Frustrations of Starting in Locum Tenens

I have been working as a traveling nurse practitioner for a while now, that I forgot how frustrating it could be to initially work in locum tenens.

 

  • Tons of paperwork: Each time you accept a new assignment you have to be credentialed with the new site. This requires filling out tons of paperwork and providing copies of your licenses, vaccination records, certifications, references, etc. If you are also working with a new agency for the first time, expect your paperwork to double. In addition, you will have to do a drug test for both the agency and site.

 

  • Last minute: There will be times you won’t know your exact start date until 1 week out or less. There will be times you wont know where you will be living until the morning you leave. It may be scary at first, but part of working in locum tenens is being okay with the unknown. After a while, you get used to knowing things last minute.

 

  • Licensing issues: Is your license taking longer than you thought? Maybe you didn’t realize you also need a prescribing license, in addition to the RN and ARNP licenses in that state. Some agencies have really good licensing teams that can get in touch with the state board of nursing and expedite the processing of your licenses.

 

  • Recruiters: Not having a good relationship with your recruiter can make your locum tenens experience awful. Your recruiter should be your advocate. If they are putting you down and not being helpful, ask for a new recruiter!

 

I think the above four topics are probably the most frustrating aspects of starting a career in locum tenens. After a while, you get used to those things and realize the benefits of being a traveler outweigh the nuisances. Also, keep in mind that being a traveling nurse practitioner isn’t for everyone.

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 travelingNP.com@gmail.com.

 

  • How does housing work for locum tenens positions? Would I need to have my own housing for my “off” days?

 

Housing options vary by agency, sites, length of assignment, and locations. For the most part, the average locum tenens assignment is 3 months long and you will be provided an apartment or hotel for the duration of your assignment. So if you are off for the weekend, you will still be able to live in the accommodations provided.

 Some assignments only want local providers so they do not offer lodging. In these cases, people commute from their homes.

There are sites that will provide their own housing options, especially if they are located in rural areas. For instance, there was an Indian health services location that provided a house for each of its locum tenens providers to stay in. I also know of a remote facility that housed its providers in a dorm like building and offered free breakfast on the first floor.

Locum Tenens Blogs – May 2017

Each month I share blog posts about locum tenens and nurse practitioners from around the web.


Check out this article I am featured in talking about pay and benefits of working as a traveling nurse practitioner. I think many people in the medical profession think it’s a downgrade being a locum tenens worker, but it truly is not!

 

As a woman and a nurse practitioner, I have to share:

SoFi (peer to peer lending company) that I used to refinance my student loans, is currently promoting Raise Week. Check out Sofi Raise Week for tips on how to ask for a raise you deserve! Don’t forget, you can also get a raise as a traveling nurse practitioner.

 

I know some working mothers that work locum tenens home health. The schedule is definitely flexible and you can often see as many or as little patients as you want. You are often paid per patient instead of hourly so this may be beneficial. For example, you may be paid up to $100 per patient so you would only need to do 5 home visits per day to make adequate pay. Read more about some perks of working in home health:

 

There continues to be an increased need for nurse practitioners and locum tenens professionals. Read the article below for more details:

 

 

 

If you missed last months posting, you can find it here.

Best and Worst States for Nurse Practitioners


I stumbled upon these two articles about the best and worst states for nurse practitioners to practice in. I thought it would be interesting to share with my readers since we are always looking to work somewhere new.

6 Best States for Nurse Practitioners

I agree that Washington is one of the best states for nurse practitioners to practice in. We have full practice authority there, so we do not have to worry about collaboration with a physician. The pay is pretty good and there are always tons of jobs available. Plus, there is so much to do for those that love the outdoors! Click the link above to find out what other states are great for nurse practitioners.

5 Worst States for Nurse Practitioners

I completely agree that Florida is one of the worst states to practice in as a nurse practitioner. As much as I love living in Florida, nurse practitioners have limited practice authority, needing supervision from a physician. Florida was the last state to allow nurse practitioners to prescribe controlled substances (this just happened last year). The job market is tough since the state is saturated with nurse practitioners due to an abundance of nurse practitioner schools. And the pay is pretty low in comparison to most states in the U.S.  Click the link above to learn what other states you should probably avoid working in as a Nurse Practitioner.

