask questions, but then several people crammed in the room when we were learning about the Swan measurements, because no one knew how to do them, so I didn't feel too bad. It was a good night.

Even better, I'm off for the next two nights, then I work one night. After that, I have five days off, most of which will be spent in the Boston area. So, I'm even having a good day. I didn't sleep after work, it's a beautiful day outside and I didn't trust myself to wake up at noon after working four shifts in a row. Then again, I'm spending the beautiful day sitting in a Bruegger's Bagel shop writing this. Hmm...

Referring to the upcoming seven out of eight days off, I was reading the Facebook page of someone who just started travel nursing at the beginning of June (as if I'm an old hand at this). He was saying how this gig is turning out to be more like a long vacaction than work.

Indeed.

Until next time, be safe.

Posted by aloukonen at 02:17 PM | Permalink | Comments (0) | TrackBacks (0)

That is actually a frequent issue for all married or dating nurses, even staff nurses. Occasionally, as staff nurses at that Big D, we ended up working terrible schedules like that. As a traveler, it is only worse, as you are there to fill in the gaps that the scheduling needs. Jess submitted a schedule and somehow ended up with most of the shifts she asked for. Encouraged, I submitted a schedule, which I think they used as a reference to give me almost the opposite of what I asked for. It's frustrating, but it goes with the territory. We have next weekend off together, three days in fact, and have a lot of options to choose from.

On the other hand, having a night to yourself allows opportunities to do things like go to movies your spouse definitely would not want to go to. I finally was able to see the new Indiana Jones movie. I had dragged Jess literally halfway there until she whined enough about having to see it that I turned around. So, I went to see it one of the nights that she was working. Not only was it a great movie, but feeling shafted by having paid $10.50 for a movie, I snuck into Don't Mess With The Zohan, another movie she wouldn't have enjoyed. Then I ended up going out with other nurses until 4:30 in the morning, which after having her brain drained by two movies she woudn't have enjoyed, she certainly would not have been appreciative of. Not me, though, I had a grand old time.

Last night was my first night in four days, and it set a new record for me. I admitted a patient from the ER who had come in with a temperature of 108.1 F. I'd never seen anyone with a temp that high, much less live through it. He was vented and unresponsive when he arrived, but remarkably awakened (i.e. became combative and annoying) a couple of hours later. I sedated him and quietly ignored the intern's interest in "waking him up," so I don't know how badly he fried his brain. I can't imagine he is going to walk away from this unharmed. Guess he shouldn't have taken heroin and cocaine all on the same trip.

While we haven't made up our minds yet about where to go in August, I did speak to my manager this morning as I got off of work, to see what their position would be for another assignment this fall. While I didn't get a straightforward affirmation that the position would be available, I was happy to hear that they definitely would want me to stay for the position if it happens to be available. I guess that means they won't be firing me.

I have had a very nice four days off. It's great being in a place so accessible to interesting places. People from Connecticut ask me why I came here, since it's so boring. I have found that in contrary it's really a diverse and interesting state, and haven't found myself bored yet. I didn't end up going on the photographer's expedition on Saturday to Mystic, but Jess and I went on Monday, and found that it is a great place. We stayed most of the day in the Seaport, which is an outdoor museum. You hardly notice that it's a museum, however, even for someone who becomes rapidly comatose within hours of stepping into a typical museum like myself. I was so busy taking pictures I hardly had time to even consider it a museum. It's a good place for a day trip.

I had been looking for good scenic areas nearby, and came across descriptions of a 30-mile highway heading north from I-395 to the Massachusetts state line, the Route 169. Apparently, it's described as the essence of New England; stone walls, old churches, quaint villages. Indeed, there were plenty of stone walls, and there were villages along the way. Most were very small, and fairly spread out, though. In addition, there were very few vantage spots, where you could look out over a valley or farmland for photography purposes. The highway itself is lined with tall forests, which I don't find all that scenic. Also, there are no gas stations along the way, and only because this road parallels I-395 as it heads north am I not parked out there still with an empty gas tank. It wasn't all that it was cracked up to be, and I ended up frantically heading down country lanes looking for that perfect vantage point, racing the setting sun. It didn't happen. Then it turns out there's a nearby village, Guilford, is just as quaint picturesque and old, and, even better, is only twenty minutes away, saving me the five hours of driving time. I'm sure there's plenty of villages that embody the spirit of New England that are nearby.

