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.

Bad Interviews

For the majority of locum tenens positions, a phone interview is done prior to a site offering you a position. They are typically less nerve wrenching in comparison to in-person interviews. In fact, I don’t even think twice about them anymore.

They typically start the same way where the company summarizes how they work and why they have a need at this time. Then they want you to talk about yourself and your background. Sometimes they may ask a few clinical questions as well.

It’s always funny to hear about interviews that went wrong. One of my close friends recited a story to me about an odd interview she had for a locum tenens position. Apparently the interviewer kept talking down to her, making my friend feel like she was on trial. The interviewer made it seem like she was not interested in offering a position to my friend. Then 5 minutes later, she called back asking if it was true that my friend was fluent in Spanish. My friend said yes, and the interviewer said ‘you got the job!’ Of course my friend did not accept.

One of my readers shared her experience interviewing for a locum tenens position. The interviewer told her that when she sees the word “locum tenens on a CV” she thinks to herself “what’s wrong with them, why can’t they get a job?” This didn’t make any sense considering that site was looking for a locum tenens provider, so should be well aware of how locum tenens can fit the needs of a practice.

Fortunately, I’ve had only one bad interviewing experience. The interviewer asked me tons of insurance specific questions that I couldn’t answer. She made me feel like an idiot for not knowing those answers. I didn’t care since my job is to treat patients, not to know the specific details for different health insurance providers. At the end, she still offered me the position, in which I declined.

I think the most important aspect of the interview is to feel like the site will be welcoming, patient, and understanding with you. Considering I will be joining them to provide help, I wouldn’t want to work somewhere that does not give off a positive vibe.

Anyone want to share some weird interview experiences?

Thailand and Dubai

I recently returned from a 3-week trip to Thailand and the United Arab Emirates with my family. Since Thailand is so far, I was able to get a free stopover in Dubai for a few days. We flew Emirates for the first time, which is the most luxurious plane with the best service! Our plane was two stories and we had access to the bar. We really enjoyed our 14-hour flight from Fort Lauderdale, FL to Dubai.

It was our first time in the Middle East, and we actually come from a Lebanese background, so it was exciting to be in Dubai. The Middle Eastern food was delicious! The city was really clean and modern. Our favorite day was when we went on the desert safari excursion. We went sand dune riding in the desert and rode ATV wheelers. We also visited a camel farm and rode on some camels.

On the way back from Thailand we stopped in Abu Dhabi to break up the flight. We went to visit the Sheikh Zayed Mosque, which was absolutely stunning!

Bangkok was a pretty crazy city. Our first day there we rode on a tuk-tuk and it was the funniest experience. Our driver didn’t speak English so he would just bring us to all of these random places instead of where we needed to go

Thailand was incredibly cheap! We would get 1-2 hour massages for $8 almost every day. A 45 min taxi ride cost about $5-6. A family of four ate for about $20-40/dinner.

I have always been intrigued by the Buddhist religion and enjoyed visiting various Buddha temples. My favorite Buddha was the reclining Buddha!

We visited the old capital of Thailand, Ayutthaya. It was interesting to see the ruins of the city and learn how this Buddha head ended up in this tree:

It turns out that the Buddha head fell off the statue during an invasion of the city. As the Buddha head lay on the floor, birds pooped around it. Eventually a tree started to grow and the Buddha head grew with it.

My favorite food besides sushi is Thai food. We ate tons of good food during the trip! And I never thought I would say this, but by the end of the trip I was actually tired of Thai food.

As much as I loved seeing all of the Buddha’s, the best part of Thailand was going to Phuket and the Phi Phi Islands. We had an incredible time swimming in beautiful water, snorkeling with a variety of fish, and sailing on a speed boat. We literally felt like we were in paradise.

Losing a Patient

I write this post with humility.

After returning from a 3-week vacation, I was a bit nervous about how much work waited for me (lab/imaging results to review, medication refills, phone messages etc). Surprisingly, my first day back went pretty smoothly. My schedule wasn’t too crazy. My co-workers were ecstatic to see me, and my patients were relieved that I was back.

At the end of the day I was skimming through hundreds of work emails, deleting most, keeping the important ones. I came across some emails about one of my patients being in the hospital for a heart attack. I wrote down his name on my to-do list, so that I could give him a call and see how he was doing.

