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.

Flexibility

One aspect of being an amazing Locum CRNA is being flexible.  Yes, I mean being able to reach your toes and bend over backwards.  OK OK not so much.  Flexibility in this case refers to your time and ability.  Your ability to manage just about any case you need to do and be happy doing it.  Your ability to stay late ... again.  Can you come in early?  Are you able to take call?  Can you set-up the Heart?  Will you go do the epidural?  Will you take the student and teach them?  

These are definitely all questions I've had.  Flexibility is being able to answer the call.  The more you can say yes and be able to do so with a smile.  The more likely you will be seen as an asset the facility needs despite your being a rental.  I find that it leads to returning multiple times to facilities.  I think it leads to satisfaction of the overall group and interpersonal dynamics when everyone from the janitor, anesthesia tech, other CRNAs, and management can see that you are both knowledgable and have a can-do attitude.  Do I think you should do something that makes you uncomfortable?  No, but do you say "No, I won't do that"  ... I'd say that's a poor way to communicate.  I'd say, "Hmmm, I haven't done a retrobulbar block before would someone be able to do those with me or is there a room with Interscalene Blocks as I've dont hundreds of those?" This gives the group an opportunity to use you to the extent of your skills but also tells them that eyeballs just aren't blocks your comfortable doing.  So, flexibility with skills can be very important. 

Case flexibility is very important and is a play on skills.  The more comfortable you are in a variety of cases and practice types, the more marketable you become.  The better you market yourself or the agency is able to market you, the more likelihood you can ask for higher pay, more hours or keep yourself in demand.  

Hours flexibility.  Many times I hear someone say I just want to work 8 hour shifts.  Sometimes, locum providers are scheduled just 8 hour shifts.  Totally true.  I don't know what to do with myself only doing 8 hours.  Many places have gaps in their schedule because most employees want that cushy 8 hour schedule.  If you are flexible in your hours you might get to work overtime, get mid-week days off, or even have time to get some errands done before or after work on certain days.  Many times it's all in how you contract with a facility.  For example 8 hour per day guarantee versus a 40 hour per week guarantee.  

Flexibility leads to hospital and group satisfaction.  Consider this as you continue to grow as a locum provider.  

Topics to come will be skills, attitude, and presence. 

Getting things done.

OK, here is the deal.  I'm on vacation in between contracts in Massachusetts and Pennsylvania.  I am getting alot done on the rental houses to be.  My husband is tired of obliging my desire to do these but always loves just how well my dad gets the homes ready to go.  It is pretty darn impressive.  All I do when I get into town is have a ton of meetings, write the checks, and manual labor of paint, haul, and yard stuff.  Thankfully, Dad was released from the hospital yesterday but I am hopeful this gives him the minimal fortitude to take it a little easier and not stress so much.  However, that means I have to pick up more.  

I was asked, by the client hospital to start a week earlier so now we are trying to arrange this through the agency.  I don't know what the problem could be with doing that.  However, it is a week and while it sounds awesome to my wallet there are a few things to consider. This means no great move-in time or quick vacation to DC/NYC before starting.  It means very few options of dry run to drive to the facility.  It means the first few days will be a mad dash to purchase a few critical furniture pieces as we got rid of in Massachusetts and Kansas as our apartment just shrank a few hundred more square feet.  

All of this said, I still have no PA license and I'm pretty sure that due to the critical need and nature of the contract.  Credentialing should be done and even if not.  Orientation can still be completed.  Locum work is not for the faint of heart as each time it seems to truly come down to the wire for things.  

I am assured on the side of the client group, agency and state that things will all come together but I bring a bit of a pessimists perspective and tend to over analyze.  It's just the opposite with the Rental Homes. The scarier the project and all that needs to be done, the more intriqued I am.  

It's almost 7:30AM. I hope they don't get to mad I'm mowing the yard. Today is going to be a very busy day as we have three homes to get ready.  Tuck U Inn B&B, my AirBNB and then my parents guest cottage all in Aitchison, KS.  Atchison is the birth place of Amelia Earhart and has a large private college (Benedictine College).  I am already looking forward to about 5pm when all has to be done :).  

Best of luck to you in your locum journey.  Let me know what you are doing! 

