Philadelphia

During one of holiday weekends, I went to Philadelphia to visit for the first time. It was a 5-hour drive but I opted for the 1 hour flight instead.

I had a fantastic time in Philly! It was pretty diverse and there was so much to do. I visited tons of museums, including looking at my favorite artists.

My visit also reminded me of why it is so great to be an American! I toured the independence hall and the liberty bell. It’s crazy to think that our forefathers had the courage to rebel against Great Britain, the most powerful country in the world at that time. It’s even more amazing to think that the 13 original colonies all united together to fight for their beliefs.

Why I Decided Not To Go Perm

My previous post demonstrated all of the good reasons I should become permanent at my current assignment. I’ll now explain why I chose not to go that route.

I actually spent a few days leaning towards going permanent. There are two main reasons that I chose not to. The first reason is that I received my extension bonus and realized after taxes I was only going to take half of it home. This reminded me that one of the main reasons I love working in locum tenens, is that I can alternate between being a W2 employee and being a 1099 contractor. This allows me to deduct more taxes at the end of the year.

I am currently working as a W2 employee and was reminded that I needed to work the remaining 3 months of the year as a 1099 contractor, or else I would be paying $60k in taxes at the end of the year! As much as I love my current job, I don’t think any job is worth working just for your income to go to uncle sam.

The idea of becoming a partner at the clinic initially sparked my interest. I compared my current salary and benefits with those I would earn if I were to become a partner. An experienced nurse practitioner at my job confided in me her current salary, and just by being a traveler I was making $20k more than her. In addition, by being a partner, after the initial raise and the quarterly bonuses, this would equate to an extra $20k. I calculated the cost of my living arrangements for the past year and recognized that my job had paid $20k over the past year for my rent, furniture rental, cable/internet, and electricity.

So just to review, becoming a permanent employee could possibly push me back $20k. Even if it didn’t, becoming a partner wasn’t even worth it because I was already receiving the financial benefit through my covered housing costs alone.

The other main reason I decided not to go permanent is because the longer I stay at my assignment, the more drama I began to notice. I observed that the working environment isn’t always quite fair. Some physicians have an easier case load than others, while the most hard working physicians often go unnoticed. I also had some issues with a couple of my medical assistants, where they get too comfortable with you that they think they don’t need to do their job. I had been working in locums for so long, that I had forgotten about the annoying bureaucratic issues of working at a permanent job.

I asked a handful of people for advice; most people told me that if I liked my job then I should consider staying. I never saw myself settling down in Virginia, but wondered if the job was worth it. We do spend the majority of our time at work. And it would just be a year or two, and I am pretty sure my job would still allow me to travel abroad all of the time.

My sister who knows me best was the only person that told me not to stay permanently and to continue being a traveler. She told me not to think about the patients because they come and go. She told me that I am living the best kind of life being able to travel and have constant new experiences, as well as tons of freedom. She told me that I am still young and should think a bit more selfishly.

That pretty much sums up the main reasons I decided not to stay permanently. What do you guys think? Did I make the right decision?

How I Almost Went Perm

When I realized I only had 1 more month left of my year long assignment, I found myself becoming sad. I was close to my co-workers and I truly cared about the 250+ patients in my panel. I began to wonder if I could see myself working anywhere else.

I mentioned to one of the physicians that it was bittersweet that the end was near. She replied that I should consider becoming permanent. She told me that I wouldn’t have to stay there forever, but could commit to 1 or 2 years. I laughed because I never even thought a permanent job would be an option for me.

Yet, I started to ponder over the idea of staying there permanently. The clinic wanted me to help them open one of their new clinics in Florida afterwards. I thought about how I would have to start all over. I would have to get to know 250+ patients from scratch, in comparison to already knowing my current patient panel pretty well. The most challenging time at my job were the first 6-9 months becoming familiar with the patients and helping them become stable. Afterwards, my patients improved so much, that their frequent visits with me became a breeze.

My patient outcomes were really good, that I could have easily become on track for partner status. Becoming a partner with the firm meant an automatic raise, quarterly bonuses, and some other perks such as an easier referral process.

