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Clinical Corner: What the Dialysis?!

What The Dialysis - Clinical Corner: What the Dialysis?!
Clinical Corner demystifies dialysis!

By Phil Niles, Clinical Nurse Manager, Medical Solutions

As healthcare providers, many of you have cared for a patient that is dependent on dialysis. Yet, even you may have wondered, what the heck is dialysis? Well, let’s talk about that! A friendly dialysis RN shows up on their dialysis day, takes up your sink, clogs your room with machines, and, in the end, leaves you with a healthy smell of bleach lingering in the air. What happened? You know the basics of the process: The blood is “cleaned” and fluid is removed from the patient over three-four hours. The patient has an access such as a catheter, fistula, or graft that the dialysis RN accesses for the treatment. Patients commonly have three four-hour treatments per week. But, what else is going on during the treatment?

First, we start with water. A single dialysis treatment uses over 150 liters of water. Water from the faucet cannot be used because there are impurities, trace heavy metals, and chlorine in standard faucet water. This is all fine and dandy for us to drink, but during dialysis this water will come into contact with the patient’s blood, so it must be as pure as possible. One of the machines that a Dialysis RN brings into the room is a reverse osmosis machine or RO. This machine moves solutes from a concentration to a higher concentration producing high-concentrated water (waste water) and very low concentration water (RO water). The RO water is used for the treatment and delivered to the hemodialysis machine by a product hose. Tap water generally has total dissolved solutes level of 100-200 parts per million. Dialysis water is 10-15 parts per million — a much lower concentration. Before the water can be used the Dialysis RN must conduct a series of quality control tests to be sure the water is good to use. The main test is a chloramine test. Chloramine is a derivative of ammonia that’s used to treat drinking water. It cannot be in the product water because regular levels of chloramine would cause seizures and potentially death in your dialysis patients. After all the tests are complete, the water is considered good and the hemodialysis machine can now be set up.  

The dialysis machine is then put through its own tests and it is “strung.” Stringing the machine means installing the blood tubing and dialysis filter, and priming out all of the air in the system. During this process “acid” and “bicarb” are added to the water being delivered by the RO. Acid is acetic acid or vinegar with electrolytes added specific to the patient’s needs. The bicarb is just sodium bicarb. The machine mixes dialysate at a ratio of one part acid, two parts bicarb, to 40 parts water. The pH is blended to the pH of normal blood. Dialysis patients are usually in early metabolic acidosis before treatment. The dialysis treatment normalizes this, while also balancing electrolytes and removing excess body fluid. 

Once the machine is set up and has passed all quality control tests, the patient can be accessed and bled on to the dialysis tubing, which is called the circuit. Patient access is either an externalized catheter or internalized fistula or graft. The catheter is commonly surgically placed in the right or left jugular vein then tunneled under the skin four-six inches to where it comes out into two limbs, the arterial and venous access. The blood being accessed is venous blood. The arterial limb is called arterial only because it is moving away from the body. The “venous” limb returns cleaned blood back to the patient. A fistula is an access created by a passthrough or “fistula” between an artery and a vein that was not there before. This causes higher pressure arterial blood to flow through a lower pressure larger vein. Over time, usually two-three months, the vein enlarges due to the increased pressure and the walls of the vessel thicken. At this point the newly developed fistula vessel can be accessed by larger fistula needles. New fistulas are accessed by 16-17-gauge needles until the vessel becomes accustomed to the needlestick. Standard dialysis treatments are run with 15-14-gauge needles. Two needles are required — an arterial needle to pull blood to the dialysis machine and a venous needle to return the newly cleaned blood. Needles are placed at least an inch apart from each other to prevent recirculation, or recleaning of freshly cleaned blood. A graft access is a synthetic tube that is placed under the skin connecting a vein to an artery. The optimal access for a dialysis patient is a fistula. However, not all patients are candidates to receive one. 

The biggest rule to follow is to never allow the extremity with the fistula or graft to be occluded, including and especially taking blood pressures. All lab draws and blood pressures must be done on the non-fistula extremity. Occluding the vessels or the fistula itself can lead to it clotting off and potentially losing that access. Many long-term dialysis patients do not have many options for accesses, so it is so important to protect your dialysis patient’s access while in your care. This is their lifeline!

The dialysis process itself is a fairly simple one that works on two principles — a concentration gradient and a pressure gradient. Diffusion, as most of you are very aware, is the movement of solute from a high concentration to a lower concentration. This is the entire science of electrolyte balance in a dialysis treatment. Potassium is usually high in a dialysis patient needing treatment. The dialysate mixed by the machine has a specific potassium prescription based on a sliding scale. This prescription will bring the patient’s potassium to a normal level after dialysis. The dialysis treatment does this with all electrolytes. It is important to note that the dialysis treatment only balances electrolytes in the blood. Higher levels may exist in the tissue and as dialysis progresses these higher levels continue to shift to the blood stream throughout treatment. Lab values are not accurate until at least an hour after dialysis treatment. It is highly discouraged to order labs before this so that inaccurate results are not given. 

The other half of the dialysis treatment is fluid removal. This is accomplished by the dialysis machine exerting a specific negative pressure on the dialysis filter that causes fluid to move from the blood stream to the dialysate side of the filter and be disposed of. Generally speaking two-four liters of patient fluid is removed from the patient during a four-hour treatment. Fluid removal is the component of the dialysis treatment that can lead to episodes of low blood pressure in the patient. This occurs when fluid is being “pulled” faster than the patient’s vasculature can tolerate. The ability to tolerate fluid removal varies greatly from patient to patient. Blood pressure and other vitals are watched and recorded at least every 15 minutes during treatment. Fluid removal also requires work from the body to shift that fluid.  Patients are often very tired after treatment due to this. 

