CRAFTING WELLNESS STORY

Travel ER Nursing; Planes, Trains, and Vans

A Travel ER Nurse sat down with MDF Instruments to talk about the benefits of Travel nursing, how to navigate through licensing in different states, and what you need to know to advocate for yourself. From advice about what apps to use, what questions to ask, and how to travel in a cost effective manner; Nurse Anthony is the man to guide you through your travel bug itch.

TRANSCRIPT

Anthony
I used to entertain the thought and I then I saw more and more people doing it. They loved it. I think when it became more real though is obviously when COVID hit you know travel nurse rates were just ridiculously high they were just you know, you're making so much more lucrative you know, when I found out like just by travel nursing I can make four to five times as much as what I made as a staff nurse I could make that much and still get to travel and do things I like all at once so I'm not really spending my money to buy plane tickets like I normally would. I was like, Oh man, we got a really got to really think this through then because like this is kind of the time. I'm Anthony Pope. I'm an ER nurse currently traveling, but I'm from Grand Rapids, Michigan, and I just finished assignment in Salinas, California.

Brooke Smith
I'd love to hear a little bit about why you became a nurse how you became an ER nurse, like what drove you to this career? Was it something you always knew that you wanted to? To pursue? Hi, everyone, welcome to MDF instruments crafting wellness Podcast.

Anthony
When I was younger, I had no idea what I wanted to do as a career, like what could I do for the rest of my life and not hate it? Or get tired of it. But I knew I liked science, like specifically I loved my anatomy physiology class, I took like, and a high school. And then my mom, actually, she was like a CNA, she worked in medicine. And I knew I liked working and talking with people. So I kind of just combined the two. And during that time period actually figuring out what I wanted to do for a career. That was during a time where more men were joining the whole nursing workforce. So that was kind of the big thing, the movement. So I kind of just hopped on board that ship and kind of rolled it all the way here. You chose er medicine as your specialties that can talk a little bit about why you chose emergency room medicine as opposed to another kind of nursing. Before entered. Well, everybody been around the same time, but like I worked as a nursing assistant on like a medical surgical floor. I worked there for about maybe four or five years. So in during that time I picked up over time, and I got pulled to many different units oncology, orthopedics, you know, kind of a little bit of everything. And so I mean, it's not quite the nursing aspect, just the nursing assistant aspect, but I did get an idea of the kind of patients I would see. And I got to see kind of what the nurses got to do, you know, on those kinds of units, what they liked and didn't like, just by what they complained about. And then I got pulled once to the ER, which is kind of like more of a rare thing, because that's such a different specialty where they you really kind of have to know more before you get taken down there. But I was taken down there just to kind of sit for a suicide patient, I got to look around. And I'm like this is pretty cool. And you know, judging from like watching TV shows, which are probably the most inaccuratedescription of any kind of medicine ever. When I got the chance, I transferred down to the ER and became like a tech down there. And I loved it, I had more autonomy kind of could do more things, learned a ton just because it was kind of a completely different side of nursing, I had no idea about. So when I entered school to become a nurse upon graduation, you know, I talked to my manager, and he's like, oh, yeah, like, once you graduate, just let me know. And you pretty much got a job and we'll start training you. You'll just have to, you know, do A, B and C, you know, pass your NCLEX your state licensure exam and all that within a certain amount of time. And then yeah, it just things kind of took off from there and I just kind of completely fell in love with the whole er aspect of nursing.

Brooke Smith
Yeah, I know. It's definitely a different energy there. I wonder did you do you work a lot of night shifts or because I've heard that when, especially when you're starting out? I know you've been doing a little while now. But you know, every nurse has to start in my chest. So I was wondering, are you a night shift or a day shifter?

Anthony
It's kind of funny because when I started out just in medicine, I started up day shift and then I worked like everything just because I wanted to make more money and then I slowly just became nightshift. So I've actually been night shift probably for about maybe seven or eight years. I've kind of dabbled between like a three to three shifts so 3pm to 3am and then night shift so majority evenings and nights but yeah, I've been nightshift majority of the time with every random now and then I'll pick up a day shifts not quite my thing

Brooke Smith
Yeah it's so funny because either people really love night shift or they really load the night shift. I think it's like people are either more night owls or more you know day people but how does that affect like your your day to day life like normal? Because obviously bouncing between like when you're supposed to when society is sleeping and when you're sleeping.What is that?What is that kind of like? How did you make that adjustment and still be able to balance like your life and still working those crazy hours?

Anthony
There's always pros and cons working nights or days, you know, day shift is I'd say, like busier just because you know, people are awake during the day coming into the hospital surgeries happen usually more in the day, the scheduled ones. Night Shift, though, is busy, in a sense, where it's the graveyard shift were usually your, if you're gonna be short staffed, it's gonna be on a night shift, you usually don't have as much staff, it's harder to staff night shift.So for my functioning, I mean, that's kind of the you know, the thing you kind of give up too is when you work nights, you kind of lose the next day, or at least a good portion of the next day. Just you know, you have to sleep you can power through once or twice, but if you know you're coming back to work the next night, you have to at least get like maybe four to five hours minimum of sleep just to be a good functioning competent nurse. But yes, that kind of thing is like I kind of plan out like when I want to hang out with friends and family a little bit of a struggle, but in terms of like lighting, I don't own blackout curtains never have. I'm a person who can. I can fall asleep kind of in any scenario, you could put me on a hardwood floor, I could fall asleep if I'm tired enough.

Brooke Smith
Yeah, you have the sleeping skill. I have that skill too. like anywhere and if I'm tired I can I can sleep on a plane to train doesn't matter. I'm in a hospital.