Although there was a permanent physician starting right after my assignment was ending, I knew me staying would really help the clinic. I could continue to carry my current patient panel, while the new physician accepted all of the new patients. Our clinic was growing very quickly, about 50 new patients per month, and there was no provider for them to go to. Nurse practitioners at my site have a panel of about 250 patients, where as the physicians have a panel of 400 patients.

This meant that I could continue with my current panel since I was already maxed out. I wouldn’t even have to take any new patients. Or the physician gave me the idea that if I agreed to stay permanently, I could discuss with the medical director that I would stay with the possibility of giving a handful of my most complex patients to one of the partner physicians. Since those partner physicians have been there for years, their panel should be really stable since they have a long-term relationship with their patients, and could afford to acquire a few more complex patients to their panel.

This all sounded pretty great, but my next posting will be about the reasons why I did not choose to stay permanently.

Locum Tenens Blogs – September 2017

 

This month, I enjoyed reading Nurse Practitioners: Doing What You Love, Loving What You Do from TinkBird which gives some suggestions on how nurse practitioners can empower themselves.

 

How Will Working With Millennials Change Your Healthcare Career? was an interesting article to read since I am a millennial myself. I liked how it mentioned that locum tenens may be a good fit for many millennials.

I also recommend checking out these two articles from Barton Associate’s Blog:

7 Reasons to Work With a Locum Tenens Agency Instead of a Medical Group

7 Ways Healthcare Professionals Can Reduce Stress and Burnout

 

 

Questions from Readers – September

Each month I will include a blog entry answering some of the most common questions I get from readers about locum tenens as a nurse practitioner. Feel free to comment any questions you have or email me at travelingNP.com@gmail.com.

 

  • I have worked at a permanent job for over 10 years. I am now interested in trying out locum tenens, but I am a bit worried about the transition. You always seem so confident so was wondering if you had any tips for us newbies?

 

This is an example of a pretty common question I get from my readers. I think any major step in life can be a bit nerve wrecking; this includes buying a house or getting married. Nothing in life is guaranteed but if you want to start a new adventure, travel to new places, and build yourself professionally; working in locum tenens can be a great option!

Here are a few tips of I have for those of you initially starting a career as a locum tenens nurse practitioner:

-Stay open minded, especially with your first assignment. Your first assignment will be a learning curve, so don’t think you HAVE to go to the best place on earth. (I have seen a lot of you act on this advice, which is great).

-Work with multiple agencies. To increase your probability of finding the right assignment, you are going to have to work with more than one agency. Yes this means tedious paperwork, but it pays off in the end. You can also compare benefits and choose which one you prefer. (Example: working W2 vs 1099, living in a hotel vs having an apartment).

-Always look for your next assignment. After working the first month of your current assignment, you should already be thinking about where you are going next. Should you be working on obtaining another license? Start looking at states you are interested in to see if there are job options there that meet your needs. The last month at your current assignment is crucial, as that’s when most jobs will open up (last minute). You can easily have your next assignment secured 1 to 4 weeks in advance.

 

South America

My most recent international trip was to South America. I went to Colombia, Argentina, and Chile. I was originally supposed to go to Brazil as well but my visa didn’t make it in time.


My first stop was in Buenos Aires, Argentina. The first day I was there, I witnessed the person next to me get his Iphone stolen from him right out of his hands. This was definitely eye opening since I thought Argentina would be the safest place in South America. My favorite part of Argentina was watching a tango show one evening.

After a few days I went to Santiago, Chile. Ironically, it had been the last place I was looking forward to going to but ended up liking it the most. I think the combination of being in a big city with snow capped mountains and awesome seafood did the trick! The weather was a bit cold but I enjoyed being outside with the awesome scenery.

To end the trip, I went to Cartagena, Colombia, which is a small town on the coast. The people were very friendly and hard workers. No one begged for money, but everyone was hustling and trying to sell you something. I had a lot of fun and enjoyed visiting Castillo San Felipe de Barajas, which is a super-fort built long ago by the Spanish.

This was my second time in South America (I had gone to Peru a few years ago). As always, I enjoyed learning about the local culture and trying new things. I hope to get back down there to visit Brazil once my visa comes through.

