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.
I’ve been doing locums for about 2 years. About half of them were telelocums because of covid. But I would be really appreciate if you could do a little more about the startup part. Knowing for example that California is known for taking a legendary long time to license someone. And that for every license you have you will pay a fee for verification unless they use nurses and that does cost money to. Some agencies will pay for your license and DEA in a state but obligate you for a period of time to working for only them in that state. There are non-compete clauses that forbid you to work with a location on your own or with a different agency if you liked the location and want to go back at some point. If you want to be hired directly having used the Locum as a trial of work there you can stay but the facility will have to pay quite a bit of money something like 30 to $50,000 to keep you and you might want to consider splitting that amount by taking a cod in your first year salary or something similar. But I also wish that you would tell a little bit about some of the games that get played. Most np’s who are Savvy work with several agencies as you said. That gives you more options and more leverage for negotiating if you are not dependent upon one agency for work. If they know that you have only them they tend to offer you lower rates and push you harder to take assignments that are not ideal for you. But please tell about such things as lying about how long it will take to credential somewhere and then pushing you to wait if it’s taking a long time even if your other assignment has ended and you will be unemployed in the meantime. As you said they will guilt trip you to take an assignment that you don’t want after all. I’ve seen them do things that let me know they almost certainly offered the work site a backup person if you seemed stubborn at all about pay rate or other things. And as you may have said and is made clear on other Locum websites keep in mind that the agencies main customer is the work site not the Locum practitioner. Ultimately they will do what is best for the work site at your expense if need be. That’s why it becomes very important you have backup options and to know all the things that need to be negotiated and as you said understand the contract and make sure everything is covered so that you aren’t left high and dry. I went from one assignment to another with the same agency and no break in between when I was $2,200 mi from home and they had rented a car for me. On the first assignment I followed the usual pattern of accepting their housing and so that was included in my pay and on the second one I chose the additional amount as a stipend and found my own housing but arranged to keep using the same rental car. I found that the cost of the rental car went up from $900 a month to $1,500 a month once I was paying it as a weekly deduction. And the agency didn’t tell me that the cost was going to get that high. It of course could have changed but they could also have told me before I negotiated the details and they didn’t bother. And also I specified a certain size and paid for that size and when it had a problem the agency helped arrange for another one but it was a much smaller vehicle and would not hold my pets and my belongings for the trip home. I put some in storage and I’m still paying storage because it cost so much to retrieve that stuff and have it sent to my home base. There are just things like that but the biggest one is that the agencies have a backup person and they won’t admit that. And so they may push you to take an assignment and then if something causes a delay, instead of negotiating with the work site to be patient they will just offer them someone else. Likewise that they may push you hard to take an assignment and that’s a warning sign that it’s an assignment nobody wants. The ones who are hoping you will take an assignment from them when your current assignment is with a different agency will sometimes lie about how long it takes to be licensed in credentialed as I’ve said. But the agency that wants you to stay with them May tell whatever lies they need to in order to keep you interested in and assignment and if you seem reluctant instead of offering you good assignments when you got about two or three months left in your current contract they will wait until you are almost done telling you that there is nothing available. And so having convinced you that they did have good assignments and you should wait for one to come along any minute they will purposely leave you perilously close to the end of your steady income so that you will be much more flexible about the quality of the assignment that follows. I have experienced all of those things and was told for one site that the credentialing would be 2 months because I’d already done the two months with the agency to be credentialed with it and the remaining two months with was being credential that the work site and enrolled with payers at the work site. It actually turned out to be 6 months and they kept telling me it was going to be two weeks 2 weeks 2 weeks and then I realized that it wasn’t going to be an I backed out of that contract. They immediately found me another one and they did exactly the same thing and so I ended up being unemployed for 11 months except for my telemedicine job which paid 50% of my income. I nearly lost everything and I was just naive and believed as they told me that it was just a freak thing and could not possibly happen again. And the final thing that I’ve seen is that an agency may not support you at all when you encounter something nightmarish. I worked for one of the four agencies you mentioned and my first assignment went okay actually my second one did too working with that same agency but on the third one I worked for a community clinic doing telemedicine. They were not set up for it at all and the agency said they were. The agency provided equipment but the agencies it Department shut down at 4:00 p.m. eastern time and my job lasted until 7:00 p.m. West Coast time. This meant when an IT nightmare happened I spent hours off the clock trying to work it out. I got almost no support from the agency and the clinic was totally at Sea and becoming very irritated that I couldn’t manage with the unworkable system they had. It turned out to be a nightmare assignment and That agency did not do a thing to make it better. The last thing I found is that work sites will contract with you to pay hourly but if you run into overtime they will simply refuse to extend your contract and so many locums act as though they are on salary even when they’re not in order to continue to get otherwise good assignments.
My apologies for all the typos. I have a broken finger so I’m using voice to text and it’s not great. What I tried to say is that you will pay a license verification fee for all the states in which you have a license every time you are obtaining a new license. If the state uses Nursys, then it’s a little cheaper.