As I continued going over my emails, I was in disbelief when I read “patient expired. Sorry for your loss.” It turns out that the patient that had a heart attack in the hospital was discharged home a few days later in stable condition. The following day he passed away at home. It was a complex situation, as he had a history of severe coronary artery disease and other co-morbidities. Even though you know all that could have been done, was done for him, you still feel like it wasn’t enough.

I immediately started crying like crazy, as I had never cried before. He was actually one of my favorite patients, and one of the first patients I developed a relationship with at my clinic. A very pleasant man and compliant with all medical recommendations. During the 6 months of working at this clinic, I had seen him at least 10 times.

My co-workers tried to comfort me, explaining that all of our patients are much older and much more sick than the average person. They tried to reassure me that at least he is no longer in pain and was able to pass away in the comfort of his home.

It was so hard for me because I had seen him right before I went on my trip, not knowing it would be the last time. I had also wished I was here when he passed so that I could have at least attended his funeral.

The following day I was still grieving and wasn’t sure how I was going to face my other patients. I thought to myself, what is the point of all this? I had a busy day and it was actually a good thing. It distracted me and also reminded me that there were still other patients that needed me.

It has been so hard for me because I have never had anyone close to me pass away before. Although I also worked with a geriatric population in Miami for several years, none of my patients ever died while under my care. They didn’t seem to be as sick as my current patients. As a child I had distant relatives pass away, but death seemed so foreign as a kid.

The other providers told me that the first few patients they lost were really hard. But after a while, you have to learn to become less emotionally invested. I think the passing of my patient reminded me how near, death truly is. Death is inevitable. I realize I cannot promise my patients that they will never die. But I can help them to live a comfortable life and gain more time to spend with their loved ones.

May he rest in peace.

Continuing Education Reimbursement

I enjoy sharing benefits of working as a traveling nurse practitioners and any incentives provided by agencies with my readers.

I am currently working with Comp Health for my assignment in Virginia. I was contacted over the phone last month to go over my annual review. I have worked with Comp Health on and off over the past year.

When I was done with the review, I was notified that after working 500 hours with Comp Health, I am eligible to receive up to $500 in reimbursement for continuing education. Working one 3-month assignment with Comp Health automatically makes you qualify for the 500 hours minimum requirement. However, there is a stipulation where you will be reimbursed for your CEU’s as long as you are committed to your next assignment with Comp Health.

In my case, I met the 500 hours of working with Comp Health, and since I extended my current assignment, this qualified me to receive up to $500 in reimbursement for CEU’s. This can include conference registration fees, nursing membership organization fees, and all certification fees.

This year I am due to renew my Family Nurse Practitioner certificate through the ANCC. This comes with a hefty fee of $350. Luckily this certification is reimbursable through the $500 CEU credit.

This is definitely a nice little perk because permanent positions often cover CEU costs. So it is nice to have these benefits without having to commit to a full-time position.

Extending My Assignment Part 2

In continuation of my last post, I wanted to animate more details about extending my current assignment – logistically speaking.

A lot of times, when a site wants you to extend your contract, they are willing to increase your hourly rate. Unfortunately, the site could not afford to increase my hourly rate. It didn’t matter to me because I am already paid at a high rate, and an extra $5/h is insignificant over the course of 3 months.

Instead, they offered an extra round-trip flight home of up to $450. I had received mileage reimbursement for getting to Virginia, and will again receive mileage reimbursement when I return home at the end of my assignment. So this airfare is primarily meant for me to use in between ending my original 3 months and beginning my next 3 months here. I probably won’t use it until I plan on going home prior to my next vacation in March, but it’s a nice bonus.

My recruiter asked me if I wanted to stay at my current apartment or move elsewhere. I am satisfied with my current housing so I opted to stay.

My only concern was about my requested time off. Usually when I accept an assignment, I provide the weeks I need off beforehand, so I am guaranteed those days before I start. To me, the best part of doing locum tenens is I can take off as much time as I want, since I like to travel abroad.

I discussed this with the medical director, and she guaranteed that my requested time off would all be approved as long as I give advance notice.

Of course a new contract was drafted and signed. All of this was done 2 weeks prior to the end of my current assignment. I am confident that I made the right decision, but lets hope that I do not get too antsy staying in the same place.

Extending My Assignment

For the first time, I will be extending my current locum tenens assignment. As a big fan of short-term assignments (3 months or less), it is surprising to most that I have agreed to be in Virginia for another 3 months.

In the past, working in locums I mostly covered vacation leaves and maternity leaves. I have been asked previously to extend my assignment or to stay permanently. There have been times where I did want to stay longer, but thought it would be best for me to move on.

