Primary care, team care, who cares?

 

Many nurses new to the field of camp nursing are not aware of the competing practice models for nursing service in the field. In fact for both new and experienced nurses entering the camp specialty success is often as much about the camps practice model as the individual nurse’s proficiency, and skill.

In this article I will briefly explain the advantages and drawbacks of the primary, and team models in the camp setting, how they affect nurse without a camp background especially, and what can be done to ease entry into each respective model.

Primary care nursing is practiced in 33% of camps nationwide (1). By primary care, I mean that one nurse is responsible for the totality of the medical or nursing care provided at a location. This has a few distinct advantages. One nurse handles all information and communication, presenting a unified front of practice technique and information management. There is excellent continuity of care, as the same nurse is evaluation the same situation for the duration. The nurse will generally form strong working relationships with camp management as they will be the sole contact point for health issues and questions.

This model has a major challenge for new camp nurses, the lack of clinical assistance or training. A prudent camp director will be aware and concerned with how to address this and should make arrangements. Many camps using this model will have a more experienced nurse who is available for questions via phone, or a comprehensive policy and startup guidebook. These are a big plus to helping a new nurse succeed. However new camp nurses, and even experienced nurses, will have many questions that may not be easily answered by reference materials or an offsite provider. Being the only health resource for a few hundred people can be overwhelming even for experienced nurses, who often have to call on their wits and grit to get through long nights or a disease outbreak. A better solution is if they have an experienced nurse providing onsite training for a week or two of actual in-session camp. It's even better if the more experienced nurse is locally available and can easily be physically present on camp to help if needed, or check in regularly. If proper training and support is provided, the new nurse will easily be more successful in this environment.

There are some issues that may arise that can be major obstacles to new camp nurses. Most concerning is if there is a complete lack of assistance. If previous nurses are not willing to assist, this can be an ominous sign that their experience on the job was not good. Another issue is if the camp director is dismissive or not at all concerned that you’re inexperienced. Some camp directors are completely uninterested in the challenges that face new nurses in the camp setting. A director should adequately address your weaknesses and concerns. If you don't feel this is happening, I recommend you steer clear of that camp. Finally, there should be a plan to make arrangements if you become ill, have a family or personal emergency, or are incapacitated in some way. If no plan exists, this is a red flag that you may become stuck on camp, unable to turn over you patient assignment.

Primary nursing can be a challenging but rewarding practice model. The nurse often feels fully immersed In the camp experience. Being the sole nurse is in immense responsibility, and is a huge amount of work, but many find it profoundly rewarding. Nurses who are not experienced in camp practice, or in a closely related specialty such as school nursing, should be cautious with this model, however if the known issues can be mitigated then a good experience is more likely.

A more common camp practice model is the team approach. Team nursing in the camp setting is generally defined as a single head or charge nurse who delegates tasks to other nurses or, if permitted, unlicensed assistive personnel; to provide all of the health needs of a camp. The major benefit of team nursing to the camp organization is that it allows for larger camps. A single nurse could not provide adequate care to camps that have 500+ campers and staff. A survey conducted by the Association of Camp Nurses shows that 67% of camp nurses indicate they work with another healthcare provider. Another RN was present in 19% of respondents, an LPN was on staff for 68% of respondents (1). The team approach is a newer model, coming into popularity as the complexity of camp health needs, and the size of camps, both increased. This model allows for direct collaboration between nurses. This makes unusual clinical situations or emergencies more easily managed and allow the new nurse to be supported as they learn the ropes. With the team approach, nurses are given a better work life balance as shifts are often assigned. This can prevent excessive fatigue and burnout. It also allows for staff illness and personal emergencies to happen without threatening the delivery of nursing services completely.

There are some drawbacks however; larger camps have larger organizational headaches. More camper information on intake and more nurses being needed to organize it can lead to miscommunication and confusion. There is always some degree of care in-continuity, as each nurse will have subtle differences in their approach to situations, both personal and clinical. Communication both on-camp to staff, and off-camp to parents can become fragmented, as different nurses communicate different information due to having varied levels of understanding in a particular situation. These communication and practice variances can leave new nurses feeling confused and uneasy.

These are a few things that a new nurse should look for that will make their entry into this practice environment easier. Most importantly, in my opinion, is having a good, knowledgeable manager in place. A good manager will delegate without confusion and facilitate communication. Having a good idea of the type of manager you will be working with will offer insight to the culture and work environment of the health center. Whenever possible, speak with the head nurse or health manager when being interviewed. Additionally having a sloid understanding on how communication between nurses, staff, and parent occurs is important to understanding the health services role in camp. I personally favor the team model for nurses new to camp practice, especially for recent graduates, or nurses with little pediatric experience.

