66 hours

It has been a long week and typically I love it.  Yesterday was Francisco's Birthday and we did get to go out to eat, but it was still a pretty long day at work.  Have you ever had one of those days where ... just about everything was a little off?  That was my day.  The first case I had three people telling me how I had to do a standard gastric sleeve.  I generally accept help and how people want to do cases but having three cooks on the kitchen at induction it stresses the patient, me, and then the surgeons have a diminished view as well. 

I was hoping that the day would improve from there but it seemed there were little stupid things that were just a little off the rest of the day.  

One of these days I say that all will be perfect but I have yet to see anyone do a perfect case in everyones eye.  I tend to self deprecate and I definitely need to work on that.  Otherwise, I'm still working on my flexibility and even wanting to do more work as the day goes into 11-12 hours.  

All that is true, but today I'm home :).  I like being home with Francisco and Elizabeth.  I work a little on the site and adding to the states, updating the jobs available, and work on Francisco's new site in spanish.  (www.Conmuchosabor.com).  

I then go to the rental houses and dealing with what needs to happen in the coming week.  You know, this week was a bummer of a week on that aspect.  We lost another HVAC and have to redo an entire roof tear-off and gutters.  

I talked to two of our colleagues. One regarding 1099 perm position and the financial components and the need to really ask CPA and financial advisors questions and ensure they are on the same page as you.  Ensure they understand the differences and how it effects the nature of your finances from the start all the way through retirement.  

Another person asked about a contract that he was working on with another company.  The sticky points were a somewhat low amount per hour, a long drive, and a non-specific non-compete that could be detrimental should the place lose their contract.  

OK... feel free to E-mail at LocumCRNAs@gmail.com anytime!  Have a great weekend!

Maintaining the contract.

I like to check in about this point.   We are at two weeks into the contract and I have to say it's always a bit rocky.  I wonder what people really think versus what is said behind closed doors.  Every permanent person is your critic.  From the janitor to the OR manager, permanent anesthesia staff and other individual locums.  One poor view of you from the wrong person and the OR tech who thinks she knows everything can affect your job, contract and if you are hired again by the anesthesia management group.  

I check in with the docs to see what can be done better.  I check in with the AMG to ask them if something can be done better.  I check in with the chief CRNA to find out how things are going and what I can do to help out.  I want to be taken as part of the team and not the one just here for money.  

I was with a locum MDA this past weekend and he was so very talkative.  I had to get him to focus, he would keep patting me on the back or chest to say things like "you know how it is, big guy"... so many things I despise about that but touching me is a big no.  I knew I only had a few hours and he would be at a different facility.  I bit my tongue and tried to focus on the patient throughout.  It's definitely a learning curve and despite my inherent self I have to be a people person.  I have to keep a smile and work to keep everyone happy even when boiling on the inside.  A tech in the room is criticizing the chief surgical resident for going to get the patient with me and the chart not coming down with the patient.  In all other hospitals I have been to the OR nurse meets the patient and goes through the chart prior to entering the OR.  All of this said the people pleasing is definitely part of the contract maintenance.  

I also think that self-reliance is very important.  The more you can figure out where things are without calling every two seconds for something to be brought, the better you are perceived.  Being able to search the stock room, store cabinets, OR carts, and anesthesia drawers/kits/carts will serve you 20 fold in how you are perceived.  I typically hate calling for things and feel horrible when they are right there in the room.  

Process, this is very difficult as most places have set process' in place.  What do you do when a process doesn't work or is obviously going to be a challenge?  I ran into a problem with a patient that was having a potentially large surgery in a hospital with little process for Arterial Lines, monitoring, ABG's and other lab work.  I sent them off and was unable to get my numbers back in a timely fashion and although stable I was hoping to be able to optimize the patient.  This case allowed me to understand some missing links in the chain and to find out who in the process was unwilling to help in a hospital process.  I'm still not sure how to go about solving this but as a new takeover.  I know that there is an administrative process that might make it easier in the future to get these items fixed.  I will be using the staff that are part of the facility to bring it to the management as a potential problem in doing similar cases in the future.  This type of case should be able to be done in just about any hospital in the country and had process issues but not detrimental to patient care issues at this point.  The last thing I should do is take something to administration or try to yell, complain and make trouble for the current staff.  I am here in place of permanent staff and not as admin or a person to make policy or even affect politics.  

OK... I should stop for now.  On to a 32 hour call shift in the morning.  Best of luck to all in the next week!