So You Want to be a Medical Mercenary?

The call of the road is whispering to you. Visions of adventure and riches flash before you while you stare at the same old monitor you have now been looking at for years. The life you dream of does exist, but, my friends, the road is as fraught with peril as it is with reward. Do you have what it takes to be a cath lab road warrior? Hopefully, this article will help you on your journey to that golden cath lab of lore or will you be dashed on the rocks of treachery and deceit? I have been a traveler, off and on, for about 8 years. I have my share of experiences, both positive and negative, in the art of traveling via medicine. This article will discuss some helpful tips and suggestions for beginning this process. What are the benefits of travel? This is a very individual question. To me, the ability to meet new people and see new places weighed the heaviest in my decision. I also wanted to test my mettle out of my comfort zone and see if I could succeed in other cath labs. For others, it may be the money or the chance to be close to family. We are lucky enough to be in a profession where jobs are plentiful and the choices are many. By venturing into travel, you will find yourself meeting people you otherwise would never have had the opportunity to know (I happened to meet my fiance© in a New Zealand lab). Your skills will expand dramatically as you are exposed to new techniques, taught by expert people and learn how to adapt along the way. Traveling may also be your chance to share your knowledge with others. I have found that there is always give-and-take, and both parties tend to benefit from the experience. I have had a wonderful career as a traveler in cardiac cath labs and would encourage everyone to try it at some point. You may be worried by some of the content in this article; however, it is not meant to deter anyone from the experience, only to make it a more pleasant journey for you. The Agents If you choose a career in travel, it is almost certain that you will be seeking the help of one of the hundreds of travel companies out there. Rule # 1. They work for you. You will soon learn that agencies often need to be reminded of this simple fact. The problem is that once you have signed the contract, you technically work for them. As a result, when selecting an agency, it is very important for them to understand that your selection is based on an audition you are holding. At the very least, choose an agency which sees you as a partner in the travel experience. Agencies use your professional qualifications to make money for themselves, so the least they can do is treat you as a professional. An important part of choosing your travel company is choosing your representative. This is the one person with whom you will have the most contact and should be responsible for seeing you through your contract. It is as important to choose the right representative as it is to choose the company. You should also interview the representatives and select the one that best suits your needs. There are many nursing discussion boards related to both traveling and travel companies. They are very good at alerting you to pitfalls of the trade. You will find that many people have different opinions of the same company; this is usually related to their representative and not the company. I have met people who had an absolutely horrible time with a company and then heard someone else sing their praises. Remember that the hospital does not pay a temporary agency separately from you. The money goes into one pot and from it comes your pay, housing, insurance and other benefits. This means anything you do not get paid or spent on you by the agency, they pocket. The average movie star or music agent gets around 10-15% of their clients’ earnings. Nursing agencies can get up to 25-50%. If you don’t fight for it, they will be happy to keep it. The Basics For Getting Started 1. If you cannot speak with a representative directly, then you may not want to select that particular agency. Many agencies want you to complete online forms or mail in forms that are usually flawed in their ability to represent your true qualifications and experience. If the agency is dedicated to doing the best job (as most advertise) then the least they can do is have a human answer your questions directly. Find out before handing them all of your information. 2. If it isn’t in writing, then it doesn’t exist! Do not believe that you are being housed in a luxury condo with a sauna, maid and stocked bar unless you see those exact words in writing as part of the contract. There will be many discussions with things being offered, traded, omitted or retracted, often in the same conversation. There will be a lot of technical jargon being used (often making something more appealing that would not normally be). Things can get quite confusing. After any conversation, ask that it be typed up on company letterhead with their signature, and then you will look it over for consideration. Communicate via email to have a record of what is being said (even if it is not the soundest evidence, it is better than verbal). 3. If an agency doesn’t know what a cath lab is, or what an RCIS or cardiovascular tech is, then you had best steer clear. The cath lab, as you know, is very different than working on the floors. If you start down this path, then chances are you will be trying to explain everything, from why you have so much overtime to why you deserve more pay an hour because you have your RCIS, RN, or both. Skills like being cross-trained make you a valuable commodity to those who know what it means. Most nursing agencies are geared toward nurses who work regularly encountered hours (8, 10, 12 hour shifts). You will find that almost everything in their standardized contracts relates to these types of jobs and will be amended one at a time (as the problems arise) and may involve much explanation from your end (a real hassle when you are trying to concentrate on your new work environment). I prefer agencies that specialize in cath lab or in radiology placements. These agencies tend to treat you like a professional more than straight nursing agencies. If you are looking at a nursing agency, then you should inquire about their Allied Health division. These representatives are specialists in non-nursing professionals. You may want to contact the allied health division even if you are a nurse. They tend to know more about specialized areas like the cath lab or special procedures. It has been my experience that nursing representatives often treat you like an employee, and are not above threatening and intimidation tactics to get more for themselves. The simple fact is that there are more nurses out there and they don’t have to treat them as well as they do specialized professionals there will always be someone else around the corner who will do as they wish. 4. Remember: GET IT IN WRITING FIRST. This will save an enormous amount of strain on you in the future. Agree to nothing that is not in writing. 