Regardless of practice environment nurses of all experience levels, should set themselves up for success as much as possible. One part of this is the camp practice model and culture however a larger part of success and happiness is being open to the experience and flexible in practice. Truthfully, camp nursing is often not technically difficult; but it is personally challenging. Nurses must start a new job, move residence, and be isolated from personal supports. Keeping an open mind and staying positive will dramatically improve your experience.

Nurses will also benefit from reading up on the profession to gain insight. Two amazing resources are “The Basics of Camp Nursing” by Linda Erceg and Myra Pravda; and “Camp Nursing - Circles if Care” by Mary Casey. The Association of Camp Nurses offers a quarterly Compass Point newsletter with membership. A back catalog of Compass Points is also available.

I hope that this helps you be prepared for entering the expanding and evolving specialty of camp nursing, by increasing understanding of how each practice model benefits and challenges nurses.

 

References:

(1) ACN Compass Point volume 16, no 1 " roles and responsibilities of seasonal and year round camp nurses survey results part 1"

Camp Contracts for Beginners

Many nurses considering camp work are confronted for the first time in their careers with the prospect of negotiating an employment contract. Careful consideration and confident actions are often required to reach a satisfactory agreement for both sides. We will discuss some important things to consider when beginning negotiation or signing a contract.   

Many factors contribute to the employment agreement between a nurse and camp employer. The purpose of this post is to focus on the monetary aspect of the relationship. To make sure your a good fit culturally for the camp, please see the post by CampNurse1 here.

The camp employment process can moved very quickly, in my experience the time from application to employment offer can be as little as 24 hours. This can often catch nurses unaware of their own needs and may lead to them signing a contract they later regret. Also remember that the interview isn't over yet; rest assured that the prospective camp is observing how you carry yourself during the negotiation process and you should also note how they behave. Are you concerns addressed in a meaningful way? Do you feel rushed? Are they impatient with you? These are all red flags that you may want to reconsider your choice of employer. 

Before even interviewing, the first thing that a nurse will have to figure out is what is your bottom line pay requirement. A simple breakdown of your routine expenses will help you arrive at this number. Consider rent, health insurance, auto insurance, credit card bills, and any other reoccurring expenses. However, exclude food, gas, and other daily expenses that will be covered by living on camp. This number is your walk away, obviously any pay offer below it will not meet your needs. It is important to have this number in mind when you arrive at the negotiation.

Realize your not going to be paid the same rate for working at camp as you would in a more acute care setting. Camp nurses are on average, in my experience, paid between $50-$100 per day to start. Knowing your bottom line and setting a realistic goal is very important to being satisfied with your contract, and not breaking the bank on your first camp excursion.

During your interview you should be very clear on the expected number of hours and days you will be working. Many camps expect you to be available 24/7 while camp is in session, often for weeks at a time. Others will set a schedule that involves set days and hours. Still another common arrangement is a set number of hours for the season to be scheduled to meet camp needs. You should also determine how each camp will cover staffing shortages or staff illness. It's important to know upfront if staffing issues will affect you and if it will influence your compensation. Realize that many camps will not increase your compensation if a staffing shortage dramatically increases the number of hours you have to work, however those camps should have a plan in place to relieve short staffing.  Whatever the staffing system the camp uses, keep in mind the total days and hours expected; this will help you to decide if you are getting an offer that is acceptable to you.

You should also determine how your contract will pay out. Many contracts will pay weekly or biweekly. However some contracts will pay only a portion of the total amount, and pay the remainder upon completion. In reality, any means of distributing funds can be put forth in a contract; make sure you clearly understand and consider the terms. Match the estimated pay net (roughly 3/4 of the gross amount paid) against your expected expenses and their due dates. A lucrative contract is no good to you if the pay structure will force you to be late on bills or carry your expenses on credit.

Now that you are ready with your walk away and pay expectations, you have gathered the information on work expectations and pay terms during you interview, you are ready to talk numbers. Try whenever possible try to not make the first offer, many camps will want you to name your price first. This puts you at two distinct risks. Firstly you may quote a number that is completely normal in the outside world, but is way above what camp is willing to pay, and price yourself out of a job. Conversely you may quote a price way below what the camp was willing to offer, if they jump at the first number you threw out, you probably missed out on some money. Try saying something to the effect of "I'm really not sure what the average is for organizations such as yours" or I wouldn't want to insult you by being completely off base with my offer".

Ideally the camp will make the initial offer. This is generally on the low side of what they want to pay. It will be accompanied by phrases such as "this is what we pay new nurses" or "this is what's in our budget" or some other phrase designed to discourage a counter offer. I assure you your not going to break the bank and they are anticipating a counter offer from you. Be very excited to receive the job offer and say you will need some time to think it over. Give yourself ample time to consider if the offer is good for you and if not exactly what you need to make it work.

