St. David’s South Austin Medical Center
in Austin, Texas
The details: 20-bed mixed/medical ICU in a 266-bed hospital in Austin. Level IV trauma center (trying to get their Level II, so operating as a Level II). Floated to Cardiovascular Recovery Unit. Meditech used as EMR. On assignment November 2016 to February 2017.
OK, before I get into this review, I just feel like making a few statements/disclaimers. Most travel nurses come to Austin because it’s an awesome, trendy city — and it is! However, as I’ve said before, many, many times on this blog… I spent so much time in Austin in my early 20s already. It’s a familiar city for me. I mainly came to Austin so I could be close to home for a contract instead of far away, especially over the holidays. I wasn’t planning on it, but I ended up spending pretty much all my days off in San Antonio, instead of Austin. So. With that being said… this didn’t feel like a true “travel” assignment for me.
And, because I feel the need to add this: these are all my own personal opinion! #pleasedontsuemeforslander
The hospital (pros):
- The nurses and other staff who worked here were very friendly, and always helpful.
- It’s in a great location, right off 290. One thing with Austin, is unless you want an hour+ commute to work, you NEED to live close to where you work. Living close to the hospital, you’re right in the middle of South Austin. SoCo, South Lamar, Zilker Park, downtown… all the fun places of Austin are close by!
- The cafeteria was open from 10pm-12am, and there were plenty of delivery options nearby as well for night shifters.
- There are a TON of travelers on the unit. I think one night I counted, and there were only 3 staff and 10 travelers on at night.
- Minimal floating! For me, at least. Towards the end of my contract, other travelers mentioned being floated a lot. I only floated to their CVRU twice for my whole contract.
- We did get a handful of sick patients, and travelers were able to take these patients. We had CRRT, a patient on nitric, frequent hypothermia protocols, even a Swan at one point. No rotoprone beds, though!
The hospital (cons):
- HCA hospital. I had no staffing issues — in my time there, I don’t think anyone was tripled, but they really are extremely focused on the patient as a customer and pleasing the family/patient as opposed to providing appropriate patient care.
- Everything seemed to be a “day shift problem”. We had NPs on at night starting around 10pm, and it was like pulling teeth to get any actual orders that will make a difference at night. This is a third party story, but one nurse had a patient that seems to be circling the drain, and told another nurse that they weren’t gonna call the NP about it because they wouldn’t do anything about it, anyway.
- Another case, I once had issues with a patient in metabolic acidosis. They hadn’t slept in days, but the team didn’t want to give any sedatives or sleeping pills — which I understood. When I came on shift, they were A&O x3, but as the night progressed they got more and more confused, pulling O2 off, pulling at their foley and IV. With my charge nurse, we decided they needed to be restrained and placed on the BIPAP in case their CO2 had climbed up again. They were STRONG and getting restraints on them was no easy feat. I called the NP to let them know of the changes in the pt condition, and suggested that now they were on BIPAP, they could maybe tolerate some haldol or even ativan. They refused to order anything, claiming they didn’t want to sedate them (again, understandabe) — except for haldol isn’t even a sedative. Eventually, by the time the NP actually came up to the unit to assess the pt, their HR was up in the 150s and they were thrashing around in bed. Only then I got an order — for 0.5mg of ativan. Cue eye-roll.
- As I said, the nurses on the unit were all really friendly and helpful, but a lot of nurses seemed to be in that 2-5 years of experience range. Not knocking it, I’ve only been a nurse for a little over 2.5 years myself. It was just strange that sometimes staff nurses would come to me for help, and I found myself being a resource for nurses. I’m not sure this is a “con”, as it made me more confident in my nursing abilities that these nurses were coming to me to for help, but on the one hand… I’m just a visitor here, shouldn’t staff be more knowledgeable about their own hospital and policies?
