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I’ve spent the past 5 months evaluating my job and trying to figure out the parts I like and the parts I dislike.

I like being able to figure things out medically– sort of like a puzzle. I also like offering patients natural treatment options for their ailments such as probiotics or exercise. I like helping patients and providing accessible care. And I love having the power to prescribe.

I thought my main dislike would be being overscheduled or forced to see walk-in patients without appointments. But I realized these nuisances weren’t often and they were fleeting. Even when I did have extra time to spend with patients, I found myself rushing to end the visit.

There is a reason why I am always exhausted after each shift, and need weekends to recharge. The answer is because I am an introvert. An introvert has a limited battery life to interact with other people, and once that battery is empty, they need alone time to recharge.

Although I like helping people, spending all day every day talking to tons of people is mentally exhausting for me, as an introvert.

This is why when I take 1-2 months off from work, I am mentally recharged and excited to get back to work. That is … until I am depleted again 4-6 weeks later.

I never thought about how being an introvert could accelerate my risk for burnout until I read a similar perspective on a financial forum. The person posting was actually a physical therapist. He said that as much as he loved his job, he wanted to become financially independent so he could work less. He stated that since he is an introvert, talking to different people all day long was overwhelming for him. When I read his post – I was like yessss! I completely identified with that.

I think next year I am going to make some changes professionally and I wanted to evaluate what those changes should be. As an introvert, it may make more sense for me to work part time. That way I am not spending 40+ hours a week giving away all of my energy to other people. I may also consider continuing locums but trying to work shorter assignments or taking a mandatory 1-2 month break in between gigs. That way when I am working, I can give the best version of me instead of a drained version of me.

I know it’s easy to ignore recruiters when they blow up our phones or emails with job options. But I try to send a quick response via text or email letting them know I am not interested or are currently on an assignment. This keeps my relationship with recruiters strong.

If I were to ignore them often and only reach out when I needed them, the recruiters would be less inclined to help. On the other hand, since we are often in close contact, I am one of the first providers they consider for any relative assignment.

I am often asked by peers if there are times that I do not have consistent work as a traveler. My answer is no, in fact I typically have multiple job options at any given time. One of the reasons for this is because I have established strong relationships with multiple recruiters.

In addition, I have built connections with previous work sites. So, when they have a new opportunity (they often do), they will contact me to come back. When I first started traveling as a nurse practitioner, I didn’t expect I would ever return to a previous assignment. My thought was I would only want to go somewhere new. Fast forward to 5-6 years later and my mind has changed.

For example, my options are limited in winter so I don’t mind going back to a previous job in California or Florida. I have also formed relationships with staff and the local community, so I enjoy returning for brief periods to catch up with my new friends.

Even though I only work at each place for 3 months (initially), I always put my best foot forward to give them a good impression of me. This way, I’ll always have a job to return to if needed or can help in their clinics in other places (like I do now for the geriatric company).

If you see locum tenens in your near future or want to work in this field long term, be sure to network and work on your professional relationships. 

When staying at a hotel while working at an assignment, I try to stay at a Marriott hotel. Their Residence Inn chains have a kitchen which I like to have. I like Marriott because they have a large footprint especially since they bought the Starwood preferred group chain (think Sheraton). So whether I am traveling domestically or abroad, I can typically find a Marriott hotel to book. Since I am a Titanium member (their highest elite status), I can request late checkout up to 4pm. This is convenient if I have a late flight or want to store my things before moving into my apartment.

When traveling for leisure I love to stay at Hilton hotels. Since I am a Diamond member (their highest elite status), they often treat me as royalty. Think room upgrades, free breakfast for my guests and me, and lounge access. I especially love staying at Hilton hotels abroad because they are usually very luxurious. When I went to Bali in 2019, they upgraded me (for free) to a huge suite. Instead of just a standard bedroom, I had a dining room and living room too. They also gave me free breakfast at their expansive buffet, and allowed my 3 guests to dine with me for free as well.

Since I stay at Hilton and Marriott chains frequently, I definitely have a credit card of each brand. This allows me to accumulate points to stay there for free. If you are interested in getting either of these cards, check out my referral links below.

