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Writer's pictureReuben Diachenko
May 3, 202212 min read

A Year of Astounding Adventure and Firsts - 50 of the Best Sites in the Four Corners States || VLOG

Updated: May 18, 2022

LOCATION

Arizona, New Mexico, Utah, Colorado, and Texas while on contract in Fort Defiance Arizona (staying in Gallup, NM)

CAIRN TRAVELER VLOG || EP42

Almost a year in the contract in Arizona and sadly time to move on. Enjoy this recap of a year’s worth of mind-blowing adventure!!

Be creative and find your adventure this week!! ✌️😎

Continue reading to find links to some of the awesome adventures I have been on, a summary of living in Gallup, a review of the hospital I worked at, and some details of the RV park where I stayed.

ADVENTURE

These are just a few of the amazing places I have been during this contract here in Arizona from October 2020 to September 2021.



When I consider taking a new assignment, I do a good bit of research first. I check out the hospital of course - from a travel nurse perspective, The Travel Nurse Network - The Gypsy Nurse group on Facebook is a great source of information on this (use the search group function just below the page banner to search for a particular place). I check out the hospital’s website, photos posted of the facility, and sometimes I’ll look at Google review but from a patient perspective these are almost always a mixed bag and not very indicative of the actual care at the hospital.

Next I use the AllStays app to check for the closest campgrounds to the hospital. I usually jot down my top 5 and then start making calls to check on monthly availability. AllStays is great as it offers user reviews, details on the campground, phone numbers, websites, etc. and all in one convenient location. I always get a campground locked in before I agree to an assignment.

I do some brief research on the town I’ll be staying in - usually just Wikipedia - checking things like town population (~22,000 - I am very much averse to working in large cities), history, socioeconomics, etc. Google Maps is a great way to just look around an area and see what stores, amenities, etc. are offered. Gallup has a Walmart, Home Depot, Hobby Lobby, Safeway (and several other grocery stores), multiple laundries of varying quality, a Chevrolet dealership and service (as I drive a Chevrolet Silverado this was convenient for me for maintenance), a very nice Aquatic Center if you are interested in swimming, and multiple restaurants. Gallup is a historic Route 66 town and has all that nostalgic quirkiness. Gallup is also a major train town with a large train depot and multiple trains coming and going throughout the day.


Interestingly according to one site, Gallup ranks as sixth in “The 10 Worst Places To Live In New Mexico for 2021.” Many places in New Mexico have a high crime rate and part of my research was to look at a crime reporting map for Gallup to determine which areas were the most dodgy and to avoid. Thankfully the two main campgrounds in the area are on the East and West outskirts of Gallup and thus in safer areas. I can say that I NEVER had any crime-related issues in Gallup but then I’m not prone to wandering in places that are sketchy.

One thing that I LOVE about Gallup is that it lies squarely on Interstate 40, making it incredibly easy to take road trips to just about anywhere. Flagstaff, Sedona, and Albuquerque are all about 2.5 hours straight drive away. Santa Fe is about 3 hours. Grand Canyon National Park is about 3.5 hours. You can also be in Utah or Colorado within 3 hours.


Gallup is considered high desert at 6,467’ which means that even during the hight of the summer, temperatures cool off quite drastically at night (110s at maximum during the day and 60-70s at night). Having stayed for almost an entire year, I was able to experience the full range of weather. Throughout most of the year, Gallup is subject to fairly severe winds which can also whip up dust and sand in the area. The hottest summer months are actually rather short-lived from June-September. With the exception of the summer monsoons which arrive in mid July-September, it is a very dry heat with little humidity. The monsoons (which occasionally included some hail) are consistently in the afternoon when the heat reaches its maximum, leaving the mornings quite pleasant. You will also find that the heat is extremely sun-dependent with as much as a 20 degree difference in shade and again the mornings being cool and pleasant until 10-11AM. Winters can be very cold with temperatures dropping into the negative teens and we had several feet of snow with the truly cold months lasting from November through March.