Anthony
I hadfallen asleep once I think it was like the winter time. And it's like usually, when I work three to three, I'm fine leaving work. But when I work seven to seven, it sucks because that's like the morning traffic everyone leaving the hospital but also morning traffic, all normal people going to work. I've actually been in my car, turned it on had the heat going. And I just look reclining a bit saying Oh, no, I can't back up. There's all this, you know, kind of traffic, everyone's leaving the structure right now. So I'll just wait it out. Like I've gotten in my car at 730. And I woke up at 10am Because I'd fallen asleep in my car. And I'm just thinking, I fell asleep in my car in the middle of winter and no one even decided to knock or check on me the cars on thankfully. So when I had a full winter jacket on, of course I

Brooke Smith
Yeah, that's the one thing I can't sleep if I'm too cold, but I just didn't have Well, I mean, that's a good kind of trade that you have for obviously your profession, just being able to kind of be more of a night owl so you can work those night shifts. And then also the sleeping schedule, which is is very helpful thing but I think you know, like anything you acclimate your body acclimates and you get used to things.

Anthony
Oh, yeah, if you do it enough, you know, your body's like, alright, this is my normal, because right now I'm in the process of trying to learn how to wake up at like 6am. Again, just because I've been wanting to try to get more things done early in the morning on my off days, because I tried a bunch on my night shifts together. So then the rest of the week is just okay. I want to get back on a day shift schedule, but it's like, I can wake up maybe at seven 8am Which isn't bad, but I used to wake up both, I could wake up at 5am No problem. Like it'd be wide awake, get so much done, basically gym breakfast and had my whole day planned out. And like, alright, this is a good day. It's only 630

Brooke Smith
Yeah, I know. That's, it's I was gonna ask that, like, if you're working the shifts, like in a row, because I know I want to talk to my people. They're like, sometimes I just want to get three in a row. And then we offer us the week so that they can do you know, have their life and their balance.

Anthony
Oh, yeah, there's one thing that Night Shift Nurses hate. Don't put staggering days don't have any work on Monday, Wednesday, Friday, you will be a zombie just trying to function especially for people with families trying to you know, get things done. It's like no heavy work on Monday, Tuesday, Wednesday, and then I'm off for the rest of the week. And then you know, I'll do three on three, you know, four off or, you know, some people they'll do six in a row. And then they'll have like a pretty much a week off and they don't work until like you know, you know a whole week later and they'll do it again. So six on seven off. Wow. YeahYeah, I think the most nights I've ever worked in a row. And this is obviously picking up overtime. I worked like 14 nights in a row.Those nights were like 16 hour shifts. SoOh, yeah, it was it was horrible. But I mean flu season, overtime, all this extra pay and stuff that was going on just because the flu was crazy. That year was great. But I mean, I was I think like when I did get a day off, I think I slept for 16 hours.

Brooke Smith
That yeah, did you take a little bit of time after the 16 days you'd take like a week or so or two off?

Anthony
I think it was like probably two or three days off.

Brooke Smith
You're making that money. You're like I want to do the overtime.

Anthony
You gotta get it while it's there.

Brooke Smith
Okay, so I want to hear about travel nursing, because this is really exciting.Obviously, okay, first, I guess my first question is How long have you been a nurse?

Anthony
I've been a nurse for like, as of right now probably about five ish years, five, six years.

Brooke Smith
Okay. And then how long have you been doing the travel nursing? How did you find travel nursing? Tell us a little bit about I know you're an adventurous soul. I can tell that from all your years.Awesome post on social, but I just kind of want to hear how did you make that transition and just tell us a little bit about what that process and journey has been like for you?

Anthony
Well, when I first worked in my first er, back in my hometown where I grew up,I heard about travel nursing, I wasn't quite sure everything about it, but I'm like, oh, like, I like to travel and stuff like that. And that sounds kind of cool. I didn't notice logistics. And it seemed like ooh, like a lot of legwork and a lot of paperwork, things to figure out and like, oh, this sounds like a nursing school, like it's a headache.And so I kind of just kind of, like entertained the thought. And I saw more and more people doing it, they loved it.I think when it became more real, though, is obviously when COVID hit, you know, travel nurse rates were just ridiculously high, they were just, you know, you're making so much more lucrative.You know, when I found out like, just by travel nursing, I could make four to five times as much as what I made as a staff nurse, I could make that much and still get to travel and do things I like all at once. So I'm not really spending my money to buy plane tickets, like I normally would. I was like, Oh man, we gotta really got to really think this through then because like, this is kind of the time this is you know, COVID is not gonna last forever. So.But who knows, that might be a thing that lasts forever.But yeah, so once once started putting more thought into it, I think the hardest part was, um, my fiancee, she's also a nurse, she does work in the ER, she works rehab, if she had the harder time jumping on board, just because we're living in the town where all our whole family lives, three nephews and a niece. And they're all like, under the age of like, seven. So you know, you miss out on family time, and all these events, birthdays, holidays.So, you know, that was like the hardest part for her to give up. And so you know, took a lot of talking and kind of figuring out because they're usually only three month contracts.And, you know, you can maybe plan it out. Or if you want to, when you negotiate a contract, you can negotiate certain times off, if you wanted to leave to go home and come back. Or if there's certain things we were okay with missing, versus, you know, just we have to be there for so, and then the long term goals of like, okay, we want to do so we can, you know, short term thing, we're going to make, you know, money for the next year or two or three, and then kind of reevaluate then.And so once you know, kind of became on board, that's when we started getting the process going of like, alright, what agency do we want to work for? We kind of had to do our own little survey people we knew like, hey, what ones do you work for? Do you like them? And it's kind of a learning kind of curve. Like as you're going about it, you don't learn everything you can from other people. Some you do learn from experience.So what goes into it? So it was it's been fun journey so far. Especially we just got done with California, California is probably the highest state tax ever.

Brooke Smith
Tell me about it.

Anthony
Yeah, I was like, Holy crap, like, and since we have a house here in Michigan, we're paying Michigan State taxes and California State taxes. But come tax season, I'm pretty sure we'll get a kickback.