Hilton Card

Marriott Card

Check out an article I wrote on Barton Associates blog about beginning your career as a locum tenens provider:

https://www.bartonassociates.com/blog/top-5-questions-for-your-locum-tenens-recruiter

As my Virginia Beach assignment comes to an end I want to focus on the wins of this assignment. After my second month I started having to work 50+ hours a week in order to keep up with my growing patient panel. This left me exhausted and looking forward to the end of my time here. I don’t regret coming here for the following reasons below.

Here are some of my Virginia wins:

-Nice catching up with old friends and making new ones.

-Interesting visiting Thomas Jefferson’s estate after reading his biography.

-Having my parents come to visit.

-A patient made me home baked chocolate chip cookies. This was a thank you for catching a breast mass on her (she hadn’t had a PCP in decades), which ended up being bilateral breast cancer (treatable). So she was grateful.

-Having ~60 days with no patients in the hospital

-Advocating for patients to be placed in long term care that couldn’t take care of themselves anymore or getting their families more involved (had dozens of these patients).

-Meeting grumpy patients and by the end of the visit they had a smile on their face and were very thankful.

-Identifying when it’s time for a patient to go on hospice (non-cancer related) and them passing away shortly after comfortably at home.

-Having patients and staff ask me if I was opening up my own practice so they could follow me there.

The biggest win of all was showing hundreds of elderly patients that a nurse practitioner is just as competent as the physician they are used to seeing.

Feel free to comment with some of your recent wins while on assignment below!

I mentioned before that I wanted to come back to Virginia because I wanted to visit Thomas Jefferson’s estate. I am happy to say that it did not disappoint. It was amazing to get more insight into the life of such a brilliant man. I was also able to see where he is buried – next to his wife and daughter.

His home is in Monticello which is right outside of Charlottesville. Since this is only about 1 hour away from Shenandoah National Park, I went there to spend the weekend with my parents who were visiting. The views were beautiful since it was the peak of spring. I even forced my parents on a 1.5 mile hike which they enjoyed.

We also went to the Lurray Caverns. It ended up being more expansive than I had imagined.

Lastly, Virginia Beach is nice because it has a boardwalk you can walk or bike ride on. People often play music there and you can grab a bite to eat while listening to the waves. Being from Florida, I am biased to our beautiful beaches there, but the beach here is more than enough to relax in on a warm sunny day.

I think I have a little PTSD from working with the same company in Kentucky where the patients were just awful. Since then I am always apprehensive to meet a new patient (to me) and relieved when they are normal and kind.

I find this type of work more rewarding than my job in San Diego. Although working in San Diego was easier and I had more free time, I didn’t find the job to be too rewarding. I didn’t feel like I was making much of a difference. I think it’s because the patients were fairly stable and I didn’t see them more than once or twice.

This is in comparison to my job here, where all of my patients are 65 and older and very sick. I see them once a month or sometimes even weekly depending on how complex they are. I am able to develop relationships with them and their families. I am able to help them improve their health and witness them get better. I love when we get to the point of knowing each other that we can begin to joke around.

At the same time, since the patients are vastly sicker here, I barely have any free time at work. I often have to work through lunch or stay after hours to finish my work flow (medication refills, review lab results etc.). Luckily, I am paid overtime but I would rather have the free time and feel less mentally exhausted by the end of the day.

Unfortunately, the work life balance at this job isn’t good. The physicians often respond to phone messages or do medication refills even on their days off. They are usually still working even after I have left – and like I said I leave late.

Initially, I had a few patients that were upset about not having a “doctor”. The medical assistant would warn me about this and explain why the patient’s blood pressure is high. It didn’t bother me because I knew that they just had no idea what a nurse practitioner is. When I went in the room I introduced myself to them, listened to their concerns about seeing an NP vs MD, and explained the similarities and differences between each profession. By the end of the visit, they calmed down and their blood pressure went back to normal. They had no more concerns about seeing a nurse practitioner since they realized they still got everything they needed medically.

So far, I have had only one hiccup – which sadly happened during my first week. The referrals we place to specialists have to be approved by the medical director of the clinic for cost reasons. I placed a referral to neurology for a patient with a brain mass and swelling, and physical symptoms such as expressive dysphasia and hand tremors. The medical director asked to speak to me about the referral. He said he didn’t have enough information to approve it. He needed to know what I expected the neurologist to do for the patient.