5. What are your qualifications? Do you scrub? Circulate? Monitor? Control X-ray equipment? Any combo of these means you are cross-trained and thus deserving of more pay than someone who is not. Make sure that you convey this. RCIS, RN, RT, EMT-P, and RTT are the standard licenses and certifications found in a cath lab (there are many others, but these are the main ones). This does not mean if you are an OJT CV Tech that you cannot travel. I have met people with no licensure or certifications that command the same pay as any other person in the cath lab. I have traveled twice as an RCIS rather than a nurse since the lab was not in need of a nurse at the time, so be flexible in your presentation. Spread out your experience, licensures and certifications to provide as wide a profile for yourself as possible. For example, do you perform peripheral exams and interventions? Make sure you convey this, as it opens up the area of special procedures to you. Ultimately, the representative you choose should have a firm understanding of what you do and the credentials you hold. 6.You will be responsible for acquiring licensure in each state, as well as paying any fees. I have the agency help in this process, as they often know channels to quickly get at least a temporary license. The fees are usually paid by you (any good agency will pay costs up front for needs and then recoup it from your paychecks over time). What is a Good Contract? Simply, a good contract is one that meets the majority of your needs and desires. Feel free to play agencies against one another to try and get the best deal. Remember that they are using your skills and hard work to make money for themselves. You should not feel like you are doing all the work. It is their job to find you work, safe housing, and support you throughout the assignment. If they are not doing one of these basics, then they are failing you and should not be making money off your name. If the agency truly wants you, then they will bend their rules. It’s like bartering. The price is not set and should be negotiable. The best offer is not the one they will bring to the table. Some things, like desired location, wages or benefits, will narrow down the companies you may choose. Here are some general contract suggestions: Wages: A good hourly wage for an experienced cath lab worker is $28.00/hr to start. There are people who make considerably more. Schedule: Get your schedule in writing (and agreed to by your assigned lab). An 8-hour day, 5-day-a-week schedule will not work if you show up and the lab works 3 x 12s. The company may punish you for the fact that you do not work the scheduled days (yes, this happens). Job Description: Do not take the chance of being floated to a pediatric ward because there are no cases today. You may find yourself being chastised because you can’t scrub when you never had any intention of doing so. You should have guaranteed minimum hours that the facility must pay for, in the area you were hired to work, whether there is a need or not. Do not spend 3 months being called off every other day. You will not be getting the money for which you signed on. If I want to be a float nurse, I will specify it in my contract otherwise I am staying with the specialty to which I agreed. Housing: Housing should be paid. If it is not completely free, then you need to know why. Some companies give you a housing allowance and the rest is up to you to pay. If this is the case, ask why. It may be that they try to get better accommodation. Some companies offer free shared (with another traveler) housing and partially paid single housing. Be wary of placement in unsafe areas or anywhere not acceptable to you. It is your right to be moved if you want. If not, then you have chosen the wrong company. I was once placed in a bad apartment and had a robbery suspect run by my door with a gun (apparently a common occurrence where I was living, according to my worried new workmates). When I asked to be moved, the company informed me that being from Arkansas, I obviously wasn’t aware of how the real world was and they would not be helping me move. You can imagine how this went over on my end. Yes, I did move. However, I had to do all the work, while also trying to also do the job for which I was hired. I’ve also had a company try and place me one hour from a cath lab job that required call time. I pointed this out to them and I assure you, had they not been scared that the lab would be upset, they would not have budged (my convenience was of no concern). They never thanked me for pointing this out and this has cemented my belief in avoiding representatives who don’t understand my job thoroughly. Housing should be furnished with a bed and somewhere to sit at the least. Pots, pans and utensils need to be brought. One helpful thing to know is that it takes at least $200 to make even a furnished apartment livable to normal standards. The items you never think of can cost quite a bit when you buy them all at one time: e.g., shower curtains, toilet brush, trash can, bathroom rug, etc. Buy them once and hang on to them throughout your travels. Bills: All common bills except the phone bill should be paid. Call: Call time should be at least $4 hour, with time and a half for callback. Inquire as to how often you will be on call and have it answered in writing. O.T.: Overtime should be over 40 hours per week, and time and a half as well. Inquire as to how much O.T. is usual and have it put in writing. (You know how cath labs can be…) Bonuses: Some companies offer bonuses upon completion. You should understand their policy well before agreeing. This area is often fraught with confusion and is often related to very strict rules. Bonuses can be the leverage a company holds against you if, in their opinion, you have not fulfilled a contract. Per diem: Some companies offer per diem of $20-$40 dollars a day for daily expenses. You may find that this is a better option than big bonuses that often get eaten up by taxes anyway. It is tax-free and since you are paid in each paycheck, it cannot be withheld later. Insurance: You should receive some form of free adequate insurance for yourself