Cara DeGuzman on Travel Nursing, Working While In School, and Nurse Bullies

December 06, 2020 Updated: July 29, 2021 25 min read

In this Instagram Live, Cathy interviews her colleague Cara DeGuzman, BSN, RN, PCCN, CMC & CSC, who has a wide variety of experience in nursing. Over her 19-year career, Cara has worked in Tele, ICU, PCU, and been a travel nurse as well as a mentor nurse! In this video, Cathy chats with her about all these different departments and takes listener questions about where new grad nurses should start.

Topics

01:46 How Cara's nursing career began

02:59 What it's like to transition from Tele to ICU

05:41 Live question: Should new grad nurses go straight into the ICU from nursing school?

07:12 The benefits of starting in Tele

08:27 Travel nursing - Pros and cons

10:40 Travel nursing - The pay

12:18 Travel nursing - Breaking your contract

13:03 Travel nursing - Travel nursing in exotic locations (e.g., Hawaii)

15:00 The pros and cons of being a mentor nurse

15:51 Nurse-patient communication tricks

17:53 Working in a PCU vs. Tele

20:13 Live question: What advice would you give a new grad nurse with just clinical experience on which unit to apply to first?

20:59 Live question: Is a new grad getting a job in the ICU unrealistic?

21:36 Working in the ICU vs. ER

22:47 Live question: Any advice for a new grad nurse on a tele-PCU unit?

23:50 Live question: Is it possible to go to nursing school and also be PRN at work?

24:20 Working as a CNA while in nursing school

28:58 Live question: How do you deal with nurses who are bullies?

34:04 Live question: Should new grad nurses start in an LTACH?

Note: Due to technical difficulties we encountered at the time, this video was saved from a screen recording of our Instagram story, so the comments are on screen for majority of the time. We apologize for this production quality and hope you are still able to get some awesome insights from this video.


Full Transcript

Cathy: Hey, it's Cathy. So it is teaching Tuesday and I am here live. And in just a minute I'm going to be joined by a friend of mine. So I see Cara has joined. So once I have Cara join us on screen here, we will get to ask her lots of questions. Hey, guys. Thanks, everybody for joining. So we're here on Tuesday again to do some more teaching. I always love bringing some of my friends and coworkers on board so that you guys can ask them questions and learn. So let me bring Cara on here. We'll give her a minute here and see if that works out. And then once she's on screen, I want to introduce you to her.

Cathy: Hi, Cara. Thank you so much for joining us. Everybody just getting online right now and I'm super excited to have you with us today. So for all of you guys out here, Cara is a coworker of mine. She works at Scripps Encinitas with me and she-- you've been a bedside nurse for how many years now, Cara?

Cara: 19

Cathy: 19 years. She has a huge range of experience. So she's worked in tele. She's worked in ICU. She's been a travel nurse. She has been a mentor nurse, progressive care nurse. I was, actually, I didn't even realize all the different things you've done until you sent me kind of some lists of that. Did I miss any of the big ones?

Cara: No. I think that's the big ones.

Cathy: Okay. That's awesome. So where did you go to school for nursing school, Cara?

Cara: So I grew up in upstate New York. So I went to a state college in New York in Plattsburgh.

Cathy: Okay.

Cara: Upstate New York. And I have a bachelor's.

Cathy: And you have a-- so you were in a bachelor's program?

Cara: Yes.

Cathy: Very cool and then you started off in tele, is that right?

Cara: I did. So once I graduated, my sister and I moved to Baltimore, Maryland immediately. And so initially I was going to work at Johns Hopkins. And so I had interviewed all over and heart was my favorite thing when I was in college. And so then I ended up finding another little hospital in Towson that specialized in cardiac procedures. And so I started working there on their tele unit.

Cathy: Okay. So it's like a tele-Med-Surg or it's mostly just tele and heart conditions?

Cara: Pretty much just all tele.

Cathy: Okay. Very cool. And so you worked there for about two years and then?

Cara: Yes.

Cathy: And then you moved into ICU.

Cara: I did.

Cathy: And then how long were you in ICU for?

Cara: So I was in the ICU there for a year.

Cathy: Okay.

Cara: So did then I had three years of nursing.

Cathy: Okay. So was that transition from tele to ICU, how was that? Was that hard? Did they give you a lot of training or did your tele experience really help prepare you or--?