I told him I disagreed as I provided more than enough information, and since I was not a neurologist I didn’t know what they would do. I also told him I wasn’t a new provider and knew what to include in my referral notes. I had never had an issue with my referrals in the past 5 years that I have worked for this company.

He still kept going on and on about what he needed to approve the referral. I was so mad that I just walked away as he continued to talk. I went to see another patient and when I came back his demeanor had changed. He told me that I was doing such a great job and had already noticed an improvement in the patient numbers; and that he was so grateful I was here.

I don’t think I even responded – just stared, because I was dumbfounded. I thought to myself ‘yes you better suck up to me because you need my help’. One of the physicians had retired earlier than expected so the physician that would be taking that panel wouldn’t start until the end of summer. Thus, they were grateful to have me cover the 3-month gap. The funny thing is that medical director had shadowed me when he was a resident my first time working for this company 5 years ago. So, I really didn’t care for his feedback.

He ended up approving the referral – if he hadn’t that would have been a big lawsuit waiting to happen. I just want to do what I enjoy which is seeing patients and not be bothered with trivial things. If he bothers me again I may decide to discuss the matter with the chief medical officer. She told me to let her know if I came across any issues.

For some reason there aren’t many short-term apartments available currently, even though Virginia Beach is a military town. The options the agency sent me were either 30 min each way from the clinic or had wall unit a/c (it gets really hot here in the summer).

So, I was put in a Courtyard Marriott hotel. I thought it would be for only 1-2 weeks until they found me something. I even searched myself and no short-term units were available close to work. After living in a hotel with just a minifridge and a microwave for one month, I was finally transferred to a hotel with a kitchenette. I didn’t complain too much because the hotel was 5 minutes from my job.

I am currently staying at a Hilton Home2Suites 10 minutes from work. It has a full-size kitchen minus an oven. Apparently, the Marriott Residence Inn hotels were out of budget.

It’s funny because I sort of forgot what it was like to live in a hotel for a long period of time. It’s actually not that bad because they offer breakfast and someone cleans my room. I even have an extra bed for guests.

Another bonus is that all of these stays are contributing to my elite status qualification, and I am earning thousands of points that I can use for leisure travel.

After the first week where I had the incident of the medical director micromanaging me, things went smoothly. I think the medical director realized I know what I am doing because he hasn’t bothered me since. In fact, he is constantly thanking me for my help and letting me know that I could stay as long as I want to.

The other PCPs are really nice too, they see their own walk-ins and even offer to see the walk-in that the nurse asks me to see. I only had one bad afternoon out of my entire first month. I had a packed schedule and was surprised to have a new patient show up at the end of the day with only a 20 min slot. Typically, our new patients are scheduled for 40 minutes, in reality they are at the clinic for 2 hours between the visit with me and all of the work up testing.

At that moment I felt very overwhelmed because I already had 4 patients in the clinic (some brought early due to transportation), and one of them was already a new patient. I asked the front desk how come the new patient was scheduled only 20 minutes and they said the clinic manager had approved it. Of course, the clinic manager wasn’t there for me to confront, so I told them they would have to reschedule the patient. Apparently one of the other PCPs had an opening so they transferred the patient to her.

The following day I couldn’t wait to ask the clinic manager why he thought it would be a good idea to schedule a new patient with me in only 20 minutes, especially since all of the patients are new to me and I can’t be efficient as I could be had I known these patients for months or years.

Before I even had the chance to approach the clinic manager, he came up to me and apologized for scheduling that new patient incorrectly and not talking to me about it beforehand. I was grateful for his apology and I took the opportunity to tell him I needed the last slot of my schedule blocked. As my patient panel is rapidly growing, I am beginning to become overwhelmed and need that time to return phone messages to patients I do not know (since I am covering for the newly retired PCP).

He said ok but later came to tell me that if he blocked the lost slot of the day, he would have to remove the block before lunch (that all of the providers including me have), in order for me to meet the expected amount of patients per day seen.

I told him that in my contract I have it listed that I am only supposed to see up to 16 patients per day – not the 18-21 patients per day that the full time PCPs are required to see. Considering I am a temporary PCP, this is the number I am comfortable seeing since the patients are complex geriatrics and I am only there briefly.

