Me

Hospitals all over the country fill in gaps in their nurse staffing by bringing in nurses on contract. Pay varies widely from state to state. Here are a few samples of pay rates available for nurses on contract:

• California $10,500 a week.
• Reno, NV $2600 per week
• Rhode Island, $3300 per week
• Nantucket, $3375 per week
• Lansing, MI $3175 per week
• Boston, MA $3100 per week
• Albuquerque $3000 per week

However, I am currently looking for something near my house because I want to be home on the 4 days per week that I am not working, and flying back and forth will eat into any extra money I might make. Here are some that are showing:

• Lake Placid, FL $1900/week
• Davenport $1800/week
• Fort Meyers, $2200/week

So it looks like Florida is somewhere around $2000 per week. The costs would be gas and tolls to and from one day per week, plus the cost of a 2 night hotel stay, so call my costs about $300 per week, plus the fuel to get there. As a contracted nurse, I have a lot more control over my work conditions than I do when I am tied to an employer. My conditions for accepting any given contract are:

• the 3 days each week must be consecutive. Some hospitals like to have you work Monday, Wednesday, and Thursday one week, then Saturday, Monday, and Thursday the next week. I won’t accept a contract like that, unless I get more money.
• No mandatory meetings or training, unless it is during my contracted work days. Most hospitals actually like this condition, because they don’t want to invest money in a contract nurse who isn’t staying.
• No mandatory overtime. If I do decide to take overtime, it must be mutually agreed upon, and my overtime rate is going to cost enough that I can compensate for the extra costs. Somewhere around $100 per hour.

My recruiter says all of this is doable, but some hospitals won’t agree to consecutive workdays. That’s fine, I told her, I don’t need to take those contracts. However, if they offer enough extra money, I might. Taking non-consecutive days increases my costs and my time commitment in driving time, so I pass them along to the hospital. If they don’t want to do that, that’s OK. They can hire someone else.

Let’s say that I take a job that is a 2 hour drive from here. I drive there, work my three shifts, and drive home. Total time working and driving is 40 hours. If you break those days into complete non-consecutive, I have to drive there and back three times. That adds 8 hours to my work week, so it’s going to cost you an extra $1200 a week. Don’t want to pay that? OK, no problem. Just find someone else. I would take a job that required me to fly up to Rhode Island every week before I will spend 12 hours a week in a car for no extra money.

Like Liam Neeson, I have a particular set of skills, honed over decades of learning my craft. Those skills are specialized and difficult. I can now dictate the terms under which I will work, and I don’t NEED to work full time. In fact, I don’t WANT to work full time. That puts me in charge of when and how I will work.

After all, how many nurses are there that are certified for critical care, emergency nursing, pediatrics, and trauma? The answer is not enough to cover demand.

Contract nursing has variable terms. Most contracts are for 13 weeks at a time, but there are agencies that have contracts that vary between 8 and 24 weeks. There are even agencies that offer one day contracts, but those don’t come with stipends, meaning that you can take those even if they are within 50 miles of your house. Say a hospital in the area has a need for a nurse two days from now, but only needs that position filled for two days. Your agency will offer you the contract for two days for $1800, but it would be 100% taxable.

I’m really liking the idea of being self employed.

I spent the day upgrading the computer I play games on. I put an RTX 5080 16 gb in today. Now this is a serious gaming system.

• Ryzen 7 7800X3D 4.2 ghz CPU
• 64 gb ddr5 RAM
• 1tb NvMe SSD
• 2 tb NvMe SSD
• ASUS GeForce RTX 5080 OC GP
• TrackIR system
• Winwing Orion2 Warthog HOTAS

yeah, my wife was surprised that Im a gaming nerd, too. That may be the last upgrade for awhile. Chips are getting pricey.

I have been applying to various hospitals as I see jobs I am interested in. I had never tried job search companies before, so I signed up for Monster, Indeed, and Zip recruiter. That turns out to have been a mistake on my part.

My phone won’t stop ringing with calls and text messages, and my email box is inundated with recruiters trying to offer me jobs that I am not interested in, with many of them being jobs I am not qualified for. Most of the people sending them have Indian names. It goes like this: “I just reviewed your impressive resume, and I have a job I think perfectly suits you. One of my clients is looking for” then the job title is totally inappropriate- things like Physician, Neuro Surgeon, Physician Assistant. There are also the offers for night shift jobs in Indiana or New Mexico. I have gotten calls to sell insurance on commission, and even to be a night shift janitorial supervisor. Why are they wasting my time and their own?

It’s a pain in the ass. Avoid those three companies like the plague.