Fort Defiance | Arizona


Pay Rate Look, there’s very little point in posting what I actually got paid because it’s going to vary by agency and just the general situation but let me just say it was competitive, specially for Arizona. The standard shifts are 7a-7p, 11a-11p, 1p-1a, and 7p-7a with block scheduling at a 7 on 7 off or 5 on 2 off 2 on 5 off pattern. There’s a bit of mandatory overtime in a 48/36 week schedule (i.e. 4 days one wee, 3 days the next). Clocking can be a bit of a headache (this seems to be the case when Medefis is the vendor) - my agency clocking app, plus timesheet, plus an old-style timecard punch clock - these have to be signed at week’s end by both the charge nurse and an administrator (ED manager, director, or house supervisor).

The Basics It’s an 11 bed ED with a 6 bed fast track (closes at 11p) and 6 bed observation unit. They have a hospitalist/medicine service, general surgery, and OB. They also have pediatric, podiatry, ophthalmology, orthopedics, and primary care clinics in the hospital as well (most also available on call) so there’s pretty good follow up. Lab, radiology, and pharmacy are on site 24/7 (pharmacy will fill patient Rx 24/7 as well).

Charting Their charting system (RPMS EHR) is a pretty old electronic system from the government but used across all of the Indian Health Service facilities. Essentially its just free-text charting though - there are a few templates but they just generate text. Overall though this is a very straight forward and fast system for charting.

There is no medication scanning at this time. It would seem that in the distant past there had been issues with diversion (per discussions it seems this was actually on the pharmacy side of things) and it requires two nurses to even withdraw a controlled substance from the medication dispensing service - this can sometimes be a hassle. That being said, they are actually very conservative on controlled substances with most patients receiving acetaminophen or ibuprofen (they actually use quite a bit of IV acetaminophen) and this works very effectively for most of the patient population.

EHR downtime did occur (usually monthly) and we had to convert to paper charting for several hours. Their Medical Records department is VERY particular about accurate charting and as a charge nurse, I usually received a thick stack of records back to correct.

One thing that was new to me was that the nurses generated the discharge paperwork - this usually meant that a provider would verbally tell you the discharge plan or you would find this in the comments of the tracking board.

Staffing I can only speak for the time I was there and keep in mind this was during the COVID 19 Pandemic so they may have been up-staffed and I don’t know if this level of staffing will be the case indefinitely but as of the time I was there, this is BY FAR THE BEST STAFFED location I have EVER worked at. We were typically at a 3:1 ratio in the main ED. The manager also did a very good job at overlapping oncoming staff so we would have a bit extra as some folks ended their contracts and new staff were coming on. For night shift, there was a floating charge nurse, triage nurse, and float nurse. There were 2 medical assistants which could do EKGs, splint, and give PO/IM medications.

Most nights there was at least one 11a-11p nurse, one to two 1p-1a nurses, and seven to nine 7p-7a nurses. Some nights we would close the observation unit and move resources back to the main ED, other nights it would have to stay open. While patient volume could be over 200 during the day (many of these being clinic/Fast Track patients), the volume dramatically dropped at night.

There are very few actual staff members with contractors making up 98% of the ED workforce. Due to the onsite housing and MANY return contractors, there’s a bit of a summer camp vibe.


The providers at TMC are excellent, easy to work with, and plentiful with triple MD coverage until 9pm, then double coverage until 1am. There was also at least one mid-level provider until 1am. They utilize a Rapid Triage Assessment (RTA) model as well where patients can be seen in the exam rooms off Triage - a provider can provide a medical screening exam and then if the patient is truly a Triage level 4-5, can verbally discharge the patient without any further intervention (many times just discharging them to pharmacy to pick up their medications).

This location also has some of the best security coverage I have ever seen with 5-7 overnight officers (full protective vests, etc.). Due to the nature of this being a government facility, any violent acts against the healthcare staff are considered a federal offense.



Equipment TMC had excellent equipment - Alaris pumps in all ED rooms, Nihon-Koden monitors (vitals do not cross into the EHR though, you have to enter these manually), they have both a Glidoscope and CMAC for intubations, two VERY nice bedside ultrasounds, and 2 Thermacore rapid infusers in the trauma bays. The facility itself is only about 12-18 years old and very nice. In addition, it’s Tribal-run instead of run by the government - while still IHS, I’m told by several travelers that it’s the most well-run facility of all in this area - they are very proud of this hospital and it shows.

