And the world will know!

Everything I ever knew about strikes I learned from Newsies. From the spontaneous musical numbers to the violent fistfights, I’ve been preparing myself. That’s right, people. Stanford Nurses may be going on strike. I’m not officially a scab….yet. But I was led to believe otherwise by a staff nurse one night during change of shift. Maybe I was reading into it, but she kept referring to travel nurses as “scabs” and asked if I was thinking about taking a bonus from the hospital for working the strike, subtly implying that I would burn in hell for doing so. First off, none of your business, second, why would you call the people covering you while you strike a nasty name?? I’m making your strike possible, so how ‘bout you be a little more careful with your choice of words and tone of voice.

haters

In Nursing School, strikes and unions were commonly discussed and debated. Even then, I was of two minds on the issue. On one hand, it seems to go against the spirit of the nursing profession to abandon the care of your patients because of your working conditions. Yet, most nurses are striking because (and this is the most important point) the health and wellness of your nursing staff determines the outcome of your patients.

Pay is almost always one of the reasons for a strike, but it is usually the smaller point among some much larger issues, such as high ratios of patients to nurses, required overtime and unrealistic staffing demands. In the long game, changing these factors makes for better and safer patient care. Temporarily leaving your assignment for the betterment of patients down the road seems like a noble cause to me.

You can read up on the whole strike here. There are some things that aren’t really clear in the article so I’ve been talking to a lot of the staff nurses, trying to get an understanding of what the big issues are. Don’t feel obligated to read it, I just thought it prudent to provide the source material for fact checking, etc. Luckily, we have several union board members that work on our floor so I’ve been able to get a clearer picture over the last week.

I’ll try to sum it up as best I can. Stanford Hospital (which includes Lucile Packard) is currently in the process of expanding to a much larger building, slated to open in 2017. As part of their expansion, they will be hiring a large number of nurses. However, CRONA (the union) wants Stanford to fix the current issues that are already causing nurses to leave Stanford in droves. Issues like:

Pay: Cost of living is so astronomically high in Palo Alto and surrounding areas that nurses have been leaving Stanford to go work for other bay area hospitals like UCSF and Kaiser, where pay is far more competitive. The union has proposed a pay raise that is, admittedly, very high over the next three years. In theory, this pay raise would catch Stanford nurses’ salaries up to the surrounding hospitals and make it possible for them to live closer to Stanford. Which brings me to the next point.

On call hours: I’m not positive how “on call” works for OR nurses, but from my understanding, it is required for nurses to be on call for a certain amount of time every week and within a certain distance from the hospital. At Stanford, on call requirements are 24 hours and you must be within 30 minutes from the hospital. Combine that with the high cost of living and that means you have nurses sleeping in their cars because they can’t afford to live or stay 30 minutes from the hospital for that long a period of time. CRONA wants Stanford to reduce on call hours to 12 hours per week to make this more manageable.

Reporting for duty!
If you want your OR nurses looking like this…just sayin’….

Flexible working hours: One of the most important issues, according to staff I’ve talked with, is flexibility of hours. At Stanford, RNs do not have the option of working decreased hours. You’re either Full Time or PRN. There is no in between. I think this might be different for outpatient, but I’m not positive. So, say a nurse has small children, wants to continue working inpatient, but would rather work one or two shifts a week instead of three. Not an option, so that nurse goes to PRN. That means staffing can call that nurse in for 8, 10 or 12 hour shifts as needed, when their available. That also means that nurses are constantly being shuffled around the hospital throughout the day based on needs and handoffs are being made multiple times to multiple different nurses. I was literally called in one day for FOUR HOURS. 3pm to 7pm. I received report at 3pm, did my assessment of my patients, gave a few meds, then turned around and gave report to the night shift nurse. In the hospital, nursing care is a 24 hour job, and each time the next shift comes on, you have to report the patient’s progress (or lack of progress), the plan of care and pass along any duties that you weren’t able to get done on your shift. If you split the shift up too much, the effect is like the game Telephone- information gets misinterpreted, or missed altogether and patient care suffers, as a result. By giving more senior nurses the option to work 24 or even 12 hours a week, they might be able to retain nurses and save money, not to mention provide safer care and require less support from travel nurses.

Aaaaannnd that's how rumors start, kids!
Aaaaannnd that’s how rumors start, kids!

As a travel nurse who has already extended my contract, I’m not sure what this means for me. Some people have suggested  I cancel my contract and sign on to work the strike so I can make more money. Admittedly, if I continue working for the same pay while the strike nurses are making significantly more, I will be pretty pissed. On the other hand, it just feels ethically wrong for me to break my contract like that. They need nurses that know the patients, the floor and how to give chemotherapy. I expect to have some sort of compensation, don’t get me wrong, but I would rather keep my contract and get compensated accordingly. What scares me is the idea of having to be one of the “experts” while they call in reinforcements to staff the hospital. I’m scared for the patients and, to be honest, I’m pissed at the hospital for letting it come to this.