He said “oh sorry I had no idea!” and I told him it’s fine that usually I have more blocks on my schedule, but I am trying to be flexible since I know there are a lot of patients that need to be seen. But at the same time, I need him to work with me to make sure I don’t get burnt out and am not working too much overtime. It’s funny because I have been working with them on and off for the past 5 years, so I make sure to get everything I need listed in my contract before starting the assignment, to cover all bases.

At the end of the month I won an award for having no patients in the hospital during my first 4 weeks there. Out of 22 PCPs in the market it was just me and another nurse practitioner that got this award. Go figure. It’s about time they got a taste of what I am made of.

I pretty much moved out of San Diego, spent a few days in Birmingham, AL (where my sister lives), spent a few days in Miami (home), and started my new assignment in Virginia Beach all within 1 week.

I immediately regretted my decision to only take 1 week off between assignments. However, I knew that the position in Virginia Beach was desperate for me to start since one of their physicians had retired abruptly.

Flights have been cheap lately – my flight from San Diego to Miami was only $125 one way. Yet, for some reason the flights from Miami to Virginia Beach were ridiculous for the date I needed – about $500 one way. Most of them had layovers and the total flight time was about 10 hours. So, I opted for the only non-stop flight which was at 7 am and a total of 2.5 hours of flight time. I also regretted this decision when I had to wake up at 4:30 am that morning to make my flight on time.

Even though my agency knew about this assignment since January (I started in April), they still hadn’t found me an apartment. Thus, I had to stay at a hotel the first 1-2 weeks. I usually like to stay at a residence inn Marriott but these were apparently over budget. I settled for a Towneplace Suites Marriott since it was still a Marriott and had a kitchenette. When I went to check it, turns out it is no longer a Marriott chain. It was now an Extended Stay hotel. My room smelled horrible and the a/c barely worked. I was too tired to request a different hotel. I quickly showered and was disgusted by the towels which were more like rags from a car wash and lint from the towel would stick to me. I was additionally grossed out when I noticed how unclean the room was, with random hairs everywhere and dirty tables etc.

I sent an email to my recruiter telling her I would need to be moved to a different hotel the following day.

My first day in the clinic I was still tired from the previous day and annoyed that I wasn’t in a comfortable housing situation. However, the clinic staff made up for it. They were so nice, by decorating my desk and giving me flowers upon my arrival. Everyone made sure I was comfortable and reassured me to let them know if I needed anything.

Once I met everyone and completed meetings with leadership, I was disappointed to find out that my EHR login wasn’t working. I spent hours on the phone with IT getting everything re-set up. I hadn’t worked with this company for 5 months, and in a different state so they had to get everything transferred over. Not sure why this wasn’t done prior to my start date. I was grateful I didn’t have any patients until the afternoon. By then my EHR access was working but no e-prescribe. So once again I was back on the phone with IT.

During lunch, my agency had moved me to another hotel. It didn’t have a kitchenette, just a mini fridge and microwave. But I was desperate and figured I could survive like that for just 1-2 weeks. I was moved to a Courtyard Marriott. I am very happy with the change – nothing beats having a place you feel safe and can relax in after work. Also, as a Marriott Titanium Member, I was given a $10/day credit to use at the café or snack bar.

My second day at work I was able to see a few other people I knew from my time working in Virginia before, which was nice. I started seeing a full day of patients. Some of the patients were distressed when they found out their PCP retired, but luckily I was able to calm them down and they felt better once they realized they would still be taken care of until their new PCP starts over the summer.

At the end of the day, I received a surprise delivery of an Edible Arrangement and bag of flavored popcorn. It was a gift from the medical director welcoming me back to Virginia. I thought that was incredibly sweet! They keep hinting that they really want me to stay longer. It’s way too early for me to make that decision.

So far the specific clinic I am working at is nice. The other providers are friendly and check in with me to make sure I am doing ok. And they don’t expect me to see all of the walk-ins (which has been a problem in similar clinics elsewhere). The clinic is reluctant to overwhelm me, that I had to encourage them to give me more patients and to send me medication refill requests for the retired physicians patient panel.

Even though things started a bit rocky, I am happy to say I am looking forward to my assignment here!