Walking into a new environment

I’m just about to walk into week 3.  It’s amazing to find a new place to work.  Each new place has its’ nuances and differences.  

I find that each place has a few people that are challenging to work with that challenge the way in which we are used to working.  This comes full circle into relationship building.  Most of the time I do awesome at saying “this is what I’d like to do and this is why”.  For the first time ever (as I recall) I found someone that didn’t respond to that and has been a bit difficult to work with.  However, I have tried to maintain a high road and be respectful.  I try to daily go in positive on the day and the work that has to get done.  With each case and with each good day I feel the rest of the group becoming more relaxed in understanding that I bring some ability to the practice.  

I take every opportunity to tell the person running the board I’m available and ready to work.  I come in a little early and set-up my room.  I have my coffee early and don’t assume I’ll get out right away for a break in order to get coffee or breakfast.  I try to be available and flexible in order to get the work done so others can go home.  I don’t ask to get out early assume that I’ll be afforded the same opportunity to either go home or take a break.  Most places I go to seem to want to test any new CRNA in case types, personality, proficiency, & the willingness to do within the group.   

This all comes down to relationship building and interpersonal communication as much as it is about CRNA skills.  A place can usually work with someone that needs a skill or a case set more than they can teach flexibility and good attitude.  So, continue to grow in personal development as much as your CRNA development as you continue your journey.  

Leveraging Relationships

  you relationship building and keeping up with your previous facilities, colleagues, and friends?  Are you taking opportunity to go to state level CRNA meetings for continuing education?  

Everyday facilities are looking at the cost of anesthesia and if they can keep expenses low.  Groups are turning over, people go on vacation or maternity/sick leave, & independent practitioners are looking for quality people that don’t want their job but can come in and help.   

Update your resume and keep people aware of your ability to help them given your scheduling.  Keep your files up to date so your credentialing would be easy.  Keep some of you appointments at facilities you might like the opportunity to return to.   

Maintain quality interactions and keep your social media up to date and appropriate so that people know your personal and business life are together.   

Debt reduction as a locum.

I’ve been so fortunate that Francisco is an amazing parent!  Elizabeth has been at home with Francisco 90% of the time and we found a great babysitter through a friend.  Francisco has been knocking it out-of-the-Park with his YouTube channel/ website ConMuchoSabor.com.   

I looked at our debt 7 months ago and was so stressed that we were over $250k in debt not including our home.  I traded my truck for less than half the cost new SUV.  I went to work on locums and raised my rate while telling the place I needed any hours or call I could get.  I’ve been away from the family returning about every 4 weeks for a few days to a week.  We’ve still had time to visit family and a good “working” vacation.  I’m happy to report that our net worth is positive and debt is below 100K.  I’m going to a 2 week on 2 week off lifestyle with intermittent days on my weeks off that will allow us to keep decreasing our debt and allow me more time at home!  Our rental properties have picked up and are now paying for one new property per year and paying thier own expenses.   

I have approximately 3 more weeks away before getting started on my new locum contract!  I’m 12 weeks into my MBA carrying a 3.8 gpa and learning weekly.  I get to pour over financial reports and am doing better each week with my own reports as well!   

I continue to consider business opportunities and think that with time 1,2 or 3 could become something just like the rentals, YouTube or the websites.   

I just wanted to check in and thank you all for the positivity and thank our Locum professionals for keeping us in great standing so we can work, travel, & provide for our families!  We are so blessed!   

Flexibility with Travel, Work, & Vacations

The flexibility & vacation time in working locums drew me in and kept me as a locum nurse Anesthetist.  

Work flexibility with a few facilities around the country has allowed the opportunities to do more with my time. 

Recently, my family visited Costa Rica and extended family!  I was able to speak and although I was a little excited, nervous, & even got a little lost in speaking; it was great to see other CRNAs and have them meet the family.   

