Category: Travel NP Advice

Some nurse practitioners I speak with think that finding a locum tenens position is a quick and easy process. They believe you can contact one agency and find the ideal position in a matter of a few days. This is definitely not the case. I believe it is important that every potential locum tenens nurse practitioner knows that he or she should develop a relationship with more than one agency.

Choosing an agency to work with starts off by determining your preference of compensation and benefits. If you are looking for a high hourly salary, then 1099 paying agencies are a good match. If you are more interested in having health insurance for your family, retirement benefits, and/or taxes easily removed from your paycheck, then W2 paying agencies should be your first choice.

Please see my Agencies page for a list of the most common national placing locum tenens agencies. Take the time to review their websites and analyze which agencies are paying W2 vs 1099. After determining which agencies compensation matches with your interests, establish a relationship with a recruiter from that agency. I highly recommended contacting at least 5 or 6 agencies.

If you think that your recruiter is always going to be searching for you and contact you if anything new comes up, you are wrong. Unfortunately, the first assignment is tricky because you have not technically “proven yourself”. Therefore, you must constantly follow-up with your recruiter to see if there is anything new out there.

It is okay to email your recruiter, but for a quick response time, I recommend calling your recruiter. It’s common that you may email your recruiters and they may not respond. For some reason, unbeknownst to me, recruiters are not that responsive via email. It may have to do with them being a ‘salesperson’, and believing in verbal conversation being more effective.

After the first couple of days or conversations, you will soon realize which recruiter and agency you like most. Your favorite recruiter may be very friendly, always keeping you in the loop, or looking out for your best interest.

If you have a recruiter that never returns your phone calls or emails, or discourages you from jobs telling you that you lack the experience, consider changing recruiters. One recruiter does not represent the entire agency, and I would hate for you to lose out on great opportunities because of a poor relationship with your recruiter.

As far as choosing an agency, it’s not as easy as choosing a meal. It is more similar to choosing the right car. You need to do some research, test drive the car, follow-up with the salesperson, and determine if it’s right for you.

Your preference of an agency should also be directly linked to job availability. If you have any questions as far as highly recommended agencies, feel free to email me at travelingnp.com@gmail.com or comment on this post.

After accepting your assignment, there a few things you need to do to prepare for it.

-Complete licensing application and supporting materials if needed. For more information see: Licensing as a Travel Nurse Practitioner

-Apply for credentialing. Most sites will need you to be credentialed prior to starting. They will have you complete paperwork to make sure they have all your necessary information for legal and billing purposes. The paperwork can be tedious, but luckily agencies usually have someone who will complete the paperwork for you. You will just need to review the information and sign a consent form allowing them to be your proxy.

-Some sites may have you do a drug test before you start.

-Confirm travel arrangements. Typically once credentialing is complete, your recruiter/account manager will have the travel team contact you to book your flight (if you are flying). Some agencies will have two separate people working on your travel/car rental and lodging. If you have a rewards number, you can provide it to them at this time, so they can include it in your reservation.

-Confirm lodging arrangements. Unfortunately, lodging can often be arranged last-minute. It’s not unlikely that you may not know your lodging until the day before arrival or upon arrival. Before your assignment, they will ask for any special requests such as kitchenette, accommodating pets, close to work facility etc.

-Packing: please see post on packing

There are two ways to go about obtaining a license. Some people prefer to wait until they have an assignment before applying for the state license. In this case, most agencies have a licensing team that will assist you in the process. You will most likely have to complete a standard form with your personal information, and they will use that data to complete the license applications for you.

Others will apply for a license in a state they are committed to working in, even before having an actual assignment. In this instance, they are more likely to apply on their own. Sometimes agencies will allow you to apply for a license proactively (before confirming an assignment), and in this case they will assist with the application.