Housing Housing can be an issue - Fort Defiance is a very small town - the hospital does have some on-campus housing but it often this comes down to a wait list. I commuted from over the border in Gallup where I found a very nice RV park - many of the other travelers commute from Gallup as well. I actually enjoy the commute (as I did in Colorado) and like the time to listen to podcasts, audio books, or just have some quiet thinking time. There are two main RV campgrounds in Gallup as well as a small one closer to the hospital which often utilizes a wait list as well. There are some locals that rent out rooms to contractors.

Patient Population

Originally I thought the patient population would be a mix of native and hispanic but turns out it’s almost entirely native - they acted surprised when I asked if they ever needed a Spanish interpreter - there’s plenty of local staff that speak Navajo which helps with the older folks. While it’s a very poor demographic (many living without running water), my observation is that they are also very patient with little expectations, kind, respectful, and appreciative of care. There’s also a good deal of family support here (specially for the elderly). Alcohol is definitely a problem and we typically have several “metabolizing” overnight but for the most part these tend to be compliant and non-violent. Drugs use is almost non-existent here.

Both Gallup and the Navajo reservation have been a hot spot for COVID and thankfully they have taken it very seriously and the Navajos are generally very compliant with precautions. We always had plentiful PPE and were able to take full precautions on everyone regardless of symptomatic or not (N95, eye protection, gloves, and gowns) - this remained the case until shortly before my departure when the COVID numbers began to drop significantly. For much of the time I was there, the reservation maintained a nightly curfew and weekend lockdowns to prevent the spread of infection.

Transfers With limited services transfers are frequently the final disposition - we also have many that leave for definitive psychiatric care. Transfers have been relatively quick and smooth (the unit clerks - oh by the way, we have that too, 24/7 - handle the whole thing except the consent signature). The winter and wind can become an issue with flying and the observation unit comes in handy in this situation. The only transfers that go by ground are to Gallup which generally speaking is a lateral transfer (having similar services to ours in Fort Defiance). There is a small airport in Window Rock and we are able to send patients by “fixed wing” flight transport.

This has been one of my favorite campgrounds I have stayed at so far and I can’t recommend this highly enough. The monthly fee was $600. It is spacious and very clean with large pull-through gravel sites, full hookups, and most with 50amp service. Due to the high volume of travel nurses at the area hospitals (and lack of other good housing accommodations) you will find quite a few contract workers at the local campgrounds on a monthly basis.


There is a pool, playground, small store and gift shop, and two bathhouses with restrooms, showers, and on-site laundry. In addition to this, propane can be refilled on site and they supplied me with a 100lb larger propane tank for the winter and automatically refilled this weekly so I didn’t have to worry about running the furnace and running out (the charge at the end of the month was usually around $70-80).

The cold weather months are pretty serious and you will definitely need to make preparations to winter-proof your RV. The Airstream is more truly three than four season but did a great job over the winter - I got skirting for the rig and went as far as installing the snaps around the perimeter but then could never really wrap my head around cutting the material and it turns out I didn’t really need it anyway. I used a heated hose with an insulated spigot cover, ran the furnace to keep the tanks and internal plumbing heated, and left the water dripping on specially cold nights and I never had any issues.

There is a dirt access road next to the campground with several short trails in a field which allowed for a great walking area for Hiker and I each day. Surrounding roads are not terribly busy and have a generous shoulder area so I was able to do a good bit of running here as well.


More photography from this and other trips is available both on Instagram and here on the CAIRN Traveler Gallery Page (both color and in the Western Shadows Galley in black and white).



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PRODUCTION NOTES

Audio: RODE VideoMic PRO+, RODE Wireless GO, Apple AirPods Pro, and Device Native Mics

Editing: Adobe Premier Pro (Creative Cloud)

Music: Epidemic Sound, MUSICBED, Soundstripe, YouTube Music Library


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