As a general rule you can expect to counter offer for an additional ten to fifteen percent, with a reasonable expectation that the offer will be accepted. If even with this additional amount you find the offer to be unsatisfactory or below you walk away number, then you may need to negotiate a substantially larger amount or consider cutting your loses. Never counter-offer without a reasoned, rational explanation why you are asking for more money. Always be pleasant and appreciative even if you end up not accepting the initial or counter offer. There is no reason to make enemies or leave a bad impression at any point during the negotiations. The point of this whole process is to try and reach an agreement that is satisfactory for both parties. If an agreement cannot be reached, thank them for their time and invite them to contact you if their needs change. You may find that an offer that was not to the liking of a camp 10 weeks before the kids arrive, may be better received at 2 weeks until the kids arrive, never burn your bridges.

Don't forget to include non-monetary benefits into your agreement. Many camps will allow you to include tuition for children or other child care arrangements. You may be able to bring pets, find jobs for spouses, include the use of a camp vehicle, or schedule yourself on recreational trips. Practically anything can be negotiated, in fact you may have better luck getting non monetary items then countering for additional money.

Once an agreement has been reached you will be asked to sign your contract. This may be the first time you actually see the document.  Most contracts used by camps are the legal equivalent of form letters, they will generally only cover the basics of dates to be worked and pay. Read the contract closely and then be sure to save a copy of it for your later reference. Keep all communications between yourself and the camp for your reference. If items discussed and agreed upon are not be present in you actual contract, emails and other documents may be your only proof of the non-monetary or special accommodations you agreed to. After signing a contract, email a generous thank you and reiterate the terms and conditions to avoid any surprises.

I hope that this prepares you to enter an employment contract with a camp this summer,  and that you feel more comfortable, with an often uncomfortable portion of the camp employment process.

All opinions expressed here are my own and do not represent those of my employer. Remember anyone can pretend to be anyone on the internet, so please verify all information presented. NEVER take advice from strangers.

 

 

Choosing a Camp

Post appears on Allnurses.com posted on 2/28/13 and can be found here  Content posted on campfire nursing is used with the permission of the author CampNurse1.  

I've been meaning to write this for some time. Spring will be here before we know it, and many nurses are looking for camps to work at this summer.

I hope this will be seen as an open-ended thread. I am eager to read the additions our brother and sister nurses make. Each camp has its own unique identity, so my experiences may not apply to you. My motivation is to help nurses avoid some of the mistakes I made when I was new at camp nursing. If you and your job are the right fit, the summer is over before you know it. If you are nursing at the wrong camp, the summer is endless.

The first thing to do is decide what you are looking for. ACA reports there are over 12,000 camps in the USA, so the choices can be daunting. Narrow it down. Do you want a traditional sleep away camp? A day camp? Wilderness camp? A "Dirty Dancing" kind of resort? Healthy campers? Special needs? Music? Sports? Religious? Non-profit and For-profit camps have way different corporate culture. You get the idea.

Define your personal needs. What kind of salary do you require? Some camps ask for volunteer nurses. Others pay really well, some hardly at all, with most camps being somewhere in the middle. Some camps "trade for tuition," that is, they will allow your children to come to camp for no charge in exchange for your services. Some will offer a salary on top of it. Room and board, of course, is offered at every camp I ever heard of. You should be able to find a suitable compensation package with a little hunting. However, if "How much does it pay?" is your first thought, camp nursing is probably not for you.

It is good to ask yourself what camp nursing means to you. If you have a picture in your mind of idyllic days patching the occasional boo-boo and making s'mores, you are clinging to a stereotype. Camp nursing, while it does have some down time, is hard work! Expect long days and nights. I always need a week to rest at the end of the summer. Many people come to work at camp hoping to relive the magic of their childhood at camp. As a nurse, you will be disappointed if you have that hope. The camp nurse is usually one of the older members of the staff, in my case, over 30 years, lol! While you are an important part of camp life, you should expect some isolation. Why do you want to be a camp nurse? Find the answer in your heart, because you will be asked that question a lot.

What's your family situation. Single? You are good to go. Not single? If your family is not on board, you should probably put off the idea of camp nursing for another summer. It just can't work if your family does not want you to go. If single, are you good with leaving your home or apartment vacant for the summer? Maybe you can work out a house-sitter or sub-lease for that time. There are companies that can help with these arrangements. Who's going to mow the grass? Some camps let you bring your pet, some do not. Don''t forget to think about your cable, phone, utilities, and other bills that will have to be paid, whether you are there or not.

Think about your job situation. If you are a new grad or between jobs, this is no problem. Getting a leave from your hospital job can be a problem. It often seems that HR has not gotten the memo there is a nursing shortage. I have heard from nurses over and over they could not camp without quitting their jobs. That was true in my case also, back when I was working med-surg. I solved my problem by going to the DON and covering her desk with the cards and letters I had gotten over the years. "What are you doing,?" she said. I told her, "I am showing you the kind of nurse you are letting walk out the door." She told me to go to camp, and she would take care of HR. I found out after the summer she simply put me on the schedule every two weeks, and called me in sick. It's a shame, but you are going to have to get creative here. I solved this problem for good by going full time as a camp nurse, a rare job.