- Building on that, sometimes the nurses were just lacking clinical experience. Once, a nurse was talking with me about issues they were having with a patient. The patient had come in for TIA/strokes, but they also had a (stable!) aortic dissection. The nurse was curious about what to do for the patient’s BP — should they be on the high side because of the TIAs, or on the low side because of the aortic dissection? I asked the nurse if they had taken their BP on the other arm or the legs, because that’s the first sign of an advancing dissection. The nurse did this, and the BP measurements between arms was VERY different. They thanked me for remembering this trick, as it helped the patient condition. But, it left me wondering… if I wasn’t there to remind the nurse of it, what would have happened to the patient?
- Meditech charting is the worst. It’s an old-ass, shitty-ass DOS system. I didn’t even know the F keys were still used in 2017. It took maybe a week to get used to, but even though I was used to the charting it still was SO SLOW loading. It took me a long time to be able to find things in the chart, and it takes forever to look and see if you remembered to chart what you were supposed to chart, instead of having it all available for you.
- Even with Meditech, the hospital still used paper charting, which I found ridiculous. Often, I couldn’t even read what I had written on the paper chart when transcribing it onto the EMR. Another issue was it took me a while to get my time management down. The educator provided a “cheat sheet” for charting, with everything you’re supposed to do and at what time. The issue is, a lot of things are supposed to be charted at 0600. Whoever came up with this, I may need to have a few words with them. Who wants to be charting I&Os, making a new flowsheet for the day, pt weights, the end of shift assessment, AND doing the typical end of shift actual patient care all with just an hour left on shift?! It was only a few occasions that I felt all done with patient care AND all my charting at 0645.
- It’s a medical ICU, so most of you can probably guess what the patient population was like — elderly men and women just waiting to die. There were a few patient circumstances that really upset me on a moral/ethical level, and being on night shift, it felt like there wasn’t being anything done so that family would understand the patient’s condition and let them die with dignity instead of suffering in the ICU for weeks. I don’t like dealing with this patient population because it gets to me and upsets me too much. I don’t like taking care of a patient in situations where it’s closer to torture than care.
- I think this is a side effect of being an HCA hospital, and it doesn’t truly affect me as a traveler. But it still bothered me. There’s not nurse practice, EBP, quality improvements, anything of that sort going on on the unit. The staff nurses don’t have any incentive like a clinical ladder to work up. They don’t have any clinical trials to go on, and it just makes me go… what are you basing your practice on??? I came from a teaching, research, Magnet hospital, so the fact that there was nursing care going on without any research or evidence to back up what we are doing just… blew my mind, really.
- I’ve been on night shift my entire time as a nurse, and I don’t mind it. However… if you want to come to this hospital on day shift, tough luck. Travelers are all on night shift. Some travelers were on their 3rd or 4th extension and were able to pick up swing shifts or day shifts here and there, but their default was nights.
- They are SUPER short staffed. I was getting texts really frequently from the manager asking if I would like to pick up shifts, even when I was on vacation.
- At one point, I had switched around and ended up on the schedule for 5 nights in a row. I had to do this because I was going on vacation. The NM made sure I was aware that I was working 5 in a row before she put it on the schedule. However, later she asked if I could pick up a night right before that 5 in a row — which would put me at 6 in a row. I said no and told her exactly why — because I would be working 6 in a row.
- I feel like not picking up shifts frequently made the manager… not like me? Plenty of other travelers picked up overtime, and I did once as well… but the paycheck really wasn’t worth the OT in my opinion.
The housing: A friend’s house in southeast Austin, and then Red Roof Plus+ Austin South right off 290 and I-35
- I took the stipend again for this contract. I rented a room in my friend’s house.
- I decided to change housing for the last 3-4 weeks of my contract. Although my friends were either gone during the day or kept quiet, I still found it difficult to sleep during the day while staying at their house, and was always horribly exhausted. My dog also had a hard time adjusting to living at their house for some reason, and was having accidents inside really frequently. I think she just never was able to settle into a routine while we were there.