and the option to add family to the policy at a fair price. Contract length: The contract length will be whatever is offered and you agree to (again, IN WRITING). The usual length is 13 weeks, but there are many possibilities related to the hospital’s needs. Remember that you will not get any paid days off (usually) and should make some time in between contracts for rest time. Generally speaking, if you miss work for any reason, you are not paid, but you should be able to make up those hours. Often, if you miss a scheduled workday, you will have to pay for that day’s housing. Relocation expenses: You should be paid a fair rate (one that actually covers your real expenses) for your travel to your assignment. This varies, but should be negotiated and seen in writing. Problems at work: Just remember, no matter what happens, you should never walk out on a job without going through the proper channels. If it is the hospital that is the problem, have your agency solve the problem. You have the right to quit an assignment, but will still be contracted to the agency to fulfill the remainder somewhere else. If you quit without their approval, you may lose the pay owed to you. If the agency is the problem, then you need to contact their QA representative or the highest level manager you can. Do not try to solve problems with your representative by dealing exclusively with them. Preparation You’ve received an assignment. Now what? Contact the day-to-day charge person at the lab to which you are assigned. You may find that they know nothing of your being hired, as a superior makes all the travel personnel decisions, or that the person who requested you hasn’t worked in the lab for a while. Introduce yourself and ask how you can best prepare to work in their lab (something as simple as asking Does the scrub pan or inject? can have a huge effect on preparation). If you think all labs are the same, or how many ways could it be done?, get ready for a surprise. You will have to be very flexible, as almost every little task you take for granted can be performed very differently. The initial instinct is to assume they are doing it all wrong, but be open-minded. Your way is not the only way, and in fact, may not even be the best way. I have worked in a lab that had 3 different manifold setups (1 off tap and 2 different on taps) in their packs, and 6 more variations of physician preferences on top of that, related to where the flush or contrast connects. I had to use any or all of these on any given day scrubbing talk about having to focus! Of course, most staff and doctors assume that you were born in their lab or should have telepathically picked up how to do everything the moment you arrive. This is rarely communicated in a rude way, but it’s usually because they’ve never thought of the skill being done differently either. You may think that these things will be handled in an orientation period. How about 2 days? That’s pretty standard. Here’s the change room, toilet, coffee and can...you scrub the next case. This is when you wonder if traveling was the best option. However, after the first sweaty, frustrating couple of weeks, you find a groove and things get much easier. Everyone has his or her preferred and dreaded positions. I am now at the point where I can walk in, say hi, and feel comfortable scrubbing in after being in a lab for 2 minutes. Circulating needs more orientation because it can be very dangerous to realize you don’t know where the defib is, the medications that have been placed in 10 different cabinets, or where the guide catheters live. Monitoring has its own evils learning new hemodynamic monitors can be quite daunting. Usually by the time you leave your assignment you have just about figured out how to do a RHC with 2 transducers and Thermodilution C.O. Most of the time, the people you are working with have never worked in another lab and really do not understand how confusing even the simplest task can be in a new environment. They very rarely intend to be rude and will be glad to help if you explain that you need to see how they do things. DO NOT be the person who repeats Well, we did it this way, or In my lab, we… You can imagine how well this would go over in your lab, right? You also have to realize that in some people’s eyes you are making megabucks and should know everything about everything to deserve it thus, why should they have to teach you? Luckily, these people are rarely in charge and can often be found sitting around in various areas of the lab all day with no apparent purpose. Labs that request travelers are short-handed. This is the reason you are there. The staff is probably tired and teaching takes a lot of effort. Ask for information; don’t expect it to always be spoon-fed to you. Don’t expect to get up to the speed at which they usually run (which, as you know can be hectic, frantic or reminiscent of an assembly line). YOUR FIRST PRIORITY IS YOUR AND THE PATIENTS’ SAFETY! You cannot safely work as fast simply because you haven’t spent years working at that particular lab (this is not meant to imply that working that fast is safe in the first place). Before long, you will find that you are part of the team and will have to actually remind yourself that you are a traveler. You will meet new life-long friends. Departing may be a sad affair, but more than likely you will be ready for your next adventure. One of the best things about being a traveler is avoiding the politics that can make a lab hard to work in on permanent basis. In your travels, you may indeed find that Golden Cath Lab or be lucky enough to acquire a wealth of knowledge, a treasure of friends, and a lifetime of experiences. The best way to find out is to give it a try. Hopefully, this article will help you along the way, and who knows maybe our paths will cross someday under the warm glow of a cath lab monitor. We can share stories of the road warrior life over a bottle of the finest contrast. Author’s note: The opinions and experiences in this article are mine alone. I realize others may have different views. This article is intended to help people get started out in traveling with a focus on avoiding common pitfalls encountered in the trade. Try some of these websites for information related to travel. They offer bulletin boards for medical professionals to exchange information: www.allnurses.com www.delphiforums.com www.cathlab.com Feel free to contact Jason Money if you have any further questions, or if your lab is in need of two Oexperienced travel nurses or techs: Oneworld99@yahoo.com

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