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With the stay at home order, non-essential workers are forced to stay at home – whether they are able to work or not. As a result, plenty of my friends and family have tons of extra time on their hands. They are constantly asking me what I am up to and how I am keeping busy.

I have to remind them that I am still working. Although we are not seeing the majority of our patients in the clinic, I am still going to the clinic to do telehealth visits. My job wants us all in the clinic in case some of our patients need to come in for acute reasons (such as Congestive Heart Failure or COPD exacerbation). Thus, my week days are still as busy as before.

Even though we aren’t seeing as many patients in the office, many of them are constantly calling with questions all day. So, I feel more tired than usual when I go home after work.

With my free time, I have continued to be physically active. I take walks outside by the river. I also use the gym in my apartment building (there is typically only 1 other person in there).

I continue to read books, maybe at a quicker pace than usual. I can finish a new book within a week. Of course, I am binge watching TV Shows such as Ozark on Netflix and Outlander on Starz.

Every other weekend it is someone in my family’s birthday, so we all gather together on Zoom to celebrate. I have been catching up with my friends via text and phone.

I continue to work on my blog. I write entries far in advance. I listen to podcasts regularly: some about financial freedom, others about entertainment (such as the show The Bachelor).

I am an introvert so I don’t feel completely bothered by this social distancing. However, I have to admit that I do miss my family and friends and am looking forward to seeing them soon!

What have you been doing to keep busy during this strange time?

Most health care providers have been preoccupied with the coronavirus lately. Yet, last month Florida Nurse Practitioners received good news. Advanced registered nurses in Florida officially gained full autonomy!

The bill proposing independent practice for nurse practitioners was finally approved by both the House of Representatives and the Senate. Governor Ron DeSantis was quick to sign this bill into law. This has been something we have been striving for for many years.

Under this new law, nurse practitioners with at least 3,000 hours of experience under a supervising physician can practice independently. No more collaborative agreements with a physician after proving competency. This is extremely beneficial to nurse practitioners that want to own their own practice without having to pay a physician to just supervise them “on paper”.

I am really happy that my home state, Florida, is moving in the right direction when it comes to nurse practitioners!

I have really admired how well my current workplace has led us through the coronavirus pandemic. As soon as the coronavirus was spreading in China, my job formed a Covid19 committee. This committee kept us up to date with the most recent news.

Once the coronavirus started spreading in the USA, we prepared to start screening all of our patients via phone when confirming appointments. We put a ‘gatekeeper’ at the front door to check everyone’s temperature when walking into the building – both patients and employees.

We also converted the majority of our office visits to phone visits within a week. Since our patient population are all 65 years old or older with multiple comorbidities, they are high risk for complications from the virus. Thus, we needed them to stay home as much as possible.

My clinic meets on a daily basis about the coronavirus and the impact on our clinic flow. For instance, we learned how many test kits we have and when we should utilize testing. We discussed screening patients and when we should try management at home versus sending them to the emergency room.

In addition, we have weekly corporate wide virtual meetings to discuss the latest research findings about the virus and treatment options. Management has been clear about which employees can work from home and who needs to come into the clinic. They have been flexible with employees that need to work from home due to lack of child care or have health risks making them susceptible to the virus.

I respect that my job always has a plan in place and are quick to adapt. I have spoken to a lot of my friends that also work in healthcare, and how there has been limited guidance from their jobs. Many people think that healthcare is a secure career during this time, but actually it is not.

Many physicians have had to close their offices as non-urgent visits and elective surgeries are cancelled. These offices will remain closed for an indefinite period of time. As a result, there will be limited income for both the practice and their employees.

I have a friend that is a Dentist who was furloughed. Other peers that are specialty physicians were let go from their practice. Not to mention many older internists resigned from the hospital due their risk of health complications from the coronavirus.

I believe there is only security in the healthcare field if you are a nurse or physician that works in the hospital and does not rely on elective procedures. I have seen the demand for RN’s in NYC increase drastically. They are willing to pay ICU travel nurses the income of a physician!

Since my current job does not practice fee for service care, we are financially secure. We bill through Medicare advantage plans. Meaning we are paid a lump sum of money per patient per quarter from the health insurance – not per visit. In that case, we are able to manage our patients virtually and still profit from that. In fact, the profit from last year is already on hand to pay for costs of this year.  

I have been really impressed working for this company during such a time of chaos. The fact that they are also financially secure, and will not be laying off any of their employees is a plus. With the inevitable recession coming, I may have to rethink my work goals. 

