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Once I made up my mind that I wanted to go to San Diego instead, I dreaded having to tell my recruiter that I was no longer moving forward with the Kaiser job. If any of you have backed out of an assignment before, you know how recruiters can get nasty real quick. I remember one of my friends telling me that his recruiter threatened him with a lawsuit even though he backed out more than 30 days prior (his contract stated he can cancel an assignment with a 30-day notice).

The truth it, I knew my recruiter/agency couldn’t do anything to me since I never actually signed a contract. Part of me still wanted to work with Kaiser eventually, just to see what it’s like. So instead of cancelling completely, I asked if my assignment could be postponed until April.

Of course, my recruiter was over dramatic. He said I was leaving Kaiser with ultimately no providers, since they were counting on me to start. He must have forgotten that he told me he had placed 2 other providers at Kaiser to start right before me. He made it seem that the clinic was going to be without any providers. My interviewer there told me they have over 100 providers at any given time.

My recruiter said he didn’t know how Kaiser would take this and maybe they would put be on a black list. I laughed at that because I was almost done with credentialing with them (which takes 60 days), so I knew they wouldn’t mind the convenience of having me in the future.

He also asked me if I was sure I could get another job in January on such short notice. He seemed very doubtful. I laughed at that too. At this point in my career, I have worked in over 20 different practices, so my connections are endless. Not to mention I already had another job secured.

I was glad when that conversation was over. A few days later he let me know that Kaiser said it was actually fine for me to start with them in April. But he needed to know if I was 100% committed. I told him I would let him know in January after I start my new assignment. April was months away.

He clearly didn’t like that response because he sent me a long message saying how they can’t wait that long – and how I need to hold my commitment to that start date – and if I don’t start in April after all then it will damage my name with them and also their relationship with the site too. Blah Blah Blah.

I did not answer because at that time I was focusing on meeting my newborn niece, the upcoming holidays, and my assignment in San Diego. I didn’t appreciate the way he was “threatening” me, and the fact that he sent me the same message AGAIN on Christmas eve with a “merry Christmas” at the end. -_-

My first week in San Diego, I was obviously busy with orientation and adjusting to my new job. That didn’t stop him from blowing up my phone every single day. Multiple missed calls, voice messages, text messages, emails, and even his co-workers were calling me daily! I was so furious because I had already told him I would let him know once I started my new job. One thing at a time….

But since he couldn’t respect my decision and continued to “harass me”, I texted him on Friday to let him know my answer for starting at Kaiser in April was “No Thank you”. He couldn’t even accept that decision either, he responded with all of the reasons why I should work with Kaiser after all.

The truth is, I do want to work at Kaiser. But I am extremely turned off by his lack of professionalism and is not someone I would ever want to work again with in the future.

Have any of you had a similar experience when backing out of an assignment?

Besides the weather, there were multiple factors that were deterring me away from the job in Northern California. I wrote a recent post about the California AB5 bill, which doesn’t allow nurse practitioners to work in California as a sole proprietor. This job with Kaiser was with a different agency than I normally work for, although I have worked with them in the past. Part of my desire to work with them was to get some 1099 work for the 2021 year.

I usually work with Comp Health for the majority of my assignments, which pays me as a W2 employee. I like to have at least a little bit of 1099 work each year to help reduce my overall taxes.

However, due to the AB5 bill, the agency had just notified me that they would have to pay me as a W2 employee while working in California. This meant they had to offer me benefits such as health insurance and a 401k, but if I accepted the benefits, I would be given a decreased hourly pay. I thought to myself, than I would rather just work with Comp Health to get my usual benefits and usual higher pay.

In addition, I was also drawn to this particular job because they were offering a $3500/mo housing stipend. I had found a furnished apartment that was going to cost me $2000/mo, so was planning on pocketing the extra $1500/mo. But since I was now going to be an employee for them, they could no longer give me a stipend. They could only reimburse my cost of housing.