Anyhow, until next time, be safe.

Posted by aloukonen at 12:44 AM | Permalink | Comments (0) | TrackBacks (0)

I'm back at work, but not really at work, per se. The unit is pretty slow tonight, in particular my patients.

We've kept busy these last few days with our social life, which is a primary concern for travelers. I think that a big reason that a lot of nurses don't get into traveling is because they end up leaving their friends to go somewhere where they don't know anybody, and where they have to make new friends. On top of this, it's not that common for staff nurses and travel nurses to become more than acquaintances, because it doesn't make a lot of sense to invest the time and effort to cultivate a friendship with someone who will only be in their lives for as little as three months. Travel nurses tend to become friends with other travel nurses, especially since they can relate to the experiences each other is having, and because there's always the potential of crossing paths further down the road, or even traveling together.

So, it was good fortune that while being floated to the SICU for four hours the other day, I happened to meet another traveler. We talked a little, and it turns out that she lives directly across the hall from our apartment. So, last evening, Jess and I went out for sushi with her and her boyfriend, who also is a traveler. They both have been in the travel world for at least a year, and so could offer us some insight as to what to expect. We had a lot to talk about, and it was good to meet someone like the two of them. I think that Jess is feeling a little isolated, because she's used to having friends at work to hang out with, to call up and talk to, to go out after work with. Here, it's just me, and apparently even that gets a little old after awhile.

We also had a few old friends drop by. My friend Will, who drives a truck, swung through for a night. We may end up seeing a fair amount of him, since he's through the area frequently, as he drives up and down the Eastern seaboard, or even out West and back. Our friend Patty came down for lunch today. She's working in a summer camp here in Connecticut for very sick kids. The first batch of campers comes in tomorrow, so I guess she'll have a lot of stories to tell about that. It sounds interesting, Jess seemed to be intrigued about working there next summer perhaps.

We are still undecided about where we will be going this August, or if we'll be going anywhere at all. The prospect of being able to go anywhere is both tantalizing and daunting at the same time. There are so many interesting places we've thought of traveling to--Providence, RI; NYC; Seattle; Dartmouth in New Hampshire, Alaska, Salt Lake City, Phoenix. It is a little overwhelming, though, to consider that each time that we'll just be starting to get comfortable in one of these places, it will be about time to move on to the next place. There is always the option of staying longer in assignments, but then that limits how many places we could travel to, as we don't want to be traveling for a decade. We've even discussed international traveling, to Europe or Australia. That creates its own dilemmas.

So, in other news, it turns out that traveling has the potential to be quite fattening for me. In North Carolina, I had a routine for jogging, which is how I kept at it. Since leaving NC, that routine has been gone, and so I have only jogged a few times since. Ask Jess, and she'll tell you I'm getting a little chunky(which is what inspired my jogging in NC, as she had no qualms of describing the gut I was developing). I jogged this week for the first time in weeks. It was a tiring experience, but I'm feeling motivated (somewhat) to continue it. I have no excuses; the apartment complex has a great gym, and there is a paved, flat, miles-long pedestrian trail that runs directly by the complex. We'll see how my motivation stands up against my laziness.

I've been adding some nursing links to the sidebar. During the sushi dinner with the fellow travelers, we also talked about travel nursing forums, which are interactive message boards where travel nurses can ask any sort of question or reply. There is a lot of experience and advice to be gained from that sort of thing, which is essential for new travelers. So, I'll be exploring those and posting links to the best of them.

Until next time, be safe.

Posted by aloukonen at 09:10 PM | Permalink | Comments (0) | TrackBacks (0)

I'm back on again after a weekend in Rhode Island.