It’s great when a state’s application is online and everything can be done electronically. For example, my application with Texas was all electronic and therefore the process was quick. On the other hand, some states only have paper applications in which you have to submit via mail. My application for the Washington state license took a little longer than expected due to this process. Apparently it can take about 2 weeks for mail to be received from the east coast to the west coast.

In each state you will need two licenses: RN and ARNP. Some states may even require an additional application for prescriptive authority. Typically this is just an extra fee or additional pharmacological CEUs. Some states will allow you to submit both the RN and ARNP application at the same time, while other states will only allow you to submit the ARNP application once you have been issued a temporary or permanent RN license.

• For the RN license, you will need to submit the following (depending on the state):
  -Application and fee
  -Nursys verification (tells the new state that you have a license through examination/schooling from your current state)
  -Fingerprints/Background check and fee
  -RN transcripts (depending on the state)

• For the ARNP license, you will need to submit the following (depending on the state):
  -Application and fee
  -Verification of education form (depending on state)
  -Graduate school transcripts
  -Certification verification by ANCC/AANP
  -Additional prescriptive fee or CEUs (depending on state)

The point is to notice that there are a lot of requirements and it can easily be overwhelming. I find it best to just read the application thoroughly and contact the board of nursing if I need to clarify anything. I keep a checklist for each state that I am applying to, to make sure I have everything covered. Keep in mind that you only need one set of fingerprints/background check per RN & ARNP applications.

Some states request miscellaneous things. For example: California requests passport photos for both applications; Washington requires a proof of current employment as an ARNP (can be a note from your employer or a pay stub), Texas requires you to take and pass a nursing jurisprudence exam etc.

• Benefits of applying for licenses on your own:
  -You are not restricted to a specific agency (but can be reimbursed after selecting agency/assignment)
  -Work is less redundant – you are not filling in a separate form for the agency, nor answering questions about your application for the agency representative
  -Even if the agency applied for you, you would still have to do a lot of the leg work yourself (fingerprints, requesting transcripts etc.)

• Benefits of applying for licenses through your agency:
  -Quick turnover (they overnight all mail)
  -There is someone checking up on the status of your application almost daily
  -Less stress for you if you are not organized
  -No upfront costs

Make sure to keep receipts of everything if you expect to be reimbursed. For applications sent via mail, I usually ask them to email me a receipt. Initially applying for a license appears to be a lot of work, but then you realize it’s nothing you haven’t done before.

After your interview, your recruiter will want to speak with you about how the interview went. Then they will ask you “If this facility were to offer you a job, would you accept it?” This is an informal agreement to accepting the job. If you say yes, technically you do not HAVE to take the assignment, but it is expected that you will. Later that day or the following day, your recruiter will follow-up with you and will confirm the job offer. They will have to draw up the contract for you and the facility to sign.

Although salary was already discussed during your initial conversations with the recruiter, there is no better time to negotiate your salary than right before signing the contract. Perhaps you initially wanted $60/hour but then you realized that moving to California would increase your cost of living, so now you want $70/hour. This is a good time to ask for everything you need because you already know the facility likes and wants you, and that the agency will do anything necessary to have you work there.

In my personal case, I actually had two different offers from two separate agencies and facilities on the exact same day (1 hour apart). Both facilities seemed awesome and both locations were ideal for me. I decided to be honest with both of my recruiters to help me make a decision. One of my recruiters offered $10/hour more than I originally requested. When I informed the other recruiter, they agreed to match that offer. So now I was back to square one. Coming from Florida I didn’t have a DEA license. The application fee for this license is $700+…. Something I really didn’t want to pay for. The first agency had already offered to pay for my DEA. When the second agency matched my hourly rate, they were sure it was a done deal. However, I told them that the other agency was also paying for my DEA. After pulling a few more strings, my recruiter informed me that they will also be able to pay for my DEA.