At this point I knew I wanted to take a job with Comp Health in San Diego instead. I had already interviewed with the job in San Diego twice in 2020 but hadn’t moved forward with them for covid related reasons. The first reason was when covid just started, I decided to extend at my current assignment to wait things out. And the second time was because I had the opportunity to work in Florida which was closer to home.

Stay tuned for part III!

Working during the months of January – March, my options are quite limited since I hate being in cold weather. I usually try to be in Florida or California during this time.

In November, I was presented an opportunity to work with Kaiser Permanente in one of their Northern California clinics. I was really interested in this offer because Kaiser is supposed to be the “mecca” of healthcare. They use EPIC EHR which is supposed to be the best – ironically, I haven’t yet come across it after working with over 15 different electronic healthcare systems.

I even spoke to a provider that was working there and they told me how much they loved it. She told me there are tons of specialists that work there so you can always get a curbside consult when needed. The orientation and training process are very thorough as well.

My main hesitancy was that credentialing takes 60 days. That meant I had to make up my mind as soon as possible. And if you recall my ‘FOMO’ post, I hate committing early on. I also wasn’t thrilled about the location. I prefer to be in Southern California. It is more my vibe and less cold. Plus, I know more people there.

When I finally decided to move forward with the assignment, I let my recruiter know that my CA licenses and DEA were going to expire at the end of the year. Thus, I needed them to cover the costs of renewal. I was surprised when the recruiter made it seem like I was crazy for asking for this. He told me these things aren’t typically covered.

I said for sure state licenses that are used for the job are usually covered. I knew that particular agency usually doesn’t cover the cost of the DEA since it’s $700+, but they had paid for it for me in the past. He tried to negotiate with me, saying if they covered the cost of the CA RN license can I cover the cost of the NP one. Obviously, I said no. I am no rookie here…

In the end they ended up agreeing to cover the cost of all CA licenses and my DEA. When they sent me the contract, of course there was no mention about paying for my licenses. I did not sign the contract. I sent it back to them requesting that information be added to the contract. I know from experience not to take a recruiter’s word for anything. Everything must be in the contract!

In the meantime, I started credentialing so that my start date wouldn’t be delayed. Fast forward to a couple of weeks before my start date, and I still hadn’t received my contract. I hadn’t mentioned anything to my recruiter because I knew without a contract I still had the opportunity to back out last minute.

So when a “cold front” hit Florida for a few days, I knew I wasn’t cut out for winter in Northern California afterall. I checked the weather there and saw it was in the 30’s and 40’s. I then checked the weather in Southern California and it was in the 50’s and 60’s – more my style. Luckily I knew had another option in Southern California.

Stay tuned for part II!

FOMO stands for “fear of missing out”. Usually people use this expression when they missed out on a trip or a reunion with friends etc.

As a traveling nurse practitioner, I sometimes have FOMO when it comes to choosing my next assignment. For instance, some sites have a credentialing process that takes 2-3 months. I try to avoid these jobs because I don’t like committing to an assignment too early.

Locums jobs are usually available last minute. Typically, there wont be a job posting until about 1 month before the assignment start date. This is why I am not a fan of committing to a job 2-3 months in advance. What if a better job comes along? Maybe something in a better city or a job that pays better. What if I need to be closer to home?

I know most people would like to be committed to multiple assignments in advance so they won’t have to worry about it last minute. I guess I have been doing locums for so long that I am the opposite. I like to decide on my next assignment within a few weeks of the start date. When I commit to a job well in advance, I often start second guessing it.

I even have FOMO when extending an assignment! Often, I am asked to extend during the first month of my 3-month assignment. I usually tell them I will let them know closer to the end. Of course the site wants to know sooner than later to see if they need to hire someone else. But I need to decide last minute to see what my needs and desires are at that time.

The only time I don’t mind committing to a job super early is when I have a bunch of vacations/trips planned. That way I know where I will be prior or during the trip so I can book my flights instead of assuming I will be flying from Miami.

Any other traveling nurse practitioners with FOMO out there?

