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april's blog

april's blog

As this site is relatively new, I will be adding blog posts as time progresses. At a future date I plan to open the blogs up for comments and discussion. If you'd like to respond, please contact me with your comments and I'll add them to the posts. Thanks!


The Anesthesia Practice/Credentialing Paradox

June 3, 2019

I suppose it has been awhile since my last blog. I apologize. But who is listening? And, if no one is listening, what does it matter if I write or not? Now that is a philosophical question! “Do falling trees in the forest make noise, if no one is listening?” Well, whether or not, anyone is listening, I will do my best to write about my life as a traveling CRNA.

Last month, I started another assignment and completed yet another credentialing process. This will be my third credentialing in less than six months. I have come to believe a career in anesthesia is less about the practicing anesthesia and more about proving you are worthy to practice anesthesia. Our jobs used to be filled with providing safe, efficient and comfortable care to our patients. Now, after all the duties we are responsible for, that is the easiest to accomplish. We have a multitude of tools and techniques at our disposal. The sonogram for peripheral nerve blocks, the C-mac for difficult airways and Sugammadex to provide quick and complete reversal, to name of few. I must confess providing excellent anesthesia care in the work place is the easy part of my “job”. It is all that leads up to that first day on the job that is the most difficult. Credentialing is top on the list with travel arrangements second.

Why is Credentialing so stressful and time consuming? Unfortunately, there is no quick answer to this question. With each credentialing it seems there is something new to stall it. Luckily, I have an excellent friend to help me out. She has put this website together for me. And, now with the help of some credentialing specialists to review the site, I may get this process tuned up and ready for anything anyone throws at me! I must tell you, my friends and readers, I have said this before as I have gone through multiple ways of organizing only to have yet another credentialing process derailed. I will keep you posted.

After over 10 years of practicing anesthesia, I have come to the conclusion that, as anesthesia practice gets easier, credentialing gets more difficult. Recently, I’ve heard the “fast track” credentialing, made specifically for Locum workers on short term assignments, is being “phased out”. This is federal mandate not an individual hospital’s rule (this is according to a CAQH specialist and personal friend). A podiatrist in an OR conversation told me that she was on a committee debating whether or not CRNAs should have to go through, yet another, level of review when credentialing. At present, it is the medical advisory committee that meets once a month to review and approve your credentialing packet prior to granting privileges. Now, they may require both the medical committee and the hospital’s board of directors to review and approve our credentialing packet before privileges are granted. Why? Is it so easy to be an imposter CRNA? Upon our first day at work, especially travelers, if we don’t know what we are doing it becomes immediately apparent to the supervising MD. Personally, I feel it would be easier, and a lot more profitable, to be an imposter as an MD. Needless to say, the amount of scrutiny placed on traveling CRNAs is getting cumbersome at best and downright impossible at worst.

I have friends who have quit traveling solely because they do not want to credential ever again. A few bad experiences (to no fault of the CRNA) can make a person gun shy to try again. To complicate things further, the turnover of personnel in most credentialing offices, is high. It’s a thankless job and these people are caught between providers and seemingly unduly regulations. My credentialing specialist friend worked in a Florida hurricane. She told me that when the hospital building was closed, the doctors who work there could not get credentialed at other facilities for up to 6 months. That resulting in many doctors out of work during an increased need for their care.

I’m not sure what can be done about this problem. However, I do know that the first step to solving a problem, is to recognize that there is one.

Thanks for listening.

Independence

March 26, 2019

It was in the month of Dec, the year of 2014 when I fully committed to becoming a CRNA traveler. I had traveled before, but this was different. This time I would travel for the sole purpose of traveling. Travel would be my end game, not just a means to an end. I knew there would be tough times and I would need to have a good reason for pursuing this path. Trust me when I say, money alone doesn’t cut it. Money comes and goes, we spend what we make, and then the more we make the more we spend. So I came up with a better reason; Independence. I make my own choices. I will not be ruled by any one institution’s internal politics. I travel because it gives me the freedom to make the best choices for me. And I take full responsibility for the good, as well as the not so good choices I make. Over the past five years I have accomplished the goal of being independent of any one institution. Now, my goal is to, as much as possible, become independent of staffing agencies.

One of the advantages of travel is the time off between assignments. It provides time to regroup, contemplate and move forward towards living the life you dreamed. During this break I decided to take my time heading back to Alaska. I have to take my truck back, so I have to drive. I figure I would stop by to see a good friend in Denver and then again in Seattle. I’m hoping the snow and inclement weather will be gone by the time I get to Canada. My husband says “just put the chains on, when the roads get bad.” Me? Putting chains on? In the cold? By myself? I don’t see that happening. But then again I was planning on hiking the Appalachian Trail alone. So maybe, in his eyes, it’s not that different. Luckily my husband, being the man he is, caved in. and said he would come with me on the stretch from Seattle to Anchorage. So there it is. Bax and I are off to Alaska! Wish us luck. Stay tuned.

The Ugly, the Bad, and the Good

March 20, 2019

As with all life’s choices, travel has its ups and downs. Recently, I’ve experienced the down sides of travel. Oddly, depending on how I looked at it, it could be viewed as an upside as well. Let me explain.