Fortunately, I was able to negotiate my time in a way that I was able to confirm both assignments, in which I would do one before the other. Sometimes I just really hate saying no. The second agency was initially upset with me because I verbally confirmed I would accept the job if offered. Yet since no contract was submitted to me, I did have the right to back out. As soon as I confirmed the new benefits, they submitted a contract for me to sign.

I made sure that everything we discussed was listed in the contract. The contract clearly listed my hourly pay, my schedule to include 40 hours a week Monday – Friday, reimbursement for state licensing fees, DEA license cost coverage, travel costs (specifically flight, lodging, rental car), my start and end date, and my requested vacation days.

Looking back now there are some things that I should have requested but did not think of at the time. For example, my flight to the site was covered but my luggage was not. So I had to pay $25 per suitcase per flight. In addition, my site was about 2 hours from the airport, so the gas I used to drive 2 hours each way to/from the airport was not covered. It’s obviously a learning process and in the future I will make sure to negotiate these costs as well. I didn’t think it was the biggest deal since they did book me a day early in Seattle, which was much-needed after a long flight.

Upon finding a travel Nurse Practitioner assignment that interests you, the next step is for the agency to submit your resume. After reviewing your resume, if interested, the site will request a phone interview with you. The turnaround time between reviewing your resume and setting up a phone interview can range from a few hours to one week. The agency will ask you to provide them with hours of availability for the interview. Depending on the agency, there may be an agency representative on the phone, or it may just be you and the site representative.

Do not stress the phone interviews! They are not going to ask you doses of medications or to diagnose a rare elusive disorder. Examples of questions they may ask are:

Tell me about yourself.

What is your experience working as a nurse practitioner or provider?

How many patients do you see per day?

What type of patients do you see?

Why are you interested in working with my facility?

 

Sometimes you may be asked some clinical questions. They just want to make sure you have an idea of what you are doing. They are not expecting you to be experts in every area. Some examples of clinical questions are:

Which preventative measures would you take with a Diabetic client, including labs, screenings, and assessment?

How would you handle patients that are requesting opioids for their chronic pain?

If a patient comes to the clinic with elevated blood pressure, how would you respond to this?

 

Then the remainder of the conversation will be them talking about their facility and their need. They will usually end the conversation by asking if you have any questions for them. I highly recommend you have a list of questions prepared for them or it will appear that you are not really interested.

Some questions I suggest you ask them are the following:

Does the facility use EHR, if so which one?

What type of patients are seen at the clinic? (Including demographics and illnesses)

Will there be other providers present?

What type of supportive staff would I have?

What are the hours of the facility?

 

Depending on the facility, they may request another interview. The second interview may be with their medical director or CEO. It is usually just a formality but definitely a good sign!

Depending on your flexibility, the search process can take several weeks to months. If you are open to going anywhere then that increases your chance of finding an assignment quickly. Often medical facilities want you to begin ASAP, so if you do not hold a license in the state they are located, they are unwilling to wait. Therefore, your first locum tenens assignment is commonly the toughest one to find.

Since the agency has not worked with you previously, they do not know how serious you are about starting a travel nurse practitioner position. Unfortunately, finding the first assignment requires you to be an advocate for yourself. If you need assistance during the search process, feel free to contact me ,as I can help vouch for you with my recruiters.

My favorite locum tenens agencies were the ones that my recruiters were following up with me frequently. Even if they didn’t have something that matched my interest, I knew they were looking out for me.

 

For my first travel nurse practitioner assignment, I initially wanted to go to the New England area. Some challenges I faced were the sites unwillingness to wait for me to obtain a license because they needed someone to start right away. When I did find places that were willing to wait for me to get a license, they wanted a long commitment that extended into winter. Coming from south Florida, I knew winters in New England would be too difficult for me. After 1-2 months without any luck, I decided to change my location interest.

I was interested in the pacific coast, although I knew California licenses can take several months to obtain. After discussing this with my recruiters, they informed me that there were a lot of opportunities in Washington State and Oregon. I had always wanted to go to Seattle but never had the chance, so I figured it would be the perfect time.

