By Nina Mosely

October 3, 2018

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Unveiling AGNP-C: A Comprehensive Guide to Adult Gerontology Nurse Practitioners

While most people are familiar with the term FNP (Family Nurse Practitioner) at this point in time, when approached with the title AGNP (Adult-Gerontology NP), it can get a bit confusing. By the name alone, you would think that this designation deals with geriatrics, which is the treatment of elderly patients.

However, that isn’t always the case. Although an AGNP may specialize in geriatrics, they may also deal with patients ranging from adolescents through all stages of adulthood up to and including geriatric patients. From there, it can get even more confusing because there are also two different focuses in an AGNP degree. If you are looking at Nursing School Programs, this might be a career goal for you to pursue.

Two Different AGNP Credentials

As an advanced practice nurse, the first thing you need to know is that you are required to have a BS in nursing prior to attending graduate school. Many applicants to an AGNP program have worked as an RN for several years before pursuing an advanced degree. As an AGNP, you can specialize in acute care or in primary care, and the focus is totally different in both designations.

With a specialization in acute care, you will most often be working with inpatients at hospitals. These AGNPs focus on treating patients who are ill. As a primary care AGNP, you will be focusing on a patient population who aren’t usually ill, and your focus will be to keep them well. This is just a broad understanding because as a practitioner, you will be treating ill patients who see you at your office, but they will not be considered acute care patients until they are admitted into a hospital.

Addressing the Confusion in the Nursing Designation of AGNP

Once someone sees the words gerontology or geriatrics, they assume this nurse practitioner only deals with the elderly. Since they will be licensed to see patients from adolescence onward, the only patients an AGNP will not deal with are infants and children up to adolescence. Younger patients would see an FNP, and that Family Nurse Practitioner may, or may not, specialize in children.

The Role of an Adult-Gerontology Acute Care Practitioner

Since you know that an AG-ACNP (Acute Care NP specializing in adult-gerontology) deals with patients in a hospital setting, the focus of your training will be on:

  • Stabilizing the patient’s condition
  • Preventing any complications
  • Restoring maximum health
  • Providing palliative care

This is according to the Adult-Gerontology Acute Care NP Competencies, as established by the American Association of Colleges of Nursing. Tasks may include such things as making a diagnosis, prescribing medications, and monitoring the patient throughout his or her stay in the hospital. Upon being released, an AG-ACNP may also make referrals to specialists as needed.

The Role of an Adult-Gerontology Primary Care Nurse Practitioner (AG-PCNP)

While an AG-ACNP will focus on treating inpatients, an AG-PCNP will primarily focus on keeping their patients well with an emphasis on promoting healthy choices. AG-PCNPs may work in clinics throughout the community, but they may also carry on their own private practice as well.

The focus of an AGNP in a primary care setting will be to improve outcomes within the population they have chosen to serve. They may be required to manage chronic illnesses, as opposed to acute care AGNPs who focus on helping their patients recover from acute illnesses of abbreviated duration.

Bringing Your Nursing Skillset Forward as an AGNP

As an increasing number of people within the general population begin understanding exactly what an AGNP is and what it is they do, many more nurses will be needed to fill these two roles. At the time, the AGNP designation is somewhere in the shadow of an FNP simply because most people equate the designation with the treatment of the elderly.

Perhaps when this confusion is better addressed, those nursing skills that made you who you are will be in high demand as an AGNP. Consider for just a moment how most patients describe their doctors. You usually won’t hear them talking about all those letters behind their titles and you won’t hear them talking about the rapidity in which they made an accurate diagnosis. For the most part, you will hear patients describing their doctor’s “bedside manner.” As a nurse, you have what it takes to communicate on a better level with the patients you see.

It would be nice if medicals schools required their doctors to work on the floor with patient care before licensing them as medical doctors, but, that will never happen. Some doctors have a special personality that helps them engage well with patients and others are simply too busy being a doctor. As a nurse, you have learned both sides of the fence and that is what you can bring with you to this new level of nursing. If your primary focus is on adolescents and adults of any age, an AGNP degree is for you.

If you are a new travel nurse or looking into becoming a travel nurse:

Travel Nurse Guide: Step-by-Step (now offered in a PDF Downloadable version!)

By Bianca Festa

October 1, 2018

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What To Do While On Assignment In The Sunshine State

Being a travel nurse, you’re always on the move. It can be exciting and refreshing to pick up your stuff and stay in a place that maybe you’ve always wanted to go to or go somewhere that you didn’t really expect to go to, but you thought, “Hey, why not?”. While you’re living in your new home, you’re going to learn a lot about the new place you’re staying at and doing a job that’s making a difference in people’s lives!

sunshine state

For some Travel RN’s, the thought of what to do or see when you’re in a new location may cross their mind. If you’re a Travel Nurse who’s on assignment in Florida, the sunshine state, here are some fun things to do and places that are worth a visit:

 Duval Street, Key West

Duval Street is located in downtown Key West Florida and by day, it’s a fun place to shop with something for everyone and offers boat tours. Also, only a few minutes away, is the Southernmost Point Buoy where people come to take a few pictures (and some selfies) at the Southernmost Point of the continental U.S. As the evening approaches, Duval street comes to life, and the variety of restaurants and famous bars are full of people who come to eat delicious meals, listen to live music and enjoy themselves.

