Packing List for CRNA Locums

Have you ever had luggage show up late or been to your destination to realize you don’t have the basics of what you need? Have you gone on vacation or to your assignments and realized you brought too much stuff? This goes with my YouTube video: Here’s my basic packing list:

Things I do:

1. Pack for just 7 days.

2. Have a set of dress casual clothes for day 1 at work.

3. Have my laptop and phone fully charged and have the cables.

4. Pack imperative items for the first day of work in my carry-on luggage.

5. Have all my assignment details either memorized or printed. It’s horrible to get in the rental car and not know where your going because your phone died as you were listening to that amazing audio-book on the plane.

6. Have something you love to do with you.

7. If you work out everyday but forgot your favorite gear. That will make you alter your routine or put you in a funk from the beginning.

8. Make sure you unpack on arrival and know exactly what you have to go to work with in the morning. Take the time to have your paperwork printed and ready to go.

9. Follow a routine so when you are packing you have checked your list and not just brought everything from home that you won’t use.

10. Don’t over analyze and pack for unlikely contingencies. Pack your everyday items for one week.

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!   

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.  :).  

Is it difficult to set-up a sep-IRA?

I have been a CRNA for quite some time, as you might be aware.  I have tended to keep my earnings and retirement away from the stock market.  As many would chastise me for not taking advantage of tax sheltering, and even I wish I were a better saver.  

I have always invested in real estate.  For a while it was my own home.  Then it was the start of rental property in Kansas.  I am still invested in Kansas and started on my current home in Virginia.  

I have avoided the stock market though.  I have used an E-Trade account as if it were a casino.  I haven’t been an investor but a speculator.  I have invested over the years in the military Thrift Savings Plan ... 1% for 9 years... you know how little that is.  I forget to take time to learn about those things.  I know I need to shelter my taxable income so I am actually doing this.  

I went for weeks totge website for Vanguard but then they said they couldn’t verify me.  Then I had to fax things for the Solo 401K but... I missed 2017.  So, I decided I would do a simple Sep-IRA if I could.   

I was checking my E*TRADE to make sure my Roth IRA transaction went through and then I had an epiphany.  Why not try to set up just an IRA.  I saw the set-up a retirement account button and so I clicked on it.  Bam, Sep-IRA option right there.  Two minutes later i had $6k coming out of my account to fund a Sep-IRA for 2017.  I have until my taxes are filed toget those dollars cought up. I would prefer a Solo-401k but I didn’t get it set-up in 2017 which means no $$$ can beplaced in it for 2017.  So, i now have a sep and I’m working on saving a tax bracket or two by saving more pre-tax dollars toward retirement as my rentals are post tax.

Is it possible to invest in retirement with real estate?  Yes, but have I done this... no.   

Every year, I will try to be more active in my tax planning and save betterfor my family and child or children (someday).   

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!

Holiday

Merry Christmas Eve, 

This means the Holidays are here!  You would not believe the trouble that surrounds this time of year.  Scheduling work is more challenging as most groups are not looking for summer vacation or the recruiters seem to know this time of year can be more challenging so pay can be less.  I see groups looking for just the holiday week coverage thinking 105 is great pay for that.  It’s sad that groups, recruiters, or CRNAs take advantage of other CRNAs by paying so little.  These rates have been the same since the early 2000s where R.N. travel rates have continued to climb steadily.   

I’ve seen many new CRNA owned companies coming out for CEUs, jobs, & other.  We are becoming more resourceful and entrepreneurial.  Just like going to a new group or workplace please do your diligence in knowing the people you are working with.  I’m going to be speaking for the first time with Education Adventures for CRNAs.  I have a one hour trial lecture with them in Costa Rica where I hope to talk on the pros and cons of locum anesthesia and what i believe some of the requisites, helpful qualities, and needs of the market are through my experiences in the past 7-8 years.  

Christmas can be a challenge for some and even for those that don’t “do” Christmas it’s a period that comes with down-time.  Less activity, less to do and work is minimal.  Look out for those that might have challenges, recent loss in the family, seem to be super happy but no plans.  Sit and chat or ask how they are doing.  Lend an ear or just be a happy person that’s there for them!   

I hope you have an amazing holiday season and from my family to yours.  Have an excellent holiday season and I’ll be chatting with you right here! 

Lazy

Lazy is totally unacceptable... at work anyway.  It's another Sunday and yesterday was housekeeping day.   I found my Solo 401K paperwork sitting on my desk under the mountain of paperwork.  Don't let this be you.  

