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! 

Post Turkey Post

Let’s talk cold turkey.  Who is ready to do locums? What things do you have to consider?   

Insurance

this is a big one and i hate paying people in the off chance i need insurance.  I would rather put my money to work for me so that it can pay for what i need in the future.  Alas, i still pay for the family insurance for health, vision, dental and then have a malpractice policy.  I put up that we have liberty healthshare, some form of VA, and Cigna PPO.  Vision is VSP pro and dental is Delta Dental if i recall.  Malpractice insurance is through the AANA.  Are these perfect? Nope, and they don’t cover everything.  I’m on my way for a sleeve gastrectomy in Mexico.  I have tried every weight loss plan known to man and am doing this not because insurance thinks it’s a good idea... in fact they do not cover weight loss surgery even in morbid obesity.  It’s a $9,000 surgery and not covered.  I’ll see if they will cover any portion but my guess is no.  

Time off

I absolutely love and hate time off.  I love it because i work hard and want to truly enjoy life.  I hate it because i am losing income and spending $$.  I do everything i can not to miss paychecks in the year!  Being a locum does allow me to take months off per year if i need it though.  My daughter was born in January and I didn’t go back to work until March.  I contracted for the 2.5 weeks over thanksgiving to be off for surgery and vacation.  I’ll also be off all of January this coming 2018.   

I’ll also be speaking in Costa Rica for an hour in January!  sooooo, you can see time off can be had and when it’s important.  That doesn’t however mean that i tell facilities i can work only special hours or days.  I tell them I’m here to work.  Work extra??? Most times that is a hell yes! 

What else? 

there is plenty to talk about!  Let me know what you think.  Locumcrnas@gmail.com

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! 

Fun plan

Today I was at a third hospital and people say things like I can't believe you remember from place to place what you need to do.  The good news is anesthesia is anesthesia.  Knowing where everything is even at a place you've worked for a year has a bit of a relativity factor.  Meaning you get used to a place fairly quickly and if you get a halfway decent OR crew, anesthesia tech and are surrounded by decent people... it's probably going to be ok.  

Now, Fun.  Seriously, you have to go to work having fun!  Plan each day to be exciting and happy.  If you drag people down everyday and you are around people stressed and unhappy. Where will your job satisfaction be?   

You have to have fun on the weekends, after work, and plan vacay!!! Life isn't just work.  What you do outside of work leads to your whole self health.  When I get off work I'm going to.... 

If your friend said when I get off work I'm going to take my daughter out for a walk along the river, see the urban culture of a melting pot of people at a skatepark to skulling for their college crew teams, then shower and have a relaxing corona by the pool.  Would you think they were negative about the city or bored?  If you are on an assignment you have to be the person that makes your afterwork and weekend plans.  You have to be the friend that says hey let's go to Atlantic City.    

Every place is what you make of it and it's important to keep yourself and others excited about what you do.  That first plan was my night tonight.  It cost 2$ for the beer and otherwise it was a free nights entertainment.  Your colleagues, nurses, techs don't need to know when you spend $1000 on a trip but they should hear how excited you are about what's happening in their backyard.  It also leads to your overall satisfaction by not becoming TV bound or complacent.  

Best of luck and add some fun to your plan!   

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 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.