My current locum tenens job is a bit different. I was contracted for 3 months after one of their physicians had to retire due to medical reasons. However, the site made it clear that if everything worked out, they had other plans for me. For instance, they are permanently recruiting for my position but there will not be a physician available until July, as residency ends in June.

In addition, they are hoping I can become an internal locum for them. They have clinics in several states including Georgia, Florida, Kentucky, Louisiana, and Illinois. They would like me to become licensed in all of these states, and provide coverage when needed (such as maternity leave, FMLA, etc.).

In the mean time, they asked me to stay at my current assignment until July 2017. This would be an additional 6 months after my original contracted 3 months. As I mentioned before, I usually just want to move on. So it took me several weeks to ponder my decision.

In this case I was torn. I did want to move on and continue my versatile journey. On the other hand, I really really really enjoy working with this facility. Everyone has been so welcoming and friendly. I am constantly learning and being challenged. I also realized that I miss the “follow-up” aspect of primary care. Our patients at this clinic see us every month, so I have already established relationships with hundreds of patients.

I knew that if I did not extend, these patients would have no one to care for them. Thus, I decided to extend for another 3 months. Everyone is thrilled, and I believe they are all secretly hoping I will extend for another 3 months to meet their needs until July. I recently found out that one of the Physicians at my clinic is pregnant, and she will be due in July. Looks like they will try to keep me to cover her patients until October as well! Will I ever get out of here?

Honestly, I have been happy here. I truly enjoy my job and the location is convenient, where I can easily travel to nearby states or go home for the weekend. Although I love working as a locum tenens nurse practitioner, I want to keep a good relationship with this facility, as an option to work with if I ever decide to go back to a permanent position.

California Licenses Expiring Soon

If you read my blog regularly, then you should be familiar with my bittersweet experiences working as a locum tenens nurse practitioner in California.

After spending 7 months in California in 2016, I was ready to move on. I told myself I had no reason to ever return to California for work. A few months later, I received a letter in the mail from the California Board of Nursing notifying me that my licenses were going to expire at the end of the year, unless I paid for their renewal.

I immediately thought I would renew my CA licenses since it was such a hassle to obtain them. As the deadline drew closer I realized I would have to pay several hundreds of dollars in renewal fees. This seemed like a lot considering I was not even sure I would use these licenses again.

I do not plan on going back to California in 2017, as there are many other states I have licenses in that I haven’t yet worked in. On the other hand, there are ALWAYS tons of jobs available in California. I contemplated keeping active licenses there as a back up in case I ever needed a locum tenens assignment to start immediately.

After weighing the pros and cons, I decided NOT to renew my California licenses. I worked with 4 different sites while in California, and I hated all of them. Before and after California, I have loved every single job. Thus, I know I have no intention of ever returning to California for work. I am grateful I was able to explore almost every inch of that state while I was there, and had a fabulous time doing so.

Snow Day

Before I accepted my assignment in Virginia, I asked about snow during the winter. The Medical Director assured me not to worry. She told me that it rarely snowed near Virginia Beach, and if it did, the entire city would shut down.

Coming from Florida, I prefer to be as warm as possible. I have seen snow several times before, but have never been a fan. Perhaps it is because snow is cold, wet, and dangerous to drive in.

When I made it safely into the New Year without snow, I believed I was impervious. The year prior, I had completed my Washington State assignment the day before it snowed!

Shortly after, a winter storm from the west was making its way to the east coast. The city became chaotic as everyone prepared for the storm. It reminded me of Florida during hurricane season.

It had snowed all night that Friday. When I awoke the following morning, I actually enjoyed the snow. The snow was powdery and soft, unlike snow I have seen before. It snowed half of the day, which was pretty neat since I have only seen snow on the ground, not coming from above.

When it finally stopped snowing, my car was completely covered. It took quite a while for me to dig it out of snow. I thought to myself – I do not see myself doing this everyday. I also wondered how people lived in the North East and Midwest where it snowed often.

The following day, the sun came out but it was still quite colder than usual. The snow started to melt, leaving an icy and slippery road. I did not leave my apartment all weekend, as I have never driven in snow, and did not want to get into an accident. Work was cancelled for Monday because the roads were still bad. Since we do not get snow that often, there is no infrastructure in place to clear up the roads when we do.

My co-workers were super sweet, as many of them checked in on me over the weekend to make sure I was okay. Other than a hint of cabin fever, I survived my first time living in snow!