Brooke Smith
Yeah, you will. They'll split. They'll they'll, they'll figure it out. Because sometimes I work in like, I'll film in Texas, or I'll film in Georgia and Jeremy's local, and then I'll pay and then I have to like figure it out. But they'll

Anthony
hire a good CPA

Brooke Smith
you need a good accountant? Oh, my goodness. Well, so isn't there a different there's different licensing, right for the each state? So how do you go about that, like, you're not obviously licensed in every state? So how does that work?

Anthony
Well, unfortunately, Michigan, my home state where my original license was, that is not a compact state. So compact states, kind of our states, you know, they're part of a group of states that if you have your original license in one of those states, it's much easier to get a license in other compact states as well, because they all participate in this. So you're not have to go through all this much of these hoops, or, you know, you get the you get your license quicker. Because the thing is, for a lot of these states, California is by far the worst.But you would apply for your state license there. And it could take anywhere from sometimes three weeks, eight weeks. Or if you like California, it probably took me about like three ish months, maybe give or take like a couple more weeks just to get my license. And if you don't have your license, you can't work in that state. So even if you're ready to go and a place needs you, if you can't get it, you can't work. So usually your agency provides you with like the whole two page thing of like, this is how you go about getting your license on that state website. You pay all the fees, the license, you have to get your fingerprinted, and kind of you know pay for all the stuff that you say there's receipts, you send them to your agency, and they reimburse you, but they only reimburse you if you work in that state. So you could, you know, apply for five different states. But if I only worked in two of them, I'm only getting reimbursed for two. So what kind of incentive to work in the other three? Right? So does thatAgency helped negotiate your contracts to for these these short term stunts or is that all on you to negotiate your rate and everythingthey would negotiate, you kind of let your agency or recruiter know like the terms you need, like, Hey, I would really not want to work every weekend. I'd like you know, I'm okay with every other weekend, or, Hey, I'm an ER nurse, I don't want to float, I don't want to I don't feel comfortable floating to other units, especially if it's not my specialty. So they would negotiate those things. And then the hospitals say yea or nay when it came to that. The hard part is that people don't realize is when it comes to travel nurse contracts. Theso basically, the agency is the vendor, the hospital is the buyer, and the nurses are the product. So really, those contracts aren't meant to protect nurses, they're meant to protect more. So the agency in the hospital, so those contracts, unfortunately, they don't hold a lot of weight when it you want to stand up for you as a nurse. So they've had it where you know, especially COVID made it a lot worse. Oh yeah, we'll hire you in you'll be be paid at this rate. And then suddenly, two weeks into your 13 week contract, hey, we're lowering your rate. What's the point of a contract? If like, you know, you can just change it. And they don't call it changing it. They just say no, that contract is null and void. This is a new contract we're bringing up. So basically, if you don't agree to this contract, then you don't have to work for us. So I'm off the hook, at least I don't get in trouble for leaving.But if I don't sign here, and you're already, you know, yeah.The hardest part is travel nurses, these are people who've picked up there everything their whole life to move from like Michigan to California, you know, if I got there started working for two weeks, you know, I already spent like my first month's rent and a deposit down. And now they're saying they're changing it, if I said, No, I won't take it and I don't have a job. Well, I also don't have, I only have a place to live for the next two weeks, then because I only paid for one month so far. So you kind of like wasted money getting there, because they don't reimburse you, you know, necessarily on getting there. And then your first month's rent and the deposit. And depending on who you rent from, they may not be so generous as well. So you know, you may make great money as a travel nurse. But there's also great risk, and there's not always a whole lot of protection. So that's where you really have to educate yourself. Know, Like, you know, make sure that you can see the place before you put a downpayment or like, you know, just a security deposit or anything like that. You can sometimes look up hospital reviews, just to see how hospitals treat travelers. I've done this one or two ways, you can join a ton of different travel nurse groups on Facebook, all of them are great, they have 1000s of nurses on there. You can ask about, you know, a place though, and you may get a million messages that diverge into nothing about the hospital, but more about, you know, things that irks them come you know, all this internet arguing, or you can get a ton of stuff, which is great useful, or you can get nothing.

Brooke Smith
Now, this this one, I found, I found, there's a app. And so the med adventure app, it's kind of a traveling effort, traveler traveled health care workers. And what's great about that is it's primarily useful only if you're on the west side of the United States, because I think that's where it originated from. And it's still growing. But here's an area where you can look up your hospital, people have put reviews in on those hospitals. And you can rate them on like, Okay, how's the management? How's the staff? How's the nurse to patient ratio, you know, how's housing in the area? Is the budgeting good? Everything, you can look at every little thing you want? So I'm really hoping that does grow, because as it does grow, it'll become a better tool for travelers. Yeah, absolutely. Because you're kind of going, you know, in the dark, when you're moving somewhere you don't know and work in a hospital, you don't know. And you're kind of just like, let's hope that this is a good one, you know, so it's good that you can use tools that will help you make better decisions on when you're choosing, you're picking up your life, you know, for the next three months, or whatever it's going to be and then you can I imagine you can extend your contract past that if you'd like to, but, um, but I'm interested about the housing situation. So does the agency help you find temporary housing because I know like in California, for example, I know that short term housing like that, they will really jack up your prices quite a bit. So how does that make it worth it for you if you're having to go and pay this exorbitant amount for like rent to California, for example? How does is there something that they do to help balance that a little bit for you guys? Or is it just kind of like, you're on your own?