And there you have it! I hope this sheds a little light on the often-mysterious ways of dialysis and gives you more knowledge to better care for you patients. I also hope it makes you more aware of what your kidneys do for you! Uncontrolled diabetes and high blood pressure are the top causes of kidney failure. Love, protect, and care for your kidneys!

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State Spotlight: Texas

Texas Austin Water - State Spotlight: Texas
Texas is a great location for your next Travel Nurse gig!

This month’s State Spotlight takes us to tremendous Texas! The Lone Star State is known for its warm weather and varied landscape, exciting sports culture, thriving arts scene, incredible food, maverick attitude, and tons more. Read on to learn more about why you just might want to mess with Texas during your career in Travel Nursing!

Travel Nursing in Texas

Texas Stamp - State Spotlight: Texas
Texas has more hospitals than any other state in the nation — which means loads of gigs for Travelers!

They say everything’s bigger in Texas — and that includes the state’s abundance of Travel Nursing opportunities. Not only does The Lone Star State dependably have lots of Travel Nurse jobs at great facilities, Texas also offers plenty of exciting, bucket list level things to do and see on your days off.

Texas is home to about 600 hospitals — more than any other state in the nation — 23 of which meet high enough standards to be ranked among U.S. News & World Report’s 2018/2019 Best Hospitals list. That includes their #1-ranked Texas hospital, Houston Medical Center in Houston, which is nationally ranked in eight adult specialties, in addition to being ranked “High Performing” in two additional adult specialties and nine procedures/conditions. Rounding out the top five overall best hospitals in Texas are: UT Southwestern Medical Center in Dallas, Baylor University Medical Center in Dallas, Baylor St. Luke’s Medical Center in Houston, and Memorial Hermann-Texas Medical Center in Houston.   

U.S. News & World Report’s 2018 “Best States”ranked Texas #36 overall, as well as #8 for economy,#17 for fiscal stability, and #21 for infrastructure. Livability.com ranked Austin, Houston, San Antonio, Lubbock, College Station, Dallas, San Antonio, Denton, Plano, Garland, and Fort Worth among the best places to live in Texas.

As for licensing, Texas is not currently a walk-through state, but it is a compact state and a NURSYS state. Click here for more, up to date info on licensing in Texas.

Texas Fast Facts

Lone Star State - State Spotlight: Texas
Texas is dubbed The Lone Star State because of its flag.

State Nickname: The Lone Star State

Capital: Austin

Largest City: Houston

National Parks: 14

State Parks: 95

National Historic and Natural Landmarks: 67

State Motto: “Friendship”  

State Flower: Bluebonnet

State Tree: Pecan

State Mammal: Texas Longhorn

State Small Mammal: Armadillo

State Bird: Mockingbird

State Dish: Chili

State Fruit: Texas Red Grapefruit

State Sport: Rodeo

State Music: Western Swing

Texas was the 28th state.

After being an independent nation from 1836-1845, Texas became the only state ever to join the United States by treaty rather than territorial annexation.

Texas is the nation’s second-largest state, coming in behind Alaska.

In fact, The King Ranch in Texas is itself larger than the entire state of Rhode Island!

Austin, Texas has been dubbed the live music capitol of the world.  

The Dallas/Fort Worth airport is home to the world’s largest parking lot.

Alamo - State Spotlight: Texas
Remember the Alamo!

Handheld calculators, 3D printing, stadium nachos, integrated circuits, liquid paper, frozen margaritas, silicone breast implants, corndogs, ruby red grapefruits, Whole Foods, Dell computers, chili, Six Flags, 7-Eleven, fajitas, shopping centers, and Dr. Pepper were all invented in or originated in Texas!

Texas’ 624 miles of coastline run along the Gulf of Mexico.

Caddo Lake is the only natural lake in Texas.  

The Waco Bridge was the first suspension bridge built in the U.S.

On July 20, 1969, “Houston” was the first word spoken from the moon.

The Texas cattle population is estimated to be 16 million.

Amarillo, Texas is home to the world’s largest helium well.

Jalapeno pepper jelly originated in Lake Jackson, Texas. 

The world’s first rodeo was in Pecos, Texas on July 4, 1883. 

Famous folks from or who’ve lived in Texas include Chuck Norris, Beyonce, Matthew McConaughey, Robin Wright, Jamie Foxx, Patrick Swayze, Woody Harrelson, Ethan Hawke, Kelly Clarkson, Jessica Simpson, Carol Burnett, Jennifer Garner, Selena Gomez, Joan Crawford, Dwight D. Eisenhower, Lyndon B. Johnson, Larry Hagman, Buddy Holly, Janis Joplin, Tommy Lee Jones, Willie Nelson, Sandra Day O’Connor, Dan Rather, Rip Torn, George W. and H.W. Bush, Alvin Ailey, George Foreman, Kenny Rogers, Luke and Owen Wilson, Ciara, Roy Orbison, Steve Martin, Jim Parsons, and Mary Kay Ash.     

Honorary members of the Texas rangers law enforcement group include Chuck Norris, Will Rogers, and John Wayne.

Approximately 75% of the world’s Snickers bars are made in Waco, Texas at the Mars/M&M plant. 

Laredo, Texas is the world’s biggest inland port.

The famous saying “Don’t Mess With Texas” originated as part of a 1986 campaign to eliminate litter from Texas roadways.

San Antonio’s Bracken Cave is home to the world’s largest bat colony.