- So, for my sanity and for my dog, I stayed at a Red Roof Inn for the last part of my contract.
- The location was great, and super convenient to working at the hospital. There are a bunch of other extended stays/suites in the area as well, if the Red Roof doesn’t fit your needs. It was easier to sleep during the day, and although they are pet friendly, I left my dog at home for this portion of my contract.
- The only downside is that, working night shift, I was often sleeping when the cleaning ladies came by, so my room never got cleaned like at a hotel. But all I really did there was sleep, so it didn’t bother me too much.
- They did have free Wifi, which I enjoyed because I had school work to do during the week!
- I had a little trouble sleeping during the day, but I felt much better and well-rested compared to when I was staying at my friend’s house. Also, I had a shared bathroom situation at my friend’s place, so it was nice to have my own at the Red Roof.
- I would actually consider staying here again even just for a quick trip to Austin, as it was in a great location and pretty nice for a bargain hotel.
The city (pros):
- Austin is popular for a reason! There’s so much to do for every type of person.
- There’s a ton of state parks and other outdoor activities all within a 1-2 hour drive.
- The food scene is ridiculous. There are food trucks everywhere, and the restaurants are to die for.
- South Lamar, Rainey Street, East 6th Street, “Dirty 6th” are all popular areas of town around where I was living.
- There’s also things to do up north, like the Domain area, but I don’t like driving that much so I never really made it all the way up there.
- Nightlife is great! There’s always bars and restaurants open late and plenty of things to do. I was there in the winter, so some of the typical Austin summer activities weren’t available, but it’s been 80 degrees in February now so I’m sure there will be lots of opportunities for the water activities like floating the river and paddle-boarding on the lake coming up soon!
- I wish I had more actual places for recommendations for things to do or places to eat, but I didn’t spend too much of my free time in Austin, because I was going back down to San Antonio fairly frequently. However, here’s a list of things I wanted to do while I was in Austin. Most of these places I have gone to throughout the years, and just didn’t make it there on my contract, and none of these places were disappointing!
- Food: Ramen Tatsuya, Michi Ramen, Amy’s Ice Cream, Chi’Lantro, Four Brothers food truck, Frank, Hopdoddy Burger Bar, Shake Shack, Polvos Mexican Restaurant, Casino El Camino, Torchy’s Tacos, Clay Pit, G’Raj Mahal, Odd Duck (for those fancy date nights), P. Terry’s Burger Stand, Snooze, an A.M. Eatery, East Side King, Franklin Barbecue (getting up early to wait in line for BBQ is definitely an Austin experience you can’t miss), Via 313 Pizzeria, Voodoo Doughnut (I know this is a Portland thing, but if you never get to Oregon, you gotta try them out here), Pinthouse Pizza, Bufalina (my fav pizza place!), Austin Beerworks, Juniper, Banger’s Sausage House & Beer Garden (get here early for Sunday brunch, shit gets BUSY), Tiny Pies, Mozart’s Coffee Roasters, The Oasis on Lake Travis (I’ve never been, but I’ve heard the food is mediocre, drinks get the job done, but the VIEWS are stunning!)
- Activity: Austin Trail of Lights (Christmas season), SXSW (every March), Austin City Limits Music Festival (two weekend a year, every September/October), Hope Outdoor Gallery, Rainey Street, 6th Street, Barton Springs, the Greenbelt, Congress Ave Bridge Bats, Zilker Park, Mount Bonnell, Austin’s 360 Bridge (also known as the Pennybacker Bridge), Hamilton Pool Preserve, Jacob’s Well Natural Area, Guadalupe River State Park (also tubing along the river in New Braunfels!), Pedernales Falls State Park, Lost Maples State Natural Area, Enchanted Rock State Natural Area
The city (cons):
- The number one thing every Austinite will tell you sucks about Austin is… the traffic. Austin grew and expanded SO much within the past 20 years, and the city couldn’t keep up with the growth. There’s only ONE major interstate highway in the whole city, everything else is just basically back roads. Traffic SUCKS, but I avoided it by living close to the hospital, so I didn’t have a long commute, and by working opposite shift from the traffic!