The Ugly
In November of 2018 I made plans to travel to Columbus, Georgia and arrive by March 2019. My husband planned to fly down from Anchorage to New England (where I was on assignment at Dartmouth-Hitchcock in Lebanon, NH) and drive together with me and my dog, Bax, south to Georgia. It would be springtime and I had heard Georgia is beautiful in the spring. I figured since I don’t have any allergies to pollen, I should be good. I also have some very good friends who live near Atlanta. I could spend my off time visiting them and learning more about the state. Unfortunately, due to the mishandling of paperwork on staffing agency's end, the Georgia BON decided to hold up my RN licensing, making it impossible to reach the deadline for credentialing. Because of the delay, NorthStar/Columbus, GA decided to cancel my assignment altogether. Usually staffing agencies postpone the start date rather than cancel, so this was a surprise. The staffing agency I was working with at the time, suggested I go to Derry NH, since I already have my license in New Hampshire. However, even if everything were to go smoothly, it was already late to start credentialing and I would most likely be out of work for several weeks. I told StaffCare I would do it. But then, three weeks later, my staffing agency told me they neglected to submit my CV to the Derry facility and that assignment fell through.

The Bad
My assignment at Dartmouth ended in March 2019. And, due to the previous blunders, I am out of work for the time being. A word for the wise: if you are considering traveling as a line of work, be prepared for situations like this and always have a backup plan. For me, I figure with every loss, comes the chance for something new. I must confess, I can say this because I have a husband who can support me when times get tough. Not everyone has this luxury. However, in the staffing agency circuit, news of a provider’s availability travels fast. I’m not sure how that works but they all seem to know when to call. I received calls from several staffing agencies with possible assignments in Fairbanks, AK, Concord, NH, Littleton, NH and several positions in New York. At first, I thought, Littleton, NH was a good option. The staffing agency for Littleton seemed to think I was the “perfect” fit and even called my references. However, I was denied that particular assignment because, although I have worked independently, I don’t have extensive experience in peripheral blocks (I’ve done blocks, just not that many – a subjective call on my part). This was an all CRNA anesthesia group and they had no interest in “training” CRNAs to do blocks their way. Although I am confident in my own skill set, they are not. I recommend avoiding situations like this, since it may lead to licensing issues down the road. Better to be safe than sorry.

The Good
Finally, I decided to go to Alaska and work as an independent contractor. This would be a good opportunity to use my business without the “interference” of a staffing agency. I would have to prepare my own contract and work directly with the credentialing office to get my paperwork approved. I would need to arrange all my own travel and living. There most likely would be unforeseen costs to account for and plan for in future assignments. But I would be home and free to work as needed. I figured it was time. Time to go home and regroup. I believe all the assignment flip flopping of the past may have led me right where I needed to go, back to my roots, back to why I chose to travel in the first place.

My First Blog

February 24, 2019

One year ago, a good friend of mine suggested I build a website for my business, DreamSafe Anesthesia Staffing, Inc. I was reluctant at first. I thought “how can a website help me to achieve my career goals?” I looked for what might be a similar site and found nothing that fit. So, I decided to take the risk dove in head first! Since then I’ve learned a lot about how a website can improve my business. And I am glad I took the plunge! However, my original goal was to help others in my line of work as well as myself. This aspect of the website has proven to be a bit more challenging. My goal is to build a network of CRNAs and a site where their ideas can be shared. I’m told a blog is a place to start. Unfortunately, I’m not the most eloquent writer nor do I fully understand the internet’s social media. I don’t like Facebook, never have and my extent of what a blog is, comes mostly from the movie “Julie & Julia”! I’ve already made multiple attempts without success. So, I’m starting again with a definition, ironically, from the internet:

“What is a blog? Definition of blog. A blog (shortening of “weblog”) is an online journal or informational website displaying information in the reverse chronological order, with latest posts appearing first. It is a platform where a writer or even a group of writers share their views on an individual subject.” Dec 7, 2018

Ah, I can do that. I have found, in life, that people are often more open to telling their stories, if you open up to yours first. So here it goes…

Feb 23rd 2019

Today I am in beautiful New England, where the snow is falling creating a world of white. New England is where I grew up, my original home. However, my assignment is coming to an end and a new adventure about to begin.

The start of my next assignment has taken a rocky road. I was originally scheduled to go to Columbus, GA. However, getting my GA RN license proved far more difficult than expected and since it took so long to get it, the site cancelled their offer. This was a first. But also demonstrates the risks involved in locum’s work. The ‘fine print’ not often disclosed by recruiters from staffing agencies. I’m lucky I have a wonderful, understanding husband who I can always fall back on if I need to. Amazingly, however, these things always seem to work themselves out. I’ve been given another opportunity in southern NH. It will take some re-organizing, but it is doable and may even be fun! How do I handle the stress? By letting go of the things I have no control over, by enjoying the opportunities that do come my way and by having faith everything will work itself out. In truth my website helps me keep things in perspective. I know I do good work.

However, this past experience has made me question the hurdles placed upon practitioners by Licensing “Analysts” and Credentialing “Specialists”. Why do they have so much power in deciding our job opportunities? The GA BON Licensing Analyst complained about how my staffing agency neglected to fill out the “Verification of Employment” form correctly. She said, and I quote “How do I know you are not working as a plumber for the hospital and not a CRNA?”. The process was delayed three months because of a single form (in a multiple form application). Although this was the first assignment cancellation due to the delays I’ve experienced, it is not the first time ‘specialists’ have delayed my paperwork. Delayed Credentialing is one of the fears about working as a traveler CRNA. There is unfortunately, no recourse or some way to hold people accountable for their actions in causing the delay and the resulting staffing shortage. I have found it to be one of the most frustrating aspects of this line of work. And why? For what purpose? Do the benefits of credentialing outweigh the risks of shortages in staffing? I’d put money on a study proving otherwise! I don’t have these answers. But I do know, if we don’t address the issue, it will never change.

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