Rumor has it that Aurora, Texas is home to an alien grave, after a UFO crashed in the area in the 1800s.

To Do & See in Texas

San Antonio RW - State Spotlight: Texas
San Antonio, Texas is known for its beautiful riverwalk. And don’t forget The Alamo!

Texas is known for being big and distinct. Thoughts of The Lone Star State may conjure images of everything from prairies to ranches to beaches, from charming small towns to urban hubs. And the truth is, Texas contains all of these multitudes and more!

Texas’ capital of Austin is known for keepin’ it weird and for being hailed “the live music capital of the world.” Great music, abundant outdoor activities, killer breakfast tacos, and cool festivals like South By Southwest and Fun Fun Fun Fest are just a few reasons why U.S. News & World Report named Austin #1 on its list of Best Places to Live. Check out Austin’s Rainey Street District, South Congress Avenue, Lady Bird Lake, Barton Springs Pool, Mount Bonnell, and the famous Congress Bridge Bats.     

In Houston, Texas’ largest city, you’ll want to check out the Space Center Houston, Discovery Green, Museum of Natural Science, Buffalo Bayou, The Galleria, and tons more. There’s also lots to see in cities like San Antonio, Fort Worth, Dallas, El Paso, and other urban hotspots.

Sports fans will be right at home in the state that made “Friday Night Lights” a thing. Pro teams here include the Dallas Cowboys, Dallass Mavericks, Dallas Stars, Dallas Wings, FC Dallas, Houston Astros, Houston Dash, Houston Dynamo, Houston Rockets, Houston Texans, San Antonio Spurs, and Texas Rangers. But keep in mind that Texas is also packed with incredible collegiate and high school teams, and the state is also a hotbed for rodeo sports, golf, gymnastics, and motorsports.

Texas food - State Spotlight: Texas
Texas is known for delicious chili, barbecue, Tex Mex, burgers, Gulf shrimp and oysters, and other yummy eats!

When the chuckwagon comes a rollin’ ’round in Texas, taste buds are bound to be delighted. In addition to The Lone Star State’s famous barbecue, Texas is also known for iconic faves like chili, chicken fried steak, kolaches, funnel cake, burgers, breakfast tacos, pecan pie, Gulf shrimp and oysters, peaches, Blue Bell ice cream, Frito pie, fried okra, Texas caviar, Vietnamese, Mexican, and Tex Mex like fajitas and queso. Wash it all down with an ice-cold Dr Pepper, sweet tea, or frozen margarita and you’ll be living like a true Texan!

When it comes to outdoor adventure, be sure to explore Big Bend National Park, Padre Island National Seashore, Palo Duro Canyon, Del Rio/Lake Amistad, Hueco Tanks State Park, Santa Elena Canyon, Natural Bridge Caverns, Lake Travis, Fort Davis, and many more of Texas’ natural wonders.

Ready for your adventure to terrific Texas?! Search jobs now to find your dream Travel Nurse job in Texas! Or, search all jobs here.  

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Congrats to Medical Solutions’ 2018 Traveler of the Year and Rising Star of the Year!

Kelsey C TotM
Congrats to the Medical Solutions 2018 Traveler of the Year, Kelsey C. (pictured) and Rising Star of the Year, Nicole M.! Each of them won a $500 Amazon gift card.

A big thanks and mega congrats to Medical Solutions’ 2018 Traveler of the Year and Rising Star of the Year winners! We are honored to work with healthcare pros who go out every day and make us proud by providing superior patient care with a great attitude. Because we have such great Travelers, we look forward to these annual honors which recognize a couple of our best and brightest. Each month we recognize a Traveler of the Month and a Rising Star of the Month, and our two annual winners are chosen from the pool of monthly winners. Learn more about the Traveler of the Month program here.

Without further ado, here are the 2018 winners!

Traveler of the Year

Congrats to Kelsey C. for being named 2018 Traveler of the Year! Kelsey, an RN, BSN specializing in progressive care/step down, was Traveler of the Month for July 2018. She’s been traveling since January 2018 and works with Career Consultant Jon Laubert.

“The best part of Travel Nursing is the freedom to go wherever you want on an assignment,” says Kelsey. “It’s so fun traveling to different states, meeting new people, and having new experiences. You get to see the diversity of geography, lifestyle. and culture within our own country. I also get to learn new skills and different policies at each hospital, which helps to enhance my overall nursing knowledge.”

Kelsey won a $500 Amazon gift card and received flowers as her prize for winning Traveler of the Year. Thanks so much for everything you do, Kelsey!  

Rising Star of the Year

Congrats to Nicole M. for being named 2018 Rising Star of the Year! Nicole is an RN, BSN, CNOR who’s been in nursing for nearly nine years and traveling since early 2018. She was named Rising Star of the Month for July 2018 and works with Career Consultant Travis Pond.

Nicole, who loves to weightlift and read in her spare time, enjoys the independence that Travel Nursing affords her.

“[The best thing about Travel Nursing] is the lifestyle of freedom it provides,” she says.

Nicole won a $500 Amazon gift card and received lunch catered in to her unit as her prize for winning Rising Star of the Year. Thanks so much for everything you do, Nicole!  

Congratulations again to our winners and a big thank you to ALL of our incredible Travelers!

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Clinical Corner: Team Nursing and Delegation

Team - Clinical Corner: Team Nursing and Delegation
Team Nursing can be a great, collaborative experience for patients and healthcare workers — as long as you know how to navigate the process!