- Austin is EXPENSIVE. Rent is expensive, which is why I was glad I was able to stay with a friend instead. I would definitely suggest finding a roommate, or just renting a room instead of the whole place to yourself if you come here and take the housing stipend instead of company housing.
- There’s a large group of Austinites that are definitely a certain “type”. They’re really into hippie shit, for lack of better terms. I admit, I’m not the healthiest or most mindful person around, so I sometimes felt a little out of the loop because I wasn’t vegan/vegetarian, or didn’t do yoga every damn day, or didn’t recycle, or because I ate fast food like 90% of the time. But, most of the nurses on my unit weren’t really this type of person either. It’s more of a “vibe” thing for when you go out into Austin itself, if that makes sense.
The company: Randstad Healthcare
- This was my second contract with Randstad and my recruiter, Alexis.
- I submitted for two other hospitals in Austin through Aureus, but had accepted the offer for South Austin through Randstad before I got a call back from one of the other hospitals. The people I spoke with at Aureus were really friendly and on top of my submissions, great at keeping in touch with me, and offered a great pay package. The initial paperwork required for submission wasn’t a hassle either.
- Again, I did not take Randstad’s housing or benefits.
- Parallon/HealthTrust was the Vendor Management System for this contract, because it was at an HCA hospital.
- The on-boarding was a little hectic. Meditech/HCA modules are a pain to get through, but this is not the fault of any agency, it’s HCA/Parallon.
- With Randstad, I had to get a new Tdap vaccine, but they only told me about it maybe the week before I started… so it was a little hectic getting to a Concentra to get the vaccine. Kind of annoying, because I had gotten a Tdap vaccine many years ago, but because they didn’t have the lot number written on my vaccine record it didn’t count so I had to get a completely new one. Or track down where I had gotten the vaccine however many years ago, and see if they had it in their system so I could update my credentialing specialist with the lot number. Obviously, while I don’t like getting vaccines for no reason, I was on a time crunch so I could get to work and found it easier to just get a new vaccine.
- I had to remind Alexis for my compensation for completing the modules which was paid on my 5th week, and got reimbursed appropriately for my BLS renewal. Other than that, I had no issues getting paid. I was unable to log-in to Kronos or any other system to check my hours, but Alexis e-mailed me almost every Monday verifying my hours were all accounted for.
- Again, Alexis responded within HOURS most of the time I had any questions, even if it was just to tell me she would look into the problem and get back to me later. I love having her as a recruiter, I know she always has my back!
- Soooo when I first submitted for this hospital, it was back in September (for my November start date, I like to get a head start, what can I say). It was an older posting, but Alexis and I figured, what the hell, and submitted for it. I heard back from the manager 10 days later (because Parallon/HealthTrust takes so long for the applications to filter down to the managers, I guess). I was given one pay package that, while a little on the low side, I was perfectly OK with the pay cut so I could be close to home and in Austin.
- However, after I had been offered the position, I was informed that the pay package I had been quoted was actually only for nurses starting/submitting before a certain date (I forgot the details of the mix-up), and long story short, my pay package was actually going to be about $200 less per week than originally stated.
- Now, many jaded travel nurses will most likely say this was a bait-and-switch, but having worked with Alexis before, I know she would have been upfront with me about it, and she was very apologetic — even forwarding me emails between her and the account manager about getting the original rate. I debated turning down the contract because, well, $200 less put me way below my “required per week” bottom line. But, I decided I would take an even bigger pay cut in order to be close to home, at the exact hospital I wanted to be at.
- So, that sucked, the pay has sucked, but it really has been COMPLETELY, 100% WORTH IT to be able to come home every week or two and see my family — especially during the holiday season. And, I was still making more than I was making as a staff nurse anyway! As with most things in life, it’s all about perspective.