Cara: My tele experience definitely prepared me. The difference, and then when I first got there, we went through like a two-week critical care course. So I went straight to classes for two weeks and learned all about vents, and blood gases, and all those different things. Then we went on to the unit and had our training with the nurse. So that's how that went. And the difference I thought was really funny because when I was in tele at the end of my preceptorship when I was done, I was ready to be on my own. I felt like I had seen everything. I could ask my colleagues. I was very confident. But when I was in the ICU, I felt very different. I felt like there was just so much more to learn. And I was a lot more nervous.

Cathy: Yeah. And did you feel like-- I don't know. My impression when I go down to ICU, because I as a wound nurse I kind of go to all the units, I feel like they're pretty close there and when one person gets an admission it's like the whole team is getting an admission and everybody's kind of supporting each other.

Cara: It is. Yeah. Yes.

Cathy: Was that your experience in ICU as well?

Cara: Yes. So every patient that came in as an admission, no matter where they came from, the charge nurse came and helped settle.

Cathy: That's awesome.

Cara: So we always had people come help. It was definitely a team approach, very, very much. That was my favorite place for team nursing.

Cathy: And then how come you stay there? You weren't there that long. What made you decide to leave there?

Cara: I was kind of just wanting to explore. I was so young at the time and I thought I wanted to travel and do all those different things. And so that's kind of what I did. I felt like I had seen enough and I wanted to get out and see more.

Cathy: Okay.

Cara: So then I [crosstalk]--

Cathy: And have you ever thought about going back to ICU? Is that ever something you'd think about doing again?

Cara: I do. I think I'd be very good at it. I am very good at it. But, the programs here you'd have to work nights, and I'm just not willing to do that anymore.

Cathy: Yeah. No, that's usually the thing that stops a lot of people from going back because I know quite a few nurses who would love to go into ICU, but you got to take a bullet. You got to work those nights for at least a year or more.

Cara: Right. And I'm not willing to do that. So I'm pretty happy where I am.

Cathy: Yeah, well we're happy with you where you are too.

Cara: Yeah.

Cathy: So how do you feel? One of the questions that the crowd kind of submitted, at least a couple of people did, is how do you think it would work out if someone went straight into ICU from nursing school? Is that a bad idea in your opinion or a good idea? Or what are your thoughts about going straight into something like a critical care setting before doing tele, or would you really highly recommend doing a med-surg tele role before going into ICU?

Cara: So I've seen nurses that have done both. And I was one that started on the floor and then went to the ICU, and the major difference was-- and I think it's possible. I really do think it's possible straight into critical care, but you never really develop a great sense of multitasking. And so when I would work with other nurses, if we were overstaffed I had the opportunity to go work on tele again, and I could take more patients. No problem. However, the nurses that had gone straight into the ICU were overwhelmed with that, and they could never actually take on the stress of that.

Cathy: Right, having four patients, three patients, whatever.

Cara: Right.

Cathy: A whole different bag.

Cara: Could not. Correct. And they're just very rigid whereas in tele we know how to-- you have a med do it this time. We know how to group activities and move things around, so we're not so rigid into the time thing has to have to happen. And so you're more flexible and I feel like that's a great skill to have.

Cathy: Okay. Well, yeah that's some really good input. So if you want to be able to do different things, if you go into med-surg tele to start, it gives you that foundation to be able to kind of do whatever then, right?

Cara: It does. And I think tele is the best place to start, in my own opinion, because I think learning rhythms will help you your whole career. And so if you don't actually do that in the beginning, it just is not something that you pick up later on, but if you learn it in the beginning it stays with you forever. So in my opinion I loved my tele experience.

Cathy: That's awesome. And it still helps you today probably on--

Cara: Oh, absolutely. Yes.

Cathy: --on Two West.

Cara: Oh, yes.

Cathy: And for people who may need help with EKG interpretation and rhythms, we do have a video series and cards on our website that can really help with that. I feel like when I was in nursing school, it was kind of a blur learning those rhythms and I didn't really understand the why behind a lot of the different rhythms and the differences. So with this video series I have, I really tried to explain it in a way that helps students understand why that rhythm looks like it does and the difference. So very cool. So let's talk about travel nursing. So I know a lot of people are interested in one day doing travel nursing, and I feel like there's probably some pros and cons to travel nursing, and I just want to talk to you about your experience. How long were you a travel nurse?