By Phil Niles, Clinical Nurse Manager, Medical Solutions

Many of you have encountered the concept of team nursing during your travel and/or nursing careers. If you have not encountered it, you might one day hear something like, “Your assignment will have you taking a 1:10 assignment.” Then you might say, “What???” and they might reply, “Don’t worry — it’s team nursing!” Even more confused at this point, you might ask, “Well, what is team nursing?” What a great question! Let’s start with some definitions.

Team nursing is pairing nurses of varying skill sets and experience levels to care for a larger group of patients. This team can consist of an experienced nurse and a new nurse, a RN and an LPN, or either of these two with the addition of a nurse aide. The team is intended to create a collaborative, supportive environment that will collectively meet patient needs and promote improved communication between team members.

Team nursing is not meant to be an authoritarian hierarchy with one person ordering everyone else around. In fact, many factors go into determining how the workload is divided. Team members collaborate at the beginning of the shift to divide tasks amongst each other according to skill, scope of practice, and familiarity with each patient. A common misconception of team nursing is thinking you’d have to control every detail of care for all patients assigned to you. It’s difficult to get out of the mindset of primary nursing (one nurse to a group of patients) and give up a little control and the idea that you need to do everything yourself. For Travelers working an assignment with team nursing for the first time, it can be a challenge at first to adjust. So, let’s address a few questions you may have about team nursing as a Traveler.

What can my team members legally do in their scope of practice?

This is probably the most commonly asked question and an important topic to address. Scope of practice of LPNs and nurse aides varies by state, so it’s important to study up on the Nurse Practice Act of the state you are traveling to ahead of time. Each state’s Board of Nursing website is a good resource for this. You can also reference the National Council of State Boards of Nursing (NCSBN) website. Click here and you’ll find they have a drop down box where you can select your state and to generate a link to its Nurse Practice Act. You can also ask the floor manager or even the team members themselves! It is important to remember that hospitals may not allow the same scope of practice that a state lists as acceptable, so never assume anything. Even after reviewing your state’s Nurse Practice Act, make sure to ask the manager about the hospital’s specific LPN and nurse aide scope of practice.

What if something goes wrong with a patient whom an LPN or aide on my team was assigned to?

What is your accountability when delegating tasks to others? Every member of the team is accountable for their own actions. For example, an LPN may be held accountable for negligent or improper care that resulted in patient harm. However, the RN may also be held accountable for improper delegation or not intervening in the negligent care if the RN had knowledge that the care was not to standards of care.  There is a balance to be struck between delegating care and assuring that care was carried out. The RN is in a supervisory role in team nursing when the other member of the team is a LPN or aide. No one in a supervisory role should ever assume when you hand off a task that it was completed without verifying this themselves. As the RN Traveler in a team nursing scenario, you will likely see the same patients throughout the day while doing separate tasks. Take this time to also verify that all care was delivered and appropriate. 

What if the other members of my team do not communicate with me?

Team nursing relies on clear, consistent communication between all team members, so never be afraid to ask questions. Often, drops in communication happen because the other person assumes you already know the information. For example, a good way to approach this type of situation would be to say, “I’m going to see Mrs. X next. Did you already change her dressing? Do you have time to change it with me now, so we can both assess it?” This is a collaborative approach with clear communication. The other person will not be threatened or feel ordered around and will likely make a plan with you. On the other hand, an approach I do not recommend is to say, “Hey! When are you going to change Mrs. X’s dressing? You need to talk to me!” As you can tell, this may spark a bit of defensiveness and potentially damage your working relationship. Still, there are those that once in a while do not respond well to coaching, so you can always go to your charge for support if you feel your team is not working well together or have a concern about a particular team member. 

I hope this gives you guidance and arms you with information if you ever work in a team nursing environment. I also hope you see it as an opportunity to meet your patients’ needs in a new way.

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Congrats to December 2018’s Traveler of the Month and Rising Star!

Many thanks and congrats to the December 2018 Traveler of the Month, Quincy H., and also our Rising Star winner, Ivy P.! 
Traveler of the Month Quincy is an RN specializing in critical care, currently on assignment in New Orleans, Louisiana.
Three cheers each for our latest Traveler of the Month winner, Quincy H., and Rising Star winner, Ivy P.!

Many thanks and congrats to the December 2018 Traveler of the Month, Quincy H., and also our Rising Star winner, Ivy P.!

Traveler of the Month Quincy is an RN specializing in critical care, currently on assignment in New Orleans, Louisiana. He’s been in nursing for seven years and traveling for about six years. Quincy works withCareer Consultant Michelle White.

“After my first travel assignment I discovered what I love the most about Travel Nursing, which is the ability to be the boss of myself,” says Quincy. “I’m able choose not only the city and state, but the hospital I want to work at. Travel Nurses are able to choose what time of the year they want to work. You also meet so many different people and expand your knowledge of various cultures.”

Quinn, who travels with his fiancé, says his most memorable travel assignment so far was in Santa Clara, California.  

“The staff was awesome, not to mention the perfect location near the Bay Area with beautiful scenery, beach, and mountains that have seasonal snow,” he says.

Quinn says his unique ability to adapt to any situation or circumstance has been very important to his success as a Travel Nurse. He also shared these great tips for other Travelers.

“A few tips from an experienced traveler to a beginner traveler: Have flexibility, be open-minded, kind, and don’t be afraid to speak up when something doesn’t feel right,” he advises.  

Thanks so much for your hard work and great advice, Quincy!

Rising Star Ivy is an ER RNcurrently on assignment in Ottumwa, Iowa. She’s been in nursing for three years and traveling since October 2018. Ivy with Career Consultant Bill Thomson.