In my previous post, I talked about some options I was considering for my next assignment. In reality, as the coronavirus continued to spread in the USA, I felt like I couldn’t make a decision until the very last minute. That meant my option working in the retail health clinic was out the window, because credentialing takes about a month.

I declined the offer to work at the community health center in San Diego, as I mentioned in my previous post, I was not interested in returning there. Ironically, they were begging me to accept the offer.

That left me with two last options, a primary care office in San Diego and a community health center in Chicago. The week prior to my current assignment ending, I started wondering if it was a bad idea to travel at all. I knew my current assignment would be open to me extending, since they didn’t have a new provider coming in to take my patients until summer.

Originally, I absolutely declined their offer to extend my assignment in Kentucky. Both the complexity of the patients and their “sour” attitudes had me looking forward to the end of my assignment.  

Once the coronavirus reached Kentucky, we converted the majority of our appointments to phone visits. If I decided to extend, the job would be somewhat easier since there would be few face to face visits. I figured the easiest thing to do was extend my time in Kentucky.

When I followed up with the primary care office in San Diego, they no longer had a need because I was initially going to be covering a PCP military leave. Due to the covid 19, all military travel was cancelled. I also inquired about the position at the community health center in Chicago. They were still trying to figure out how they were going to proceed with visits so could not confirm if they wanted to move forward with the assignment.

Overnight, my traveling options were no longer existent. I thought about just going home (to Miami) like I had originally planned at the end of this assignment. Although it would have been nice to be close to family, I knew I would go stir crazy being stuck at home due to social distancing. It was also impossible to tell how long social isolation/state shut downs would last. Thus, I didn’t want to be out of work for more than a month.

I contemplated going back to my last assignment in Chicago, where I had a panel of patients I wanted to return to. But there was no point in going back there just to do phone visits. And again – this would require me to travel.

In conclusion, I decided to extend my assignment in Kentucky for another month. I was a bit worried that my job would decline the extension, thinking that anyone else could simply cover my patient panel by doing the phone calls. Yet, I think the phone visits would be challenging for a provider that didn’t know my patients already. My job agreed to an extension and the other PCPs were happy I was staying. I also had an extra month left on my apartment lease that the site would be responsible paying for whether I stayed or not.

I am not sure what will happen once my extension ends. I am taking it day by day just like the rest of the world. But I am grateful to be able to continue providing care to such a vulnerable population.

This post isn’t about the threat of the coronavirus and what you should be doing to protect yourself and others. This post is about how the coronavirus has affected my life specifically as a traveling nurse practitioner.

I was working during my last few weeks in Kentucky when the coronavirus became a global concern. My first worry was that I wasn’t going to be able to go to Europe for spring as I originally planned. I was in much need of a vacation so was very bummed about limited travel. Not only was there a ban on travel from Europe, but museums and tourist attractions would be closed in those countries anyways.

The more time passed, the more of a threat the coronavirus became in the USA. I started wondering what this would mean for me as a traveling nurse practitioner. They started cancelling large events, NBA games, and even closing restaurants and bars. Trying to contain the virus, there is so much up in the air.

As I searched for my next assignment, I felt like I couldn’t commit to a particular assignment at the moment. I was unsure if by the time I became credentialed they would limit domestic travel or even quarantine certain states. I also started becoming nervous about finishing my current assignment.

Would I be stuck in Kentucky for an indefinite amount of time? Will I be able to travel home in Miami to at least be with my family during such a questionable period?

As a traveling nurse practitioner, I don’t buy things in bulk. Meaning, I don’t go to Costco and buy tons of food for a month. Since I am always transient, it makes more sense to buy a little at a time. As a result, I wouldn’t be prepared if I had to self-quarantine for 14 days. When I had two weeks left with my current assignment, I did make sure to buy enough food for two weeks. But if I somehow got stuck here for longer, I hope I will be able to find items that I need since the grocery stories continue to be practically empty.

This virus has also led to economic repercussions, due to cancellation of flights, hotel stays, events, and small businesses. Fortunately, in healthcare there will always be a job for me. Yet, with so much unknown going on between the spread of the virus and risk for going into a recession, transitioning to a permanent job is looking more attractive to me. 

It has been over a year since I have had a phone interview. This is because I kept extending when I was in Chicago and ended up working at the same place for 9 months. Then my next assignment was with the same company in their Kentucky location, so there was no need for an interview.