In the end, I called my recruiter, A-Aron, and he shared some stories he heard from other nurses working at Stanford that made me realize just how awesome this unit is. Some nurses are telling travelers that they will lose their contract if they work the strike, and some managers are requiring their travelers to strike with them. Aaron assured me that a) I will not lose my contract and b) I will likely be compensated in some way. Regardless, the message I continue to receive from my unit is “you have to do what is right by you.” So kudos to the nurses of the Bass Center at LPCH for being so amazing. For those of you who plan on participating in the strike, I leave you with this:

My better half

Most people are curious to know what Jason is up to during our travels, and I am ashamed to say that, until this point, I’ve failed to mention his endeavors. It’s easy to get caught up in my own experiences through all of this. If you would like to read up on his most recent musings, you can catch it on his blog here. I was a nurse for maybe six months before Jason started asking when we could start travel nursing. As a fledgling RN, when my hands still shook with every port access and IV start, I didn’t feel capable of venturing into a new environment every three months. I told him to give me some time to feel competent before I throw myself into that scenario. The biggest revelation I’ve had about myself is that I will always have areas to grow and learn. Originally, I would have said that I take a long time to learn new skills and feel comfortable, but with each assignment, I find I’m more at ease with hitting the ground running and learning as I go. That being said, I still show stress and frustration all over my face all the time…

You can't change a tiger's stripes...
You can’t change a tiger’s stripes…

Jason lacks the luxury of having everything in place for him upon arrival. He has to put himself out there with each new location in a way I never experience. I’ve seen him change his approach with each move, too. Now in our third locale, he hit the pavement right away and within two weeks, he secured two jobs teaching music through different schools/companies. As is the nature of all things extracurricular, they must fit around school and work, so although he doesn’t work many hours during the day,  he teaches lessons every single day. Much like my experiences, some days are better than others and he is also learning the pros and cons of each company. Last week while I lounged by the pool enjoying my day off, he struggled through an afternoon of teaching only boys. Really, the text he sent me is too hilarious not to share and this is more for posterity than anything.

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Of course this is all from my perspective, but it is obvious that after working manual labor and driving for Uber, Jason is much happier teaching on a regular basis. Some people are lucky enough that their talent and career seem to join together harmoniously. We should all be so lucky! I envy Jason that he started his career so much sooner than I did. That’s not to say teaching is the only thing he wants to do with his talents, but he clearly enjoys it- at least most of the time. He’s discovering new facets about his passion for music education with each new experience, just like I am. I was discussing the possibility of returning to school with my mother. I currently have no desire to return to school (the accelerated nursing program really took the ginger out of me there). Jason, however, would like to return to school, but he doesn’t know what he would return for. I realized that while I will likely need to return to school to further my career, Jason chose the school of hard knocks. He is learning, through trial and error. It doesn’t provide him with a masters degree, but it is shedding light on how he would or would not run his own business while perfecting his creative writing and building up his portfolio of compositions. He is a Renaissance Man through and through. 

Not that kind of Renaissance man…

 

I started this post with the intent of writing about California and our experiences thus far. But I have gone too long without acknowledging how lucky I am to have Jason here, and how much more challenging this journey is for him. So I’ll give you the brief:

 

  • California is breathtaking

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  • San Francisco is lots of fun and only an hour train ride awayIMG_20160213_152402774_HDR
  • There are bike lanes everywhere and lots of opportunities for outdoor adventure

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  • Palo Alto is super expensive and kind of hoity toity but we have some great neighbors
True....hence, funny
True….hence, funny
  • Mandated 45 minute lunches are the bomb-diggity. Being scheduled nearly every weekend because I’m a traveler is not. So the jury is still out on Lucile Packard.
  • I tried to get to the Pacific Northwest but both jobs I applied for didn’t work out. Long story, but it’s the third time Portland has screwed me over. I’m pretty sure I’m cursed.
    Hi, Portland! I meet all your requirements for this job and I think I would be a great...okay
    Hi, Portland! I meet all your requirements for this job and I think I would be a great…okay

     

Finally, since nothing else really popped up for me this month and my contract was coming up in May, we decided to stay in Palo Alto until June! Come visit. It’s lovely here.

Into the West…

Obviously time has flown by in the great state of Colorado. Jason and I finally made it up to the mountains again! I mentioned how disappointed I was about not getting extended at Colorado Children’s, but what I didn’t reveal (because I wanted to build some suspense) was that the very same day I learned my contract would not be extended, I received my official California Nursing License in the mail. Call it Fate, God or Chance, but that’s a coincidence that cannot be ignored.

A sign

Getting your California Nursing License takes FOREVER. Of course you have to forward your transcripts, but you also have to get fingerprints done on their approved fingerprint cards using their approved abbreviations for eye and hair color. Apparently, BRN and BRO do not mean the same thing in California.