Walt Disney World, Orlando

For those RN’s who want to let their inner kid out, welcome to the magical world of Disney, aka the happiest place on Earth. It’s composed of four different parks, so there is something for everyone. Magic Kingdom is the heart of Disney and has almost all the characters shown in Disney movies and has multiple rides. Epcot is where you’re able to experience a bit of the world in a day. 11 different nations are featured in this park so that visitors can learn and experience the culture of each place. Animal Kingdom features nature, animals, and pre-historic life with attractions and simulations. Hollywood Studios is that last park, and when you walk in, it feels as if you are on the set of different movies depending on where you are. In addition, every night, each park has its own firework show! A great option for a sunshine state city to take an assignment.

Wynwood, Miami

Wynwood is one of those places that someone has to visit while being in Miami. It’s known as the art or fashion district, so art covers most of the walls and is also scattered on the sidewalks. Street artists worldwide come down and create their masterpiece, which is influenced by all different types of cultures. There are art galleries, bars, unique restaurants, and one-of-a-kind boutiques seated in the area.

City Place, West Palm Beach

City Place is a hangout area where individuals and families eat at various restaurants and shops. For those who don’t want to have a whole dining experience, City Place has some places where you can grab a snack and relax. Also, there’s a large movie theater located in City Place. If you’re not really in the mood for a movie, there’s a not-for-profit art center that’s walking distance from City Place. There is a schedule on the Kravis Center website that shows what will be going on, on certain days. Some of the showings include ballets, concerts, plays, and orchestras.

Flea Masters Fleamarket, Fort Myers

For those who want to spend some time finding unique treasures, the Flea Masters Fleamarket is open Friday to Sunday from 9 AM to 5 PM. It’s an indoor and outdoor market where you’re able to buy almost anything, eat, and drink. Also, on certain days there’s some live music.

 Riverside Arts Market, Jacksonville

The Riverside Arts Market is open every Saturday from 10 AM to 3 PM with a selection of fresh produce and one-of-a-kind pieces. Each purchase allows you to support local small businesses and individuals! In certain months you’re able to participate in morning yoga or take a bike ride.

 Busch Gardens, Tampa

For the adventurous ones out there, Busch Gardens is a must. Visitors can see different animals, go on a safari tour and ride some thrilling roller coasters. There are different dining options and shows available for those who still want to experience an amusement park without the adrenaline-filled rides. It’s a place for all ages to enjoy!

These are a few things that you should check out and do while you’re in the sunshine state! Hopefully, you can visit a place or two and even make your own discoveries. For more information on Travel Nurse jobs in the sunshine state (Florida), check out the job page on The Gypsy Nurse.

By Health Providers Choice

September 25, 2018

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Travel Nurses: What To Do About A Toxic Work Culture

This article is provided by: Health Providers Choice.

If you’ve dealt with a toxic workplace, you know how quickly passion can turn into dread. Unfortunately, bullying doesn’t stay confined to the schoolyard. Today, even adults are known for this type of harassment. However, their tactics are often more refined. Bullying is usually the leading cause of a toxic work environment in health care facilities. For travel nurses, toxic environments can feel particularly stressful.

The environment

Sometimes bullying occurs overtly, like when someone shows hostility. Other cases of bullying happen when the victim isn’t present to fight against it. Some workers describe being “thrown under the bus,” or blamed for mistakes that they didn’t make.

Workplace bullying has become relatively common in health care. One survey asked health care workers why they quit their jobs, and nearly half cited abusive behavior. Travel nurses in particular can become easy targets. Resident nurses may feel threatened by travel nurses. Some may think of travel nurses as “outsiders.” Every workplace has its own culture, and when a travel nurse has to learn the culture, other people in that workplace may be quick to point out mistakes.

☣ The impact of a toxic work culture ☠

As a travel nurse, your job is already stressful and emotionally charged. It carries so much stress that you certainly need a supportive environment. How can you find respite when other nurses and physicians want to add more stress to your workload? A toxic environment will erode your self-esteem, confidence, and attitude. In fact, stress can even impact your physical appearance and the way in which you carry yourself.

These changes rarely go unnoticed by your patients. They even feel residual stress, especially since many of them have to deal with stressful situations of their own. Furthermore, it causes you to have far less care and focus than you should have while caring for your patients. The results of this can be detrimental in many cases.

A few solutions

As a travel nurse, you have options to help you deal with toxicity. First, distance yourself from the problem. Of course, the term “distance yourself” doesn’t mean ignoring the problem. Instead, firmly let the bully know that you won’t play games, and then only interact with this person if you must.

Second, maintain positivity. Bullies thrive on control and they love knowing that they affect the surrounding environment. When you stay positive, you take away their control which helps everyone in the workplace.