That was quite a nice visit. Newport is truly a city of rich schmucks, and has been for a good part of its history. This is demonstrated by the proliferation of mansions, huge residences that reek of the greed of the people who apparently only need them a few weeks a year. It's not just the mansions build in the "guilded age," from 1850 to 1900. There are plenty of modern-day mansions dotting the landscape, obstructing the beautiful ocean views and limiting access to the limited beaches. Those things are just as large and much less beautiful than the ones built a century and more ago.

Still, there is a lot of interesting history within the walls of the old mansions. We toured two of the mansions, The Breakers and The Elms. I believe The Breakers is the better known of the two, but I think I enjoyed The Elms if only because they had a recorded tour that you could listen to at your leisure. If you have any interest in the old rich families of America, like the Vanderbuilts, then these are good places to see what their lives were like. Honestly, it doesn't look like it was much fun; even summer vacations were socializing marathons in a terribly competitive society. On the other hand, it's real hard to feel very sorry for these folks.

Newport itself is steeped in history. We unfortunately didn't know much about it, but as we plan on visiting at least Rhode Island again, to check out the rest of the storied shoreline, we'll read more into its history. Saturday was windy and foggy, so visiting the two mansions were good options. We also went to the seaward point's shoreline, a rocky landscape that had big, angry waves crashing one after another. I took a lot of pictures while Jess took a nap in the car. That night, I took Jess out for a very nice seafood meal. Sunday morning, we went back to the beach to see it in dazzling sunlight before heading back to Newport and work.

I came into the Y tonight to a bit of a surprise: they'd floated me up to the SICU for just four hours, until 2300. I didn't mind, though, I was interested to see what it was like. The setup of the unit was similar to the MICU, in particular the layout. I quickly noticed that many of the patients are much sicker. There were some crazy wounds, chest tubes, drains, things that I haven't seen down in the MICU yet. It was pretty interesting. Unfortunately, I only had the four hours, which flew by because I received report, gave all my meds, did an assessment of both my patients, bathed one of them, gave the 2300 meds, counted the output up, and gave report on them both. It was 2330 by the time I finished, just in time to rush down to the MICU and get report on my patients there. In the SICU, both the patients were intubated, heavily sedated, on insulin drips, the works. Really, I wouldn't have minded staying there the night. I'm guessing I'll get floated again.

Back on the MICU, I had an empty room and a patient on just oxygen. The big excitement in that room is putting on a percussion vest. I've kept busy helping other people out around me, others have had loads to do. It was a little sigh of relief coming back down, finding that I know where most of the stuff is and how most things are done here, in the MICU. That's something not to be taken for granted.

Until next time, be safe.

Posted by aloukonen at 02:42 AM | Permalink | Comments (0) | TrackBacks (0)

At any rate, this is a nice town. It has a long history of really rich schmucks building ji-normous mansions for "summer retreats," so everywhere you look, there's some massive relic. The downtown area is nice, though, lots of interesting architecture, wood building dating back to the 1700s. We came in mid-afternoon, so we haven't seen it all, but it's promising.

New Haven is actually a great location to travel to in New England. We have close access to Rhode Island, New York City, Boston, and other areas, and even going up to Maine isn't that far. I hadn't ever imagined that I'd be living somewhere that was only a couple of hours from Newport or NYC. It hasn't really sunk in yet (although it's starting to).

We're both quite happy to be done with the week. For one thing, we finally got paid today, and how great that was. It was pretty awesome to see how well we're getting paid, not to mention the fact that we're not even paying rent or utilities here. Also, it's been a busy week. Jess has been taking care of the sickest kid on the unit, pronounced so by surgeons there, and was even doubled with that patient. She's been pretty worn out by those nights. I'm proud of her.

My last evening, when I wrote the previous entry, went sour about four hours after I'd finished with the entry. I was pretty bored all evening; I even wrote all my notes and had all my charting completely up to date. Good thing, because at four, after being turned, my non-intubated patient suddenly decompensated and quickly went into full-blown pulmonary edema, complete with pink froth and everything. This is where I experienced a sharp departure in the way things are done at the Y and how they were done in the Big D.

