03.13.15
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Ask a Travel Nurse: How picky can I be when choosing a Travel Nursing assignment?

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Woman choosing a Travel Nursing assignment

Ask a Travel Nurse: How picky can I be when choosing a Travel Nursing assignment?

Ask a Travel Nurse Question:

Hi David, I kind of have two questions. First, I’ve been told that when looking for a Travel Nurse assignment, you should go through a couple different agencies. True or false?

Well, I did that, and just accepted an exciting job in Washington. When I told my other recruiter that I got a job, she wasn’t too happy with me. And when she was working with me she seemed to want me to take the first hospital that called me for an interview. So, my second question is how picky can I be when choosing a Travel Nursing assignment? Don’t I have the right to go through a couple agencies and find the best job? I’m not sure if the recruiter I was working with is really good or just really pushy and wants to land a contract for her company. Plus, she wanted to me to go to Yuma, Arizona for my first assignment, which I haven’t heard the best things about. What do you think? Thanks!

Ask a Travel Nurse Answer:

Using multiple agencies? True, this is the best practice. I’m not sure I know of any seasoned travelers who do not use more than one agency. I hit two decades of travel this year and I am on file with about six or seven agencies to meet my needs.

Additionally, my recruiters know that I use multiple agencies. I have even had one recruiter tell me that she would honestly go with another company for an upcoming assignment. This was due to the fact that her company could not match the stipend ($400/month more) that another company was offering on the exact same assignment (same location, same hospital, even same unit!!).

However, this type of dialog is only possible when you have great recruiters that know that even if you do not take an assignment with them today, you may very well take one with them in the future.

All recruiters want to put you to work and even mine have pushed a time or two when exploring assignment options. The difference is, when I stated my position clearly, they acquiesced and didn’t get mad, didn’t pout, and often played it off with an “Alright, I understand” in a dejected, but pleasant tone.

You are in charge and as I have written many times before, it is not so much the company that you work for that is the integral part of a good travel experience, but rather, the Travel Nurse recruiter with whom you are working.

Plus, at this time of year, if your recruiter can’t get you to Phoenix (a much nicer assignment location than Yuma), then that agency may not have all the assignment options you should have available.

I keep toying with the notion of consulting and putting together a one day education program for the travel companies where I go to their offices and teach their recruiters what they should know about travel … from a Travel Nurse’s perspective!! Every time I receive an email like yours, I truly see there is a need for it. J

I hope this helps and answers all your questions.

David

david@travelnursesbible.com

 

 

03.13.15
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Sutter Santa Rosa Nurses Vote to Approve Possible Strike

With a large turnout Thursday, registered nurses at Sutter Santa Rosa Regional Hospital voted by 98 percent to authorize their nurse negotiators to call a strike, if needed, to protest the hospital’s refusal to act on their concerns for improved patient care staffing and management demands for significant cuts in health coverage for the nurses and their families.

Santa Rosa is the latest Sutter hospital in the past few weeks where RNs have voted to approve possible strikes with nearly unanimous votes.

Strike authorization has already occurred at Sutter Roseville Medical Center, a 96 percent strike vote, Sutter Auburn Faith, a 94 percent margin, Sutter Tracy, a 94 percent vote, and Mills-Peninsula Health Services, with facilities in Burlingame and San Mateo, a 97 percent margin. Together the five medical centers have nearly 2,600 RNs, represented by the California Nurses Association/National Nurses United. No date has been set for a possible strike.   

“Sutter is trying to force nurses to pay enormous out of pocket costs for healthcare, up to $10,000 per year for services, outside of monthly premium costs,” said Sutter Santa Rosa RN Nancy Anderson. “This employer is offering health care plans to the public that are better than what they are offering their own nurses. We need adequate health care for ourselves and our families and we need safe staffing that allows us to, minimally, take meals and breaks.”   

At each facility the RNs are fighting similar Sutter demands for cuts that nurses say will erode patient safety by a chain with a notorious history in recent years of cutting patient services while rolling up huge profits – nearly $3.5 billion the past five years.

“This vote shows that we are prepared to fight Sutter’s slash-and-burn agenda,” said Mills Peninsula RN Chris Picard. “As a nurse negotiator I am proud to stand with my fellow Mills-Peninsula RNs today: united, determined, and strong.”

“Many Sutter Tracy nurses came out to vote yes to a strike because they see power in solidarity. Over the last month, nurses have been collectively advocating for safe staffing by voicing their concerns and filling out ADOs (Assignment Despite Objection forms, which nurses provide to management documenting what they believe to be an unsafe patient assignment). Nurses are seeing what it really means to stand united,” said Sutter Tracy RN Victoria Lat, RN.