Anthony
There are a few resources so the agency, my agency and some agencies, not all of them, but they provide you a whole bunch of like kinda like the corporate code.Your code you can use for hotels so that way you get the discounted because if you spend $60 a day on a hotel, you know, okay, that can actually average something that's doable. But you're in a hotel. So it's kind of just met, you know, it's not your thing, it just depends on your preference. There's codes for Airbnb that allow you to stay a certain amount of time as well.And then there's an app called furnish finders, it's the worst app in the world, I feel like if they updated it, it could be great. But that shows in the area in different color codes, you know, green for hotels, I believe it was like purple for like, some people rent out their rooms just in their house. So if you're a single traveler, it's nice. But that's if you're comfortable living with another person or family, especially if you know this, the whole workforce is primarily women may not be a thing that you want to try.Or just a place where you have to yourself, which is usually more expensive, since it offers that amenity.Other than that, though, you can look on like Facebook groups as well. The hard part is like yeah, during COVID, and you know, travel nursing becoming such a high volume thing going on in the US. I feel like a lot of people who have owned these places have jacked up the prices because they are aware of how much travel nurses make. And they know Oh, yeah, you can you can afford it and like, well, the moment it becomes where I'm not making money or enough where it makes it worth it, that's when you're going to drive people away.So unfortunately, you know, we're given a stipend, you know, from the government. But it's based off of like the market value of the area you're in. And unfortunately, just due to the horrible inflation, I don't believe those rates have been adjusted to inflation. So you may get the MAX type and you can for your area. But if the areas you know, housing costs are just way above, you know, in what they try to do is they try to say, Oh, your stipend, you're getting this much money, like, you know, in the hourly, like, when I was in California, I was getting paid $20 An hour less than the staff was. And yeah, it's it made no sense. They just said, oh, yeah, but your stipend is this. And like, Yeah, but my stipend pays for my house at home in Michigan. And then it's paying for my place here. And it's not just housing, you know, because I have like my little camera that looks at my house at home, so I can view it, but I pay for that subscription. But in order for that camera to run, I have to keep paying for my internet here, then. And then, you know, since I was gone for the winter, and we get you know, cold winters actually here in Michigan, I make sure my app, I can adjust my heating. So I'm still running heat and everything in my house here. So all these other little bills are trickling in, I pay for a lawn service to mow my lawn, because I'm not going to expect family to come every two weeks.So all these other little bills, that's what that pays for. But then the agencies and other hospitals will say say that counts as income like that really counts for living expenses. Everything else that taxable wage is income. So that's the very difficult part is, you know, they can disguise it, especially to the newer travelers who have joined, which there are a lot of them. If they don't know the jargon, they don't understand how it goes. It's very easy to disguise it. And you know, your stipend as actual income and it looks good up front. But in reality, even though you might still be making more money, you're also potentially missing out on money.

Brooke Smith
Yeah, and especially in a place like California when everything is just astronomically. Oh, yeah. A lot of other places. Does the agency take a percentage of your cut like as well, or getting you the contract or helping you through? Like, how did they here's

Anthony
the crazy thing is when I joined travel nursing, it's It's kind of insane, because I feel likeso the hospital has a bill rate, you know, what the how much they pay for me, you know, and like the whole package. And so, and the agency takes a cut of that. And then I'd get like the with the rest. But here's the thing is, I don't you know, the agency will never tell the nurse what the bill rate is.And so if they don't tell us what the bill rate is, then it's hard to tell like if my rate drops, is it because the bill rate dropped? Or is it because my agency is taking a bigger cut? And you don't know because if if the bill rate drops, that means the hospital lowered how much they're paying for me, which means naturally, my agency will have to lower my pay, then that that makes sense. It means I would blame the hospital for my my pay cut. But the bill rates the same. And my pay still changes. That tells me my agency is taking a bigger cut. So they're not there's no like limit on how much they can take from a cut there isn't like, okay, Max is you can take 10% or there's no kind of It's a free no, there's no there's no limit that I'm aware of, because I've heard of many different you know, agencies I want to say like I've been told like Iowa has been sometimes the worst with that word, you know, and I don't know how these numbers how accurate they are because it's just from people like online you get to you want to hear it enough though. It's like, hey, some part of it must be accurate if it's very consistent information I'm seeingSeeing, but looking, you know, seems like I might take about 40% of the bill rate, which I'm like thinking, I feel like when you're an agent who like, you know, helps people find stuff, you know, we're like you're an agent for an actor or an actress and stuff like that, you know, that agent might have a bill rate, but I don't think they take like 40 to 50%, they might takeyou

Brooke Smith
10% agent, Max for managers. 15%. So you didn't a manager, you're paying out 25%. But you know, and then you get tax on it. You know how it is. It's just one dime you to death. But I just can't imagine like, I didn't know that. And that's really scary to think about that. There's no kind of protection on like, if you're not even aware of, like, you can't say to them, Hey, what are you taking what person? Like, it's, that's crazy to me, because you're just leaving it at the trust to other people to be good to you. But.

Anthony
yeah, so they say, if like, you can try to request the bill rate from your agent or your from your recruiter, and they may just most likely say that's proprietary information, you know, they can't give that out. And like just all this bigger word jargon, which, you know, it's like if you really want to push at it, but he's, you know, I always say, you know, it's hard, because you can kind of push against the recruiter so much, but remember, they're the ones who find you stuff. So it's kind of hard for newer nurses or newer people in the travel world to want to push back because hey, this is the person who finds me work, and who finds me the highest paying work, do I really want to upset them? Because it's like, you know, there's always a job somewhere for nurses, you can always work for different companies. But it's a very difficult place. But if you have a really cool like hospital, you work for like my last hospital, the manager was perfectly fine showing me the bill rate, like he showed me on his computer. I'm like, okay, so I can see the bill rate, and I can keep track of if something drops, I can see why.

Brooke Smith
Right. And you have that transparency. Like, it's crazy to me that, you know, it's shady to me, just Oh, yeah. 100% and all that kind of information from you? Because it's like, why don't you just share it? If it's if you're on the up and up, then you should just be able to tell me what the bill rate is? And what percentage are taking it's not going to change? Yeah, yeah. Shouldn't be. That's very crazy. Wow, I didn't know that.