We moved to Virginia for surrogacy and failed our first attempts.  It was a true and sad failure but due to locums I’ve been able to pay down the debt that occurred for this attempt.   

We’re paying down our debt load and continued to build the real estate venture over the past 6 months.  It’s been amazing to follow a move and family changes over the past 6 months.  I’ve been able to build on relationships and although working a lot... we are still well on our way to continued financial success in our lives.  Although, I know it’s possible to do this in one location with one job, it’s getting done on a condensed schedule.   

Life, flexibility and continue strong work ethic are leading to change as I continue all the things that are important in our family life.   

Finally, school is just about to finish the first 10 week term toward the MBA.  Nothing game-changing but working on a business mindset continues to be a fun opportunity for change despite my whining and complaining :).   

Totally looking forward to the coming weeks and months!  More to come. 

Depressed?

I had someway say that I sounded down.  I’m so sorry, I didn’t mean to give a negative impression.  I’m excited 99% of the time.  I stress out now that I’m truly focusing on radical family development.  This involves the adoption or surrogate portion of our lives that will be the coming together of our family.  I am focusing on the bills and trying to get us away from paying interest to companies.  I don’t like the amount in interest I pay.  The focus is the revolving debt but I’m working on making my fixed debts lower as well.  

I enjoy the rentals and I hope to have many able-bodied years to continue the rentals as they are a source of income and throw off 20+% per annum.  There are times I get stressed and it’s usually a mix of buying and working on the houses.  Not with tenant issues.  I could care less if someone moves out and it sits for 3 months until the next moves in ... because I want to be particular in screening and ensuring good tenants will take care of things and pay rent.  I have the luxury of doing this now but in 5 years I may hire a property management group so family doesn’t need to manage but.. that’s a we’ll see thing. 

i start my mba program on Monday.  I have the post 9/11 GI bill for 3 years and am psyched!  It’s free education and housing allowance while I work full time.  I’d have to say that is amazing!  I’m going to see about the reserves and if I can do that in several months but I’m not sure about my history and the ability... but it’s in the back of my brain.  It may be a way we can work less and still get some long term benefits.  there is sooo much I don’t know or understand on the reserves.

i go back to Massachusetts today and I love the people but it’s so hard to leave Elizabeth and Francisco at home.  It’s better for them and stability or I’d just have them go up.  It’ll be something like 5 weeks.  I am pretty sure I’ll miss the first word unless the occasional hi sound counts like a word but it’s not completely intentional.  Elizabeth is so animated and talks to us despite no comprehensible speech yet. I love FaceTime, pictures and video.... I don’t feel I’m missing things and when I’m home... I’m with them as much as humanly possible.  I’m there for the melt-downs, when she just wakes up and is soooo cute and happy.  I’m here to take care of bills, office things, management of the home and supporting every person in the family in ways they need.   

So ... I’m happy, I’ve made my choices that will support my intermediate goals and mission so that we are happier and together more.   

Now I must get the last minute packing done.  We are off to the airport in no less than 2 hours.   

Think

Every day I spend time with podcasts or learning in some way.  I listened to multiple this week.  Some of the things I learned this week. 

Be Better:  Every day or every week work on how you can be better.  A little change that will help you approach your goal or commitment.  It doesn’t have to be something earth shattering.  If you do 52 weeks of little changes toward your goals you will find yourself inching toward it and be there before you know it.  I read my books this way.  I’m paying down my debt this way. I’m growing the websites this way.  I grow my life, family, & relationships by spending seconds or minutes to interact and tell people thank you or awesome job.  Make a commitment and not get overwhelmed by doing something everyday.  