Ivy is known for smiling often, which makes her a great fit in the sometimes-challenging field of healthcare because she keeps the level of optimism high! Ottumwa is her first Travel Nursing job and she says the best thing about traveling is keeping things fresh.

“[I enjoy] meeting new people, new environments and new challenges,” says Ivy.

Ivy offered the following advice to new and aspiring Travelers: “Be open-minded and unafraid to ask questions and express concerns.”

Thank you for all of your hard work and dedication to quality patient care, Ivy!

Congratulations again to the Medical Solutions December 2018 Traveler of the Month and Rising Star! Quincy and Ivy, we are so thankful to each of you for your dedication to patient care and Travel Nursing!

Could you be the next Medical Solutions Traveler of the Month or Rising Star? Travelers who receive a perfect hospital evaluation are eligible to win these monthly awards — with Rising Star going to newer Medical Solutions Travelers. Click here to learn more and to see if you could be the next winner of a $100 Visa or Amazon gift card as recognition for a job well done!

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State Spotlight: Hawaii

Hawaii Kayak - State Spotlight: Hawaii
Say “Aloha” to Travel Nursing in Hawaii!

This month’s State Spotlight takes us to humble Hawaii! The Aloha State is known for its otherworldly landscape and flora, gorgeous beaches, unique native culture, delicious food, and so much more. There’s a reason why Hawaii is a jackpot destination for so many Travelers — and that reason is simply that Hawaii is all-around incredible. Read on to learn more about why Travel Nursing in Hawaii will have you at “Aloha” and give you plenty to write home about!

Travel Nursing in Hawaii

Hawaii Stamp - State Spotlight: Hawaii

Hawaii is a fabulous state for Travel Nursing — in fact, it’s a bucket list state for most Travelers! The Aloha State offers so much to experience on your days off and you’ll enjoy access to lots of amazing career opportunities at incredible facilities.

Hawaii is home to about 38 hospitals — three of which meet high enough standards to be ranked among U.S. News & World Report’s 2018/2019 Best Hospitals list. That includes their #1-ranked Hawaii hospital, Queen’s Medical Center in Honolulu, which is nationally ranked in one specialty, in addition to being ranked “High Performing” in five adult specialties and six procedures/conditions. Rounding out the top three overall best hospitals in Hawaii are: Honolulu’s Straub Medical Center and Kaiser Permanente Moanalua Medical Center, also in Honolulu.   

U.S. News & World Report’s 2018 “Best States” ranked Hawaii #17 overall, as well as #1 for healthcare, #16 for crime & corrections, and #18 for opportunity. Livability.com ranked Honolulu, Hilo, and Kahului among the best places to live in Hawaii.

As for licensing, Hawaii is not currently a walk-through, compact, or NURSYS state. Click here for more, up to date info on licensing in Hawaii.

Hawaii Fast Facts

Surfboards - State Spotlight: Hawaii
A bunch of surfboards beckon on a sunny day in Maui.


State Nickname: The Aloha State

Capital: Honolulu

Largest City: Honolulu

National Parks: 8

State Parks: 50

National Historic and Natural Landmarks: 40

State Motto: “Ua Mau ke Ea o ka ‘Āina i ka Pono” meaning “The life of the land is perpetuated in righteousness”  

State Flower: Pua Aloalo

State Tree: Kukui

State Mammal: Hawaiian Monk Seal

State Dance: Hula

State Musical Instrument: Ukulele

State Gem: Black coral

Hawaii was the 50th state.

Hawaii is comprised of these eight main islands: Nihau, Kauai, Oahu, Maui, Molokaim Lanai, Kahoolawe, and the Big Island (officially called Hawai’i).

The Hawaiian alphabet has just 13 letters and every word and syllable ends in a vowel.

Hawaii is the only state that commercially grows coffee, cacao, and vanilla beans.

Hawaii has the highest life expectancy age in the nation.

Unrelated to the above fact, Hawaiians consume the most Spam per capita in the U.S. It is even served at their McDonald’s and Burger Kings!

Surfing, surfboards, hooked cane knives, beach cleaning machines, Ocean vodka, radioactive particle cleaning gel, pineapple coring machines, and Kona coffee, were all invented in or originated in Oregon!

Hawaii was the first state to ban billboards.

Hawaii has a great variety of sand! They have black, white, yellow, red, and green beaches.  

The largest and most active volcano in the world is the Kilauea volcano, which has been raging for 600,000-some years.

Because of the continuous eruption from the Kilauea volcano, The Big Island grows by about 42 acres annually.

Because of its resemblance to the surface of the moon, astronauts in the 1960s trained for moon travel by walking on Mauna Loa’s hardened lava fields.

Named for the Earl of Sandwich, Hawaii was once called the Sandwich Isles.

Hawaii has no statewide police force or department of motor vehicles. These are managed by each county government. 

The north shore of Molokai features the world’s largest sea cliffs, clocking in at 3,000-plus feet high. 

Famous folks from or who’ve lived in Hawaii include Barack Obama, Jason Momoa, Nicole Kidman, Bruno Mars, Lauren Graham, Tia Carrere, Jack Johnson, Bethany Hamilton, Lois Lowry, Marcus Mariota, Don Ho, Michelle Wie, and Bette Midler.     

One of the wettest spots on Earth is Waialeale Mountain which averages 488-some inches of rain each year.

Only two mammals are thought to be native to Hawaii: the hoary bat and the monk seal.

While Hawaii is the widest state in the nation, if you consider landmass it would take 40 Hawaiis to make up one Texas. 

Hawaii has its own time zone and does not practice daylight savings time.