Anthony
Yeah, cuz I feel like if you were transparent, no one would be upset. There'd be just, you know, way less arguing over this way, much less complaining and more time towards actually what matters then, like patient care and working and stuff like that. But you know, that way? Good question.

Brooke Smith
Yeah, and healthcare workers are naturally very empathetic, very giving very generous, you know, your guys, you're sacrificing your time with your family, you're there, you know, for the hardest, most difficult times of people's lives and like, that takes a certain kind of person. So I feel like there is a propensity for people to take advantage of healthcare workers, because there's a certain kind of person that goes to do those jobs. And like that, we don't like that. I mean, I'm glad we're shedding light on it. Because like, that is the kind of thing that can cause changes when people start talking about these things. And like, well, this maybe needs to be done differently. You know,

Anthony
ya know, I've told like newer travelers and stuff, and it'd be hard because you know, no matter what, you need income, but obviously, if you want certain things to stop, you kind of have to set those boundaries. But it's hard to say, no, because your recruiters might hit you up for oh, yeah, I had this contract here in this area for this much. And it's like,

Brooke Smith
I'll give it to someone and another person. Yeah, have you? Because they're not

Anthony
hearing no enough? You know, because you can say, oh, no, I'm not gonna take that contract that, you know, that doesn't pay doesn't duplicate my expenses. Like, I can't, I can't pay for my house and pay for being there. It's not worth it. For me, it wasn't pay enough. And they'll say, oh, that's the best for that area. I'm like, Well, have you looked at the housing in that area, it's impossible to find, especially in California, actually. It's very difficult. So we know from those nurses, those nurses who are either been doing this a while who have a little cushion, their bank account, or just those, you know, nurses who are really, you know, type a go getters, everyone else kind of you know, they might push a little bit, but then eventually they kind of fold because it's like, hey, I need to make an income. It's been a little bit. So that's the hard part. What do you do about that? They take advantage of the fact that

Brooke Smith
you get rid of the middleman I think like hospitals should just try to hire people directly.

Anthony
And that's been a thing that's talk is like, you know, you know, nurses if they get like, they're like C Corp, LLC, something like that, and they kind of just, you know, work just directly with the hospital. I haven't looked a whole bunch though, into what goes into that because I'm pretty sure you know, your agent. The agency probably does do things behind the scenes that nurses are unaware, you know, but it's not something that can't be taught or learned, you know, so if you work directly with the hospital, if there's some weird stuff that needs to be done, you know, business like stuff rather than medical stuff, it's like well, I mean, when you're traveling there's you can learn some business stuff then especially that means you get to pocket the majority of like the bill rate

Brooke Smith
Also, like there's incentive for the hospitals, because let's say that you know, the certain amount that they're paying, if they know that the agency takes a percentage of that cut, the rate has to be higher for the hospital. So to justify the nurse being able to take the job, if you cut that out, then the hospital actually probably could end up paying less than you'd actually still be making more, you know? Yeah, I'm sure there is a lot more to it than just, you know, I'm sure it's more complicated than than what we're talking about. But I think, you know, that without the transparency there, that the agency, if they were all very transparent about it, then I think it would be a different story, but when it's kind of like a free for all, and they can take whatever, whatever they feel like or justify, or, you know, I have to tell you, that's an entirely different conversation, I think, you know,

Anthony
oh, yeah, no, absolutely, yeah. Because one thing that agencies can do is they have the whole database. So if I want to work in a state, I'll put Arizona, like, from this time, this time, I don't care if it's nights or days, and then everything in state, Arizona, that they work with, and have like, they'll show me, so that's great. But if I just worked myself, and I worked, you know, just with talking to hospitals, I would probably have to locate a hospital myself in a state and like, oh, this hospital has some good Yelp reviews. And then I would probably see if I call her HR or whatever, and kind of say, hey, you know, traveler, and I, you know, do you need people and stuff like that. And so you'd have to do it one at a time, which could be tedious. Versus if I just see a huge database, oh, here's these hospitals, here's their pay packages. And kind of like all the details of like the unit, if there are any, which it's quicker, but you know, it just kind of depends if your reason you take away the middleman is you're going to take on that extra work.

Brooke Smith
I know, it's a very general statement, right? We talk about mental health a lot. But I'm in in regards to health care, and being a nurse and working in an emergency room setting. I'm sure that, you know, there's a lot that goes into that. And we talk about burnout a lot. And we talk about, you know, finding time yourself, but you're on night shift. So I kind of just wanted to talk a little bit about maybe what you do for yourself to keep your mental health strong, obviously, you're traveling and you're having adventures, and I'm sure that that balance is really great. Um, but yeah, I just kind of just wanted to touch base on any advice you have. For people who might be struggling with burnout, or just anything that you want to talk about with it.