Cara: So I did that for probably a year and a half.

Cathy: Okay. And was that long enough or what did you think of it?

Cara: Well, it was long enough for me because I loved camaraderie on the unit. I loved having a staff I knew coming in and having structure. I loved that everyday being part of a group. And so I got to a point where I longed for that again. So when you're traveling, you hang out with your colleagues and everything but you're still kind of an outsider a little bit, and then you leave. And so I got to a point in my time and then I had gone to Scripps La Jolla and had such a great experience. I thought, "This is this is the job I want." And so I found a job where I actually wanted to become staff.

Cathy: Okay. So as a travel nurse-- and that was my suspicion with travel nursing, is that you never feel like you fully belong on a unit, that you are kind of an outsider. I'm sure people are nice and stuff, but you're not integrated into that community of nurses. Is that how you felt a little bit?

Cara: A little bit. It depended on the hospital I was at, for sure. Sometimes, you were just there for your contract and you kind of felt like you got the end where assignments may not have been the fairest but they decided to give things to you that way. Usually the first to float. And so one of the hospitals here will float you every four hours if they need to. So

Cathy: wow

Cara: Yes. And so that depends when you're figuring out what job you want, to really look at what's going to happen or you'll get canceled and you won't get your hours. So there are different things that go into your contract you need to be aware of.

Cathy: So they're paying you a lot more. Hospitals, they try to avoid - right? - having travel nurses because they have to pay a lot more for travel nurses. But sometimes, they're in a bind - right? - and they have to have-- they don't have anybody else.

Cara: Right.

Cathy: But since they're paying you more, then yeah, you're going to be the first to be canceled. Right?

Cara: Right.

Cathy: And they--

Cara: Well, sometimes you're not, though. My contracts usually had just one cancel a paid period. So I could only be canceled once. And the amount I got paid, it varied where I may have gotten the same as the staff, but your company gets the money on top of you. So you're not-- not all the money you're seeing. You also you get your housing for free or a stipend for it, so you're being compensated in other ways rather than your paycheck.

Cathy: Now where where did you go? Where were some of your contracts for travel nursing?

Cara: So I left Baltimore to go back to Albany, New York, which was my home. So I kind of went home for a little while, worked there for a little while. And then, I made my way out west. And so I actually took the time to drive my jeep from East Coast all the way out. I stayed in Phoenix for a while, which I loved. And then, when I got to California here in San Diego, I a couple different hospital systems.

Cathy: Okay. And then, including Scripps, is that what made you decide to join Scripps after that travel nursing?

Cara: Right. So I had been in a different facility that I didn't care for. And then [laughter]--

Cathy: We won't talk about that.

Cara: We won't talk about that one specifically. But when you break your contract, you end up with no housing or anything like that. So it was-- you kind of can be stranded. So you have to be very careful. And so I interviewed with Scripps. And the man that hired me-- the manager that hired me was just so lovely. And I just--

Cathy: It just felt right?

Cara: It really did. And everything just kind of slid into place and worked perfect.

Cathy: So did they have to like--

Cara: Everything.

Cathy: Yeah. Then, you had to worry about housing in San Diego then, which is not [laughter]-- not very affordable. Yeah.

Cara: When I became permanent, that's true. I had to start paying my own rent [laughter].

Cathy: Did you ever think about going to Hawaii? Like, when I think about travel nursing, I think about that. Is that something you ever considered?

Cara: I did. However, a lot of people consider that. And what happens is they can cancel your contract whenever they want. So a lot of people don't actually make it.

Cathy: Really?

Cara: Yes.

Cathy: So you'll start there. And then, they'll just like cancel it short or--?

Cara: They can do that or you don't even actually start. They decide they don't need you anymore. And so you don't go.

Cathy: Wow.

Cara: So there's a lot of that. That's why I never actually chose that, I wanted a more...permanent, bankable thing, instead of that.

Cathy: Okay. So it's just not as steady and as consistent and-- yeah, because everybody wants to do it, right?

Cara: They do. And so there's a lot. Yeah that's exactly right.

Cathy: Okay. So you did that for a year and a half. And I know when I was a new grad actually, you were a mentor nurse at our current hospital. So Cara helped me a lot when I was learning as a new graduate. And she can probably attest to the fact that I ask lots of questions [laughter].