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.

Time Off


Americans have a reputation of being “workaholics”. Some companies only allow 1-2 weeks of vacation each year. Luckily with locum tenens, our vacation time can be as long as we want it to be. I calculated that last year in 2016, I took a total of 12 weeks vacation time. Isn’t that amazing?!

Anyways, I had been at my current assignment for almost 6 months, with my last vacation being about 3 months ago. I started to feel antsy being in the same place. And I noticed my patience starting to dwindle down and slowly became more irritable.

Just in time, my 3-week vacation came in. I was able to relax and take some time away from the daily commotion of working in the medical field. After recharging my batteries, I came back to work an entirely new person.

I was no longer stressed. I had an abundance of patience and took my time with my work. No poor scheduling or acute complex visit was going to ruin my day. I felt like I had more energy to listen to my patients and provide them with even better care.

The reason I bring this up is because I do not think there is a medical provider out there that is not familiar with “physician burnout”. Medical workforce burnout is troublesome because it enables us to become cynical about medicine and exhausted both physically and emotionally.

There are many factors that impact this burnout. Some of these include the amount of patients seen per day; amount of time allotted per patient; working with a challenging patient population; lack of admin time; the need for thorough documentation to avoid malpractice claims; and too many bureaucratic demands.

The best way to prevent burnout in the workplace is to allow frequent periods of vacation or time off. Working in locum tenens allows this flexibility. Many locum tenens nurse practitioners choose to take time off between assignments, while others choose to only work a part-time schedule. Although I do not think I will be taking off 12 weeks again this year, it will still be more than the average medical provider.

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 travelingNP.com@gmail.com.

 

What are some challenges of finding that first assignment?

 

The first assignment may be a bit challenging to find because as new travelers we are expecting the perfect job. After time we start to realize that we have to be a bit more open minded of the location and practice setting we are looking for.

 Another challenge is having recruiters take you seriously. Many nurse practitioners are curious about locum tenens and will talk to a recruiter about locum tenens options without being completely serious about it. Thus, recruiters do not like “wasting” their time with new travelers that may never accept a locum tenens position. I find that recruiters take you more seriously after completing your first assignment. I recommend networking with other travelers so they can refer you to their recruiter, as referrals are taken more seriously. I am always more than happy to get you in touch with some of my recruiters. 

Lastly, finding that first assignment is tricky if you do not already have the state license you are searching in. It is possible to work with an agency to obtain a license and then search for jobs. However, many sites do not want to hire you until your license comes through. I personally recommend you obtain the license yourself first, and then search for jobs with multiple agencies. This will increase the probability of you finding something that meets your needs. You can always be reimbursed for the license later on. I think new travelers have a misconception that the agency will do EVERYTHING for them, so applying for a license on their own isn’t ideal.

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.

Locum Tenens Blogs – April 2017

Each month I share blog posts about locum tenens from around the web.


The Art of “Holding One’s Place”: Working With Locum Tenens Clinicians

I really enjoyed reading this article from Barton Associate’s Blog. Many other healthcare professionals have stereotypes about locum tenens providers. It was nice to see that other providers are beginning to see the qualities and strengths of locum tenen co-workers. At my current assignment, some of the physicians were surprised that I did not want to accept a permanent position. They asked me why I didn’t “prefer to have consistent work”. I explained to them that with locum tenens, there is consistent work. If anything, there are more jobs to choose from, and I prefer to have flexibility.

 

Is Locum Tenens Right for You? [Quiz]

If you are on the fence about starting locum tenens, click on the link above and take the quiz to figure out if locum tenens is for you.

 

A couple of other articles I think you may find really interesting were written by a fellow Nurse Practitioner Dr. Melissa Decapua:

5 Qualities of a Successful Nurse Practitioner

How Much is a Nurse Practitioner Worth?

 

If you missed last months posting, you can find it here.