Attitude:  The attitude you approach something with is how it’ll go in most instances.  You can’t say I hate I hate I hate and then get to the point of doing and expect not to hate it.  I get to work and genuinely say good morning, hi how’s today and yup I’m annoyingly upbeat.  I do this for everyone and myself.  If people see me pissy and depressed everyday I’m adding an attitude that just brings down the whole team.  I’m there to work... not to complain, be unhappy, & just be a body.  I’m there because these groups have people that act this way or they can’t keep people because they are all stressed... if I can be a stress-free person at work.  I’m more likely to be asked back. I’m more likely to feel like my days go well.  I’m more likely to truly have fun and make the days go by.  I miss my family at home and I’m so excited to see family pictures or video and I share this with the people I work with.  Kids and dogs make everyone light up a little.  

Stick to it:  If I sign a contract or give my word.  That’s it.  I’ve said I’ll do something. I’m going to darn well do it.  I’m not going to tell someone that I said I’d do their room tomorrow then not because I found out the surgeon I like has just two easy cases for the day.  If I get what I want and ask for ... I honor what I said I would do.  This makes me reliable, dependable, the person to go to, and sought out for as a provider.  I’m reasonable in my expectations, experience, and what will come.  I know the business of anesthesia, each hand in the cookie jar and the expenses that come after the reimbursement income and how the expenses trickle down.  

These are just some of the things I’ve learned this week and application is always the challenge in what I learn.  I choose to hear most of my education, so I then proceed to the application and notes to myself in how I can apply it towards my day/week/month.   

I’d like to tell all to have an amazing weekend!   

Traveling attitude

It’s another traveling day and of course I’m up way to early.  I have two options though.  #1 I can say I hat the airport, the rental car return, the drive, getting gas, & generally people at airports still act as if they have never seen one.  #2 I am sooooo excited to be on my way, I was upgraded on my 20 minute first leg of the flight and I see the family in just a few hours!   

Mind-set is everything right?!  It’s the same way when going to work.  If it’s a locum job, a full time gig, or your kiddo doing the chores they have been assigned.  It’s in how you approach it.  Yes, I understand that bad things happen and unforeseen circumstances can change things but ... by and large this is the everyday approach.  If you want to love locums, love the time that you spend at many places... you have to decide that it’s going to be good.  If you have decided that hospitals, people, this job, and working with medical professionals suck... you won’t be happy ANYWHERE.  So, find some joy, work on finding why you want to do this, then reach out with all your positive energy and let everyone know just how great you think things are.  Happy people are infectious.  People, surrounding the upbeat, are more relaxed.  These people are perceived as more personable.  These are part of the reasons people are invited back or not invited to return to facilities.    

I’m told over and over of people that are extended or given notice because of their attitude.  I’m also told that places are more flexible with those that have better people skills.  That may be that the individual is flexible or the work place is flexible?  I wonder if both are true at the same time.   

I get an earful of complaints here or there and find that misery loves company.  I had a nurse in the room that said I can’t stand so and so... they always lean-in the room and say “you good?” Thumbs up!  “It’s like he’s trying to run away as quick as possible”.  I say well... this is his first job... he was trained here and it’s what the other nurses do in his room... he’s been here a year right?  So, is this a person issue or is this what he’s been trained to do over the past year?  We are training people by what we exude, show, teach, act out, what’s said, and the daily attitude we display.  So what are you teaching those around you? 

Locum world

CRNAs glamorize locum position thinking that life is greener on the other side.  It can be nice but it can have its negatives.  It depends on your attitude, expectations, experience, and what you plan to walk away with.  It’s not all roses.   

I look at being a locum as slightly higher paid than the average CRNA as I risk not being able to find work, having to travel with or independent of my family, having to find my benefits, and learning the business end of anesthesia.   

Why am I needed?  When a place has a strained relationship, malignant personality, change in practice type, change in group, or people move-on/retire/pass away.  These are the typical reasons I get called to a group.  The less likely reason, albeit valid at times,  is vacation coverage.  This is typically a nicer reason or maternity leave can be more fun in small places.  

I don’t say this to whine or complain.  This is what goes with the job.  I am still expected to go in happy and excited to be at work.  Happy and excited to work with that Anesthesiologist or surgeon that people warn can be “a little challenging”.   