First and worst, I had to page the doctor. There are two teams of doctors on the unit, but don't ask me where they are most of the time, sitting in the cafeteria for all I know. So, I paged the doc (an intern--don't get me started on that), and he returned the call quickly enough. I explained that my repeatedly intubated CHF patient had O2 sats in the low 70s and that he should probably come and check it out. Apparently, I wasn't clear enough, or I didn't sound urgent enough. He ambled in fifteen minutes and two pages later, after my patient had gone from comfortable on a simple facemask to barely conscious on 100% O2 through a non-rebreather. Yet he made no decision, instead allowing the resident who actually followed him in to order Lasix, which did nothing. The resident decided then, without further interventions, that intubation was needed.

Granted, intubation was probably inevitable. Still, these doctors should have known that the man's kidneys were useless, and that what had worked for him previously was dobutamine. In hindsight, I wish I'd remembered that I'd discussed his recent dobutamine drip during my report with the day nurse and had brought it up at this point; on the other hand, it's not my job, it the doctor's job to know what has been working medically with patients like this.

At any rate, while nothing else went wrong at this point, it was completely different than what I'd always done up to that point. At the Big D, I'd be busy getting my sedation and code drugs together, as the respiratory therapists and unit doctors prepared to intubate. So, I'm asking the doctors (yes, the idiot intern and his resident friend) what they wanted for intubation, only to get a scornful look. These doctors don't intubate, as it turns out, nor do the RTs. All intubations are done by anesthesia, all of them (maybe not in a code?). So, another five to ten minutes pass, and finally the anesthesia team shows up. Wanting to make myself useful, I positioned myself at the head of the bed with my saline, ready to push drugs. No, not the thing to do, as that only brought me another scornful look.

So, in the end, I just stood aside while it all happened. Even the RT did very little. Granted, it turned out to be a very calm, almost serene intubation, but I always liked the adrenaline rush of a good intubation. The unit team, meanwhile, barely was even aware of the intubation, they sat outside the room on the computer, looking perhaps at CNN, something that was more interesting than patient care. When the paralytic the anesthesiologist used for intubation wore off and the patient's respiratory rate was 45 times a minute, I really had a hard time getting them to write orders for versed and propofol. In fact, I only got a verbal order out of them, and had to get the oncoming day doctors to actually write the order. Needless to say, I wasn't too impressed with this team, as in, what Caribbean island did you get your medical degree? WTH?

Anyhow, I left the room, the charting, everything, a monster mess. I tried to get it all together, but this happened right at a quarter after six, and I couldn't finish everything. I probably didn't make good friends with the oncoming day nurse. All in a day's work, I guess...

Anyhow, it's just nice to have it over, to be in a different place, even different state. Really, the nice thing about traveling is even when you find yourself in a big cluster, it's only a matter of time (thirteen weeks or less) until it's all over and you walk out of the place free and clear. Unless you get fired, then there's even less time.

Not that I want to get fired. No, I hope that doesn't happen.

Until next time, be safe.

Posted by aloukonen at 09:41 PM | Permalink | Comments (0) | TrackBacks (0)

It's crazy. It feels like we just started (which I guess we did), and yet we are already three weeks into our 13-week contract. That means only two and a half months remain before we either re-sign here at the Y or go to another contract. I remember how fast the last two months at Big D went by, and I can imagine that these next ten weeks aren't going to last long. We're already having to think about where we want to be by early August, and even in January (we're hoping for Phoenix for that time of the year). I guess that is part of the job, continuously preparing yourself for the next stop.

I've spent the last week taking care of stable doubles, which for non-nurses means two patients who are stable for the most part. I've kept hopping, if nothing else because of busy work. I've already had several alcoholics, reminds me of the Big D and my typical patients there. I've had the crazies trying to get bed, the big folks cyring in the middle of the night because they're starving. Yeah, it's like being at home.

Last night, though, I finally had some actual sick patients. I even had a patient on a ventilator, something different than what I'm used to. Same tonight, I can't believe they'd let me have two vented patients in a row. Thing is, here they don't like to give sedation to their vented patients, which just makes me cringe. So I maxed out my PRN meds last night, and tonight I started my patient on Propofol, the nectar of the gods. They're a little more comfortable thanks to my nursing concerns.