Now you are ready to start your search. The ACA, and ACN websites are good places to start. I just Googled "camp nurse jobs," and tons of good information popped up.

Keeping the above in mind, narrow it down to 3 or 4 camps. Go to their website. Google them and see what people are saying about them. Google the Camp Director, or Head Nurse and see if there is anything wacky. If things are good, send a resume, then, later that same day, call the Camp Director or other decision maker.

Listen closely during the phone call. Remember there is a nursing shortage. Chances are the camp really wants to hire you. Here is your chance to make this work for you. You are selling yourself to the camp, but the camp needs to sell itself to you, as well. Listen to the Camp Director. You should get a "warm fuzzy" from this person. Did he or she respond to your call or email in a reasonable time? Were they distracted. Did they have time for you? If you do not feel good about the initial contact, move on. These traits will only get worse during a busy summer.

If the initial short phone call goes well, arrange an interview. INTERVIEW AND TOUR THE CAMP PERSONALLY IF AT ALL POSSIBLE. This is very important. Your idyllic cabin could turn out to be a tar-paper shack. Your "wifi access" could be a half mile hike.
"Access to all camp activities" might mean only during down time that doesn't exist. The only way to find out is to go. Make the tour as part of an out-of-town weekend with your family. This makes the long drive not so bad. A personal tour and interview is your chance to see if the website or the initial phone call was deceptive. It happens. If you sense deception, move on. It might be part of the camp culture, and will only get worse.

It may be impossible to visit due to a long distance. In that case, rely on how you are treated in your communication. Quick, respectful response to your calls and emails is a good clue. Your phone interview should leave you with good feelings. You would hate to get to Denali, Alaska, to find out this is not the place for you. But, far away does appeal to our sense of adventure.

Your tour may come before or after the interview. Is the camp clean and well maintained? How does the Health Center look? Was it used as a storage area during the off season? Literally sniff around your quarters, and look for signs of vermin. Look for safety issues, such as broken pavement. You are looking to see if they are cutting any corners.

Do not worry or be nervous about the interview, even if you are a new grad. The CD or Head Nurse will be interviewing you, and you should be interviewing them. I believe you will leave a great impression by asking appropriate questions. It lets your decision maker know they are talking to a professional. Here are some good questions to ask:

Are you ACA accredited? That does not guarantee a good fit, but its a start.

What are my hours? What are my duties? When are my days off?

Do you have standing orders or protocols?

How far away is the Camp Doctor, and the ER?

Who takes sick or injured campers to the ER or Doctor, if needed?

Can I meet with the Camp Doctor? This is a big red flag if you are discouraged from meeting with her. I like to bring a cake or doughnuts to the office staff in the spring so they know me and will put my calls through quickly.

Do you have MARs? Who creates them? Are they electronic? Try to avoid camps where you create MARs at check in. It can take hours and hours, and leave you exhausted on the first day of camp. It is not a good sign if the CD does not know what an MAR is.

What are your medication rules? Blister pack or roll packs (easiest)? Prescription bottles (okay)? No rules? (Run!)

Who does incontinent camper laundry? The infirmary laundry?

What is the supply budget?

Do you have a flu and disaster plan?

How long will I have for orientation? I think a week is the minimum. You will have to do a hundred things during your orientation to get ready for camp. I'll write a separate article about that.

Ask about cell reception and internet access, if that is important.

Do you pay for my travel, or out of state license?

When can my family or friends visit?

What is your policy regarding sick campers at check in? What about campers who come with incomplete or no documentation?

Who deals with behavioral issues? Homesickness? Sometimes that is the nurse's job.

Try to get a feel for if the camp has a culture of safety. Some camps seem to think it is okay if someone gets sick or injured because "we have a nurse to patch them up." Other camps believe it is more important to do everything possible to prevent illness or injury. Some camps think the Health Center is a hospital.

Do you have malpractice insurance? I would recommend you get your own.

At the end of the interview, if you have a good feeling, it is time to talk pay. How will you pay me? How often? How much? If pay is the only deal-breaker you find, tell the CD. They may respond positively.

Read any contract carefully. You may want to read it at home at your leisure.

Write your interview questions down before you visit. Better a short pencil than a long memory.

At this point, you are ready to decide. It seems like a lot of trouble, but it will help you find a good match. Do not ignore any gut feelings you have. Do not ignore any red flags. I want to close by emphasizing most camps are wonderful places filled with good people. A little due diligence will help you discover the rare camp that is not as good, or one that is not a good fit for your disposition. Good luck, and feel free to contact me.