Anthony
It will Yeah, because burnout is just so huge, the most prevalent thing right now with, you know, nurses just given the pandemic and how short staffed everywhere is. So you know, just people feeling worn out unimportant, not supported by their facilities that they work for. It's just, it's horrible, makes you feel very alone and very alienated. And I think what makes it hard is just, you know, it as a health care worker, if you speak to someone who's a non healthcare worker, one of two things you get either it's like, oh, it either can't be that bad, because maybe they don't really understand the full gravity of the whole picture. Or you get people maybe don't really quite know why, because they don't work health care, but they'll be like, Oh, my goodness, that's awful. And they are, you know, kind of like supporting because I absolutely have every right to feel this way. But I feel like if you were talking with other health care workers, you might get a bit more of that empathy and that, you know, be able to relate to people, I just think it's important then not to have it, turn into more of a toxic conversation, you know, negativity, because I'm a firm believer that the energy you put out is the energy you're gonna get back. So it's like, if you're going to concentrate on everything bad that's happening. And you know, just complain about everything. And it's like, yes, there's a place for that you can certainly like vent and let that out. But just don't make that an everyday regular thing. Because what that does to you know, your co workers, your friends, family, anyone, it might push them away, because they'll just like, oh, all they do is complain about this, that and that even though you do have a viable reason for that, you know, not to feel like you're being dismissed from your feelings. I feel like you know, vent complain, have that moment, but after that, what are you going to do now? You know, what are you gonna start doing to change that? Obviously, you can't change the system, but you can change how you react to it. So. So, you know, like I said, you can talk to friends and family, you know, and you can also I think the biggest thing is like, I feel like the stigma around if you talk to a therapist, I feel like when people hear that, they look at you differently, like oh, what's wrong with you? Like, you know, and it's like, no, but I know people who go to a therapist, and there's absolutely nothing wrong with them or their relationship. It's really just upkeep like there's no problems now, but this is how we avoid having problems period. So you can just talk to therapists about anything you want really they're there to talk to and if you have certain problems they find realize they talk through that and teach you how to cope with it, how to work through it healthily, you know, teach you better coping strategies if you have you know, once they're maybe not healthy because some people you know, especially in medicine, if you work nights, a lot of night shifters they'd like to go out to like the you know, neighborhood bar afterwards and I'll have a drink together. Never a bad thing as long as you're not doing it in excess. are for the wrong reasons. So you know, just finding better habits like, hey, let's all go out to the lake today or something, you know, get outside, get out in the sun, do something productive, something that makes you feel good, like you accomplish something. Because I feel like when you accomplish things and you get outside and you feel like if something good your day, you know, you appreciate more. So probably another thing I realized that makes a huge difference, you wouldn't think it wouldn't necessarily, it may sound silly, get like a gratitude journal. So things that you were thankful for, you can literally bullet point it like you can type it in computer or you can have a physical book. I like physically writing it out, just because it's kind of like the difference between getting a typed out letter versus a written out letter is just more sentimental. So you write out like five things you're thankful for for that day. And you can do that every day, every other day, or you can do it for the weak. But then once you start looking at it, and looking back on it, like oh, I actually have a lot to be thankful for. There's a lot of good still, but it's very easy to get stuck and hung up on the negative and what's bad.

Brooke Smith
Ah, yeah, it's so true. You're talking about one, just getting the I don't think I want to say the feelings are bad, because I think all the feelings that we feel are important. And, you know, when you feel sad about something, that's how you feel joy, that's how you know the difference. So I don't think bad feelings are bad. I just think that, you know, if you don't find a way to express them, whether that's artistically, whether that's, you know, dancing in your room, or talking to someone who understands or talking to a therapist, or cooking or whatever that outlet is for you that you can like process. But I agree, I think I think talking it out is the best way, even if you talk to your dog, like just talking to, you know, physically get it out of your body emotionally, verbally, like, just get it out. I think I'm a big proponent on that. And then I think, you know, balancing your life, right, just making sure that, you know, if you work three shifts in a row, and you you know, you're tired, like, make sure you have the time to rest, but also to make room in your life for the things that matter. Like you with your traveling, you know, you kind of were able to, to combine your love for medicine, with your love for traveling. And now you get to kind of do both. So you get to explore new places, and still do what you love, which I think, you know, if people don't have to always do this linear career where you're just stuck in the same place the whole time, you can get creative with your nine year job, especially now. Two questions actually. Where is the best place that you've a traveled to for personally that you've your favorite spot where you've been? And B for work? Where your favorite place that you've traveled to? So far, it's I want to know.

Anthony
I mean, honestly, it's even though we've I've already mentioned a couple times, it's going to be California. And for many reasons, though,

Brooke Smith
yeah, because it is a beautiful state, I'll give us that.

Anthony
California has some of the most diversity. I mean, you got awesome beaches, you know, you got the public beaches, but then you got an all natural beaches. So you got the cold beach vibe, you got more inland, though you got forests, you got mountains, you got waterfalls, you got I think there's nine national parks there. You know, there's so much diversity between Northern to southern to the Bay Area of like California. So that's like the beauty of California. But then as a travel nurse, like California is typically always going to be the highest paying state when it comes for travel nursing. And then California, believe it or not, is the only state in the US that actually has laws for travel, like for nurse to patient ratios. So yeah, there are like I think about nine other states that have laws that say that hospitals have to come up with their own policies for nurse to patient ratios. But California itself has a law that sets the number for depending on what area hospital what unit, whether it's medical, surgical ICU er, for this unit, this is the maximum out of patients you can have. And you know, if you have a very acute patient, like in the ER, if I suddenly get like a stroke patient, I'm one to one with that. I cannot, you know, have like the rest of my three four other patients or whatever, I need to stick one to one with that, you know, so they kind of, you know, have laws that, you know, it protects you and that's what's great about that place is you can provide safe care because you're not giving like 678 patients because unfortunately the reality is so many states you know will have it where these nurses take care of seven or eight patients which is completely unsafe. It burns out the nurses but then also puts their licenses in jeopardy. And then at the same time, the hospital will basically make you the scapegoat if something bad happens. So it's just really unfortunate the position that nurses are put in because usually too when you're a traveler and you're traveling to a place that short staffed that's a place that you sell Think you might walk into but in California, since you know they have laws with it now, I think COVID They may have bent it a little bit because they just weren't expecting that volume to come in. But for the most part, I mean, they make sure you know, especially California's laws with breaks, mandatory breaks, which that's something I never had as a law in any state I've worked in. Yeah, a lot of perks to working in California. So I gotta say, that's probably one of the many reasons why California has been my favorite place to travel.

Brooke Smith
Oh, interesting. Okay. I wasn't expecting that. I like it, though. That's good. It's really good to know. Yeah. I know, the whole, you know, ratio has been a fight that's been going on for a long time in health care, just making safe staffing. For the nurses and for the patients. That California passed a law hopefully other state states will follow suit, and then you guys don't have to be so burdened all the time. Because that's, that's you're exactly right. I mean, you're that you are the scapegoat. When something goes wrong. They will. They'll blame the nurse first, the hospital's not gonna say oh, yeah, it's because we didn't hire enough nurses. And this nurse, one nurse was the nurse 10 patients like there.

