San Francisco Traveling

[livingkennedy]

I've never gone on a travel nurse assignment but I have been very interested in traveling to San Francisco and working in the heart of the city. I would like to hear from anyone who has worked at any of the hospitals there and what they thought of their job. I understand the difficulties of living in a big city, so most of those issues (parking, using a car, relying on public transit, etc) are not much of a concern for me. My main concerns are nurse to patient ratios on the floor and in the ICU. I heard a rumor that in California if a patient is on a titratable drip then they're an automatic 1:1 - is this true? I regularly take care of 2 and 3 patients in the ICU on titratable drips, so it's hard for me to believe (even an insulin drip??) Also, I would like to know how the staff and administration treats travel nurses in this area.

For any ICU nurses out there at these bigger city hospitals - do the nurses in the ICU run and monitor hemodialysis? If so, does this make the patient a 1:1? I have no experience with hemodialysis; at my hospital the dialysis nurse comes in the room and takes care of that whole process.

My current employer does not use computer charting as of yet. Is the computer charting easy to learn? I assume most of the hospitals there use computerized charting, even in the ICU. Is a traveler allowed sufficient training for these systems? I am quite comfortable using computers, and I am confident I would catch on quickly, but I'm not sure if I'm expected to be familiar with some of these systems or not.

I appreciate any information you are able to provide!

Thanks,

Justin

[AmandaWIRN]

Welcome! I have never worked in San Francisco, but I can tell you that, yes, the patient ratios in CA are state-mandated, and they are a dream! The maximum ratio for med/surg is 1:5, ER is 1:4, Step-down is 1:3, and ICU is 1:2. I do not know about the 1:1 for titrating drips, but I know that usually in CA, any drips need to go to the ICU, and being that their ratio is max 1:2, if one of those was something easy like an insuln gtt, cardizem gtt, etc, then that would make for a very easy shift! Of course if your patient is very critical with multiple gtts, needs constant monitoring, you would be 1:1. The CA patient ratios are a maximim, not a minimum- meaning that depending on patient condition, the ratio might be lower, but can never be higher...

Also, anything over 8 hours in CA is overtime- so if you work 12 hour shifts, the last 4 of each shift is time & a half. Be careful when talking to companies about CA pay rates, because many of them will tell you a "blended" rate (the average of the 8 reg & 4 OT hours), so just make sure you know if the rate they quote you is "blended" or not.

[ppanchorage]

I enjoyed working in the Bay Area. I liked the hospital environments and the City was awesome. Working in the burbs was easier because the BART runs and it's easy to get to the City. There is so much to do there but if you have not traveled before and want to go somewhere specific, perhaps broadening your radius of work - to the surrounding areas - will give you more options.
Computer charting is good and bad. It's not that hard to learn. You learned to be an ICU nurse and that's much harder!
Have fun. It gets a little cold there. And foggy.

[DavidRN]

I did work in SF, in the heart of the city. I was housed in an apartment complex only a few blocks from Golden Gate Park. It was kind of cool to see the red steel of the Golden Gate Bridge as I walked to work. That is about where the novelty wore off.

I was contracted to work in an ICU unit at UCSF. My very first night off of orientation, I was informed that I was to be the absorb nurse. When I questioned this, I was told that I needed to go to the staffing office, pick up a pager, write that pager numer on the board in 3 different ICU units, the PACU, and ER. If any unit needed me, they could page me. I could end up starting IV's, doing CT transports, taking patients from ER to their admission room, and if needed, take a patient assignment and then be "absorbed" into that unit's staffing for the night. Mind you, this was my first night off of orientation.

To make a long story short (too late), this was the only assignment on which I have ever seriously considered walking. I saw a nurse that I met in orientation when I was floated to the ER my second week of work. She told me that in two weeks, she had not spent a single day in her contracted unit (she was also considering cancelling her contract). Obviously, this does not speak to all the hospitals in SF, but UCSF seems to be a facility that I have heard mentioned a few times in my years of travel since that assignment.

I also did not like not being able to drive to most areas due to the congestion. If you are accustomed to mass transit, you might fare better than I. If I had to do it over again, I would still have gone, but would have contracted outside the city. I initially wanted to do this and had heard good things about Walnut Creek (about 30 minutes to the east of the city). However, I had a hard time finding an assignment there when I wanted to go.

Just my two cents' worth. I would not work for UCSF again, but might consider something in Walnut Creek.

[Anmutasc]

I worked at California Pacific Medical Center (CPMC), I was hired to work in the "CCU/MICU/SICU"... told they were all one unit working together, which they were not and the CCU hated the MICU/SICU and vice versa. In orientation there was about 12 ICU nurses and when we asked each other what the manager told us...we were all told the same story....that they just opened more beds in the ICU and needed more staff. However, this was not the case, basically we were all hired to float for the whole hospital, always twice a shift. After giving report on 2 very sick ICU patients, which took till 1145pm, when i got to the medsurg floor to get report on my 5 new patients, the nurse had taken off already and handwritten report that was basically something like this. Mr. Smith, a&0X3, lungs clear, house diet. It would take me the first two hours tryign to figure out what was wrong with everyone. The staff at this hospital treated us like crap. I was almost forced to take an unstable balloon pump from cath lab and I completely refused, caused a big scene (obviously not allowed to take a pt like this as a traveler, and never had a class on balloon pumps) and also an LVAD. Multiple nurses broke their contracts or left early. So I highly suggest not going to this hospital.
For the most part, you dont do CVVHD as a traveler, nor should you take balloon pumps, LVADS, or fresh CABG's.
But have fun in the city....it was such a fun time and the experience of living in san fran helped since i hated my assignment!

[jp1108]

I did a travel assignment about 6 years ago at Kaiser Permanente on Geary street in SF. Loved everything about the city and the bay area and never lacked for things to do but the hospital sucked. First, i was hired to work the CVICU and upon showing up for my first day, they had no clue who i was and claimed to have no CV spots available, would i mind doing Med/SurgICU instead? Apparently, the person who hires travelers at that time was in a central office in another city, they do the interviewing and ship you out to the assignments. Sure, i'd do it, i was flexible. Except the CV nurses and Med/Surg nurses did not like each other and once i was thrown into enemy camp and they found out my identity....i was treated like a leper. The other travelers were great but it seemed you had to watch out for each other because staff made it clear you didnt belong. Staff worked 8 hours, travelers 12 so usually what ended up happening is you floated at 11 to cover a leaving staff nurse that had a crappy patient an oncomming staff member didnt want. Overall, it was manageable but not the greatest assignment. i had friends in the same hospital that had even worse experiences but most were very similar to mine. Who knows....maybe things have changed....San Fran the city is great, though!!! Give it a shot :nurse-beer: