Back on the Beach

Since I extended my current assignment in Florida into spring, I decided I wanted to move closer to the beach. My previous housing was 40 minutes from the beach. This wasn’t going to work since I like to go the beach after work or early in the morning before it gets crowded. Unfortunately, Florida has gotten way more crowded over the past 2 years. 

A monthly rental on the beach would have been $7,000/month which is obviously above budget. I looked on furnishedfinder.com and found a furnished 2-bedroom apartment less than 10 minutes from the beach that was perfect. I had an extra room for guests and the apartment was between the beach and my job. 

Now that it’s spring, it’s not unbearably hot outside and the ocean water isn’t too cold. If I have a stressful day at work or simply wake up on the wrong side of the bed (haha), I make sure to stop by the beach after work to decompress. It works every time. I get home with tons of energy after that. 


Each weekend since I moved to my new place, I have been hosting visitors – from relatives to friends from all over. The beach is my happy place and I enjoy sharing it with others. I live by Anna Maria Island so usually go to that beach because it’s more residential and quieter. Sometimes I visit Siesta Key Beach which is more crowded. The beaches are different though. Siesta Key has more of a cool white powdery sand, whereas Anna Maria Island has more seashells on the shore. Both are beautiful and have amenities nearby. 

I am glad I extended to take advantage of the beautiful weather and beaches! At least I can end my time here with a tan 😉

Training New Providers

I talked about part of the reason I extended in Bradenton, Florida was to train a new nurse practitioner there. I have trained other nurse practitioners in the past, even as a locums, and I enjoy it. I know the first year working as a nurse practitioner is challenging so I like to be that mentor for other nurse practitioners. 

The new nurse practitioner at my current job is pretty laid back. This is good because she doesn’t get overwhelmed easily. She picked up on the EHR pretty quickly and the flow of things. Her greatest challenge was going to be clinical knowledge. Working at this managed care geriatric practice is challenging, and everyone goes through a huge learning curve working here. 

After she finished the 4 weeks orientation, she shadowed me for about a week. Then when she started seeing her own patients I shadowed her for a week. I tried to encourage her to study after hours because I witnessed some weaknesses in her clinical knowledge. Such as reading EKGs, pharmacology, and forming differential diagnoses. Sometimes she pawned it off that I just made her nervous when I was in the room with her. But if the patient asked her 5 times for an alternative medication and she couldn’t come up with one, I had to finally jump in myself.

As her schedule has become fuller, she is doing pretty well with time management. They have her sitting next to me for support. She bounces ideas off of me and I try to provide feedback on patient visits. I reassured her with time she will become more confident, and her clinical knowledge will improve with experience and exposure. So far she has 100% on patient experience surveys which is awesome!

On the other hand, there is a physician that started the same time as her. This is an experienced physician. Things haven’t gone well. This physician has a lot of anxiety and gets overwhelmed easily. She had a hard time ramping up her schedule beyond 5 patients per day. I’m like don’t you get bored?? Whenever staff approaches her about a walk-in she throws a tantrum. Then she is forever reliant on her medical assistant. So, if her medical assistant disappears for 5 minutes to help other patients, the physician goes crazy. 

Since the nurse practitioner I trained was doing really well, my supervisor approached me about shadowing the new physician for a day. He hoped I could give her some tips on how to finish documenting in the room while with the patient, and how to stay on time, so that she didn’t need to take work home. When I told the new physician I was going to be with her for the day, she literally said “do you have to? Is it required? Because I would rather you not. It would put me behind.” Everyone sort of gasped when she said that, and I merely answered “No you won’t be behind, in fact I will make sure you stay on schedule.”

While waiting for her first patient to be ready, I suggested she go over some of her work flow like lab results and phone messages. Then she literally when ballistic on me. She told me flat out she wanted to quit. That she doesn’t enjoy working here. That she was lied to, the patients are way more complex than she thought. That seeing one patient here is the equivalent of seeing 10 patients in a regular primary care office. That she has no work life balance and hasn’t been able to see her family since she started working here. 

I tried to reassure her that everything is hard in the beginning and it gets easier once you see the same patients over and over. Especially our patients come once a month so you don’t have to address everything at one visit. She didn’t take that as any help and instead barked at me that I don’t have any children so I wouldn’t understand. I told her I may not have children but I still finish work early every day and don’t bring any work home, and I can teach her how. She continued to say she is not in a good mental space to see any patients today and to let our supervisor know. 

Meanwhile, the other physicians were there holding their breath. Our supervisor pulled her aside and told me he planned on sending her home and asked if I could see her patients for the day. This ended up being a lot of work for me because I was seeing her follows up with only the allotted time for someone that knows the patients already. Of course, things worked out on my end, but I was in a bad mood considering all that I had to put up with. 

Apparently, she spent 2 hours talking with our supervisor, him providing her with therapy. At the end she felt better and was determined she would no longer quit but still needed the day off. -_- Leadership told us to continue offering her support and that they would limit her schedule so she can have more time to adjust. 

The other physicians approached me later and gave me props for staying calm when she went crazy on me. I laughed because I am used to being that way with patients all of the time. They were disappointed that leadership thought the situation would improve. She had been there for 2 months already and every day was a train wreck with her. We were tired of her outbursts. It also wasn’t fare that the new nurse practitioner was soaring and they started at the same time. 

Personally, I’d give it another 2 weeks before she decides to quit. I think leadership should just let her go instead of transitioning patients to her that likely will not last. 

The best part of the day were the other physicians approaching me and telling me how much they appreciate me. That they wouldn’t have been able to brush off the other PCP telling them off, nor would they have been able to accommodate seeing her entire patient schedule that day. They said since I have been there, they are able to focus on their patient panels instead of all of these outside noises. 

Also, during our monthly leadership rounding, I was told that the new nurse practitioner chose to celebrate me during her one on one. She said she wouldn’t be successful without my help, and leadership told her how lucky she is that I ended up being here at the right time. 

Despite that horrible day, I tried to focus on something my dad told me many years ago: “You never fail when you try to do something good.” No one feels good after someone yells at them. But I had to remind myself that she is going through something mentally, and I did my part in trying to help her. I just have to let that go continue focusing on helping people that want to be helped. 

The Top Airline Card

Although I prefer flying Delta over American Airlines, Miami International Airport is a hub for American. So, I often find myself flying American Airlines since they have more flights coming in and out of Miami – especially non-stop flights.

I wouldn’t say I have a favorite airline credit card, but if I had to choose one it would be the Barclay Aviator AA credit card. By having this card, I am able to check in my first baggage free (and other companions on the same reservation). This is great for someone who is always traveling. Those $30 baggage fees accumulate quickly.

What I also like about this card is that there is no minimum spend requirement. You just have to make one purchase with the card and you get the signup bonus offer which is usually around 60k AA miles. It comes with an annual fee of $99 but it may still be worth renewing each year if you are traveling enough to receive the free baggage benefit. 

An additional benefit, is that the card comes with preferred boarding. AA has nine boarding groups. Being a card holder allows you to board with group 5 (after first class flyers, elite members, military etc.) This can be helpful when traveling with a carryon and wanting to secure overhead bin space.

This card is offered as both a personal and business card product. Which means, technically you can sign up for both cards separately to earn the sign-up bonus on each one. 

Annoying Peers

I don’t think I have complained about other providers I worked with in a while. That’s because over the past 2 years, the other providers have been great. 

I do have a couple of synopses to share though. When I worked in Ohio, there was a physician there that we jokingly said he thought he was working in Grey’s Anatomy. He was a know it all that was only one year out from residency. Every single day he thought he was diagnosing a patient with an emergency disorder. For instance, one patient he thought she was having a pulmonary embolism and ordered a stat CT scan. Her only symptom was shortness of breath, which is common for patients 65+ years old. The CT scan ended up being negative. Then he had a patient that was beaten up by their son and had a bunch of bruises, pain, and swelling. The same physician thought that the patient was having compartment syndrome and sent him for a stat CT scan, which also ended up being negative. 

We call this the “zebra”. It refers to medical students thinking patients have a complex problem when in reality they have a common and straightforward disorder. This happened on a daily basis and it got annoying. Because one, he made the patients nervous about something that was obviously not complex. And two, he prided himself on not referring to specialists yet drove up costs for the patients by ordering all of these expensive imaging.

Fast forward to my current job in Florida. One of the physicians is 9 months in, older guy with lots of experience. He told me he loved nurse practitioners and had a lot of them at his previous practice. I later learned why he loved us so much – he was used to nurse practitioners helping the physicians with their workload. This is completely different to our current practice where each provider, including the nurse practitioners, have our own patient panel. 

Whenever he was asked to see a walk-in, he would tell them to ask me. They had to be like “No, she is already seeing another walk-in”. Whenever he didn’t like a patient, he would just have them switch to me. If a new patient wanted to come in sooner than scheduled, he would tell the front desk to schedule them with me. Whereas, I was already the most booked out provider since I was taking in a lot of new patients. So, the new patient he was trying to defer would have been able to get a sooner appointment 4 weeks earlier if scheduled with him versus me. I think he thought I was his assistant!

At our weekly meetings where we discuss our sickest patient, he always had something to say about one of mine. The patient is a needy woman, with history of cirrhosis, GI bleed, and chronic pain. He told me to make sure I am not prescribing her NSAIDs for her pain. My response was “duh”. This physician has a GI background so I was surprised he didn’t want to be this patient’s PCP. I later learned it’s because he doesn’t want any of the “needy” patients. I finally had to have a discussion with him to let him know I am not his assistant, and that he needs to learn how to manage his patient panel independently, the way I am managing mine. 