Third, focus on your patients. Remember why you pursued nursing in the first place. This tactic helps you provide the care that your patients need. It may also remind you of all the things you enjoy about your job rather than all the difficulties.

Fourth, give yourself a mental detox. Think about why you chose your location. Did you take a job in the Pacific Northwest for the hiking? Take a hike on your day off. Did you move to a big city because you love culture? See a musical. Avoid burnout by enforcing a no-work policy on your off days. Time off is for rest, not for thinking about work.

Finally, keep in mind that you don’t have to stay forever. If you want to leave after your assignment, then, by all means, tell your recruiter. Sometimes the promise of change is enough to help you power through your current situation. Furthermore, your recruiter is also your advocate. If a situation has become overwhelmingly toxic, do not hesitate to tell your agency.

Toxic workplaces do exist and working in one can affect your morale. Just because you are a travel nurse doesn’t mean you have to put up with a toxic environment. By taking steps to protect yourself, you can make the most of a difficult job until you can finally move on.

By Jeffery Williams

September 22, 2018

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How to Take Care of Your Teeth on the Road

Being away from home is rough. On top of living remotely and dealing with distance from family, friends and loved ones you quickly realize simple tasks can be much more difficult away from home. Oral care is one of those, but dismissing it for 13 weeks simply isn’t an option. Below we’ll look at some handy tips to keep your smile in shape as you travel the world.

Avoid the Temptation: Don’t Give in to Junk Food

Eating right at home is tough enough. Doing it on the road is even harder. Depending on your accommodations, cooking for yourself might not even be an option and with long hours, the temptation for tasty but greasy fast food flares up.

We all know regular, proper brushing is essential to a healthy smile, but we often forget that diet is equally as important (if not more) to healthy teeth. Our teeth lose minerals over the course of the day due to the activity of bacteria in our mouth; our teeth rely on the nutrients in our food to restore the minerals lost during the day, which strengthens the enamel and protects the dental tissue. The most important nutrients for our teeth are found in fruits and vegetables, but unfortunately not in the simple and easy fast food you’ll find yourself presented with on a regular basis.

Injecting some fruit and vegetables into our diet regularly will not only help your waistline but it’ll help your gum line too. Challenge yourself to eat at least one vegetable per meal or at minimum choose the healthier of the two options you’ve got in front of you. Also, don’t forget the power of meal prep Saturday/Sunday. Even if you don’t have a great kitchen, a little bit of prep for the week can go a long way.

Get an Electric Toothbrush

Let’s face it: mornings can be hectic. Sometimes that extra minute of brushing is the difference between late or on-time and even if it isn’t, getting your not-yet-awake-zombie self to take proper care of your teeth can be tough. And that’s only if you get a morning, which oftentimes doesn’t even happen.

An electric toothbrush helps with this in two ways. First is the timer. Nearly every electric toothbrush on the market comes with a built-in two minute timer to ensure you’re brushing for the dentist recommended 120 seconds. Yes, an iPhone timer works just as well but it’s an extra step in the process and often times that gets left out in the wee hours of the morning, especially if you’re trying to multitask. Having that built-in timer makes things just a bit easier.

The second is technique.

Brushing properly with a manual toothbrush isn’t as simple as some people think. Using an electric toothbrush takes all the guesswork out of technique and is nearly guaranteed to give your teeth an excellent clean time and time again. Being on the road working crazy hours can cause you to forget or skip brushing sessions. Making sure that each time you brush you get a perfect clean can be the difference between healthy teeth and significant tooth decay.

If you spring for the fancier of the brush options you start getting some really cool perks like sonic brushing action, quadrant timers, and advanced brush modes. These often aren’t necessary for keeping your teeth clean, healthy, and white, but they can make the process a bit easier and more effective.

If you decide to up your toothbrush game with some electronics, make sure you remember to bring along an extra brush head. Brush heads for electric toothbrushes need to be replaced every 2-3 months, which will likely be a bit shorter than your time on the road.

Remember The Dentist

Constantly being on the road makes it really easy to forget your twice-yearly dentist check-up. If you don’t go when you’re home, you’re probably not going to go when you’re out on assignment. As such, it’s crucial to make sure you remember to schedule your visit when you’ve got time. It’ll only take an hour and it’ll ensure that your teeth are clean, strong, and in working order.

Smile More

Our last piece of advice isn’t focused on protecting your mouth but rather using it. Being away from home is difficult, working long hours is stressful, and living in a new and different place can be ostracizing. The life of a traveling nurse can be incredibly tough sometimes and it’s important to remember to find happiness wherever you can.

And smiling more isn’t just about trying to be happier or finding delight in unexpected places. Studies show that the more you smile, the happier you are. It’s not the result of happiness as much as it’s the cause.
There’s no doubt this can be tough sometimes, but if you’re a traveling nurse, you’re likely used to a challenge.

Conclusion

Even though you may have a lot of other things on your mind while you’re roaming the globe, it’s still important to take care of yourself, and your oral health is part of that. There are a lot of dangers for your teeth that are inherent to the travel lifestyle, so follow these tips to keep your teeth and yourself happy and healthy!