The Big Island leads the world in harvesting orchids and macadamia nuts.

There are a lot of rules around leis, including the fact that it’s considered rude to refuse a lei or take it off in front of the person who gave it to you. Leis should also never be thrown away, but should be returned to the land.

Hawaii was the first state to ban plastic bags in 2015.

To Do & See in Hawaii

Kalalau Valley - State Spotlight: Hawaii
The green ridges of Kalalau Valley against the deep blue ocean on the Hawaiian Island of Kauai.

Hawaii is one of the nation’s most unique and breathtaking places, making it a very special destination for Travel Nurses. Beyond its world-famous beaches, Hawaii is well known for lush fauna, intriguing volcanoes, incredible seafood and other cuisine (yes, including the state’s quirky love of Spam), rich native culture, and so much more.

The Aloha State’s capital of Honolulu is by far its largest population center. In fact, Honolulu County is home to about 70 percent of the state’s entire population. Other cities of interest include Mililani, Pearl City, Waipahu, Kaneohe, and several other smaller communities. In Honolulu you’ll want to check out Diamond Head, Hanauma Bay Nature Preserve, Pearl Harbor and the USS Arizona Memorial Park, Iolani Palace, Waikiki Beach and neighborhood, Chinatown, the Koko Crater Trail, Manoa Falls, and so much more.

Other must-dos in Hawaii include Volcanoes National Park, Haleakala, Na Pali Coast State Wilderness Park, Hana Highway, Kilauea, Waimea Canyon State Park, Polynesian Cultural Center, Molokini, Waipio Valley, Mauna Loa Observatory, and Bishop Museum.

You can also try surfing here in the state where it was invented, attend a luau, take a helicopter tour, kayak, take a sunset cruise, snorkel, hike, bike, and so much more!

The food in Hawaii is as unique as it is delicious. As an island state, seafood is obviously a very big deal here and the state is known for that in general as well as iconic faves like loco moco, malasadas, spam musubi (spam sushi), shaved ice, Kalua pork, acai bowls, manapua, ice cream mochi, poke, haupia pie, pineapple, macadamia nuts, hula pie, ramen, huli huli chicken, lau lau, poi, and garlic shrimp. Wash it all down with a Mai Tai or a piping-hot cup of Kona coffee and you’ll be living like a true Hawaiian!

Ready for your adventure to humble Hawaii?! Search jobs now to find your dream Travel Nurse job in Hawaii! Or, search all jobs here.

Kona Coffee - State Spotlight: Hawaii
100% Pure Kona Coffee.
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Congrats to November 2018’s Traveler of the Month and Rising Star!

Laurel Maestri TotM NOV 2018 - Congrats to November 2018’s Traveler of the Month and Rising Star!
Congrats to November 2018 Traveler of the Month, Laurel M. (pictured), and Rising Star winner, Chelsea G.!

Many thanks and congrats to the November 2018 Traveler of the Month, Laurel M., and also our Rising Star winner, Chelsea G.!

Traveler of the Month Laurel is an L&D RN, currently on assignment in Monterey, California. She’s been in nursing for 11 years and traveling for seven years. Laurel works withCareer Consultant Ashley Klein.

There’s tough competition for this experienced healthcare Traveler’s favorite assignment location!

“It’s a tie between Seattle, Washington, and Jackson, Wyoming — because I love the mountains,” says Laurel, who says she loves the flexibility Travel Nursing adds to her life.

But Laurel’s not done racking up favorite destinations just yet.

“I love to travel internationally and will be summiting Mount Kilimanjaro for my birthday this year,” she says.

We asked Laurel to share some tips for future and aspiring Travelers and she offered the following fabulous advice: “As a Travel Nurse, you need to stay open-minded and have a list of questions to ask during an interview.”

Thanks so much for your great work and helpful advice, Laurel!

Rising Star Chelsea is a BSN, RN specializing in NICU. She’scurrently on assignment in Danville, Pennsylvania and works with Career Consultant Mike McSorley.

Mike praises Chelsea for her incredible work and says she has a “wonderful personality” and is “very kind and polite.”

“Chelsea is hardworking and very knowledgeable,” says Mike, adding that these and other qualities make her a great success at Travel Nursing.

“She’s flexible and committed to top-notch patient care, day in and day out,” says Mike.

Thank you for all of your hard work and dedication to quality patient care, Chelsea!

Congratulations again to the Medical Solutions November 2018 Traveler of the Month and Rising Star! Laurel and Chelsea, we are so grateful to each of you for your dedication to patient care and Travel Nursing!

Could you be the next Medical Solutions Traveler of the Month or Rising Star? Travelers who receive a perfect hospital evaluation are eligible to win these monthly awards — with Rising Star going to newer Medical Solutions Travelers. Click here to learn more and to see if you could be the next winner of a $100 Visa or Amazon gift card as recognition for a job well done!

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Clinical Corner: Assignment Safety

Safety First - Clinical Corner: Assignment Safety
Keeping yourself, your patients, and your license safe while Travel Nursing is essential to your success!

By Phil Niles, Clinical Nurse Manager, Medical Solutions

The ratios are too high, the hospital is too busy, and there isn’t any help! What do I do?!

As a Traveler, you may have felt these sentiments or even voiced them. Feeling unsafe on assignment is a scary experience — and that can be especially true in a new hospital where you really don’t know anyone. Who do you turn to for support in that situation? Because every scenario is different, there are no black and white answers, but let’s look at some assignment safety concerns commonly reported by nurses and how you can best address them.