Anyways, I thought it was hilarious to work with these physicians above and just wanted to share some “struggles” of being a traveling nurse practitioner. 

Work Culture at Bradenton

I have officially begun my extension in Bradenton, Florida. I forgot how much easier work gets when you know the patients well. I have already formed relationships with patients and they admit they are excited for their PCP visits. It is rewarding to see patient’s health improve and to see your hard work pay off. Even though at times I feel restless, wanting to go somewhere new, I have to confess I am enjoying my time here.

The work culture in this office is pretty amazing. We are a big office with over 40 employees. Everyone is excited to get to work and support each other. We share lots of laughs and fun times. There is a culture team that makes sure we celebrate birthdays once a month, which includes lunch and cake. There is always some type of themed event to get the clinic excited – such as mardi gras or pajama day.

Everyone is great, from front desk to case management. Leadership is wonderful. They don’t micromanage and are very understanding. They have high energy and make sure you feel supported. This is the type of leadership I love. We have a quick huddle every morning and the enthusiasm is contagious – something I haven’t seen in other centers.

The other PCPs always joke that I never seem stressed and somehow always stay on schedule. Some of them are new and are still adjusting. I try to reassure them that it’s a bit challenging in the beginning, but it definitely gets easier over time once you see the same patients over and over. The seasoned PCPs tell them someday they can be at my “level” where I am constantly laughing and carefree, and improving patient outcomes even though I have one of the most complex and sickest patient panels.  

It’s nice to have that feeling where you don’t dread going to work, and you feel loved and supported. I still have plenty to do socially, because of the holidays I hadn’t had the chance to meet up with many of my local friends. I am glad I extended because I still have time to meet up with them. Since I will be staying through spring, I will be moving to a different apartment closer to the beach as well.

If I wasn’t a nomad, I wouldn’t mind working here forever. It’s funny, because every single day someone asks me to stay permanently. Even the provider sitting next to me is like “you must be tired of hearing that”. When I came back from a one week vacation, everyone was so excited to see me, I felt like I had been gone on maternity leave or something. I was given gifts, hugs, and food. My boss even told me I was welcome back permanently after my 3 month summer hiatus if I wanted.

Creating an Army of Travel Nurse Practitioners

I have been working on and off for the same geriatric outpatient clinic network since 2016. They have clinics in multiple states and continue to expand in new territories. The new PCP orientation and training has been extended from 2 weeks to 4 weeks. 

This has led to a demand for temporary coverage. If a provider goes on FMLA or quits suddenly, the process to find a new physician and from the date in which they can start seeing patients, can take 3-6 months or longer. By the time the new physician is hired, they have to complete the 4-week orientation and training, and then they have a ramp up schedule of seeing 5 patients the first week, then 6 patients the following week, then 8 weeks the following week etc. 

A patient panel of 300-400 can take 4-6 months to be transitioned into the new providers schedule. Hence, suddenly I am being flooded on a daily basis with requests to provide coverage at a different clinic. I am a quick fix because I can start seeing a full schedule of patients on day 1. Sure it’s nice to feel wanted, but there is clearly a need that I, alone, cannot fill.

The company does hire locum tenens clinicians to cover on a temporary basis. However, I am the only clinician that has worked with the company multiple of times in several different markets. So even these locum tenens providers would need to do the 1 month training and ramp up schedule. I remember when I first started working with the company, the CEO at the time had asked me if I was interested in going permanently with them and being in charge of building a team of other travel nurse practitioners. 

At the time (and currently), I did not want to transition to a permanent position. But at this point, I have a strong relationship with the company. Enough that I am willing to assist in building and training a team of other travel nurse practitioners for them. Of course, I would not do this for free, but it would be nice to have other similar providers to be available when there is a need (and there is always a need). 

I reached out to the CEO to see if they were interested in hiring a group of travel nurse practitioners. Ones that could complete their orientation and be assigned to me for further training. So that when there is a need, they would be able to start right away – seeing a full schedule of patients. Normally, the new physicians complete orientation and begin seeing patients per ramp up schedule. Working with this company is a huge learning curve for any provider, but especially for nurse practitioners. 

Personally, I learned a lot my first year with the company, and fortunately I had a geriatrician sitting next to me that I could go to for any questions. I have helped train several nurse practitioners after they completed their orientation, and they all verbalized without that extra support from me, they wouldn’t have made it. 

So if the company does decide to move forward with proactively hiring travel nurse practitioners, whether via a locum tenens agency or internally, I would like to help in the success of these travel nurse practitioners. Since I extended in Bradenton, I have 3 months I can do this. It’s challenging to train other providers when you don’t know the patients yourself (in this model). Since I know my current panel, that would make it easier.

Let me know if you are interested in getting trained for this travel nurse practitioner position so I can let the company know! They are definitely interested in this.