By cheryl hurt

September 11, 2018

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So, You Want to go to Nome Alaska?

Guest Post By: Cheryl Hurt, co-written by: Kimberly Richter

alaskan travel nurseBeing an Alaskan travel nurse is an exciting and unique experience. Here are some tips from travelers that are or have been to Nome. These tips will help you prepare and know what to expect on a contract in Nome, Alaska.

Orientation

Hospital orientation is generally four days long. The first two days are focused on standard hospital business and Native Alaskan Culture. Day 1 your badge photo and fingerprinting will be done.(yes, you will have your fingerprints taken at the hospital)  Lunch will be provided for you.

Day 2, you will visit the cultural center in the afternoon and have the opportunity to try Eskimo salad (something that you really should try) or Seal.

Day 3 Healthstreams (Yikes, there are 44). Dress for days 1 and 2 are business casual. Days 3 and 4 are scrubs. This is only a guide and not set in stone as each department has its own schedule.

Tips and Suggestions:

Housing Tips

  • Nome is a very walkable town. Plan to walk!
    Cabs are available for $4 one way in town. (the town is not big!)
  • Housing is corporate female shared housing or Male Shared housing, No Co-ed, so plan on being a great roommate and respect each other.

Shipping and Mailing Tips

  • Ship as much as possible in flat-rate shipping boxes that you can get from the post office. You will ship them to:

(your name)
113 W. Front Street
Nome, Alaska 99762-9800
(This is general delivery at the post office)

  • When shipping items, remember the postal service is not gentle with packages. Pack accordingly.
  • There is a waiting list for P.O. Boxes. If anyone is going to ship items to you, use the address above and have them notify you when items have been shipped.
  • Remember, if you are landing on a Saturday or Sunday, the post office is only open M-F from 0900 – 1700. Make sure you have the essentials for the first few days.

Supplies / Food / Etc.

  • Food is expensive; gluten-free is even more expensive. There are only two grocery stores; Hanson’s and ACs.
  • Meal prepping is essential. The food here is expensive (12 oz. bag of fresh green beans is 4.99, Bananas are 1.29/lb., Strawberries/Blueberries 6.00-10.00). This also reduces wasted food. In words given to me, “suck it up and forget about the price tags.”
  • Restaurants are expensive. There are only a few. I highly recommend the Gold Dust Saloon at the Nugget Inn. The food and drinks are delicious. They serve sushi (and more) and have trivia on Thursday nights at 1900. The Polar Cafe is another great choice. They have a great breakfast.
  • Paper towels, toilet paper, spices, aluminum foil, zip-lock storage containers, and zip lock bags, etc., are expensive as well. Ship as many of these items as possible. (The items I shipped were items that I knew I would use and not have to ship back home at the end of my contract).
  • Ship teas/coffee; these too are expensive. Along with your favorite water bottle, tea/coffee cup.
  • Amazon Prime will be your best friend for toilet paper, paper towels, and non-perishable food pantry items. OR for anything, you have forgotten at home.
  • Reusable grocery bags are essential. This will keep you from buying more than you can carry while walking unless you want to pay for a taxi which is $4 one way in town.
  • There are no “Dollar Stores” in Nome.

Packing

  • Mud Boots (i.e., Bogs, Muck Boots, Extra Tough Boots) are also a must in Alaska. There is only approximately 1 mile of paved roads; all other roads are dirt/gravel. There is a lot of mud when it rains, and you can walk in the surf (my favorite part).
  • Bathing suit for the Suana, which is located in the Rec center.
  • Sunglasses: Lots of sun into the wee hours of the night and back up in the wee hours of the morning. (It does not get dark during Spring and summer)
  • A good raincoat. Why? It rains, and you will inevitably be walking in the rain. We walk here regardless of the weather.
  • Ear Band, Gloves, Hat, Scarf. It still gets cold even in June. Not to mention the wind and rain. You will want to go outside, explore and enjoy the pristine beauty of Alaska and stay warm doing it.
  • A good knife (particularly a pocket knife or survival knife for cutting things.)
  • Lunch Bag — Obvious reasons. The cafeteria is tiny with limited hours. Restaurants do delivery; however, they charge at least 8.00 as your food is delivered by taxi.
  • Ship or pack vitamins, medications, and supplements-you most likely will not be able to find them here, and if you do, they will be expensive. The exception to this is some over-the-counter medications and vitamins are available at the hospital pharmacy, and they are cheap (i.e., a Bottle of Tylenol 2.00).
  • Chargers for phone, tablet, laptop. Also, make sure that if you are bringing electronics, you put them in your carry-on. Airlines are not gentle by any means with luggage.
  • House Shoes – floors get sandy/muddy.
  • Bath towel, hand towel, and washcloth. They should be provided, but just in case.
  • A notebook – Sometimes, you just want to write/journal.
  • A good book – There is a beautiful library. It is located at the cultural center.
  • Bring clothes you can layer. Some days it actually does get warm, and most structures (houses, apartments, restaurants, hospitals, etc. are kept warm).