1.  Grab your EIN (employer Identification number).  This is what you, your accountant or whomever filed your incorporation documents sent on-line to the IRS which makes your company a living number.  For a sep or solo 401k... you need this

2. Your business name as it is in the incorporation documents complete with punctuation  

3.  Print the documents and decide how much you are going to put aside.  

4. Do it and actually send them in.  Your account and tax saving definitely won't start with out this!!

Yesterday, I was catching up on thank you's.  So, I have to vent a little.  Francisco has been a little self-oriented lately and I'm not sure if I have just overly appeased or somehow in thinking of the other... I over did it but I've had to tell him it's not just about him and I need some time for doing... everything.  He cooks and cleans amongst the everyday dog and Elizabeth duty but when I get home it seems that all shifts to me as well... so now I'm having to tell him I have to work on the business, the desk, the rental homes, the bills for the house, accountant, & lawyer.  He's like soooo you going to go to the gym in 30 minutes?  Short of having him do ... because it won't get done... how do I get him to notice all of this because he thinks it's 10 minutes worth of work?? 

I hired help but she has been on vacation and dealing with big family things for weeks.  I missed my oil change yesterday which was severely frustrating.  Francisco says what's the big deal?  Oil is on its last 10% life and I work 5 10's followed by 24 hour call. I'm not sure (when we have 1 car) here just what he thinks I can do and with what time?  

I'm reading reading reading on my gastric sleeve, talking to patients from the surgery, and reviewing everything.  I grow more convinced that I found the correct surgeon.  I think I have the normal pre-surgery jitters and it's months away.  I can't wait to fit into clothes it's been years since I saw.... granted they are mostly in Kansas so I'll be looking like baggy clothes guy for a while as I'm cheap,  in some respects!   

Work,  I was leaving Friday and found security slapped a sticker on my jeep window for move-it or be towed.  I couldn't believe it and I was fuming.  They told me to park in the garage and I did.  They failed to say or show any designated place in the garage.  So I got off early to find said sticker and called them to remove it.  They refused.  I tried to peel it and that was wrong.  I stopped at AutoZone for a razor thingy to get the sticker off... remarkably easier than I thought.   I then apologized to the security people explaining I had never dealt with a sticker and though it would be much worse to remove.  

After the sticker situation I was stuck in a GPS nightmare!  The main road was closed getting home.... construction!!! Seriously the road was fine!!! Drivers on the road they need to fire!  Seriously, they need 1000 cops pulling over these crazy drivers every time they use their car as a battering ram!  I saw an Uber driver with a dash cam... best thing ever!   

Ok, I've vented enough...back to your regularly scheduled life! 

Taking time

One of the things I truly forget about is... myself.  Taking care of myself, taking time for myself, and just taking time with family.  

I get so involved in the number of hours, case types, and thinking ahead to length of assignment/finances/bills/investments that I lose sight of self.  I forget the 70 hours of work and 40 hours of sleep is 110 hours in 5 days 5x24 120 doesn't leave a lot of time when you drive an hour a day.  Most weekends I am off which helps but notice I say most because I offer myself up to any days.   

So, as I mentioned I'm planning our family vacation to Hawaii to see my brother and sister-in-law.  This takes financial and self awareness.  You'll recall I'm 1099 which means paid vacation does not exist.  I have to make sure all standard bills will be paid while gone and that $$$ exist for hotel/AirBNB, tours, and the like.  

This week long vacay may only be a week but I've decided to do something that 50% of people say horrible things to me about and the other half... support.  I'm going to get my gastric sleeve.  Not because I can't just go on a diet and lose some weight.  It's because I can't get myself to completely change my habits.   Why?  When I diet I can rationalize that this workout or diet for three days means I can go with friends to X restaurant have drinks and dinner and enjoy... then the next day I just skip the workout because I'm tired and have a beer with dinner because man I worked so hard.  The wagon is broken.  I'm changing the ability to rationalize by saying my body has been altered and despite all things and what people say .. I'm limited in ability to fall.  Yes in 3 years if I want to screw things up... I can.  Have you changed everything for three years and decided to return to a life you didn't like?  My hope and goal is to do this drastic thing to myself to force a change in habit.  Right or wrong I'm doing this so I am around for this family.  I feel like if I don't I'll be that 40 year old in the ER with a heart attack.  I'm hoping at 37 this will allow me to physically change and reverse the negative effects on my health before they are permanent.   No it's not because I don't want to exercise.  In fact, I walked 6 miles today with elizabeth.  It's not because I hate healthy food.  I love it... too much.  It's portion re-training:  yup, I'll have to break the Diet Coke addiction too.  

That's two things I'm doing for me... but that's in November.  You can't just take a week every 3-6 months and feel fulfilled.  I think at least every couple weekends you need a little just for you or just for family time so you see the fruit of the labor.   

What do you do?