I would be remiss in not telling you that there are negative things that come with being a locum just like come with W-2 jobs.  You are very unlikely to find a perfect 7-3 m-f no call no overtime on some days and you can do everything you want and or say I don’t do XYZ.  That’s hard to find permanently much less as a fill-in worker.  Flexibility and optimism are definitely needed in our work.  

I am not saying you have to do what’s unsafe for the job.  Please don’t think that.  I’ve shipped out and cancelled cases that needed to be.  I’ve done some cases that were not wanted by others though because they had to be done.   

Please please as you walk into the land of Locums know it’s not all roses... even roses have thorns.  :).  

Check

it’s always interesting going new places.  I love it.  I have fun and treat people as if I’ve known them for years.  I have fun at work while getting the serious things done in a quick and efficient manner.  I believe that this relaxes the crew and the patient.  I always state that I’m not new to anesthesia but am new to the facility and why I’m going through the paperwork a little more. 

I expect to be checked on a little more or observed more closely if in a “Care team”  model.  CRNA group the same happens just because they don’t know me or what I do/don’t know.  It’s just how things go.  I also expect them to vary the assignments from big to little to tiny and see how they wish to utilize my skill-set... it’s a way of interviewing me.  They see if I complain or fumble or have issue with those that have the most awesome personality.  These things are part of the locum political environment. I generally say that I stay out of the politics by being a locum.  I should have been saying that I remain outside of the political arena that most ACT CRNAs are in.  It’s not that it doesn’t exist ... it’s just significantly less than full-time staff typically experience.  

I have some docs and CRNAs that try to teach me at times ... from how I should hold my Miller to doing a CVP fall whenever doing a central line.  I’m not above learning and I’ll simply nod or oblige if they want something simple that’ll re-assure them that my intervention is done safely and efficiently.   

I guess what I’m saying is that each place I go I expect a period of assessment in some way.  I expect to be thrown in to the mix quickly and handed around to the different personalities and surgeons.  I always listen too.  When I hear “oh, they put him there...” I know it’ll be an interesting day.  I think we, as locum providers, need to know whom the client is, how to handle interpersonal communications, and have to be more knowledgeable in a broader scope of practice than most institutions utilize.   

I think it takes about 4-6 weeks for a place to get used to a new provider whether it be locum or permanent... then 5-9 months to understand how a place operates and if they are a good provider fit.

These are just my thoughts on the day. 

A little independence

It’s been a great start.  Do you ever get to the point of I’m going to a new place and you are super excited until a little before you actually go?   

After all the excitement dies, the nerves kick in. You wonder why are they having such difficulty? Why am i needed?  What are the surrounding politics and issues? Then it’s a myriad of conjecture that has you just about to say “nope, I’m good to stay home.” Yes, after multiple years i continue to get those pre jitters.  This time was more because it was very temporary and only a couple weeks work.  I need the work but I could just ride the debt wave just a little.  If you don’t know debt and your a Ramsey fan... i sooooo applaud you and I’m jealous.  

Anyways,  I’m here & so happy i didn’t just give in to staying home.  I’m at a GI center with just myself and another CRNA and it’s nice.  Just enough work to pay some bills. Yet, I get home in time to do things and relax.  We even went to find a YMCA to join while we are around the country! (Did you know they have babysitters for two hours a day?!) yes, that last comment makes me sound ... older.   

Today is another day that will be busy with deliveries and paperwork that is all being pushed to Francisco and my parents as I’ll be working!  It’s awesome to be able to say that I’m sorry and have to work. It’s very true as i had more available weeks and they just couldn’t use me.   

I’ve supplemented with work back in Massachusetts for two weeks!  That’ll be somewhat more of a challenge but still fun to see people i worked with in the past.  

I can’t wait to keep you updated on locum life.  this weekend I start making my presentation for Costa Rica! What an adventure the next 6 months will be!