Other

  • Wells Fargo bank is here and a local credit union.
  • Money-Cash is nice to have, especially if you have to take a cab (they do not accept credit/debit cards). I brought 50.00 in singles. Everywhere else accepts credit/debit cards. ATMs are available.
  • Make sure to notify banks of your travel. The worst thing that could happen is they block/lock your card because they thought someone had stolen them. Contact your credit card companies as well. They usually do not block/lock cards without notification unless you are leaving the country.
  • Check with the wireless service providers to see if they have service coverage in Nome. GCI is the provider here in Nome, but it is expensive. Trac Phones are available, and I’m told that they get good service. I have Verizon, and I have had ok service so far. (Turn your phone off and then turn it back on when you get to Nome.)
  • Nome is Rural! You cannot drive to Nome as there are no roads that lead to Nome. 2 roads go about 50 miles out east and west. Fly in and Fly out!
  • You can rent a car, but it’s very pricey, like 175.00-200.00 per DAY.
  • There is a movie theater in Nome, Sundays at 4 pm are $9.00 (it’s in the Subway.)
  • You have to have a fishing license to fish in Nome, Alaska. I think they said it is $150.00/175.00 for the season for nonresident/non-Native.
  • Animals- Musk-ox, Moose, Bears, Reindeer, Eagles, Huge Ravens. Polar bears are rare in Nome. We have found a baby seal on the beach. You might see Beluga whales passing thru, but with the position of Nome, it’s Rare, they say.
  • Do Not bring a firearm as they are NOT allowed in Corporate housing.

Things that others have shipped OR put in an extra suitcase and paid for the extra baggage:

(believe us, it’s worth the extra fee!)

  • Spices/Salt and Pepper
  • Oatmeal
  • Shampoo/Conditioner
  • Body Soap/Lotion
  • Razors/Shaving Lotion
  • Qtips/Dental flossers
  • Dish Soap
  • Hand Soap
  • Laundry Detergent/Fabric Softener
  • Toilet Paper/Paper Towels
  • Crackers Cereal
  • Feminine items
  • Hot Sauce/Condiments
  • Canned Tuna
  • Canned Chicken
  • Protein Powder
  • Dry packaged food
  • Zip-Lock Storage Container/Bags of various sizes.

***Tips- Place plastic wrap under lids of liquids to keep from spilling. If you have a Food Saver, seal liquid containers. If not possible, place liquid containers in Zip-Lock bags.

Did I mention you will be walking everywhere?

alaskan travel nurseMost importantly…

Bring an open mind. When you are flying into Alaska take in the beauty of this land from the sky. It is gorgeous! But wait until you land; then it becomes breathtaking!

Directions for once you have landed:

At the first opportunity, stop and take it all in. “Shut your mouth (sorry, be quiet), close your eyes, take a deep breath and let it take hold of you. Listen to the sounds, feel the warmth of the sun, the gentle breeze of your skin, smell the world coming to life around you and taste the saltiness in the air. Take a deep breath and open your eyes-she “Mother Nature” has never been more beautiful.”

Alaska will change your life if you let it.

Words cannot describe the majestic beauty of this land/sea. The culture and the history are intriguing. The unspoiled and untouched lands are home to some of the most beautiful animals.
Finally, you will have arrived in one of the most amazing places on earth. Keep an Open mind and enjoy Nome. But be careful. A lot that lives here was once travelers and fell in Love with Nome. There is No Place like Nome!

P.S. Don’t forget scrubs, stethoscope, trauma shears, a watch etc. as you will be expected to work a little. So, You Want to go to Nome Alaska?

By The Gypsy Nurse

September 8, 2018

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The Art of ER Triage

Guest Post By: Richard D Ramsey

Triage is quickly becoming a lost art.

The Art of ER Triage

For those of you who don’t know, triage is the art of adding degrees of urgency to medical matters. For highly trained medical personnel, it’s a rapid process.

I can look at a room full of about 50 people and tell you if any of them are critically ill in about ten seconds. It’s the way ER nurses are taught to think and process information. Secondarily, we’re trained to take vital signs and ask the right questions to determine if a medical matter deserves immediate attention or not.

But, this skill is being eroded under the paradigm of patient satisfaction, that grim specter that’s killing healthcare from the inside out. Let me take you back to an emergency room twenty years ago. You go to the ER for whatever is ailing you, and the first person you encounter is the triage nurse. This person makes note of your chief complaint, takes your vital signs, and gives you a quick once over. Your treatment plan starts right then and there.

Emergency Rooms aren’t just spaces with cubicles. They’re set up in verities of ways to accommodate different needs. In fact, most ERs have minor care areas where you can be seen for bumps or bruises without having to compete with the critically ill. Also, they have different rooms with capabilities. Some rooms are larger than others, giving more room to work on more critical people. Some rooms have oxygen, some rooms have toilets, and some rooms are even better suited for pelvic exams. In a majority of hospitals, rooms are assigned to nurses in bundles. When a nurse comes on duty, they’re assigned a bundle of rooms, and they rotate patients in and out of those rooms throughout the day.