Last month, I finished my MBA. I talked to my supervisor and told them that I wanted to move into management. I was told that there were no positions available. Rich W said in comments to the post that I had just placed a target on my back.

I think you have run up against a problem of being a threat to those that interviewing you. Any time you apply for a position where the interviewing group is less qualified than you, they will see you as a threat to their position. 

It turns out that he was correct. Instead of being used for my talents and efforts, management has apparently decided that I am a threat. I was written up this week for a couple of items. This is my first time being disciplined on the job (any job) in 10 years. (The last time being when I was attacked at work)What did I do?

• I made a charting error by listing a patient’s current medication at home as an allergy. I spotted the error and changed it less than 30 minutes later. Then, on the same patient, I didn’t give an ordered medication (a laxative called “Golytely”) until three hours after it was ordered. They didn’t even ask why I delayed it. Had they asked, I would have pointed out that I couldn’t give him the medication because he spent two hours of that time in surgery, then had to remain lying flat for an hour, thus being unable to drink the laxative. Hence, the three hour delay.
• The second item on the discipline was that, four months ago, I was ordered to perform an EKG on a patient and company policy says EKGs need to be done within 10 minutes of the order, but I didn’t do it for almost 45 minutes. This was used, the discipline said, as evidence that my not following orders in a timely manner is a pattern. I can’t tell you what happened there, because this was the first I heard of it. My annual evaluation in September made no mention of it, and I have no emails or other documents that I can see that mention it, either.

How can you use an item from 4 months ago (August) that I was never told about or disciplined for as evidence to upgrade discipline? Only if you are trying to hang someone out to dry. See, you can’t discipline someone for a one-time error in charting or a delay in medication administration. That’s why they needed to come up with the event from August.

The odd thing is that I was just given an award in October for “exhibiting excellence in supporting the mission of quality nursing at [company].” I was also recently mentioned for kudos (last week) in having a 98% accuracy rate in carrying out tasks like medication administration and lab work.

At the same time, my employer has been editing people’s time cards, and the last time an accrediting body came to visit, management rushed to hide the hallway beds that were being used to hold patients, because that is a violation of Joint Commission rules. Is committing wage theft by editing time cards and demanding that employees attend unpaid training.

The dominant operational priority is door-to-bed time, regardless of nurse workload, intake status, or downstream care capacity.
• Admitted patients awaiting inpatient beds are frequently placed in a back hallway to free ED rooms.
• Boarding volume can range from none to 20–30 patients.
• This hallway boarding practice resulted in a Joint Commission citation and financial fine.
• Despite the citation and fine, leadership has continued the practice.
• During regulatory visits, management scrambles to hide hallway boarding to avoid detection.
• A manager explicitly stated that increased throughput generates more revenue than the cost of paying the fine.
This reflects a conscious decision to treat regulatory penalties as a cost of doing business, rather than a boundary for patient safety and ethical practice.

A critical insight from these observations is the erosion of ethical decision-making and lack of deference to Joint Commission standards:

Joint Commission guidelines are treated as obstacles to be managed, not standards to be upheld.

• Known violations are concealed during inspections rather than corrected.
• Financial and throughput incentives are prioritized over patient dignity, safety, and monitoring standards.
• Leadership behavior demonstrates normalization of deviance—unsafe practices become routine when no immediate harm occurs.
• Staff are implicitly expected to participate in practices that obscure reality (e.g., hallway boarding concealment, paper compliance).
• Serious safety concerns (e.g., patients left unassigned and alone in rooms without monitoring for extended periods- as long as four hours) have been raised and dismissed.

I no longer believe this organization:

• Operates in good faith with regulatory bodies
• Prioritizes patient safety over metrics
• Protects frontline clinicians from systemic risk
• Aligns with my professional values

The cumulative pattern reflects cost-driven operational collapse with intentional regulatory noncompliance, erosion of ethical standards, and displacement of organizational risk onto individual clinicians. Joint Commission guidelines are treated as negotiable, fines are internalized as acceptable expenses, and frontline staff are expected to absorb the consequences.

It’s obvious to me that my time with this employer is coming to a close. It will be a race to see if I can find a job before they can find a reason to fire me. I have an interview scheduled for the week after Christmas. Let’s hope it works out.

If I have to, I can take a non-management position. The recruiters won’t leave me alone about that, but I don’t want to settle unless I absolutely have to.

What do you know, as of today, I am a board certified Nurse Manager. This is in support of my goal to move on from direct patient care, and get a job that is away from what has, to me, become a dead end job with no chance of promotion.