Anthony
Yeah. You know, or it's like, no, they didn't hire. It's just they don't do much to retain their core staff. So if you're not paying the core staff enough, and you're not doing anything to support them, except by and pizza and cookies, you know, they're gonna end up leaving for anything else.

Brooke Smith
Yeah, totally. That's crazy. I know. Your fiance's a nurse. Yes. So is she does she travel with you? Is she also a travel nurse?

Anthony
So you know, she's a travel nurse as well. Yeah, she does rehab nursing. She's done med surg as well. But I think she enjoys a rehab more. But yeah, so basically, it's a little more difficult because usually, when there's travelers, couples, or just two travelers, as we're traveling together, they usually work on the same unit, which makes it easier, because like, hey, I need to find a unit that needs two nurses easy. For us. It's like, hey, I need to find one hospital that has a need for a rehab nurse and an ER nurse. Or I find it for California, for instance, to at least find two hospitals in the same city or vicinity that has a need for her and a need for me. And that way, you know, our home base can be in the middle. And so that way, we're not commuting crazy long distances. So it's a little bit more of a challenge, especially because I feel like with rehab nursing, there's not as high as a need as there is for er, ICU, med surg, or tele. But I mean, thankfully, we've been able to find stuff here and there. And I think since you know, California has like those great nursing ratios, she's willing to dabble back into, like medical surgical nursing, which is great, because it kind of opens the door up for more hospitals we could work at.

Brooke Smith
That's awesome. And I want to hear about this camper. Because you're doing a camper situation. So where are we at in this camper situation? What inspired this? Are you now driving across the country in your camper to do this traveling? Or is that more personal doing traveling,

Anthony
travel nursing as like, well how's the smartest way you can do this because you're gonna be when I started realizing in California, it's anywhere from like three to four to maybe sometimes even five grand a month just living somewhere, you know, to have a place to yourself I'm like, holy crap, like, you know, that's a lot of money a month and even if you're splitting with a second nurse, imagine if you're not traveling with someone you're swallowing that whole thing up every month. So even though your stipend covers that it's like what's a way I could save or make more money? And I'm thinking well it's a bit of investment but if you know you're gonna be traveling for you know, X amount more time, you can kind of get back into the green and breakeven or more get you know better. So I you know, looked into a bunch of Van companies that renovate vans, and you know, I wanted to make sure it was a newer van something that if I'm gonna be driving to and from like California to Michigan, that's a long track, I can't have it breaking down. And then you know, someone who could renovate it quickly because most of the companies I found couldn't do one until like this December or 2023. So I found a little small little company, Texas Vanco in Texas. And, you know, it's there, it's a couple and Arkadin to architects husband wife or boyfriend girlfriend I think. And they said oh yeah, like we they got like this website, they have a kind of a couple different things they can do and they said they'd like to try to do custom stuff too just because it really does make it special to each customer. So the plan was like okay, you know, I'd rather get a loan out to make this van because you know, payments for the loan are like $1,200 a month, which is much cheaper than the $3,000 a month. And at the end by the end of the day, this is something I own I'll never own these places I'm renting. Right so on top of like, you know, the cheaper you know, monthly payments and me owning it. Then it also gives you the freedom of housing thing, because now if I wanted to need to switch contracts, I wanted to go anywhere, I don't have to struggle on finding cheap housing. Not to mention not just cheap housing, but can I find housing that's close to the hospital I want to work at or am I gonna have to commute like an hour or something crazy. So it does give you a lot of that freedom, but obviously, not without sacrifice, because you're in a van, it'll have a shower, and a toilet a sink, it has a stove, you know, you do have to refill the water and empty the gray water out here and there. But you know, I have apps that kind of tell you what areas have those, you know, places you can refill and empty. It's used to kind of be flexible, and living a minimalist lifestyle, you may only have, you know, five main outfits you wear maybe just because you don't can pack so much. But this van I pick up on the 15th. So

Brooke Smith
the van looks like that, that's awesome. I love that I love taking charge you needed to if the van for whatever got a little cramped and you guys know, a little bit more space, because you're gonna be there longer, it's just not working for that one state, you know, then you can just get a place and still have your van you know, but the, the option of the freedom, and I'm all about freedom, and like taking control and being able to say, Okay, I'm efficient on my own, and I don't have to, I don't have to rely or pay an exorbitant amount of money to just show up and be able to be to my job. Oh, yeah.

Anthony
Then if we ever needed a break from the van, the two options I could think of is like, oh, yeah, every now and then we could run out like a cheap hotel, you know, and we could spend like a night or two there, whatever. Or I know, there's apps for it, I gotta see how much of a need there is for it. But um, there's people who need a house sitter, for whatever reason. And if you got people in California who say I vacation all summer in my villa in Italy, and like, I will be at your house all summer long.

Brooke Smith
You just like watch their dog or something, you know,

Anthony
I get to watch a dog and I get to spend time in the house. And I have the van outside. It's it's kind of like a and I get paid. So it's like I don't have to pay for a hotel. I get paid to just to hang out in this person's house. So it's another option.

Brooke Smith
No, I love thinking outside the box. How did you discover MDF instruments?