I'm staying surprisingly busy these nights, each night steady all the way to the end (with the exception of tonight, of course), even with fairly simple patients. I think the real issue is supplies, as I have said before; not knowing where things are can slow me down tremendously. Also, procedures are different here, and I have to approach them more slowly. Finally, there is no IV team, so I find myself spending a lot of time practicing putting in IVs, which I'm terrible at.

Jess is having her issues as well, in particular that she feels that she is very dependent on her coworkers. I have to convince her that it's not a bad thing to have to ask a lot of questions, especially with a single eight-hour orientation shift to prepare us for our units. She's doing fine, though.

Our two night trip to Rhode Island is coming up quickly (this Friday). I'm finishing my 5th shift in a row tonight, then Friday we head to the smallest state. We'll spend two nights in Newport, which from all descriptions is a great little city. Everyone seems to have something good to say about it. We're pretty cheap, though, since we've yet to receive our first paycheck, so it's looking like we'll be camped out at the HoJo or maybe Hotel 6. Even those places are more than $100 a night. B&Bs are in the $200 and greater range, especially those that allow dogs.

Another cool trip is in early June. I've joined a Meetup group for photographers, and a ton of people (photographers and their families) are meeting in Mystic, CT, for a big shoot. These meetup groups are great ways to meet people in the area. That will be a lot of fun, I think.

Until next time, be safe.

Posted by aloukonen at 11:15 PM | Permalink | Comments (0) | TrackBacks (0)

So, I've finished my first week off of orientation. For the most part, it's been fine. I haven't wiped out anyone, and there haven't been any bloopers or blunders yet. Although during all three shifts, I felt as though I were completely discombobulated and rushing around like my head was cut off, looking back it wasn't all that bad.

Probably the most difficult issues I've had to deal with was finding stuff. This might seem like a minor detail, but it's huge, really. Patient care is often the same no matter where you are; assessments, med administration, all that jazz is pretty much going to be similar regardless of the unit. However, when you can't find the most basic supplies to do the most basic procedures, it puts you back considerably in time.

Paper charting is also difficult. I'm getting the hang of it, but frequently someone comes up and points out that I've not been charting an entire section, or mischarting. Really, paper charting cuts down on the amount of charting to be done; computer charting allows much more anal charting. My hand hurts after writing a bunch of pointless, never-to-be-read nursing notes by hand, though.

The folks on my unit have been particularly helpful. I haven't felt isolated or left to myself, as I've always had people around me who are willing to assist. It's been great. I haven't met any younger people to hang out with, not that I'm really expecting to. Travelers don't often become particularly good friends with staff nurses, it seems, if only because of the short time that they will be spending on the unit. Still there are some cool people, who have offered up advice on where to go and what to do in this area.

Speaking of this area, Jess and I took our first day trip. Some friends of mine was in NYC for the week, so we went to see them. We were pretty excited to go to NYC, but it started raining as soon as we arrived. We did our best to enjoy the day, even though it was pouring until around 5 pm. We ate some excellent Indian food at a little cafe, we dunked through the rain to a few different bars and coffee shops. We sat and people-watched in Grand Central Station. Eventually, the rain stopped and we walked through Times Sqare down to Penn Station and Madison Square Gardens. I didn't manage to meet up with my friends due to complicated circumstances conspiring against that, but it was still a good trip. Even better, it only took an hour and forty-five minutes by train.

I've also gotten some fishing in. I had to go down into the New Haven ghetto (yes, it certainly exists) to find a bait shop that is open, but then I was able to fish off a small pier for free. I managed to catch a 12-inch striped bass, which is less than half the size they allow you to keep (I kept it anyhow, since it was my first fish up here; I tried to eat it, but that went badly). I should get in some more fishing later this next week.

This morning, I'll get some sleep after I get off of work, then Jess and I are touring the area around New Haven. We are planning on getting lunch at a nice place, then maybe going on a wine tour. We have most of next weekend off, so we are planning on visiting Rhode Island. That will be a great trip. Even better, we'll get our first paycheck in a month and a half on the 30th. That will be superb (it's a little tight right now).