The triage nurse and the charge nurse (which is my role in the ER) must have a good working relationship and line of communication. Together, we determine where patients can be placed to maximize outcomes and efficiency. Knowing my team of nurses is important in determining this. I need to know everyone’s experience, particular skill set, strengths, and weaknesses. These factors are an important part of where I’m going to place you in the ER. Sounds logical, right? You would think so.

Let’s skip forward to today. Third-party payer systems (Medicaid, Medicare, insurance, HMOs, etc.) have warped competition between healthcare companies. When you choose which gasoline to put in your car, you usually chose the cheaper option. That’s why fuel stations post their prices on their signs. With emergency care, you don’t care how much it costs. Your third-party payer covers it, and you’re just responsible for the copay. Even if you’re not covered, you can still be seen and opt to get a bill in the mail. There is NO INCENTIVE for hospitals to lower their cost of goods and services. I’ll say that again. There is NO INCENTIVE for hospitals to lower their cost of goods and services.

So where does that leave us? Hospital A still wants your business over hospital B. So, how do they compel you to use their service over the competition? Simple, they’re going to gratify you.
There’s so much we could discuss about how the paradigm of patient satisfaction has changed healthcare, but we’re here to talk about triage. Remember the triage nurse we were talking about earlier? A recent development in the race to the bottom of patient satisfaction is called immediate bedding. Immediate bedding is exactly what it sounds like. You walk into an ER and they immediately place you in a bed. This has come about as a result of satisfaction metrics, like “door to doc” time. That’s the time it takes you to see a doctor after you walk in the door. Metrics just like that are the new driving force behind how healthcare is run. This has even become such a big deal that Medicaid and Medicare reimbursement is being attached to it under the pretense of “quality indicators” as implemented by laws like Obamacare.

Just look at the billboards in your hometown. Signs that tell you how long the wait at Emergency Room X is have sprung up left and right! This sounds like a great plan, and in some respects, it is. It’s practical to get patients in front of doctors faster. That is why they come to the ER, and we shouldn’t arbitrarily hinder that process. But, the devil is in the details. When we “immediate bed” patients, we’re not taking those critical five minutes to find the best place for them so we can maximize outcomes for everyone. A child with an earache is placed immediately in a critical area because that’s where the open beds are poor stewardship of resources, and it’s highly inefficient.

In the dawn of the 21st century, when people are living longer, and those with chronic illnesses are surviving them, our ER clientele as a whole is getting larger and sicker. Skipping steps in their health care plan to improve satisfaction metrics is both inappropriate and dangerous. Be relieved if you have to wait a few minutes in the ER. It’s the people that go ahead of you that are in the worst shape. They had a competent triage and charge nurse that made that decision based on objective data.

About Richard Ramsey:  I’ve been in nursing since 1995 and full-time ER since 2000. I live in Deep East Texas with my wife and my teenage son. As well as nursing, I play music, write (having many fiction books published) and appear on TV shows from time to time; most notably “Untold Stories of the ER,” where I wrote and acted in episodes for seasons 9 and 10.

By The Gypsy Nurse

August 29, 2018

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A Traveling Family

The following is a Guest Post via Jenn

Many of us wonder what it’s like to travel with Family.  I can’t tell you how many times a staff co-worker will say to me ‘I wish I could travel like you but I have a family.’  Jenn is a great example of a Travel Nurse with a Traveling Family.  Jenn agreed to answer some questions for me about traveling with family.

How long have you been a travel nurse?  
 I have been traveling for the past 5 yrs. I usually stay close to home and just go do my days and drive back home and work my per diem job full time as well. In the past, my family has come to visit but never to stay. 

This summer I ventured to Cali. A friend wanted to do it so we did. I have had my CA license for a while. The timing was never right to go.  My frind did go back home mid contract and I chose to stay and even look for another assignment here. 
  
Tell us a little about you and your family?    I have 4 children ages 16, 15, 5 and 3. My husband and I have been homeschooling for the past 3 years, so it just works perfect. We utilize the online public school homeschool through our home state. It’s so much easier for us but others may like other options like Abeka and such. My Husband has been a house husband since being laid off 4 yrs ago,  It made the decision to travel nurse so much simplier.

What made you decide to take the family traveling with you?  I was out in Cali, my travel mate went home and I had another traveler working out here and she turned me on to an awesome opportunity, I was missing my kids and hubby a lot so we talked it over as a family and voila family travels begin. I loved the opportunity that I was going to be able to show my children many different places.

Was there someone that inspired you?   I did know another person who had done it with her family and  they loved it. She was a staff nurse at one of my assignments who left her staff position to travel .

What unique ‘road-blocks’ have you encountered traveling as a family? We really haven’t encountered any road blocks yet as this is our first time traveling together as a family. We are mostly just trying to figure it all out.

Preparations? Since we do have a house back in Florida, my husband had to get it prepared for our absense on short notice. Once we got to our assignment location I opted for unfurnished housing. This gave me a little $ to play with that allowed me to negotiate for a 2 bedroom. We furnished the apartment ourselves. I already had an air mattresses, kitchen stuff and a tv when I came out here that I had from the studio apt.

