Choosing Between Multiple Assignments

Sometimes when searching for your next assignment, you can end up with more than one offer on your lap. I personally like having multiple offers so I can choose the best one. However, I am sort of a commitment-phobe so when I have multiple offers, I end up overwhelming myself and have a hard time choosing. How should we choose between multiple assignments?

When looking for an assignment, I mentally note what my priority is at the moment. Do I HAVE to be in Florida because winter is coming? Is a HIGH pay rate important this time so I can save up for a major purchase? Am I physically drained from my last job and need a lighter work load? It’s important to evaluate what you value most in your next assignment because it will facilitate the decision making process.

My needs often vary. Sometimes I care more about the location so I am willing to take a lower pay, other times I sacrifice the location I want to work in because I do not feel like seeing 30 patients a day.

During my most recent assignment search, I ended up with several options:

1. Brief local assignment in my home base – Miami, FL. Pay lower than usual. Light patient load.

2. Brief assignment in California, in a rural setting. Pay was my usual rate. Fair patient load.

3. 3 month assignment in North Carolina, major city. Pay was my usual rate. Moderate-heavy patient load, and I would be the sole provider at the clinic.

4. Transitioning with my previous site (in Virginia) to work in their clinic in Florida (not in Miami). Same pay. Same load as before.

How did I end up choosing number 1? I think it is easier to narrow down your choice through the process of elimination. I knew I wasn’t ready for #4 because I needed a break from working at this type of setting with very complex geriatric patients. Thus, I eliminated #4 as an option. I originally thought it would be neat to go back to California for a short period of time to catch up with some friends. When I began researching flights from Virginia (where I was at that time), I realized it would take 13 hours of flying for me to reach that rural destination. I didn’t think a 3-week gig was worth the amount of flying time it takes to get to Europe or the Middle East. Thus, I also eliminated #2 as an option.

Finally, I was left with option #1 and #3. Option #1 was safe, I could just go home for a bit, which is never a bad idea. #3 was more exciting because I could live in a new state. I had traveled to North Carolina before and really liked it. Eventually, I decided to go with #1.

Foremost, I needed to be home to oversee some repairs on my house after Hurricane Irma. Although the pay was lower than usual, it was something I was able to overlook because the patient load was light, and the assignment period brief. I eliminated #3 as an option additionally because it is not ideal for me to be the sole provider at a really busy clinic.

I always think it’s good to have multiple options for your next assignment, so in case one falls through you can have a backup. Yet, it can be a challenging process to choose one assignment
from multiple great offers. How have you chosen between multiple assignment offers in the past?


Maintaining Multiple State Licenses

I currently have 5 active state licenses. Many of you have asked how I am able to manage having multiple licenses (for cost and time reasons). I usually work on obtaining about 2 new states licenses every 6 months.

I actually allow some state licenses to expire. There are state licenses that expire after one year (which can be annoying). Some people may think it’s a bad idea due to all the work that went into getting them in the first place. But the truth is, reactivating licenses is pretty easy.

I allowed my California licenses to expire. Yes, the same licenses that took more than 4 months to obtain. The fees are costly though, since you have to renew 3 licenses. I think having a California license is always a good idea because there are plenty of jobs there. I had one agency I worked with prior renew the licenses for me. It was a piece of cake. The agency’s licensing team did all of the work and paid for my renewal fees. I just had to sign a form agreeing to work with them initially with the new license.

In case I end up working with a different agency in California, I would just have them pay back the other agency for that license. It’s no big deal. Not to mention the renewal process only took 2 weeks!

I had also allowed my Texas licenses to expire. The same agency renewed the Texas licenses for me. It was nice having the licensing team work with me because they would call the board of nursing to follow up on my application. This process also only took 2 weeks!

I allowed my Washington state license to expire. Washington is really far from Miami, so I didn’t see myself going back there anytime soon.

Lastly, I always renew my Florida license because that’s my home state and initial license upon examination.

Some people may have more trouble managing their multiple licenses than me. I recommend having some agencies invest in applying for or renewing licenses for you. It facilitates the process and covers the costs upfront.


Back in the Game

After working at one assignment for the past year, I had to get back in the groove of working in locums again. I was used to working with the most amazing recruiter, which made me have high expectations for all other recruiters.

My priority for my next assignment was for it to be a 1099 job. I had worked most of the year with a W2 agency and had also paid tons of taxes to Uncle Sam. I needed to work with a 1099 agency to allow me to have more tax deductions at the end of the year. Unfortunately, this meant that I couldn’t continue working with my favorite recruiter for my next assignment.

My experiences so far have been a bit rocky. Prior to presenting me to an assignment, I felt like this one recruiter/account manager put me on the spot as if it was an official interview. He asked me “what is special about you, that would make me want to present you to my site”? I was appalled because I know I am great, but I didn’t feel as if I needed to explain to him the reasons why. Because the reality is that by me working with this site, I would be providing him with his income. This is a type of question I wouldn’t mind answering someone interviewing me from the site, but not the agency….

Another recruiter called me SEVEN times in one day! I kid you not. If this were a relationship I would have broken it off long ago! Another one of my pet peeves is when I am not scheduled for a phone interview with a site, but the site will just randomly call me. I think it is more professional when you provide your recruiter with good interview times, and then they confirm the time the site will be calling you. Instead, I had a site call me during the mid-afternoon while I was at work. Then we were playing phone tag for the rest of the week.

