A Locum’s ScrapBook: Stretched Thin- But Hangin’ In…

“Equally paramount is the frustrations of the surgeons, that are viewing you as a “patch” to fix a bad water leak- and that the quality of that “patch” is as of yet undefined, untested, unproven…”

Editor’s Note:

I’m doing some perfusion traveling as I am taking my show on the road.  As such, every once in awhile I will be dropping a few notes and pictures of places visited, and observations made.  In a sense, the beginning of a scrap book on Open Heart Surgery in America (and other places if possible).

42 hospitals and counting (places I have put someone on CPB).

Enjoy 🙂

Frank

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To view the entire series- click here

A Note To Perfusion Locums:

There are walls that you stare at occasionally in this subset of our profession.  As a Locum’s certain barriers that need to be (first of all- recognized), then assessed, placed into proper context, negotiated, and NOT taken personally.

The first thing to recognize and identify, is the level of staffing frustration that the perfusion group you are helpling is dealing with.  This ALWAYS has a lot components associated with it.  Clearly you wouldn’t be there but if not to fill a staffing gap.  The cause, duration, and solution to the gap, are all issues that are brewing and circulating right behind the doors you are about to open- the second you are credentialed, clinically available, and have gotten all your access codes, passed the POC requirements, and have been introduced to a wary (usually) and weary (sometimes) staff.

Equally paramount is the frustrations of the surgeons, that are viewing you as a “patch” to fix a bad water leak- and that the quality of that “patch” is as of yet undefined, untested, unproven, and you will find yourself most likely placed on the same level as purchasing a pair of old used shoes…

They will work in a bind- or quick fix, but it isn’t what one would plan to wear to the “main event”.

Of course you are going to be under a magnifying glass.  You don’t just casually walk into an OR and place someone on bypass just because you have the credentials “CCP” after your name.  (Shockingly- that still happens a lot.)  You will be looked at thoroughly and that circumspection comes with the territory leaving no place for the timid.

The bottom line is that there is no room to walk in with hesitation.  You are what you are- AND who you are regardless of whatever clinical uncertainty you come across due to equipment you haven’t seen before, tests you haven’t run before, or procedures you weren’t a part of before, these are all part of the process, and it is up to you to grab that opportunity to build on your clinical skill set and ultimately meet the challenge you signed up for when you just got into the profession.

Go with it, have fun with it, and don’t doubt your ability to meet the challenge.  🙂

Stretched Thin…

My observation over the past year of doing Locum’s, is that every perfusion group I have assisted is stretched pretty thin (based on a series of six in 8 months that I have encountered).  I guess that would beg the obvious conclusion- no one uses Locum’s unless they absolutely have to.

One common denominator?  

The level of expectation on perfusionists is so high- that entry level perfusionists (new grads), and even experienced travelers, are seriously behind the eight ball in terms of being able to get up to speed and garner the confidence of the surgeons/residing perfusion staff quickly enough- to warrant the investment of money and time.

Not everyone is going to meet that standard.  Thus, the staff may expend quite a bit of energy, stress, and time, trying to get a new member up to speed- only to have to re-engage the entire process should things not work out (for whatever myriad of reasons that can resonate- personality, perception, pissed off surgeons, bad-day, whatever).

And sometimes, not due to performance issues, things aren’t going to work out- plain and simple.

It can make it a long day and a long haul for the perfusion group that desperately needs a break, and can’t seem to find one.  That cycle can be a result of short visits by multiple replacement perfusionists that out of necessity, incur basically the same level of scrutiny and orientation as a new hire would- but the luxury of time (for economic or coverage effectiveness) just isn’t there.  Try doing that 3-4 times a year.  And maybe consider the fact that a person coming to relieve you for a week-will take at least that long to get to a point where you would trust them enough to put your loved one on bypass?

THAT just isn’t going to happen.

The Theme of the Team Makes the Difference

I’m at 42 hospitals (where I have actually placed patients on CPB)- plus quite a few (as a surgical 1st assist) as a Navy Corpsman and attached to the Marines.

In my opinion, being a team is probably the most difficult of accomplishments, never happens according to plan, the recognition of which tends to appear and disappear- before even recognizing yourself as a member.  There is never a list that says you are “ON IT”, and if that was what you needed for skills validation- then you probably aren’t- “ON IT”.  A team becomes and develops into what it is as a result of pressure and trust.

Pressure translates into whatever external force is out there- to propel you to meet and overcome whatever you didn’t expect- with a certain amount of clinical grace.

Trust is it’s own unique animal.  There is no formula for developing that.  It just happens.  It can take a case- or a year of waiting to do that case- or it can never manifest…

When a true team does form itself  (as I have had the pleasure to observe on my latest locums stint) it is a pleasure to be on the outskirts of it- and see the dynamics that leads to an excellent program due to the synergy that teamwork brings to the table 🙂

So anyway, just a brief reflection on my most recent adventure- one that was as rewarding as it was challenging.  Thank you  Kev, Tim, Brit, Tyler, Shahna, Marnix and the rest of the CV staff for helping me- help you!

Frank