How do you handle housing? Right now I take the housing provided we are in the process of looking for a travel trailer so @ least packing wont be so crazy and the kids can make their area truly their own.

Are there specific preparations that you make due to traveling with family? I make sure that I am well ready when it gets time to move on to the next assignment and I also make sure that on my days off it is not always about running errands and such. We all have a job, kids do their schoolwork ahead of time when I have stretches off so that it is not something we worry about when we stay up late, go somewhere to visit.

What are the children’s and spouse thoughts to living as a traveling family? Some days my 15 yo is not to happy about it. He misses stuff he did back home. He is really a big TNA Impact Jeff Hardy fan, so when we are home he goes to Impact wrestling all the time. My girls love it but right now they want to go back to LA. My husband loves it he is finally seeing things he always wanted to see.

What do you do for the children’s education?   We actually add a little more in education beyond school. One thing we do is we plan a family cruise every Dec. This true vacation consist of no electronics what-so-ever. We cut ourselves off from the world back home. The kids must find something to do with one of the countries we go to that they really want to see by researching that country. They usually have 3-9 mths to prepare. This year they actually have 11 mths.. We want to expose them to all different ways of life. 

How do they respond? They actually love learning about the difference in lifestyles and the way of living in other countries are as well as how different one place is from another.

Can you list 3 ‘perks’ to traveling with family? 
#1  I am making memories with my children that can never be replaced and my children get to go to places that they may not get to when they become adults and have families of their own.

#2 I get to actually watch my children grow and flourish in their new environment.

#3 I dont have to save up all year for my children to go on vacation once a year. We have gone to Lake Tahoe, Yosemite, Vegas, Los Angeles, and Shaver Lake all this in less than 3 months. Those vacations would of taken me 2-3 years to have enough money to take off work and plan and do. Now I just make it a day trip or even a weekend on my days off. A Working Vacation is what I call it.. 🙂

Can you list 3 ‘challenges’ to traveling with family?
#1 Worrying about the next place. Since I am the breadwinner and we do have bills back home, I always have to be conscious on my decisions.

#2 Some days are so crazy at work and I just would like to come home relax hot bubble bath and glass of wine. Try that with 2 girls who want to tell you about their day instead.

#3 When they want to do something that I cant because of my work schedule and we are with just one vehicle here.

How do you deal with these challenges? I just let GOD lead the way. As for my free moments to myself I think of it this way one day they wont be there knocking on the bathroom door to tell me about their day because they will be in their own bathroom wishing the same thing I am right now and I will miss these days.

Is there a specific event that has occurred while traveling with the family that has made you think “omg…what am I doing?” or “…this is the best decision ever?”   Yes. When my extention for this last contract was being worked on, we had to fly back on tues for me to work wed from our vacation. Until that monday they had not even gotten the contract to my recruiter so I was freaking out. Here I was, flying back with my family the week before Christmas and my job may not even be there. I stopped stressing when we left for our cruise the week before and Let it fall in GODs hands. It worked out thank God.

What words of advice would you give to someone that states “I just can’t travel now…I have a family”?  My true advice is to ask yourself ‘Do you want to wait, or do you want to Live?’ I just lost a very dear friend to me this week. She hadn’t even gotten to retire, in just 3 short months she went from a vibrate full of life person to someone who couldnt even get out of bed. She had a cruise planned (she loved cruising) and she was devastated that she had to cancel. She was also going to miss her 1st grandbaby growing up.

I want my childrens memories to be “yes my mom is a nurse but she also showed us all the wonderful new and exciting adventures the world had to offer”, not just a vacation that truthfully half of families do not even truly take. Many vacations consisit of going to families for a visit. Grab onto Life and make yours and your childrens life one big adventure!!!! Think what stories your children will pass on to their children when they are grown.

What do you feel is the #1 Benefit of having a Traveling Family? We are much closer as a family!!

About The Author:

My name is Jenn Sheppard, I have been a Labor and Delivery Nurse for the past 12 years with the last 5 yrs being a traveler. I love adventure and to see new things. Which is quite funny since I am a Virgo; but I have a fellow Virgo buddy who feels the same way and she also teaches me about the ins and outs of the industry..

This year I have made big changes.. I ventured out of my comfort zone. I traveled away from home and even quit my safety net per diem job… after 5 yrs of talking about it we made the leap of faith and became a Traveling Family.

Please click HERE If you would like to submit your story to The Gypsy Nurse.

By The Gypsy Nurse

August 16, 2018

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From a Travel Nurse Husband

The Following is a Guest Article by Jay Lane

Originally published: April 2014

This life we are still getting used to.

A life of seemingly endless conversations. Meaningful exchanges of our day’s events. Sharing the good with the bad like many married couples all over the world. Discussing current events near and far. There is nothing routine, monotonous, or laborious about these communications. These conversations are different; we hang on to every word, not taking one syllable for granted. Time zones and space separate us.

