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.

Appreciated

 

I just posted about my final extension at my current site. Moreover, I wanted to share some kind words that were said to me during the final weeks of my previous extension.

“You have changed the way I see locum tenens.” The Medical Director told me this when asking for my final extension. She said she was previously apprehensive about hiring locum tenens providers but now sees it can work with the right fit. They even hired 2 locum tenens physicians after I started to help with a maternity leave and walk-ins at some of the other clinics.

“In my eyes you are a physician. There are some nurse practitioners that work better than some physicians, and you are one of them.” The physician lead at my clinic mentioned this to me as her eyes filled with tears just thinking of the possibility of me leaving. I will always be a nurse at heart but it is nice to be appreciated by a physician and for them to recognize the benefits of having nurse practitioners at their clinics.

After telling my patient his Diabetic A1c improved from 17% to 8% in only 3 months he said: “That is thanks to you. I appreciate you looking out for me, going above and beyond and doing more things for me than most doctors.”

I sent one of my new patients, whom was completely healthy and on no medications for a routine colonoscopy. The colonoscopy was positive for colon cancer and imaging confirmed an additional renal cancer. Luckily he was able to undergo a partial colectomy and nephrectomy and recuperated really well. After seeing him post-op, he said to me: “Thank you! I wouldn’t be alive here today if it wasn’t for you!”

I thought it would be nice to shares these kind words. It is easy to get burnt out in medicine, but if you remember why you got into the healthcare field in the first place, it should keep you motivated. As a PCP we are constantly hearing ‘complaints’ all day. “My back hurts; I have difficulty breathing; I have no energy” etc. So hearing words of appreciation really makes our day J

Final Extension

Although I initially enjoyed my current assignment, after extending 3 times (for a total of 9 months), I knew it was time for a change. I needed a change in scenery both state-wise and job-wise.

The site asked if I was interested in another extension. I kindly declined and told them I was ready for a change. They hired a physician to take over my patient panel and would like for me to stay an extra 3 months to help transition my panel over to the new physician.

The Medical Director set up a meeting with me titled “What Can We Do to Keep You Longer?” She wanted to respect my wishes to move on but also to make me feel like I was appreciated. She offered me her first and second born children as a joke. She even offered me to house-sit while she went on vacation (she has a beautiful home on the lake with kayaks and jet skis etc.).

Although I knew I was ready to leave, I spent several weeks with an inner turmoil contemplating what I should do. There are normally 4 PCP’s in my clinic, one of them was approaching maternity leave, while another one was having surgery in the upcoming weeks. I felt guilty knowing 1 PCP would be all-alone in the clinic if I were to leave. When 1 PCP is out, it’s manageable. When 2 PCP’s are out it’s a disaster. Think about the walk-ins, phone messages, medication refills, reading of PT/INRs, and paperwork that needs to be completed.

I also thought about my patient panel. When I had taken over for their previous PCP, the patients had been pretty neglected for a few months since their previous PCP had gone on sick leave. I thought about the connections I had formed with these patients since they come to the clinic at least on a monthly basis. I thought about how far these patients had come after first meeting them. The uncontrolled hypertensions now well controlled, improved diabetic A1cs, resolved heart failures, controlled depression, weaning them off their opioid dependencies, and encouraging health screenings to help with early detection of newly diagnosed cancers.

My patience and level of contentment were starting to decline, as I became blasé with this routine lifestyle. The cure to this was to move onto another assignment. But for the reasons above I knew that I had to stay. Another 3 months wouldn’t kill anyone right?

In return for my final extension the site offered me a $5000 bonus. This is equivalent to an extra $10/h over 3 months. They also agreed that I did not have to continue seeing new patients, and can focus on my current patient panel since they are already very complex. The agency I work for offered me an extra round trip flight home and proactive licensing in other states.

The site is hoping when I am doing with this final extension, that I will help them open their new clinics in Florida.

Locum Tenens Blogs – July 2017

This month I wanted to share two articles I really enjoyed reading from around Barton Associate’s Blog.


The first article is: Advice for Being a First-Time Locum: What These Providers Want You to Know! Experienced locum tenens providers shared some great tips. My favorite tip was when working locum tenens, to remember why you are there and not to feel guilty leaving patients or co-workers when your assignment ends.

I also wanted to share this article: 6 Common CV Mistakes to Avoid When Applying to Locum Tenens Jobs. I often help my readers match up with some of my recruiters, and will let them know if their CV needs some work. So this article has a good outline of what your CV should look like! It helps to polish your CV and give it a makeover, especially when applying for your first assignment.

Lastly, if you missed last months posting, you can find it here.