 
At Roseville, where the RNs held a picket earlier this month, the nurses cite budget cuts and a resulting lack of beds that have meant patients are being admitted with no hospital beds available. The patients are then housed in the ER, limiting the ability of ER nurses to safely care for other patients needing emergency care while they have to also monitor and provide care for patients who should be in an inpatient hospital bed. It also results in RNs from other hospital units having to leave their patient assignments to work in the ER. 

“We’re fighting for patient safety, we’re fighting against unsafe staffing,” says Roseville RN Jennifer Barker Andrea Seils, RN. She notes staffing cuts in the labor and delivery unit where she works are being carried out under the guise of  “efficiency” that nurses say is actually about cost cutting at the expense of care. According to Seils, “They’re trying to restructure our unit to eliminate positions and combine care. It’s unsafe for mothers and babies in our community.”

Additionally, Roseville nurses say Sutter is demanding more than 30 reductions in the RNs’ existing health coverage, including big increases in out of pocket costs for nurses, all of which are paid to Sutter under Sutter Health’s self-insured plan. These costs exceed what county and school district employees covered by Sutter’s HMO pay to Sutter Health.

 “There’s no economic or operations justification for any of their proposals,” says Seils. “The strike vote will send a strong message to Sutter Health that RNs are serious about fighting for patient care.” 

In Auburn, the overwhelming strike vote was intended, said Sutter Auburn Faith RN Sandy Ralston, “to serve as a very strong signal to the employer that nurses are not willing to accept the significant health care cost increases being proposed by Sutter. It also sends an unmistakable message about staffing safely by acuity and that we are united in our commitment to a fair and just contract. ”  

CNA/NNU nurses are also engaged in a similar battle for a fair contract at Sutter’s California Pacific Medical Center-Pacific campus in San Francisco, Sutter Lakeside, Sutter Santa Cruz (a visiting nurses home health service), and Sutter Solano in Vallejo.

03.13.15
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Proposal protects healthcare workers from workplace violence

MNA members testify about S.F. 1071, workplace violence prevention bill on March 11

MNA members testify in favor of a proposal by Sen. Chuck Wiger to reduce workplace violence against healthcare workers on March 11

By Mathew Keller, RN JD, MNA Nurse Policy Specialist

As a result of the assault against staff at St. John’s Hospital last November, the hospital removed bedside poles that could be used as weapons.  While this action may prevent future violence, it’s too late to help the nurses who were attacked that day.

Meanwhile, there’s a bill in the Minnesota Legislature that could lead to better prevention and preparation for healthcare workers caught with a violent patient. HF 1087 and SF 1071 are bipartisan bills aimed at preventing violence against health care workers, require that hospitals:

  • Develop preparedness and incident response action plans in collaboration with health care workers;
  • Provide adequate security staff;
  • Allow healthcare workers to request additional staff due to concerns over possible violence;
  • Provide training to all health care workers on safety guidelines, the incident response plan, how to properly de-escalate situations and request additional staff, and the worker’s rights regarding acts of violence.

In addition, HF 1087/SF 1071 prohibit hospitals from interfering with a healthcare worker’s right to contact law enforcement or the Minnesota Department of Health regarding an act of violence, and establishes an electronic violence prevention database, which will allow the state to track trends in violence against healthcare workers at a hospital level.

The violence against healthcare workers bill could go a long way toward preventing potentially violent or abusive situations we have all experienced as bedside nurses.  Furthermore, it will prohibit hospitals from preventing or discouraging nurses from reporting abuse from patients or visitors, which we know is a common problem.

Unfortunately, the Minnesota Hospital Association would rather enact harsher punishments on perpetrators of such violence rather than prevent the violence in the first place.

MHA claims that nurses can already report safety lapses to the Office of Health Facilities Complaints, but this argument displays little understanding of how healthcare workers can interact with state agencies.  Both MDH and its commissioner tell MNA that OHFC investigates only complaints against facilities that are violating current law; when a patient assaults a worker, the facility has not violated current law, and therefore a complaint against the facility would fall outside the jurisdiction of OHFC.

The hospital association also claims that the violence prevention bill is a ploy to enable nurses to report safety issues to the Minnesota Department of Health; but as MHA itself stated in a letter dated August 13, 2014, to MNA President Linda Hamilton, they view nurses as statutorily obligated to report unsafe staffing to the Department of Health and state that “allowing hospitals, the Board of Nursing, or the Office of Health Facility Complaints to actually address any legitimate concerns” is of paramount importance.  Thus, on one hand MHA views the violence prevention bill as a ploy to enable nurse reporting to MDH, but on the other hand views such reporting as mandatory and of paramount importance.