I am a travel nurse husband.

A job that takes my wife thousands of miles from home for over a dozen weeks at a time. My wife is on her second remote assignment in the state of Alaska, and although we are 4,000 miles apart, we are in it together.

There are emotional phases for married couples whose spouse travels for work on long-distance assignments.

We share the excitement while we research her next potential assignment. She scours her resources, and we weigh the pros and cons of the different possibilities. We narrow it down and make our decision. It becomes real. My heart beats a little faster during this time period. I know there will be lonely days, but the distance between us is merely geographical.

We scrutinize contract details to make sure the “I’s are dotted, and T ‘s are crossed.” Next is the excitement of researching the location of the area to which she will be traveling. Traveling, to work to explore, to gain valuable experience. We Learn about the population, geography, and culture of her new temporary community.

Things start moving quickly the deal is signed and sealed. Anxiousness sets in, and soon comes the day of departure. The butterflies are only bare because I know her sense of accomplishment and pride are part of what makes her the woman I love. She is passionate and enthusiastic about her work and the adventure that awaits. She enjoys sharing with me her experiences, and I love hearing about them.

The phone call I eagerly await comes, “honey, I am here and settled in, the flights were fine, and I am ready to get to work.”

This is the beginning. It seems daunting. One day at a time. Every day that goes by is one day closer to being reunited with her. I wait with urgent tranquility for her return.

It’s May 16th and she’s back in my arms back in our home. We pick up where we left off.

About the Author:

Jay Lane, Self Employed Landscape Designer and Proud travel nurse husband of Gypsy Nurse Ambassador CNA, Michelle Lane;  devoted father of Krysta and Kaitlynn. Jay keeps the home fires burning and keeps the girls on track while Michelle is away on assignment, and he does it with pride, 13 weeks at a time. “Michelle is my biggest emotional support, even thousands of miles away. This would not work unless we both put in our best effort and are part of a team. I commend the sacrifices that all of the Travelers make each day.”

By Andrew Ferguson

August 10, 2018

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And We All Float On… a Travel RN’s Stress Reliever

Earlier this month, I wrote an article on how to help a travel nurse decompress from the stressors of the road and rejuvenate themselves for the next shift. That description may give it a little more credit than it deserves because it was really just about this time we went to a hot spring and how awesome it was. So, for this article, I’ve left all pre-tense behind and will be straight about the contents. It’s about this time we floated in a float tank, and how awesome it was.

I’m referring to a float tank called a sensory deprivation tank, an isolation tank, or a sensory attenuation tank. Basically, it’s a lightless, soundproof tank filled with 6-12 inches of body temperature water and between 500 and 800 pounds of magnesium sulfate (Epsom salt). A large amount of salt makes it possible for anyone to float without effort, giving you the feeling of weightlessness. This, along with the water temperature, and the tank’s design, limit any sensory input.

The result is a relaxing, ultra-quiet experience that takes a little getting used to but is worth the effort. Floatation tanks, while still growing in popularity, have been around since the early fifties. These benefits have been touted by everyone from the late theoretical physicist Richard Feyman to the popular comic and podcaster, Joe Rogan. While the jury is still out on some of the beneficial claims made by the proponents of these tanks, there is ample evidence that they are a useful tool for stress management. This way, it’s relevant to the travel nurse community. Plus, it’s cool trying to find one close to where your current assignment is.

And We All Float On… a Travel RN’s Stress Reliever

We got lucky and found one in the city where my wife is working. The next close one is a five-hour drive through the Rocky Mountains. I set up a morning appointment for my wife and me. Since we have a three-year-old, we had to take turns floating, with me being the designated Guinea pig. We paid $120 for two-two and a half-hour sessions, so it was $60 apiece. They offered one-hour sessions for $40. Prices vary from town to town, but $60-$70 for an hour seems to be average.

Each tank is in its own room, with a shower right in front of the float tank door and a changing area. All the amenities, such as lotion, shampoo, body wash, towels, and the like, are provided. This was our first, and so far, only time at a floatation facility, so I’m sure there are different setups. When I was researching this article, I ran across one in L.A. with a small pool in the middle of a room. The room itself is sound and lightproof. It didn’t open until after midnight and closed before sun up. Even though there is some variety in the set and settings involved, the basic premise remains the same-float, and relax.

Our experience was awesome. I acclimated quickly to the environment inside the tank. My wife was a little freaked out at first but ended up getting more out of the experience than I did. I really enjoyed it but couldn’t help but play around with the weightless effects, and I had to get out once for a restroom break. After my wife’s initial trepidation, she settled in and had a relaxing experience. It helped her eliminate some of the stress she felt from all the overtime she’d worked. She also got some relief from her sore back, which is something she’s always dealing with.

It was cool and something we will definitely be doing again. It’s a real blessing-all the experiences we have out here on the road, doing that travel nurse thing. Maybe that’s the real story here. Float tanks are great, and I highly recommend trying one, but they’re just a tiny part of the vast universe of adventures that await those who take the chance: good luck and travel on.