Fast forward to now, in which I am in the process of looking for an assignment for the spring. I am used to interviews being brief and the offers being quick. Surprisingly, the few jobs I have chosen to interview for haven’t been that efficient. At one given time I was considering 4 locums opportunities.

The first job was for a retail health clinic. In this case, the interview was pretty quick and they made an offer right away. The second job was a family health center that doesn’t use locum tenens providers frequently. This was apparent when during my first interview with their HR representative, he wanted me to verify if my Medicaid number was active in that particular state (a state I had worked with previously and billed for Medicaid). He clearly isn’t aware that I do not do my own credentialing for insurances.

That same job requested I have a separate interview with their medical director. In my head I was like – really? Two interviews?? I guess I have been in the game for too long because I am spoiled with the typical one brief phone interview. Not to mention that they requested this phone interview be done over facetime. After an exhausting day of work, I am not trying to look presentable over the phone. I was against the facetime call mostly because I do not want to be pre-judged. Since I look younger than I am, I feel like I often have to prove that I am ‘smarter’ than I appear.

The third job, was actually for the community health center I had worked previously in San Diego, CA several years ago. If you have followed my journey, you may recall that I didn’t particularly enjoy working there. However, I did love living in San Diego! My recruiter told me she doubted they would even need an interview from me.

I wasn’t too surprised when I learned they did want an interview, since I last worked there 4 years ago. The first interview was with someone from HR. I was a little turned off when she told me new patients are scheduled at 20 minute visits. And even more turned off when she mentioned that they expect you to see walk-ins during no-show appointment slots. In that family health center, there are ALWAYS walk-ins.

She then wanted me to interview with a few clinicians on a later date. I considered cancelling because I was already unenthusiastic about the job. But I decided to move forward with the second interview to keep my options open.

I have never been so humiliated during a phone interview! During the second interview, I was asked if I spoke fluent medical Spanish, in which I replied yes. So they gave me a patient scenario and had me respond in Spanish as if I was speaking to the patient. I was appalled! I am a nurse – the most honest profession there is. Why would I lie about speaking another language?

Then they proceeded by asking me clinical questions. For instance, giving me various patient scenarios and asking what I would do. I reluctantly answered their questions but couldn’t wait to get off the phone. Not only had I worked there previously but have also worked in over a dozen other places since then. So I am positive I am a competent nurse practitioner.

Luckily, my last interview went well. It wasn’t a scheduled interview. In fact, the HR manager called while I was at work, and I called him back when I had the chance. This isn’t my preference but each place functions differently. The HR manager was very friendly and appreciative. He also requested a second interview with some of their physicians. This second interview kept being delayed because of the time difference and the physicians were always behind schedule.

They finally reached out to me on a Sunday evening unexpectedly. Once again, not ideal but I appreciate the physicians being welcoming and not grilling me like the previous interview.

I forgot it can be a full-time job doing all of these phone interviews. Any interesting interviews you would like to share from your locum tenens experience? 

The patients from my clinic in Louisville, Kentucky are the most complex patients I have ever seen. A new patient will easily have 30 diagnoses and 20 medications. These are geriatric patients where the majority of them still smoke. There is a lot of substance abuse, including cocaine and alcohol. The patients also have poor living situations, with plenty of them coming to the clinic with either bed bugs or roaches crawling on them and their belongings.

It’s been quite challenging caring for this population because of their social issues. Fortunately, we have an amazing social worker and case manager that help support them. The patients come from poor socioeconomics backgrounds and unfortunately do not take care of themselves.

As far as medical illness, lets just say everyone has Heart Failure, COPD, Chronic Respiratory Failure, Coronary Atherosclerosis with Angina Pectoris, Chronic Kidney Disease, Hypertension, Hyperlipidemia, Major Depression, Hepatitis C, Polysubstance Abuse, Major Depression, Chronic Pain or Osteoarthritis etc.

I saw a patient that was 2 weeks post-op for a small bowel obstruction and incarcerated ventral hernia. Apparently, she never cleaned the wound, refused to let home health into her home, and continued to smoke. By the time I saw her, her wound had reopened, there was a large amount of purulent drainage, strong foul odor you could smell a mile away, and dead tissue surrounding the wound. She absolutely refused to go back to the hospital where she had the surgery. She blamed them for her complicated wound.