MHA needs to take a hard look in the mirror and accept some responsibility for a flawed system, which does little to nothing to prevent violence in the healthcare setting, ignores nurses who ask for resources to help prevent a brewing problem from exploding, and discourages nurses from reporting violent or abusive situations to the relevant authorities.  Instead of punishing sick and delusional patients even more for their abhorrent actions, let’s prevent them in the first place.  Let’s remove the pole before it is used as a weapon.

03.13.15
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Conversations with Kay, Part 1

 

      It would not be an understatement to say that the very existence of National Nurses United, and the modern bedside nurses movement it represents, would not be possible today without the leadership of Kay McVay, RN.

      McVay, a longtime Kaiser Permanente intensive care unit nurse from California, just celebrated her 80th birthday in January. In her career, she has seen nursing practice change from a time when RNs were not even allowed to draw blood to when they are routinely performing life-saving interventions, using the most sophisticated equipment, and assessing the sickest and most fragile of patients.

      And though the practice of nursing has evolved at a breakneck pace over the last 50 years, the working standards and salaries of nurses have not – a failure largely attributable to the extremely classist culture of the country’s state nursing associations and its parent organization, the American Nurses Association.

      It might sound odd to NNU members today who are used to their organization championing bread-and-butter nursing issues such as safe RN-to-patient staffing ratios and fair contracts, but, as late as the 1990s, the vast majority of the state nursing associations did not prioritize the concerns of the bedside nurse. They were controlled mainly by nursing executives and nursing academia types who actually thought that if you were a nurse who still valued or (gasp!) enjoyed providing hands-on patient care at the bedside, that you must be not very smart, not very ambitious, not very worthy, or all of the above.

      Kay McVay helped change all of this.  

      Starting in 1992, McVay, a handful of other RN leaders, and dedicated staff, including now-NNU Executive Director RoseAnn DeMoro, successfully worked to win back control of their state nursing organization, the California Nurses Association, for bedside nurses. CNA’s “staff nurse rebellion” spurred its secession from the American Nurses Association in 1995 and paved the way for many more states to follow suit, including Massachusetts, Maine, Minnesota, Michigan, and New York. Many of these states are the founding members of National Nurses United, now the vanguard organization for registered nurses across the country.

      As the new CNA’s first president, Kay McVay has been a key leader every step of the way in building this new nurses movement. Beginning in this issue, we will be regularly sharing interviews we are conducting with McVay about all that she has witnessed over her 80 years. We hope that through her stories of life, of her nursing career, of her involvement with the California Nurses Association and National Nurses United, you will better understand how far registered nurses have come, and how far we still have to go.

      In this column, Kay gives us a glimpse of what it used to be like as a staff, bedside nurse to deal with the old California Nurses Association, pre-1993.

 

Kay, you always refer to the old California Nurses Association as headed by “the ladies auxiliary.” What do you mean by that expression?

It refers to a type of society group that was popular back then for women, especially the wives of men who were in some kind of association, to belong to. They would typically concern themselves with hosting charity events and social functions that would make them look good and confer them a certain social status, but that were ultimately just superficial and never addressed any real problems.   

 

So it’s the 1980s, you had a work problem, and you called the Ladies Auxiliary. What was your problem and how did they respond?

Well, we were being told to stay and work overtime or come in and work whether you had obligations at home or not. And if you didn’t stay or come in, you could be fired. I would be called in at two in the morning, and I would go. We needed to work these types of problems out, and nobody was willing to do anything, to say anything, or to give you any insight into what to do or how to possibly talk about it with your superiors. So I remember calling the person who was in charge of nursing practice because I wanted some help in how to handle this problem, and the person told me that I had a union and I had to take my problem to the union, that I couldn’t possibly get any help from her.

 

So for the Ladies Auxiliary, the union was this completely separate thing that had nothing to do with nursing?

Right. And back then, it really was a separate department, the Economic and General Welfare division. There was no understanding that your working conditions and standards were absolutely related to nursing practice and the care you could provide as a nurse.

 

Who were these Ladies Auxiliary members and where did they come from?

They were academics and managers for different hospital chains, including Kaiser.

 

It sounds like they were really disconnected from actual nursing.