One week after agreeing to purse availabilities in the pacific west, I had an ideal offer. A site in Washington State was willing to wait for me to be licensed and were flexible in the length of my assignment. Most importantly, I was able to escape the cold winter.

 

 

Your recruiter will be your main contact person of the agency of your choosing. It is very important that you establish a good relationship with him or her. If you always have to call them and never receive a response, feel free to ask for a different recruiter.

Besides providing them with your location preference and start date, you should have a list of questions to ask them.

• What type of lodging would I be provided with?
  For short-term assignments (less than 6 months), locum tenens providers are typically placed in extended stay hotels. Some sites may provide their own form of housing such as company owned houses or apartments. Unfortunately, some agencies will try to make the most out of the budget and place you in motels. I highly suggest avoiding these agencies or negotiating for better lodging. For long-term assignments (more than 6 months), apartments or condo’s are possible because of the longer commitment.

• How will I get to my assignment?
  Agencies tend to prefer that you fly to your site and they will provide you with a rental car. If the site is not too far from your current location, they will allow you to drive and take your own car. You can negotiate what your preference is when the time comes. If you drive your own car they reimburse you 56 cents per mile. So driving from Miami to Los Angeles would be 2750 miles, and I would be reimbursed $1540 each way. Some people prefer to drive if they have pets, a significant other, or plenty of items to bring.

• What is the pay rate for family nurse practitioners? (or your respected specialty)
  Most often your recruiter will deflect this question to you, trying to find out what is your minimum hourly rate. Try to ask them for an expected range of payment so they do not low ball you. For example, let’s say they asked you what your minimum hourly rate is, and you said $50/h. If you had asked for a typical hourly range, they may have said $45-60. Yet, now they know you will easily accept anything paying $50/h and they will not offer you more. Keep in mind that the agency needs a profit for themselves.

• How does the licensing process work?
  By asking this question you first get a response about them being able to cover your new license cost or not. I know it is expected that they will, but there are cases where they will not cover the cost. Also, you want to find out if you are expected to pay for the costs and will be reimbursed in the future, or if they will pay upfront for the licensing fees. Sometimes you have the option to choose. If you pay the costs of the license yourself, the agency will commonly reimburse you after 30 days of working with them. If the agency pays for the licensing fees up front, they will occasionally have you sign an agreement preventing you from using that license with any other agency for up to 1 year.

 

After deciding to become a travel Nurse Practitioner, the next step is finding the right assignment.

Below are some things you should do before searching:

-Updating your resume
-Gathering all of your supporting documents (CEU’s, CPR/BLS, Licenses, Certifications, Vaccination/Titer record, PPD/CXR record, Graduate/Undergraduate Diplomas, Driver’s License etc.)
Note: It may be best to have all of these scanned and uploaded to your computer so you can easily submit them to agencies when requested.
-Decide what location, setting, and time frame you are interested in traveling

Next, you should contact several locum tenens agencies and ask to speak to a recruiter for nurse practitioners.

Check out my Agencies tab on the home page for some of my favorite agencies. You can also email me for direct referrals to my recruiters. Please mention my name (Sophia Khawly) when getting in contact with agencies to help support this blog.

I suggest getting into contact with at least 5 different agencies. The application and paperwork may seem redundant, but the more agencies you are connected to, the more likely you will be matched with your dream assignment.

I recommend reading through their websites to get a feel of how they work. For instance, some of them may pay you via W2 in which they take out taxes and provide benefits such as health insurance. On the other hand, some may pay you as a sole proprietor via 1099, in which they do not take out taxes but you can deduct self-employment expenses at the end of the year. Different methods of pay may benefit different types of people, so discover what works best for you.

