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? 


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.