Instead of focusing on the covid pandemic, the American Medical Association (AMA) has been advocating for #StopScopeCreep. The AMA has been calling for limits on the autonomy of NPs and PAs, and for years has been working against legislation that allows NPs to practice independently. Their argument is that Nurse Practitioners do not have adequate training to work independently. They support this by saying Nurse Practitioners have less clinical hours during graduate school than physicians have during their training and residency.

I think the AMA forgets that most NPs have experience as nurses prior to practicing as an NP. Our first 1-2 years working as an NP is technically a residency as we adjust from being in the classroom to implementing what we have learned. In addition, most independent practice states only allow nurse practitioners to become autonomous providers once they have several years of experience under a supervising physician.

It is disappointing that the AMA is using this challenging time to blast social media with misinformation about other healthcare professionals. I am not sure why they are so threatened by nurse practitioners. Physicians will always be the expert in medicine, and nurse practitioners are filling in gaps in the healthcare system.

I was happy to see the American Academy of Nurse Practitioners (AANP) publicly defend nurse practitioners and asked the AMA to discontinue the #StopScopeCreep campaign. If you aren’t already, try to support the AANP by becoming a member. We need to unite as nurse practitioners to prevent the AMA from continuing to dispraise us.

For more information, click the link below to read the statement from the AANP in response to the #StopScopeCreep campaign.

Joint Statement on the Scope of Nurse Practitioners

Last year I had a couple of posts about a new nurse practitioner in Chicago that I was mentoring. I thought it would be nice to give an update on how she is doing since then.

In my previous posts I animated how the new nurse practitioner had a lot to learn and didn’t have much support from the physicians in her clinic. Since then she has registered in multiple boot camp courses to build upon her medical knowledge. She also studied for a few hours every day after work.

Besides asking me questions from afar, there were a couple of new physicians at her clinic that she was able to form good relationships with and go to them if she had any questions. As a result, her support network has improved.

She has been practicing at that clinic for over one year now and has come a long way. I am happy to report that she has excelled even beyond her fellow peers.

In her clinic of 4 providers, she has the top patient satisfaction scores and the top patient outcomes. This means she has been the most successful in keeping her patients out of the hospital and healthy.

I have also noticed her clinical knowledge has improved, along with her confidence. She doesn’t come to me as much with questions, and if she does, she typically already knows the correct answer.

I am proud to say she has graduated from her role as a novice nurse practitioner. I think it’s so important for new nurse practitioners to continue learning their first year working and find a mentor to guide them. 

It has been a while since I made a post based off a question from a reader. I had an interesting question from a reader the other day that I get quite often, so I figured it was time to share it.

Do you have consistent work as a traveling nurse practitioner?

It seems a lot of nurse practitioners are worried about having consistent employment prior to taking the plunge as a traveling nurse practitioner.

The answer to the above question is – yes. I have consistent work because I have formed relationships with recruiters in multiple agencies. When I am ready to start searching for my next assignment (usually 1 month prior to my current assignment ending), I will reach out to my recruiters. I let them know when I am available and what I am looking for. This allows them to keep me in mind when something opens up that meets my needs.

By having these relationships, the recruiters are constantly reaching out to me when they have new gigs. I try not to ignore them, and will let them know if I am currently not available or not interested.

I think the other important aspect is that I have at least 5 active state licenses at any given time. This makes me a good candidate for job prospects, as most clients aren’t willing to wait for you to become licensed.

As I stated above, I do have consistent work being a locum nurse practitioner. In fact, there are often many options from me to choose from at any given time. It also helps when you have been traveling for a while, because previous sites may often request you to come back. I like to use these as my back up options unless I am excited to return.

The reality is you have to be flexible. If you are only open to working in a certain city vs being open to working in the general state, then your options will be limited. In addition, sometimes the start date may be delayed a week due to credentialing or licensing so you should make sure you always have a financial buffer.

I have found that newbies are concerned about consistent work but once they start working as a traveling nurse practitioner, they realize their take home pay is more than their full-time job. As a result, they recognize that they actually don’t need to work 52 weeks out of the year. And enjoy taking time off to be with family/friends or travel abroad.