I decided to accept a brief assignment with a new agency I haven’t worked with before. The credentialing process hasn’t been the smoothest. For instance, I was told by my recruiter to go to a lab site and request a urine drug test (without an order). Usually the agency provides me with a confirmation form for the urine drug test and I just bring in that paper to my scheduled appointment. I called the lab site prior just in case and they told me I needed to register for the urine drug test prior. I informed my recruiter, and she gave me a number to register for the test. When I called, they said the place of employment had to register me. -_-

The issue was resolved but sometimes it boggles my mind because don’t these people deal with this on a regular basis?

Another credentialing contact person requested I sign the protocol with my supervising physician. She only sent me the last page to sign via email. I had to let her know that I would not sign a protocol without seeing the complete set. Also, the board of nursing requires the original protocol with original blue signatures. Typically the agency will fed-ex me the protocol to sign and send back to them via fed-ex. So just printing the protocol and scanning it back to them wouldn’t make it official.

Many of my readers have shared some of their frustrations when starting locum tenens, and unfortunately a lot of them are due to their recruiter/agency. I was so used to working with some great recruiters and agencies, I almost forgot how bad others could be. Alas, I had to continue working with this agency because the assignment they offered really matched my current needs. I was a bit disappointed that my recruiter didn’t ask me how everything went after my first day of the assignment. It was something I was used to when working with other recruiters, and I think it’s a nice gesture.

After writing this, I am going to send my favorite recruiter some flowers as a big Thank You for Being Awesome! This pretty much sums up why I often advise my readers to reach out to me personally, to recommend specific agencies and recruiters, because they are not all created equally.

Ending of a Yearlong Assignment

The end of my yearlong assignment in Virginia was bittersweet. When I finally accepted that I needed to move on, I was reminded of one of the best parts of locum tenens – looking forward to the end. The things that used to bother me before didn’t bother me anymore. If the medical assistants were short staffed and took forever to bring my patient back, I no longer cared. The demanding or pessimistic patient that normally frustrates me, no longer impacted me.

It was tough to say good-bye to my patients. For some reason the majority of them were in a good mood during my last visit with them. For example, one of them randomly said: “You are really great. I’ve never had anyone explain things to me the way that you do.” This made it hard to tell her I was leaving. During a follow up with another patient, he said: “Man, you are the best! You remember everything about me and follow up on things from last visit. You review notes from my specialist before I see you. You don’t just fix everything with a pill. You explain things thoroughly and find natural ways for me to improve.” After telling him that I was leaving, he nearly caused a scene.

Many of the patients were extremely disappointed, some even cried (both men and women). I re-focused them to realizing that most importantly their health had improved significantly over the past year, and they know what to do to continue on that path. I also reassured them that since I would be working in their Florida clinic, I would be able to check on them from time to time and perhaps even see them again in the future.

I think I became too attached to the patients, but with our healthcare model, it was hard not to. The patients came every month or even more frequently, some I spoke to via phone on a weekly basis. I knew their husbands and wives pretty well too. Our goal is to keep our patients out of the hospital, and the only way I knew how to do that was to develop trust and bond with them.

My last day was extremely sad. I had never cried so much in my life. Not only was I going to miss my patients but I was going to miss my co-workers too. Our clinic is big with about 50 employees, more than half of them I was really close to. Any time one of the physicians or medical assistants would mention they were sad I was leaving, I would break down and cry. I was even super close to the Medical Director, who honestly acted like my guardian angel while I was there. It was weird knowing I wouldn’t be seeing them on a daily basis anymore. On the bright side, the Medical Director promised to fly me up for their annual holiday party and we agreed I could always come back in the future to help out when I wanted to.

The clinic surprised me with a sweet party. Everyone went around in a circle and said some nice words about me. The Center Manager told me he was so glad that I came because I brought a new uplifting energy to the clinic and between the other PCPs. The clinic also surprised with me with this beautiful gift:

I never knew leaving a job would be this hard! Yet, I am so grateful for my experiences there over the past year, and will continue to cherish the relationships I have built. I am looking forward to my next adventure and will try not to stay at one place as long again.


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.

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



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!

Questions from Readers

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

How does dating work as a locum tenens nurse practitioner?


Many traveling nurse practitioners I know travel with their spouse or significant other. The agencies will certainly accommodate your needs with lodging. Some partners have flexible jobs where they can work from home, making it easy for them to travel. Some partners will fore-go their current job and may pick up seasonal jobs in their new living area. I also know some couples that will just take turns visiting each other throughout the assignment.

For single locum tenens nurse practitioners, traveling actually helps with the dating process. People always ask me if it’s hard to date since I am always moving around. I tell them no, that in contrary it is actually easier to date since I am traveling. This is because I end up meeting way more people than I normally would. I am even able to meet different types of people too.

Miami isn’t known for having an intellectual atmosphere, which made dating pretty tough when I lived there. Being able to move to different cities, I am able to meet people that more closely fit my needs.

Some of my friends that are travel nurses, ended up dating someone while on an assignment. To figure out if things would work, they extended their assignment. If the relationship became serious they eventually just settled down in that city permanently.

In a couple of states that I traveled to, I ended up meeting and dating someone while I was there. By the near end of my assignments, I had to contemplate if staying was worth it. In one instance, I decided to move on. In another case, I decided to extend my assignment to see where things would go. It was nice to have that companionship while I was there, but I do not think I am at the stage where I am looking for something long-term.