Their attitude was that if you remain at the bedside, you must not know very much. To me, that was the only reason why I became a nurse was to be at the bedside. I didn’t want to be anything else.

 

Check back next issue to find out what Kay McVay did next.

03.13.15
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Advocates Say California Counties Need To Shore Up Care For Remaining Uninsured

With millions of Californians gaining coverage under the health care law, counties need to strengthen their health programs to serve the remaining 3 million uninsured people, nearly half of whom are living in the state illegally, according to a report by a statewide advocacy coalition.

Under state law, each county is responsible for providing care to low-income Californians who are uninsured. But eligibility restrictions in county programs vary dramatically, leaving the uninsured with uneven access to care across the state, according to the report by Health Access California.

The coalition, which surveyed all 58 counties last fall, found that 48 of them preclude residents who are in the country illegally from enrolling  in county programs, and 43 exclude any resident earning more than twice the federal poverty level. (The poverty level is $11,770 per year for an individual and $24,250 per year for a family of four.)

In 2014, counties worked hard to enroll as many of their residents as possible into new coverage options through the Affordable Care Act, said Anthony Wright, executive director of Health Access.  Because millions were enrolled either through the insurance exchange, Covered California, or through Medi-Cal, the government program for the poor, the counties experienced a significant decline in the number of people enrolled in their programs.

But significant pockets of uninsured people remain – especially immigrants living here illegally, who are mostly ineligible for state and federal programs.

In counties with strict eligibility criteria for their programs, such as Merced, Placer and Tulare counties, no residents are enrolled. But counties with expansive programs that cover the undocumented and higher-income residents are still seeing high levels of enrollment. In Los Angeles, for example, 81,000 people were signed up with My Health LA, the county program.

The widely varying levels of enrollment among counties suggest that local governments “need to re-adjust their programs,” said Wright in a press release. “We need counties and the state to reorient their safety-net programs to serve the need that continues to this day.”

Few counties have adjusted eligibility requirements for their programs in the past two years, Wright said. Instead, they have taken a “wait-and-see” approach until the effects of the ACA and the state’s reallocation of safety-net funds were clear.  Many are reconsidering how to manage their safety-net health programs as of 2016, and advocacy groups such as Health Access are hoping the counties will expand their eligibility requirements, particularly to allow immigrants here illegally to enroll.

“These county efforts should ultimately be a bridge to a statewide solution, where all Californians can be covered regardless of immigration status,” said Wright. “Immigrants are part of our economy and society, they should be fully included in our health system as well.”

But some in the state say that expanding health coverage to additional residents would be too costly. A bill currently moving through the state legislature, for example, would expand insurance options to immigrants living in the state illegally. That bill, called the Health for All Act, would cost the state between $424 million and $436 million in 2019, according an analysis from UC Berkeley’s Center for Labor Research and Education and the UCLA Center for Health Policy Research.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

03.13.15
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Credit Rating Agencies Agree To Be More Flexible About Medical Debt

Too many consumers have learned the hard way that their credit rating can be tarnished by medical bills they may not owe or when disputes delay insurer payment. That should change under a new policy agreed to this week by the three major credit reporting agencies.

The agencies say they will establish a 180-day waiting period before medical debt is added to someone’s credit report. In addition, the agencies agreed that when an insurer pays a bill, the debt will be promptly removed from the consumer’s credit report, unlike certain debts that remain for years.

The changes are part of a settlement between the credit rating agencies — Equifax, Experian and TransUnion – and the New York Attorney General’s office that aims to improve accuracy and enhance procedures for disputing credit report errors. The agreement covers consumers across the country.

The three agencies gather information from banks and collection agencies about consumers’ credit — such as payment history and how much someone owes — to create a credit score for about 200 million individuals throughout the country. A person’s credit score is used as a measure of credit-worthiness, and it can influence people’s ability to get loans and the interest rates they’re charged, among other things.

“This is going to help millions of people access more affordable loans,” says Mark Rukavina, a principal at Community Health Advisors in Chestnut Hill, Mass. “People will no longer be penalized for having a medical bill slip past them and get on their credit report even though the bill gets paid.”

Insurers sometimes wrangle with patients and providers for months before paying a bill. The new six-month waiting period will give consumers time to resolve such disputes, Rukavina noted.

Medical debt accounts for more than half of the collection items on credit reports, according to a report by the Consumer Financial Protection Bureau. Among people facing collection for only medical debt, about half have otherwise clean credit reports with no sign of past debt collection problems.

Please contact Kaiser Health News to send comments or ideas for future topics for the Insuring Your Health column.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.