Posted by aloukonen at 06:13 AM | Permalink | Comments (0) | TrackBacks (0)

We had Sunday off, which we spent checking out the New Haven area, visiting the Yale campus, that sort of thing. We hadn't moved into our apartment yet; due to a housing issue, the apartment wouldn't be ready until that following Friday. In the meantime, we were put up in a first-class hotel suite, complete with a huge flat-screen TV and a full kitchen.

For my first piece of advice to potential and practicing travel nurses, always tell everyone who asks (the travel agency, your recruiter, any housing folks) that your dog weighs under 50 pounds, no matter how much they weigh. Obviously, if you have a 150-pound dog, you may want to consider a smaller dog, because you won't get away with it. Our dog, Zuri, weighs somewhere between 50 and 60 pounds. Unfortunately, this was over the 50 pound arbitrary weight limit set by the apartment. It doesn't make any sense; after all, a 5-lb mini turd-dog can shred furniture and excrete an apartment to a premature remodeling just as fast as a 55-lb dog. Anyhow, Jess had mentioned Zuri's weight issue to our recruiter, and the apartment complex they normally put travelers in was putting up a fuss about her weight. So, Zuri went on a Photoshop diet; I changed her weight on her last vet form to 48.5 from 68.5 (which wasn't accurate anyhow), faxed the form to our recruiter, and suddenly we had an apartment waiting.

My second piece of advice is that your recruiter is the single most important decision you'll make as a traveler. If you have a good one, things will get done. If you have a bad one, they won't. If you have a great one, then everything will get done almost in miraculous form. Your choice in recruiter is more important than the company your choose to go with. If you are looking for a recruiter, I would definitely recommend ours, Dee Leon with Crosscountry. Just tell her we sent you over.

Anyhow, we started our orientation that Monday. It was an excruciating experience. Corporate hospitals literally can talk about how great they are for days on end. They brought in vice presidents to talk about the "Y Way"; they had three hour classes about diversity, customer service, all that needless junk. My favorite part was a horrifying video about being a customer service star. Essentially, they showed some poor Downs kid working as a bagger at a grocery store, who through impossibly PC mumbo-jumbo pleases all the customers and brings in tons of happy business. In other words, when it comes to customer service, if the retard can do it, so can you!

So, we endured three and a half 8-hour days of hospital orientation before we even set foot on the unit. Jess and I tossed down $600 for three months of parking, which fortunately will be reimbursed. I learned an archaic computer system that will be replaced in two weeks. Yet, everytime I started to grumble, I remembered the loads of money I was being paid to do it, and that I hadn't had a paycheck since early April, and it all seemed better.

Finally, I found myself on the unit. It turns out to be a great unit; the people seem nice for the most part, and helpful as well. The rooms are big, and it seems quite modern. Of course, having spent the first three years of my nursing career in a single place, suddenly being outside of my known territory (in terms of knowing where supplies and equipment were, the codes of the many locks and safeguards, even where a bathroom was) shocked me a little. Probably the most immediate issue was the fact that this particular unit (and hospital) have paper charting, where I was used to computer charting. While there seems to be considerably less charting with paper charting, it isn't nearly as quick and easy to do as computer charting. A big difference was that there was only one assessment area for the full day, rather than for each four hours. Any changes simply were added to previous notations. That was a bizarre concept for me to grasp.

Anyhow, I only ended up with around 12 hours of orientation before I started working. I had a full 8-hour day shift where I figured out a lot of the protocols and ways that things were done on the unit. By Sunday night, though, I was in the numbers and working independently, although I had a designated helper should I need assistance. Having only a day of orientation felt a little alarming, but It seems like everyone is helpful enough on the unit that I shouldn't have too much trouble.

Sunday night was interesting, but that is another post. I have to hit the sack in order to get up in the morning and go to NYC (the real reason we're up here in New England, to check out all these great places).

Posted by aloukonen at 01:29 PM | Permalink | Comments (0) | TrackBacks (0)