Anthony
Well, obviously, graduating nursing school, I was like, Alright, I need a stethoscope. But I want a good one. But like, you know, if you look into Littman, because, you know, I feel like Littman is one of the bigger top brands out there. You know that brand? Because like, oh yeah, I know a lot of nurses who have that brand. And I was like, oh, yeah, but you know, I looked at him like none of the colors. Screened me like they just looked all you know basic colors, nothing fun. And you know, I'm a person I know how nurses set their stethoscope down or leave it in a room and guess what it's gone. And you know hardest to find it when you say hey, I'm missing my blue or black stethoscope like that's you and everybody. How do you know which one's yours? Well, I have the edge this in the side, you wrote it down in Sharpie and it's already rubbed off because you wipe your stethoscope down with all the wipes. But um, I stumbled on MDF, I think it was just more like, I just Googled like stethoscopes and, you know, I looked like oh, wow, they have a ton of different colors and designs. So that's a plus. And then I'm like, okay, they're not like $20. So they're not cheap, which is good though I you know, I don't want to spend like, you know, a bazillion dollars, but I don't want to be a $20 stethoscope because that's when like the ear buds are rock solid plastic. And it's just gonna fall apart in a year. So I want it like that middle ground quality. But also I can have the fun with the design. So you know, I got my first one. And I've had it for like, almost my whole nursing career till I got my new one. So I wish my old self knew what I knew now. Because like, what I would tell my student, Nurse self, I mean, you know, their stuff, I always knew I was new, I'll always be learning and stuff like that, which you know, I always had that mentality, I will never know everything with nursing, it'll always be changing and evolving. But one thing I wish I taught myself because I just you know, I never I didn't have a mind for it yet because I had the medicinal mind in you know, going for me was I wish I would tell yourself like start like networking now. Like, you know, nursing cannot be your forever career. And nursing is very flexible. There's so much you can do with it. But you know, you can network there's people who are nurses who work basically, you know, they work as a nurse, but then they can have like a side hustle off social media. People who have travelers who've made a ton of money and it's great they pay off all their debt but then a smart thing to do is like oh, you can invest in real estate so you can get other passive income because if you make nursing just your only you know, option for income. What if you get hurt hurt your back? Or you know, because it's you know, I have a buddy he's a chiropractor. He's like, Yeah, usually cops and nurses are my worst backs I work on you know, if you get injured you can't work anymore. There's just you know, you're losing options. But if you can have these other avenues and think almost business entrepreneur kind of mentality If you can set yourself up so that way you have backup after backup, and the great part is you can pass these along to if I ever owned real estate, something happened to me, that's something that you could generational. Yeah, it'd be inflation.

Brooke Smith
Yeah, I know, it's so smart. Because I mean, we touched base a little bit on, because that's what you're doing, you know, you're thinking outside the box, even just starting the travel nursing and the camper, like, you're finding these creative ways to do things a little bit differently, a little more efficiently, a little more wiser, as far as with money, and just time and making, being able to create the life that you want to create and still be able to do what you want to do. But yeah, I think the entrepreneurialship of just healthcare, I talked to a nurse a couple of weeks ago who started this thing called next level nursing. And it just came from her battling her own depression in them as a as a nurse and being overwhelmed and saying, like, well, if I'm feeling this way, there's gotta be other nurses feeling this way. And so she started her own kind of thing and is branching out. And it's becoming a business, but it's also helping people and they just think that, you know, it's the entrepreneurialship in healthcare and medicine, and as a nurse, the sky's the limit, you can really take those skills that you're learning, because you're obviously great with people good bedside manner, all of these skills that you're learning as a nurse, they will serve you in other things, you know, and you can get really creative with what you do with that.

Anthony
Oh, yeah, absolutely. And 100% Agree. Just, I just feel like you know, when you think an entrepreneur mindset, it's just, it's not just if you think about making money, then you're not gonna get anywhere, it's really you just find a problem. You solve it. And you know, you find a way to solve it or make it better. And that's what you're selling. You're honestly as you can, if you can help people and provide value. That's it all in all, it will provide you like income and in return. So glad she found that because that's honestly it helped her and now she realized she could pass on to other people. And so it's you find a lot of filament from that. Yeah, absolutely. I've done like ones where I've gone to Costa Rica on a medical mission trip. You know, I've done Miss trips were back long ago, when Hurricane Katrina hit, like down south. And this was even five years after that happened. I went down there helped clean up and kind of build some stuff. But with travel nursing, it's hard to kind of participate in that. The one thing I'm probably part of them part of Emergency Nurses Association. Hi, it's great, cuz they got a lot of cool resources from that, though. So it's kind of great just to kind of learning new things happening in emergency medicine. And that way, kind of, you know, see either seeing it practice in other hospitals or implementing it, you know, myself just depending on what it is. So it kind of helps you kind of be a better critical thinker and kind of see what can what works and what doesn't

Brooke Smith
you have any any tips, tricks hacks for just either being, you know, being an emergency medicine or for nursing students, or just how to navigate through tips, tricks,

Anthony
hacks? Well, I mean, it's like especially working in emergency medicine, I guess, you know, if you come from, like, if you used to work on a floor of medical surg unit, coming to the ER, because if you come as you start working, er, as a baby nurse, as a new nurse, you kind of just kind of taught and kind of, you know, molded into like what, you know how you're trained, but if you come from a different area, obviously, you have to think differently. So it'd be very difficult handling the fast paced environment tips. I mean, you know, it's just just know who your sickest patient is, you know, and you kind of go down the line from there when it's like, okay, I have like four or five patients, I have stuff to do for all of them. Who's your sickest, and then who's your next sickest and kind of keep going and then sometimes, like, I'll see my sickest then I'll see my next one. Then I go see my sickest again just to double check them just depending on how sick they are. And then I can go to like my third one. And then you know, you kind of know who to bounce around. There's people who are you know, definitely ill they're gonna require your attention more.

Brooke Smith

Anthony
thank you so much for joining our crafting on this podcast. I would love if you could just tell everybody, any social media handles that you have. Whether it's Instagram, Facebook, Tik Tok, any of them we would love to come follow you. I know everybody would like to check out your journey. Check out your travel adventures and also maybe just ask you some more questions

Anthony
on my instagram handle is trekking with Tony t REKKINGWITH t o n y. So @trekkingwithtony is my instagram handle.

Brooke Smith
It's such a pleasure having you on.

Anthony
Thank you so much.

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