Cara: Do you have any memories of me teaching me anything? I can't remember.

Cathy: You can't remember? Oh, I remember because I kind of stink at--. So I was really good at IVs in nursing school. But as a new nurse, I don't know what the problem was. It was super frustrating. So I pulled you in there to help me with some really difficult IVs. So I remember you and I at the bedside and me bringing new IV start kits in [laughter]. I guess we were having fun with trying to start IVs sometimes on hard patients, right, patients who were really hard sticks and everything like that. So yeah, you helped me. I don't know if you remember because you probably helped so many people.

Cara: Right. Well, I did. I had the whole unit of helping, so.

Cathy: Yeah. How long were you a mentor nurse then?

Cara: What was I? Like a year and a half I want to say.

Cathy: Okay. And what did you what did you like best about it and least about it?

Cara: I loved teaching. So I liked-- with the nurses that would like, look up to me and really listened to me and take my opinion. I loved that. And then, the least I think were the people who really didn't want to listen to me [laughter]. So I would try to tell them something. And then, they would want to not listen.

Cathy: Right? So they would ask for help. And you would give them advice. And then, they just wouldn't do that or?

Cara: Yes.

Cathy: Kind of like that?

Cara: Yeah.

Cathy: So I know you gave me-- I learned something from you just the other day. I'm trying to remember which room we're in. But it was a difficult patient. And the way you phrase-- you came in there like-- you just kind of like went straight in and like, "What can we do to help you? How can we make this better for you?" versus us keep asking questions, try to make them happy. "What is it that you need from us?" or how did you phrase it? Do you remember?

Cara: Well, I know now. It's taken me a long time. Patients usually have their own point of view. And so they're kind of stuck on something. And then, we have our point of view where we want you to do this because it's important for you. And I always usually just put it back on them. And I ask them what-- their opinion or what works for them. And then, I listen to them. Like, if they're having a tough morning, I would ask them, "Well what do you need for today to make you feel better," or anything like that. I just really look for their input. And I find that so much more successful for my day.

Cathy: And it just seemed to like it kind of-- it made things easier. It's just like giving them what they need. And it gets to the heart of the issue faster than you trying to guess and make things right or whatever, so.

Cara: Well, even if they don't want to wear their SCDs or something, I ask point blank, "Well, what is it about them that you don't like?" And then, they'll tell you. And then, you're like, "Oh. Well, if they're scratchy I can do this for them," or something. They give you what the problem is. And then, you can work on it, as a person trying to preach to them about the importance of it, just to find what their problem is.

Cathy: Yeah. No, versus you sitting there like, "Well, it's really important because it helps your blood flow and prevents blood clots. And you're in the hospital," and blah, blah, blah. And instead, all you had to do was put some liner or socks on underneath it.

Cara: Exactly.

Cathy: And you were done [laughter].

Cara: Exactly [laughter].

Cathy: Alright. So you decided not to mentor after a while. So now, you were part of the time in the progressive care unit, right, on the PCU side, and then-- most of the time.

Cara: Yeah.

Cathy: And that's kind of like-- so for students out there who aren't sure about progressive care unit, it's kind of in between like ICU and Tele. So it's a step down unit. So when they're not sick enough to be in the ICU, they go to the progressive care unit. And then when they get a little better, then they move them to a tele unit typically, right?

Cara: Exactly.

Cathy: And what's your ratio there in the PCU unit usually?

Cara: Three patients to one nurse.

Cathy: Okay.

Cara: at PCU.

Cathy: And how do you like-- do you like it there at that side better versus the tele side, or what are your thoughts on PCU?

Cara: I like both. I'd like to bounce between the two. So after having been on one side for a while, I'd like to have the other side. So in the progressive care unit, they're usually attached to the hardwire monitors. So anytime they want to get up, you have to move around their leads or anything like that. And so they're always attached to something and things like that. And then they have a lot of IV medicines, and it's challenging to transport them for testing. And then on the other side, they're mobile. So they can just get up and do things and I enjoy the freedom of that.

Cathy: Okay

Cara: And they're usually more alert, oriented. So I enjoy that aspect.

Cathy: Okay. Are there other nursing paths that you've considered or that you're interested in in the future? Where do you see yourself going? What kind of other-- Like wound nursing would you ever be interested in wound nursing or not really?