Okay, California, just get over yourself...
Okay, California, just get over yourself…

You have to go through a website that verifies your current nursing license and pay for that verification, along with the processing of the application, and the processing of your fingerprints and background check. Well, suffice to say that, along with everything else in California, it’s expensive. But here is the kicker- the majority of travel nurse needs are there. California is a gold mine for nursing, and there is almost always a need for a pediatric hem/onc nurse, not to mention it has some great children’s hospitals.

I started the process of getting my license back in April of 2015 and completed it in late July. I really didn’t expect to get my license until April of 2016-that is how slow moving the process is. So imagine my surprise when, downtrodden and depressed, I open my mail to find my California nursing license, and the adventure bug strikes again! I immediately forwarded a picture of my license to my recruiter, Aaron, with an overabundance of exclamation points and, as only an amazing recruiter–sorry, agent–can do, he delivered a great job opportunity.

I have heard from both travel nurses and regular hires that Lucile Packard is a wonderful place to work. So, when an opportunity arose to work on their Hem/Onc unit, I jumped at the chance! It also doesn’t hurt that Palo Alto is about 45 minutes away from San Francisco. But as Jason and I prepare for yet another epic trek across the western states, I’ve had some time to reflect on what makes this experience both awesome and difficult.

 

Moving every three months makes you really think about the difference between “want” and “need.” Jason and I both harbour a few packrat mentalities and we come by it honestly. But when you’re moving every three months, and everything needs to fit inside a Ford Fiesta, you get a bit unsentimental. Have you ever done a really thorough spring cleaning? You know that cathartic feeling you get by just getting rid of all that extra crap you don’t need and giving it to someone who does? We get to experience that every three months. It’s pretty rad.

You're welcome, Macklemore...
You’re welcome, Macklemore…

Starting over new every few months has really stretched me professionally. Not just skills-wise but learning the nuances of different policies and procedures. You’d probably think that administering chemotherapy to children is pretty standardized, and in general, things are pretty much the same across the board, but different hospitals actually function quite differently in the details. So I’m learning. A LOT. But the best part is the way that this has stretched me by helping me not sweat the petty stuff. You certainly want to fit in and make friends quickly when you’re starting out, but I’ve noticed that I don’t worry myself with any of the usual workplace drama. In fact, I would argue that three months is the perfect amount of time, because right as you start to get a feel for the workplace drama, you leave.

Having the knowledge that you’re leaving in a few months is so empowering. It’s so much easier to write off a bad day as just that and to move on- for those that know me well, this is a HUGE deal! I don’t let go very easily but since I started traveling, letting go is getting easier. 

batman

That being said, what is NOT easy is letting go of patients. When I hear about patients that I cared for at Duke that pass away, I don’t have my coworkers to help me through. There were so many times (too many times, truth be told) when we would grieve together, sharing funny stories and raising a glass to a patient’s memory. In short, we supported each other through the loss of someone we grew to love when we couldn’t claim the same status as family or friends. When you are on your own, and far enough away that you cannot attend the memorials, you are simply left with an ache in your heart and a profound sense of loneliness in your grief. Sharing memories of these kids with those around you just makes people sad, because they didn’t know them. All they see is the loss of a young child or teenager, which is never an easy thing to stomach. It’s not the best description, but it’s the closest I can come to how I’ve felt as I’ve watched from afar while two patients that I cared for and loved very much were taken from this world. As supportive as Jason is through all of this, there is no way for him to fully relate to how I’m feeling. I have to face the fact that letting go of my patients will never, ever get easier. I sincerely hope it never does.

The other side of letting go of patients is about saying goodbye to the patients and coworkers that I connect with during my three months at each new spot. Let’s face it, there are some people you just instantly hit it off with and patients are no exception. So far, it’s been usually one or two patients that I connect with, and then have to say goodbye to at the end. One of my biggest regrets in Phoenix was not saying goodbye to my favorite patient. I said goodbye to his parents, but I never said goodbye to him. He was young enough that it would have been hard, but old enough that he deserved to know that he probably would never see me again. I think in a lot of ways I was trying to protect myself. Leaving Phoenix Children’s was already hard (just read my tribute here) and I felt like making a big thing out of it with this patient would have made it harder on my heart than I could handle. However, I found the same thing happened here in Colorado. I know that it is going to be hard to say goodbye, even though they know what’s coming (patient included, this time). But, as I said before, this is a part of my job that I don’t want to get easier. I never want to lose that desire to connect with patients and families, even if it makes the goodbye part harder.

So, as I sit here on my throne of cushions, with my laptop propped on a tupperware bin full of kitchen stuff, I am thankful. I’m thankful for the time we’ve had here. I’m thankful for the friends and family that we have been so lucky to spend our free days with. I’m thankful for the patients and coworkers that I have had the chance to get to know. But I’m also thankful for this next step- I’m thankful that I have my California license in my hand and the love of my life at my side. Now it’s time for a 19 hour drive with two cats. 

Let's do this
Preach it, Liz!