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.   

Happy mother’s day

Today is mother’s day and I must say mine has always pushed me to do better.  It doesn’t matter just how much I put in as far as effort, education, level of understanding or time... Mom has always been there pushing my boundaries to improve.  

I think that is missing in today’s generations and I’m hoping I can instill these values into Elizabeth’s core as she grows.  Not to instill negative worth of perception of never quite being good enough.  That isn’t the intent at all.  I see the amount of knowledge, work, time devoted to projects, continuous education, and effort that is put into every aspect of life.  I think the realization is that there is always someone that can do something differently or better in the results column.  I find an appreciation for the neighbor that has the most gorgeous lawn where mine is lucky to be mowed and have a few less weeds than a few other neighbors.  I think each of us have areas where our practice is not as strong as other.  In this area I hope that each of us would take time to learn and grow.  

Likewise, in this community of locums, business minded professionals and those that aren’t are all coming together and we can all learn.  I think our practice, our business skills, negotiation, and our personal lives have to be continually improved upon.   This is all-encompassing and is why you read so much on my personal life.  You read about my finances and how I’m making strides to have this burden significantly reduced by optimizing business, education, and leveraging my hours of work.  You see Francisco and I consider adoption as we want to build a family and seek opportunities to enrich Elizabeth’s life.  You see my real estate and investing strategies that will one day allow for a more diversified risk and likelihood of retirement or at least significantly reduced need for specific hours= specific dollars.  You read about family, conversations, my continued education, insurance and multiple facets as we continue down the road of life.  My hope is that people gain knowledge of life as a locum but also take from the stories the opportunity to enrich other aspects of their lives from family time to vacations. 

I’m continuing my journey by the FI principles of being just 1% better each time and way I can.  I hope it comes through to all out there.   

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. 

Rough start

We left Philadelphia and things were looking good for the first 30 seconds.... 

We hit rush-hour traffic and were in a losing battle of time and weather.  I drove the blasted uhaul (26 foot beast) straight down as much as I could.  By 8:30pm it was snowing.  I was supposed to be in by 8:55 and I had so far to go.  Francisco became overwhelmed by the night and snow forcing he and Elizabeth to stop about 80 miles from Hampton Roads.  I forged on with the thought that i would not miss closing on the house or work.   

  I woke this morning to the information that the tunnel was closed and snow would last well into the day.  I made e-mails and texts in order to get the closing on the house accomplished.  Finally, i had an Uber to the notary’s home.  I officially closed and Uber said no cars were available.... i walked through the snow in order to get back to the hotel.  We are now the proud owners of a home loan.  

I found out i was cancelled for work on Friday.  Very happy for the 8 hour guaranteed day!   

This potentially gives me time to get things moved into the house!  Many things to be done!   

All those on the New England coast... be careful in snowmageddon.  

Calendar

i don’t know about you but it’s pretty crazy around our household.  My calendar for January is looking busy. Next week will be a crazy time and my husband might disown me.  

Wednesday, like all days I’ll be up and going to work at 6 AM.  The difference is that the movers will be walking in the door at 6AM.  They are packing everything then loading the Uhaul.  Then, I’ll get home from work and we drop off the keys, fobs, and say see ya later to Philadelphia.  We are to make it 2.5 hours south into Maryland.   

Sounds totally easy right?  We only have to put the dogs up front in the Uhaul.  Get the kid in the back seat of the Jeep and have everything packed/loaded in 10 hours.  The next morning we have to leave by 7AM.  If not we miss the walk-through on the home that has caused some stress over the past weeks.  

We’ll drive another 2.5 hours and arrive immediately at the house.  Park in the driveway walk through the home and make sure all is in good order.  We’ll rush to the hotel and drop off the dogs, check in for my parents and us for the two whole nights.  Then it’s again off to closing in Virginia Beach.  When that part is done we’ll again be home-owners.   

It doesn’t sound like too much.  But, I start work the following day so again it’s up to Francisco to get things unloaded from the Uhaul and unpacked.  my parents are coming to help install, set-up, baby-proof, and shop.  I don’t know if they are ready for what they are in for!

The one-day move and in-between contracts.  It’s going to be a bit stressful but i know we can do it!   

The rest of the month is just surrogacy, 3 work places and contracts, two birthday parties, and having a fence built.  

Planning just like all things is key but being able to maintain the plan as a fluid work is key.  Happy almost New Years! 

Motivation

I was listening to someone talk in the lounge saying they would never leave this area.  Her husband was offered an amazing opportunity and they said no as it wasn’t in the city.  Their kid was going to college and they begged to have them closer to home and now they think they might return to the same city.   

I guess this idea of staying in one place for life or not entertaining moving for career or home is foreign to me.  I’ve moved around and met new people my whole life.  Freinds of the long term capacity can be hard to come by.  However, within the military life of moving i found lifetime friends.  I know moving has allowed me to make friends around the country and understand different types of people, culture, and demographics. 

I tend to think anyone could do the locum life if they were so inclined but I’m learning that the more rigidly settled a person is the less likely for them to do locums.  Per diem in multiple hospitals in the area might be their perfect gig and while it may be 1099 it is unlikely to be billed as locum.  Others find a w-2 job that will allow them to work 2 full time jobs.  I see them race from call shift to call shift and i wonder how they do it when i know how it feels working 60-80 hour weeks and how lovely it can be at 40 hours.   

I think it all comes down to motivation.  Part of my motivation is to keep up in all areas of practice so I’m well rounded.  My goal is to be flexible, work a fair amount and over.  I want to be capable of going into any room and being comfortable.   I love new sights and allowing family to see all that surrounds us and our opportunities as we grow together.  Others, look for safe, secure, & what is known.  Others look for moving up the ladder of success in leadership, research or business as they grow and that is their motivation.   

Its fun to learn where people are in life.  Then it is nice to remember those people and in going to new places meet those who might also mesh well with others and who might build people up to their potential.   

So, dream big and bring others along the journey.  Find a passion and a motivation!