Ratios

Many nurses report being “out of ratio” or facing high ratios. What exactly is high?  Well, it really comes down to what the nurse’s experience is and what their expectations are of a hospital. California is the only state with nurse:patient ratio laws. Med-surg, for instance is a 1:5 ratio there, but this ratio could be much different elsewhere in the country. Some states see up to 1:7-8 ratios and more!

So, what is “unsafe”? Well, one common average is 1:6 on a med-surg floor. If a Traveler comes from California and starts an assignment on the east coast, they could suddenly see 1:7 ratios when they are used to seeing 1:5. This is a drastic difference.  The nurse could suddenly feel overwhelmed and unable to meet the needs of the patients. Their expectation of the position may have been unrealistic as well. 

Perpetually Short-staffed Units

Another common complaint is that a unit consistently does not have enough staff to care for the patients on the floor, causing higher ratios as well. Most Travel Nurse positions exist because a hospital recognizes that there’s a critical shortage of nurses on their floors. So, travel assignments will often be short-staffed due to the nature of the work. However, this makes a big difference whether or not a hospital is actively seeking new permanent employees and/or Travelers to fill its gaps.

It’s important to do your research before accepting a position. Ask why they have a travel need when interviewing. This is a great way to get more information about this area. Even gauging how the interviewer answers the question will give you insight.

Being Asked to Take Patients Outside Your Skill Set and Comfort Level

This is a very serious situation. Travelers asked to take patients outside their skill set often feel like they have to — to keep their job and stay in good standing with their travel company. But hear this: No nurse should be forced into taking an assignment outside of their ability! Travelers must be vocal when this issue arises and calmly state the reasons they cannot accept a patient assignment. The worst thing you can do is blindly accept this kind of assignment and hope to “fake it, ’til you make it.” Be professional but be firm. Always know that anything that happens with the patient under your care will be your responsibility and under your license. Continue to take the issue up the chain of command if the hospital is adamant. Also, contact your recruiter! Many travel companies — including Medical Solutions — have in-house clinical staff that can be your advocate in the field. Find out if you have this resource before you accept an assignment with a company.

Being Asked to Cut Corners Because “That’s How it’s Done Here”

There are no circumstances where it’s acceptable to do anything outside of the standards of practice set forth by Joint Commission standards and state laws. A commonly reported situation is perm staff telling a Traveler that a physician does not like to be called at night. So, they just order labs and the physician signs it the next day. This is never acceptable, unless there is a protocol order signed by the physician in the chart already. Always call the physician. Will they be upset? Probably. But this is better than ordering something without an official physician’s order and having a complaint sent to the BON on you practicing out of scope. The core staff will do what they do, but don’t assume that risk yourself just because everyone else is doing it!

There are several other issues that Travelers tend to report as unsafe, and many of them are valid. Overall, what can you do to protect yourself?

Ask more questions. If the manager says their ratio is 1:5, but sometimes can be 6-7, then ask how often someone on the floor carries more than six patients. If the manager says Travelers float, then ask if they float round-robin with the staff or if they float first. Ask if floating mid-shift or more than once per shift is common. Ask where they expect Travelers to float. It is never out of line to ask questions during an interview. 

Also, take a personal inventory and know your expectations of each assignment. If your expectations don’t align with what the hospital expects, then it may not be a good fit. Trust your instincts! 

Lastly, talk to your travel company and have them work for you! Get enough information about an assignment from your recruiter before an interview so you can make an informed decision and be prepared to discuss any questions you have.

Traveling is an amazing experience, and you can make sure that it is just that and no less for you. Get answers to your questions, clarify your expectations, and find that perfect match!

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Experienced Nurses Needed for SeriousFun Camps!

Looking for something incredible to do with your nursing skills this summer? You’re in luck, because Medical Solutions is expanding our partnership with Roundup River Ranch to include two more incredible SeriousFun camps!

RRR logo[1]

In 2019, we are partnering with SeriousFun to help staff nurses for:

  • Roundup River Ranch, located in gorgeous Gypsum, Colorado, just 45 minutes west of Vail. 
  • Camp Boggy Creek, located in sunny Eustis, Florida, just 45 minutes north of Orlando. 
  • The Painted Turtle, located in beautiful Lake Hughes, California, just 45 minutes north of Los Angeles.

Each camp seeks three RNs for a paid assignment, including free food and housing, running from early May through the end of August. Ideal candidates for these positions are ER nurses with pediatric experience, PICU experience, or at least one year of recent pediatric experience.

rsz the painted turtle - Experienced Nurses Needed for SeriousFun Camps!

SeriousFun offers camps for children with serious illnesses that allow them a retreat from being a patient and an important chance to be a kid, have fun, enjoy new experiences, make friends, and benefit from the immeasurable healing power of happiness. Even better, SeriousFun provides this amazing experience free of charge — and they depend on excellent staff and volunteers to make that possible.

rsz camp boggy creek - Experienced Nurses Needed for SeriousFun Camps!

Click here to check out camp diaries from previous Medical Solutions Travelers who’ve gone back to camp. They’ve each had a life-changing experience!

If you’re an ER nurse with pediatric experience or a nurse with PICU experience or at least one year of recent pediatric experience who wants to be a part of this amazing effort — while also treating yourself to a sweet summer location and rewarding camp experience — please contact Kelly at kelly.grubb@medicalsolutions.com or 402.986.5124.

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7 Wonderful Winter Locations for Travel Nurse Jobs

Winter Fun Woman
Where do you want to land a Travel Nursing job this winter?