This latest certification is my first management certification and is in addition to my 3 other board certifications, although those three are purely clinical.

Sooner or later, I will have so many qualifications, I will be out of here. Now to begin working on the next one…

Once I got my MBA, one of the first things I did was to sit down with the director and her assistant. I pointed out to them that nurses who get a master’s degree do so because they don’t want to stay in their current role. The response was that there were no promotions available. They explained that we were budgeted for 10 assistant managers, and we currently have 14. Additionally, five people have been here longer than I have were promised any upcoming promotions. The result of all of this is that I would have to see nine people leave before I would even be considered for an assistant manager role. Assistant manager doesn’t even require a bachelor’s degree, as there are several who only have an associate’s in nursing.

I pointed out that I had more certifications and more education than any of those who were currently in roles over me, as many of those in line ahead of me don’t have a bachelor’s or a single board certification, much less a master’s and multiple board certifications. I am more qualified and certified than any other nurse in the department, including the director herself. That apparently didn’t matter.

My hospital is getting ready to open a free standing ED about 20 minutes down the road, and the staffing for that unit is coming from the staff of my current hospital. I asked them if I could apply to be the director of that facility. She told me that she was planning on running it directly and remotely herself, so there would be no director position to apply for. It’s more cost effective to not hire a new director, don’t you see…

The director then said, “I understand what you are trying to do. Just stick around, because there is a lot of growth planned over the next two years. There will be other opportunities for advancement, and you can apply for one of them.” To me, this was like being placed in the friend zone, where a woman leads you on in order to get you to continue to act like a boyfriend to take her out to dinner, but had no plans of ever letting things go any further.

So I began applying for other jobs. I first tried to get an assistant manager spot at other hospitals within the same company. I was offered one, but at the same pay that I am currently being paid, and I would no longer qualify for some of the incentive pays that I currently receive. In other words, a cut in pay. Topping it off, the position was an hour’s drive away. I turned it down.

So I applied to positions outside of the company. One of the interviews I went to lasted over 2 hours. I found myself saying things like “You hire professionals. They want to succeed and work for a place that is winning. A leader is there to give a team a common vision so they head in the direction that they already want to go, and the result is usually excellence.” They loved me. I was told that I could take a current position as an assistant manager, or I could wait and see if my other application for a more senior position would bear fruit. I elected to go for the higher position.

I then was asked to a second interview with the hospital’s board of directors. I went and got a Brooks Brothers suit for the interview. I got an email on Saturday, and the woman who would be my boss at the new hospital told me that she thought I was a great fit and this second interview was to be on Wednesday.

Then on Sunday, I got an email that the second interview would have to be postponed. Two days later, I was called by HR and told that I was no longer a candidate for either position, because the positions would be eliminated. As of this morning, both positions remain posted on the company’s job board.

I continue to search for a better job. It’s all good, I’ve only had an MBA for 2 weeks, and I have already had 6 job interviews. It will happen.

If we learned anything about the murder of United Healthcare CEO Brian Thompson, it’s that it is dangerous to be in liberal controlled areas, even more so if you don’t practice OPSEC. For that reason, I try to edit out any identifying information or anything that telegraphs my future movements. By the time you read this, I will be home, so security is not an issue for this post.

I have been in Boston at a conference for the past few days. The number of people who knew where I was can be counted on my fingers. We stayed at a nice hotel near Boston Common. We sampled plenty of local restaurants: Saltie Girl Seafood, Lucca Italian, Mike’s Pastries, M.J. O’Connor’s Irish Pub, and others. I spent a day riding the hop on/hop off bus to see some sights, and then it was time to come home.

Some of the things I wanted to see were closed because of the government shutdown: I couldn’t get in to the Bunker Hill memorial, the old Boston Naval Yard, the USS Constitution, or the meeting place of the Sons of Liberty because they were all closed. Shame.

A couple of people made comments to my post on earning my MBA. I did it for a number of reasons-

At nearly 60 years old, I go home at night with a sore back, feet, and legs. I was upset about being forced to take unpaid training, and other things. I am a huge proponent of this:

If you are unhappy with your job, you have two choices: you can improve your worth and get a better job, or you can bitch about it and become miserable.

I decided to do something about it, I thought long and hard about what I wanted, and how I needed to get there. I went back to school to get a master’s degree- a business one. Getting an MSN would not change things, but an MBA would qualify me for management or at least an administrative position.

That’s great advice for anyone- if you don’t like your job, what are you doing to better yourself? How are you going to move forward? You can complain, or you can DO something about it. Which plan is more likely to get you what you want?