Most of the agencies keep an updated list of current job openings on their website. Look at this page to determine if they have availability in the state of your choice. The most recent the date, the better; as many job openings are quickly filled and no longer available. After providing a recruiter with your preferences, they will follow up with you on any openings. Yet, I strongly encourage you to look on their website every couple of days to see if there are any job availabilities that interest you. Recruiters are very busy and appreciate you being active in the search process.

 

There are many different types of Nurse Practitioners that travel. In my case, I am a single young woman without any responsibilities, so I figured this would be the ideal time. Although I can be somewhat shy to new environments, I still enjoy traveling.

Other locums providers include new graduates, retirees, people who have lost their jobs, or those that just need an adventure.

Unlike RN travel nursing, new graduate Nurse Practitioners can do locum tenens work without any experience. Many healthcare sites are willing to train new graduates as long as they agree to a longer commitment. The commitment is typically 6 months or longer. Many new graduates do their first locum tenens assignment in Indian Health Services (IHS). IHS facilities always need providers since they are often in rural locations. As a federal health center, you can use any state license to work there.

Some travel Nurse Practitioners have recently retired and found themselves still wanting to work, but travel too! The good thing is with locum tenens work, your schedule can be flexible. So if you want to work part-time and explore the city on your days off, this is certainly a possibility. Imagine you are provided with a flight to San Francisco, free housing, and a rental car. All you need to do is work a few days and you can enjoy your paid vacation!

One of the first traveling Nurse Practitioners I know, actually started doing locums work when he was laid off from his full-time job due to budget cuts. With 3 children to support, the quickest way for him to start working was through locums work. He searched for positions at home but could not find any. Luckily, the licensing process took less than 1 month to complete, and he was able to work full-time hours in another state. This lasted for 6 months until he was able to get a job back home.

Lastly, some people just need an adventure! I know some traveling providers that bring their family with them if it’s the summer or spring break. Especially if they are working in sunny Florida or Hawaii. I know a woman who got fed up with being micro managed at her current job that she left and traveled on her first assignment to NYC.

The obvious fact is that being a travel Nurse Practitioner provides you with many options!

Whether you recently graduated or are embarking on a new stage of life, such as retirement, locum tenens is a great experience to add to any stage of your career.

For more information please see a blog from Barton Associates:

Locum Tenens for Every Stage of Your Career

This message was sent using ShareThis (http://www.sharethis.com)

Ever since I was a nurse, I have always wanted to do travel nursing. After I became a Nurse Practitioner, I started doing some research and realized travel nursing for Nurse Practitioner’s was called something else. “Locum Tenens” is a latin word for substitute. It applies to all travel work opportunities for Nurse Practitioners, Physician Assistants, and Physicians. The reason there is a difference in terminology, is due to the level and length of service provided. For instance, RN travel assignments are typically a 13 week contract. Whereas locum tenens assignments can range from 1 day to 1 year.

As a locum tenens provider, you are assigned to a medical facility based on your specialty. So for instance, I am a Family Nurse Practitioner so I am usually placed in a primary care facility. The length of time needed to work is often negotiable. Some facilities will specify a timeline such as 6 months, or they may need someone to cover a vacation leave for a few days. Other times the timeframe is open to your preference or considered “ongoing”. The reason for this is because facilities may have just lost a provider, and while they search for a permanent provider, they would like you to fill in the gap for as long as you can.

The process of finding an assignment begins with establishing a connection with a locum tenens agency. These agencies match your skills and credentials with hospitals, clinics, urgent cares, or federal health centers. Between your assignment site and the agency, you will typically be provided benefits such as: paid housing, paid travel, malpractice insurance, and licensing reimbursement. Some may even offer sign-on bonuses or extension bonuses.

Some people wonder why a medical facility would pay for housing and travel when they could easily hire someone who lives in town. The answer to that is the healthcare provider and nursing shortage. A lot of the medical facilities are located in rural areas, in which it may take time to recruit permanent providers. Others needing coverage for maternity leave and vacation believe the benefit outweighs the cost.