Florida Nurse Practitioners

Finally some good news for Florida Nurse Practitioners! Starting on January 19th, 2018, Florida RN’s will be able to convert their licenses to a multi-state license. This means we will be able to join the Nurse Licensure Compact. As a result, we will be able to acquire quicker licensing endorsements when applying in the other 25 states that are part of the Nurse Licensure Compact. Some of these states include: Texas, North Carolina, Georgia, Maryland, Missouri, and Utah. Although we may use our RN Florida license in these other states, we will still need to obtain new ARNP licenses. However, the wait time will be cut in half since we won’t have to wait for 2 licenses to be processed.

For more information, visit Enhanced Nurse Licensure Compact Implementation.

 

Locum Tenens Blogs – August 2017

Last week was Locum Tenens Week! It’s amazing to think how locum tenens originally started as a way to provide care in rural communities while physicians completed their training. Now it has become a large network which staffs a variety of professionals in all kinds of settings, including nurse practitioners.

5 Ways Locum Tenens NPs Are Changing Healthcare is a great article illustrating how locum tenens nurse practitioners are helping battle the primary care provider shortage.

Barton Associate’s posted several profiles last week about some of their locum tenens Nurse Practitioners and CRNA’s. Below are two profiles that I found interesting and wanted to share:

My Locum Tenens Story: Meet Marti J., Traveling Locum Tenens Nurse Practitioner

My Locum Tenens Story: Meet Mark V., Locum Tenens CRNA

Lastly, for both new and experienced locum tenens Nurse Practitioners, at times it an be a struggle finding the right agency to work with. Check out: How to Choose the Right Locum Tenens Company.

If you missed last month’s Locum Tenens blogs, feel free to check them out here!

Locums Make Stronger Nurse Practitioners

There is a new nurse practitioner that was recently hired at my current site. Watching her find her place during her first year of working as a nurse practitioner, reminded me how working as a locum tenens nurse practitioner has made me a stronger health care provider.

Working in various clinical settings and with different populations, we are constantly learning something new. Something new that we can apply to our future practice. I have gained some skill sets such as doing incision and drainages, joint injections, and skin biopsies. With much experience, I have also improved my differential diagnoses, and prescribing methods. I can think outside the box and see my patient holistically.

Being one of the first nurse practitioners to work at my current site, I could see that the new nurse practitioner did not have the support system she needed, being a new grad. Sometimes she would see my patients as walk-ins. I noticed she would give solumedrol IM injection for acute pain. In another instance, she saw my patient as a hospital discharge and failed to document that a chest xray done in the hospital incidentally noted a lung mass, which needed surveillance in 6 months.

I used these examples as teachable moments. For example: avoid solumedrol unless the patient has respiratory symptoms, especially in my diabetic patients. Read hospital records thoroughly and as nurses we are usually more thorough with our documentation in comparison to our peers. And how overlooking a diagnostic finding could lead to malpractice.

I also addressed my concern with the Medical Director. Virginia is not a full practice authority state. Thus, the new NP has a supervising physician. Besides being a name on a piece of paper, I believe the new NP definitely needed closer supervision. Even as an experienced nurse practitioner, some states I travel to may require physicians to review 5% of my charts or the first few dozen notes. The Medical Director assured me that the new NP’s supervising physician will play a closer role.

Most importantly, it is important to promote an encouraging vibe in the workplace setting. Luckily, after discussing some of my patients and concerns with the new NP, she started to ask me questions she was unsure about instead of proceeding with a wrong decision. For instance, she had a diabetic patient that could not tolerate metformin due to chronic kidney disease stage 4, and was unsure if she should add glimepiride to the patient’s plane of care, whom was already on glipizide. I discussed with her that the patient should not be on both due to increased risk of hypoglycemia, but as the patient was on a low dose of glipizide, she can titrate up.

It is not our duty to judge new nurse practitioners, as we all started somewhere. Even physicians can admit their first year working in medicine is challenging. Yet, many people are still unfamiliar with the role of a nurse practitioner. Which is why I believe it is crucial we make sure we provide competent care. This can be done by trying your foot in locum tenens to make you a stronger nurse practitioner, and to make sure we continue to mentor novice NP’s.