Cara: You know what? A lot of people say it's creative--

Cathy: It is.

Cara: --to cut things, match things, line things up. And it's like a craft almost. I've thought about it, but I really enjoy cardiac, things in the heart. So I'm definitely going to stick with cardiac.

Cathy: Okay, so you're happy where you're at and for the long term?

Cara: I am. I could do cath lab. I would probably go into the cath lab.

Cathy: Oh, that would be a good one.

Cara: [crosstalk] like that, yeah.

Cathy: Very cool. Well, let's see what other questions people submitted for Cara. Let's see. What advice would you give a novice nurse, a new grad nurse with just clinical experience on which unit to apply to first as residency programs have very limited spots? So just to give my take on that because things are so competitive for new grad nurses in getting into residency program, I think probably taking what you can get is probably [laughter] a good idea, right?

Cara: I think so, yeah. [inaudible] somewhere. I agree.

Cathy: And you were saying med-- we were talking about before Med-Surg tele is a good foundation, right, to go from?

Cara: I do.

Cathy: Let me come back to this next one. Is a new grad getting a job in the ICU unrealistic? So within our hospital system, they don't start new nurses in ICU anymore. I think they used to, years ago.

Cara: They did for a little while.

Cathy: And there are some hospital systems that will start new nurses in ICU. It sounds like you worked in the ICU where sometimes there were some new grads that started there.

Cara: It's based on need. So if they have nurses that already have experience, they'll definitely take those over new grads.

Cathy: Okay. Okay. And then have you ever thought about emergency room nursing?

Cara: I did. If I was younger, I would do it. Yeah. But it's just fast-paced and nonstop, and so it's more for somebody with a lot of energy. [laughter] So you learn a lot. It's a great place.

Cathy: A lot of variety there.

Cara: And the difference between ICU and ER basically is that ICU fairly is routine in a way. You know what you expect, whereas in the ER, you don't know.

Cathy: You don't know what you're getting. I remember this really funny meme around the holidays where it showed a whole big ball of Christmas lights from the emergency room nurse. And then the ICU nurses has them all nicely coiled up and stuff, so.

Cara: Exactly. That just summarizes it. And I love sorting my tubing. To this day, I love lining up tubing and labeling it and making everything look perfect. I love it.

Cathy: Totally. And I saw that as a-- I worked as a transporter while I was in nursing school. And I would transport these patients from the ED, and their wires and tubes are like everywhere. And they get them to the ICU and just get them organized, and so. Someone just posted here that they got an offer as a PCU Tele nurse. Any advice for them as a new grad nurse on a tele-PCU unit?

Cara: No, I think that's a great opportunity.

Cathy: It's a great start, right?

Cara: It really is. I think that's, really, a great place to start. Just kind of look at your peers and just be open and take everybody's opinion. And you'd, really, just listen to others. It's probably the best thing you can do as the new nurse.

Cathy: I feel like it's ideal because then you can decide, "Do you want to go ICU? Do you want to get a little more specialized? Or do you want to--?" There's a lot of different directions you can take .

Cara: Yeah. It sort of is perfect, isn't it? You get, yeah.

Cathy: I feel like it would be, for sure. Someone else asked, "Do you think it's possible to go to nursing school and also be PRN at work?" Well, I did that. So because residency programs and new grad programs are so competitive, having your foot in the door at a hospital really gives you a huge leg up in terms of getting that position because you're an internal candidate. And sometimes, when I was interviewing for my new grad position, they weren't even opening it up to external candidates. So it makes it kind of brutal. I don't know. Did you work during nursing school or no?

Cara: I was a CNA, so.

Cathy: You did then?

Cara: I did. Yeah.

Cathy: And being a CNA is a great experience. And it probably helped you tremendously, I'm guessing, as a new grad nurse?

Cara: It did. It was great. Yeah.

Cathy: I was a little jealous. So I worked as a transporter, which definitely gave me some patient care experience, like I was really good at transferring patients and stuff like that. And I kind of understood the flow of the hospital. I got familiar with kind of like all the different units, etc. But the other new grads, our unit who had worked as CNAs, I just felt like they had a little bit of a leg up. They were familiar with just kind of the pace and how things go on the unit, so.

Cara: I don't know. I think you did great, actually [laughter].