Getting ready for my new assignment

Francisco, Elizabeth, Bentley, Rosie, and I are all getting ready to change places of work.  We are packing up from Massachusetts after being here for about a year and a half.  We will soon be heading to Philadelphia for what looks like another year or so.  We have looked for an apartment and taken on the risks that come with signing for an apartment in the city.  We have looked for the best option for us as we will look for our daughter, and dogs.  We also have to figure out how to be mobile.  We are downsizing to have just one car which will limit Francisco in going out, taking care of all those things that we have to do in a normal week.  But alas our truck is too large for parking garages and the parking place rental is more than 10% of the rent.

            Pre-assignment I generally call the agency or get an agency call that says the contract is finishing in 30 days or I will be ready to go from a place in 30-90 days.  (I try to plan ahead by 90 days to be ready for credentialing, state needs, and to have time for vacation as I try to take them between contracts.)  If I have a vacation planned I ensure it is a non-negotiable in the contract.  So 60 daysout I like to have a plan of where I am going and be well on the way through credentialing and have my signed contract.  I tend to ask a ton of question pre-contract. 

Where is the assignment. 

What part of the city? 

What city and what is nearby? 

Then the more important things like the hours desired and required? 

Call? 

Is there any of my favorite types of cases? 

Are they going to make me do my least favorite cases? 

What type of practice is this? 

Why are they looking for help?

Then other important questions:

Rate?  What is the hourly rate?

Where are we going to stay?  Is this lodging going to work for our family?  Can they do a lodging allowance? 

Daily stipend for meals or other?

Daily/weekly mileage or car allowance?

How does all of this work out to an hourly based on a 40 hour work week?  Then is subtract out expenses of malpractice, lodging and any incurred expenses that are beyond what is paid by the agency. This might include licensing, AANA dues, PAC payments, and Student Loans.  Then I look to see if that number works for me. 

After all this is worked out.  I sign a contract.

Once a contract is signed.  I’m going to that assignment.  I don’t back out, I don’t change my mind and I don’t shop around.  Keeping my contracts and obligations is one of the things that keeps me solid in the eyes of the agency and the groups I go to.  I have cancelled after 30 to 60 days with discussions with the agency and a plan of who what when and where. 

Inevitably there is some paperwork to be done so I get that and generally complete it over a weekend and mail it back ASAP. 

Then it’s just waiting out the end of the contract and a vacation.  Moving time comes and we pack/unpack over a period of about 4 days with a Uhaul. 

In the new town I will drive to my hospital so I know GPS is correct for getting there and construction doesn’t have me totally messed up.  I scout out what I’ll need such as gyms, groceries, movies, pediatricians, vets and get the lay of the land. 

The morning of the start.  I generally arrive earlier than when paperwork states to arrive.  I do this because if they are short… I’ll be in the OR day 1 hour 1 and I like to have a clue of what I’m doing.  Second… If I’m there with the chief or before… they can’t see me as lazy or showing up late. 

What many people forget is what happens or is fact may not be reality.  Perception is reality until proven otherwise.  Having to prove otherwise means we are starting in the hole.  One of my assignments had multiple locums come and go and one of the last had taken the patient to the PACU turning blue and had not recognized the patient had gone apneic.  (at least that is what I heard from multiple sources)  Either way… when I arrived MDA’s were anti-locum and CRNA’s didn’t trust that I had a clue what anesthesia was.  One of my first cases I went to push my drugs and the MDA began to scream at me that the state law was XYZ and that’s how they practiced here and I could leave if I didn’t like it.  I nearly walked out and left him with the patient.  Weeks turned into months at this facility and the demeanor shifted.  My perception of them shifted some but I expect AMG’s with MDA supervision of CRNAs to act in a certain manner where I expect a CRNA only group to function in certain ways… and no they are not the same expectations.  AMG and MDA supervision… it’s how they operate and I do what I need to in order to keep the patient safe.  Second, the MDA’s name is on the chart. If they are insecure and petulant I show them that I’m not an idiot.  I call them when something occurs so that when out of the room they can handle a post-op cardiac work-up or manage the ICU setting.  They are close to or as liable as we are despite presence not being in the room.  If I question something or if anyone in the room says should I call the doc… I don’t take offense and say “please”.  Even an OR nurse can make life a disaster if you are managing a complication but they feel you should call the MDA.  They will go sing to the congregation whether correct or not. 

Otherwise, I try to maintain a generally happy-go-lucky attitude, smile, and be kind to all.  Sounds crazy but that is probably the number one factor in my staying at facilities longest or returning to facilities time and time again.