With winter’s chill settled in and a new year on the horizon, now is the perfect time to explore options for your next adventure in Travel Nursing. Whether you want to embrace the colder months in all their frosty glory or you prefer to hightail it somewhere warm until spring comes, there are lots of great locations for you to choose from. As your brainstorm your next move, we suggest these 7 wonderful winter locations for Travel Nurse jobs.

Hawaii

Hawaii

Spending time in The Aloha State is but a pipe dream to many — however, for Travelers, it’s not so hard to make it a dream come true! With balmy year-round temps and hundreds of miles of coastline, Hawaii is the perfect place for a winter assignment that lets you totally ignore the existence of snow and completely reject hats and gloves in favor of swimsuits and sandals. In otherworldly Hawaii, you can explore golden sands, clear waters, exciting volcanoes, rugged landscapes, gorgeous tropical foliage, island traditions, delicious seafood, and so much more.   

Click here to explore jobs in heavenly Hawaii!

Virginia

Virginia is for Lovers, state motto and welcome sign

Virginia is for lovers — and its winters are beloved by Travelers! Check into a cozy cabin, hit the slopes, or visit one of the state’s 230+ wineries to get that warm, fuzzy feeling. For some winter wildlife, check out the adorable harbor seals at Back Bay National Wildlife Refuge. Explore Virginia’s rich history at First Landing State Park (where the Jamestown colonists landed in 1607) and historic Jamestown, Mount Vernon, Wilderness Road State Park, and Colonial Williamsburg. Warm up and chill out at the famous Jefferson Pools — naturally occurring hot springs famous for the fact that Thomas Jefferson visited in 1818 and loved them so much he didn’t leave for three weeks straight! Click here to learn more about The Old Dominion State in our Virginia State Spotlight.

Click here to find your dream Travel Nurse job in Virginia.

Texas

Texas Woman Paddleboard 1 - 7 Wonderful Winter Locations for Travel Nurse Jobs
A beautiful young adult woman enjoys a peaceful moment on the water with her paddle board and faithful pet dog. The sun illuminates the scene, casting a golden glow. Shot in Austin, Texas, USA.

They say “Don’t mess with Texas,” but many Travel Nurses have absolutely loved their dalliances with The Lone Star State! From its large selection of Travel Nursing job opportunities to its ample choices for activities on your days off, Texas is a great place to land for a travel job. The temps in winter stay pretty warm here, so if winter’s not your thing, Texas just might be! Don’t forget The Alamo — not to mention wonderfully weird Austin, the San Antonio boardwalk, Houston Space Center, Padre Island, and hoppin’ urban spots like Houston and Dallas. Shopping, pro sports, museums, history, and dining are all on point in this great state as well!   

Click here to mess with Texas and find your perfect Travel Nurse job there.

California

Couple with dog skating outdoors

When it comes to Travel Nursing jobs, Cali is the year-round king. The Golden State always has lots of great Travel Nurse opportunities due to its ahead-of-the-curve staffing laws. Plus, it’s a gorgeous, diverse place that many Travelers quite enjoy calling their home for 13 weeks at a time. California has a very wide range of options in everything from landscape to activities. From skiing, surfing, hiking, and climbing to shopping, spas, sightseeing, and wine tastings, this state is a true crowd-pleaser. Learn more about this fabulous state in our California State Spotlight.   

Click here to check out California Travel Nursing jobs.

Arizona

Horseshoe Bend (Arizona)

The Grand Canyon State is a super popular destination for wintertime Travel Nursing due to its abundant natural beauty and mild winters. It also helps that a shifting population of sunbirds, among other things, means a high inventory of awesome job opportunities. One of the nation’s most marvelous sights, The Grand Canyon, is a huge draw year-round, and there’s plenty more to see and do in this southwestern state. Explore Horseshoe Bend, Red Rock Scenic Canyon, and Desert Botanical Garden. Plus, even though it does remain mild in winter, Arizona offers skiers plenty to do in the snowy peaks of Flagstaff’s Snowbowl. Click here to learn more about The Grand Canyon State in our Arizona State Spotlight.    

Click here to explore Travel Nursing jobs in Arizona.

New York

Central Park ice rink

The colder months are a great time to take a bite out of the Big Apple. Exploring incredible art museums, taking in a Broadway show, and warming up with world-class cuisine, are just a few reasons why New York is a fabulous place to embrace the winter season. If you want to get outdoors, lace up for an adventure at one of the city’s seasonal ice-skating rinks, including those hosted in Bryant Park, Van Cortland Park, and Central Park — all of which are also great choices for grabbing a thermos full of warm drink and going on a winter wonderland walk. Want to escape the concrete jungle? Head to the Catskills for a ski getaway! Click here to learn more about The Empire State in our New York State Spotlight.

Click here to check out New York Travel Nursing jobs.

Colorado

Colorado Ski

If you love winter and want to indulge in all of its snowy glory, Colorado is a fabulous choice for a winter location. The state is well-known for some of the nation’s best skiing in spots like Vail, Aspen, Beaver Creek, Breckenridge, Keystone, Telluride, and Steamboat Springs. You can also hit the slopes on a snowboard or tube, or — my personal favorite — stay in the lodge and sip spiked cocoa all day! Winter carnivals are a good way to heat things up, from Steamboat Springs’ 104-year-old Winter Carnival to Breckenridge’s Ullr Fest. Denver, Colorado Springs, Boulder, and other city centers offer great art, exciting culture, delicious food, and more urban delights year-round. Click here to learn more about The Centennial State in our Colorado State Spotlight.

Click here to explore Colorado Travel Nursing jobs.

Did we miss your dream winter location? Click here to search Travel Nursing jobs by job title, specialty, and/or state!