Cathy: It just maybe felt that way to me, right?

Cara: I think felt that way because I really think you did great. You are always inquisitive, asking questions and involved in everything. I think you did great.

Cathy: You're so sweet. And you were super helpful for me. So hey, just see you guys know, find out who your mentor nurse is and ask them questions. If you haven't done things before, bring them in, have them help you, like talk you through it and just advice, in general. They're our huge resource. So you just definitely don't want to be out there just doing your own thing and drowning. If you need help, you need advice, it's resources like Cara. Your mentor nurse is-- you definitely got to utilize your mentor nurse and learn as much as you can.

Cara: You never stop. I still will ask somebody for their opinion too. And sometimes just saying it out loud helps you decide what you're going to do once you hear yourself say it, it really helps bring it home what you need to do, so definitely keep asking questions and talking.

Cathy: And if you haven't done something-- I remember one time, I was asking for help on setting up tube feeding through a T tube, and it ended up not being very hard or a big deal, but you haven't done it before. You just want someone there to kind of watch you and to make sure your technique and everything is good, and then you're good, so just a lot of different things, a lot of different skills as a Med-Surg Tele nurse. And when you're a new grad, it's a lot. So, definitely, ask questions, and that's a really good idea. So in terms of the question, can you go to nursing school and work PRN and at work? Yes. Cara did it. I did it. It helps you get your foot in the door. It gives you some really good experience that helps you be a better nurse, but it is hard. I don't know what your experience was Cara, but it was a lot. I was in an accelerated bachelor's program. I had kids and worked part-time as a transporter. And I don't know. How many hours did you work as a CNA when you were going to nursing school?

Cara: I was in regular nursing school as a 20-year-old back then, so I didn't have the family aspect. I think that was what was different.

Cathy: Yeah. But still, working and going to school is still hard, right? It's a lot. Or were you like, "No big deal"?

Cara: Definitely not no big deal, but I enjoyed it. Let's put it that way. I enjoyed it. I enjoyed the patients. I enjoy doing it, so it wasn't too much of a big deal to me.

Cathy: And it, probably, reinforced that you were on the right path, right, that you were where you were meant to be?

Cara: And it was fun to learn about things in school and then see it in real life, so that was good. And in the nursing home, I had other nurses who would pull me aside and help.

Cathy: It froze for a second. Oh, can you say that one more time, Cara? I think you froze for a second.

Cara: Oh, did I? I was just saying, the other nurses in the nursing home knew I was in college for nursing. And so they would pull me aside and let me do fun tasks and show me how to do things, so I got to practice.

Cathy: That's awesome. And it helped you at school too to really understand--

Cara: It did. It did.

Cathy: That's awesome. That's awesome.

Cara: I think that's why it wasn't so much of a problem for me because it reinforced what I was learning.

Cathy: Okay. Very cool. Okay. Let's see what other questions we have here. How do you deal with nurses who are bullies? Have you ever had a bully situation at work?

Cara: Her name was Rose. [laughter]

Cathy: We're going to call you out, Rose.

Cara: Rose. But, yes. And so I really did not care to give her a report. And so what I had done is I changed my schedule, and so [laughter] I did. What did I do... Instead of doing three 12s, I did two 8s, two 12s, and so I would leave at 3:00, so I wouldn't see her.

Cathy: So you avoided her?

Cara: I avoided her. But now, what I would say is, if you're feeling bullied, to say something to that person because nurses have good hearts. And so I don't think they realize what impact they have. And then when you say something to them, it calls them on there, and then they have to correct it. So, I mean, nothing confrontational, just pull them aside and ask them if there's a problem or something, and leave it open-ended. And, usually, that's enough for the person to recognize their behavior is not appropriate.

Cathy: Yeah. That's good advice.

Cara: Yeah. Definitely.

Cathy: And the other thing--

Cara: The only thing I think--

Cathy: --oh, go ahead.

Cara: --the two [inaudible] things are, where sometimes if a nurse feels incompetent, and it's coming from that aspect, they have to push ahead and be kind of like a bully to make themselves feel better when they feel threatened by somebody else who has better skill or something than them. So--

Cathy: That's their reaction to feeling insecure.

Cara: Right. Correct. And then other times is just having-- if you're leaving things behind, I think that's hard for anybody. And so if you're constantly coming in, switching shifts, and leaving a lot behind, then that somebody is probably going to get mad over time about that. Those are the two things I see.