This year went by incredibly fast. I guess because most things that happen were halted by Covid such as traveling and celebrating holidays.

Finishing up my assignment in Florida, I interviewed for several assignments in California. I was looking for an assignment for November-January. Since it would be cold during those months, my options were limited. I had 3 offers from CA jobs that actually seemed great. However, I ended up turning them down because in the end I decided I just wanted to be home for the remainder of the year.

November is my birthday month and Thanksgiving. Even though I knew we wouldn’t have our usual 50-person thanksgiving dinner, I still wanted to be home to celebrate those occasions with family and friends. I had an incredible birthday, so I am glad I made the decision to be home for it.

Besides Christmas and New Year’s Eve in December, my older sister got married and my younger sister had her first baby. Thus, I had a lot of (positive) family things going on, and didn’t think it was worth traveling back and forth from California at least 10 times within 2 months.

After finishing my Florida assignment, I wasn’t burned out so I actually wanted to continue working. But after talking it out with people I am close to, I realized that I want to retire early so I can spend time with the people I care about. So why wait until I retire to do those things?

I was worried I would get bored with 2 months off, but between all of the holidays and festivities I was pretty busy. I even picked up a few per diem shifts helping out the Ft. Lauderdale, FL clinic I worked at previously 1 or 2 years ago.

I had a great end of 2020 and am looking forward to what 2021 has to offer. Happy holidays everyone!

This law passed in 2019 and went into effect 1/1/20. It was originally created to allow gig workers for Uber and Lyft to earn benefits as employees of their company. As a result, it affected other independent contractors and requires companies to reclassify them as employees. There were some exceptions such as physicians, but of course nurse practitioners and physician assistants were left out of this list of exceptions.

Unfortunately, that means nurse practitioners can no longer practice in California as sole proprietors. We can only practice there as W2 employees. That means, even an agency that usually pays their travelers as a 1099 contractor, now has to pay their employees as W2 workers when they work in California.

This has created a lot of problems for nurse practitioners in California. Many providers prefer working as a contractor because you are able to deduct a lot of expenses on your taxes. Several agencies teamed up to advocate for nurse practitioners and have them added to the exemption list. So far this has been unsuccessful.

Since I was looking to work in California for the beginning of 2021, I was interested in working through an agency that pays us as 1099 contractors. For the reasons mentioned above, this won’t be the case.  And since the agency will have to pay me as an employee, that means less pay since they are required to offer benefits. It also means that they can no longer provide me with a housing stipend, but only a reimbursement.

For one assignment, I was originally being given a $3500/month housing stipend. I was planning on renting a place that cost $2500/month and pocketing the rest. This will no longer be possible since the agency is converting all contractors to employees by 1/1/21.

Hopefully nurse practitioners can be added to the exception list eventually because this is such a disappointment and will defer myself and other nurse practitioners from practicing there in the future.

I started this blog over 5 years ago when I first became a traveling nurse practitioner. At that time, I couldn’t find much information on how to become a traveling nurse practitioner and how it deferred from travel nursing as an RN.

I decided to start blogging to document my experiences working in different settings and to help other nurse practitioners get started in traveling. I have also used this blog to vent about my frustration working in modern day medicine. I have to admit – it has been quite therapeutic.

Some of my close friends and family read my blog which I appreciate. And of course, there are hundreds of fellow nurse practitioners that read it too. I love getting feedback from you, especially if you’ve had similar experiences to me. Sometimes it takes someone working in the same field to get it…

I love receiving emails from my readers with questions or recommendations to get started in this arena. I especially like getting follow up emails months later when you’ve started your journey.

I’ve had many readers offer to meet up with me while traveling close to them. I usually travel alone so I deeply appreciate this warm gesture. It’s been nice to form a bond with other nurse practitioners just from having a similar interest in travel.

Thank you for your support and I am looking forward to many more years of blogging! If there are any topics you would like me to cover and revisit, please let me know in the comments below.