Cathy: Yeah. Another thing that I think has helped me a little bit is just I'm gonna call it ego-stroking. But just recognition. Sometimes nurses who have a lot of experience, they just want to be recognized that they have these skills and this experience that's super valuable. And I kind of like came to them like, "I really want to be as competent and as great as you are one day, can you show me how to do this?" Right? Like they just want to be recognized. I mean, that's not always the problem, right?

Cara: No. But you're right. You're definitely right about that. I think just breaking the ice and communicating with that person is helpful.

Cathy: Totally. And I did what you suggested. I have had very few bullying situations, but I did have one where, actually, it was the whole feeding tube set-up. I've never done it before as a new grad, and I was night nurse and giving report to the day nurse, and she's like, "Can you change that set-up before you go?" Which normally, I would have no problem doing that, but I hadn't done it before. And I just really asked her like, "Can you watch me do it because I haven't done it?" And she's like, "Are you kidding me?" Like, "You haven't done it." She got really snarky with me about the fact that I haven't done it before, and I'm like, "No. I haven't." And then later on she's like, "Did I hurt your feelings?" And I'm like, "Yeah. You did. You were kind of-- you were kind of mean. So you kind of did hurt my feelings. I get that the whole thing is not hard, but I just haven't done it before." Anyway, we're good friends now. But yeah. We had that moment where she--

Cara: I think that's what happens a lot of times is when you're overwhelmed, you get snarky. If you're starting your shift and you have a lot to do, you start getting overwhelmed, and that's where you get snarky.

Cathy: Yeah. So communication and just being honest like, "Yeah. You hurt my feelings." Or like, "I feel like you're really being hurtful to me." Just being honest about it. I mean, I think there always be some people that communication isn't effective, but I think for a lot of people it would be.

Cara: I agree.

Cathy: I don't know if what-- did you say your lady's name? Rose. Rosie.

Cara: Rose. [laughter]

Cathy: She may be the exception. I don't know.

Cara: No. Fine. But you know what, I think I could have handled it differently. So I think she was nervous all the time. And I think it came from that where she was nervous, and she was just mean to me because of it, so.

Cathy: Yeah. Well, hey, I want to open it up to the crowd here. Do you guys have other questions for Cara or I, regarding any of her roles as a travel nurse? She's done pretty much everything. So--

Cara: That's [inaudible]. [laughter]

Cathy: Any questions for Cara? And I also just want to let you guys know that we have more teaching Tuesdays coming up. "How about starting in an LTACH?" What do you think about starting in an LTACH, Cara?

Cara: I think if that's your first jumping-off point, go for it. I think it depends on what your path is going to be. If you find long-term acute care, that's different than-- the acuity is going to be different. But--

Cathy: I feel--

Cara: --anything you can get.

Cathy: Totally. I feel like going from LTACH to acute care would be easier. You'd be better prepared than going from a SNF to acute care. Because LTACHs, they have more acute patients.

Cara: Acute patients. They do.

Cathy: Yeah. So I feel like if your ultimate goal is to be at a hospital, like, in an acute care setting, then, if you have a position at LTACH, that will set you up better than like at a SNF.

Cara: Correct. I think so too.

Cathy: Yeah. Okay. Other questions for any-- anyone else over there have questions? So while we're waiting, we're going to do more teaching Tuesdays in the coming months. I'm really roping in all my friends at work, who have all sorts of neat experiences. So I've got-- I don't know if you know Phoebe. She's a case manager, worked home health, worked on med-surg units. So I'm going to see if she wants to come on and chat about her experiences. And if you like our recent clues that I've been posting, tips of the day, like my Cool Chicken mnemonic, we got more of that kind of stuff coming up too. So lots of exciting things. If you guys aren't following us here at Level Up RN, then definitely do that, and then subscribe to our email over at leveluprn.com. And if there's no other questions, I just want to thank Cara so much for coming on today and doing this, and I just really look up to you, and I feel like you just have so much knowledge and experience, and you're just really a great nurse and just a good person. So I'm just glad that you're my co-worker, and just appreciate you helping everybody else out today.

Cara: Well, thank you.

Cathy: Okay. Alright, well thanks, guys. We'll see you next time. [laughter] Take care. Bye.


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