I gave her some antibiotics and told her I would see if another surgeon would see her, although I knew it was doubtful. She wanted to leave because she needed to get to work (yes with that horrible wound), so I made her follow up the next day. Within 1 day the wound was 5x worse and of course no other surgeon would accept her. Luckily, I was able to convince her to go to the emergency room where she had the original surgery because she clearly needed debridement and IV antibiotics. Of course, it took a 20-minute conversation to convince her. I had to scare her and explain that she will eventually get peritonitis and/or sepsis and die.  

We offered to call an ambulance for her but she insisted that she go home and eat first. I was flabbergasted that she even had an appetite with that foul smelling wound. The entire clinic reeked after she left. Eventually she made it to the hospital and they took her to the OR for immediate surgery.

This is just one example of the type of patients we have. A lot of them have attitudes. One lady started yelling at me just for suggesting she start taking a medication for diabetes. And when I offer them the flu shot, they don’t proceed with the usual “no thanks, I had problems with the flu shot before.” They literally raise their voice and start yelling at me about how they wont take the shot and a 5 min ranting fest of why not. I won’t even mention the challenges of weaning them off opioids or declining to refill their narcotics. Let’s just say there is a reason gabapentin is a controlled substance in the state of Kentucky.

Although taking care of this patient population has been exhausting, I have learned a lot. It also makes me appreciate how good I had it with my patient panel in Chicago. I continue to be impressed at how the physicians at my clinic care for their patients despite all the above challenges.

In my last post, I mentioned a brief issue with my current assignment. In this post, I want to talk about the good things about my assignment.

First of all, I have been surprised about how cultural Louisville, Kentucky is. There is a diaspora of Cubans here, which is a nice comfort being away from home (Miami). Most people, including myself, expect Kentucky to be country. But since I am in the northern most part of the state, it is barely country to me. I have barely heard any accents at all. The people are absolutely lovely. Strangers say hi to me all of the time!

I appreciate living in a decent size town that does not have much traffic. I even appreciate having Kroger’s Supermarket, which is the closest thing to Publix (if you’re from Florida you understand). Chicago’s grocery stores were awful. I like Publix and Kroger’s because you can find everything you need in one store instead of having to go to multiple stores.

At work, I have already mentioned several times how great the physicians are. Not only are they nice to me but they do a really good job taking care of their patients. The patients at my clinic are very complex. More so than the ones at my clinic in Chicago. Their complexity reminds me of the patients at my clinic in Virginia (same company). However, in Virginia, there were always at least 15 patients in the hospital at any given time (from one clinic). Here in Kentucky, my clinic only has about 5 or less patients in the hospital at any given time. Which I think is amazing since these are some of the sickest patients I have ever seen. This shows how much the patients trust their PCPs and how much their PCPs care about them.

I have also noticed that the majority of the patients are still smoking. Some days it feels as if 75% of them are still smoking compared to the usual 10% I am used to. I heard that Kentucky is the 2^nd highest state with smokers in the USA. So that makes sense why these patients are so sick.

Anyways, back to my work environment. All of the staff are very friendly. From the front desk to the referrals team – everyone makes sure to say good morning or ask how your day is going. Sometimes it’s nice to get away from big cities, even for just a short period of time. 

Now as far as what I have been doing on my free time…

Kentucky has a forest with over-sized wooden trolls! They are from the same artist from the arboretum I visited in Chicago! I love places that have cool walking paths. Kentucky is also home to Mammoth Cave National Park. This park contains the longest cave system in the world.

Louisville itself has some cool landmarks too. I checked out the Muhammad Ali Center which was interesting, since he was born here. Of course I passed by Colonel Sanders Grave – hello Kentucky Fried Chicken. I also visited Thomas Edison’s house, the American inventor.

As usual, everything seemed great in the Kentucky clinic in the beginning. Within my first week, I already noticed the medical assistants were slower than I was accustomed to. It became unbearable when my new patient waited an hour just to be brought into a patient room. I was busy seeing patients at this time or else I would have asked my medical assistant or the nurse in charge ‘what’s going on’. Usually new patients get all of their work up before the provider sees them such as labs, EKG, and other screenings. These can take up to an hour, so normally it would have worked out to have these completed while I was seeing the other patients.

I ended up not getting a lunch that day because by the time they brought back the new patient it was 12pm. I was livid. In Chicago, even days I didn’t have a medical assistant (for one reason or another), I still finished on time because everyone worked as a team to make sure my patients were brought back. There didn’t appear to be that sense of team work here. The medical assistants (not just mine) worked pretty slowly. I have worked for this same company in 5 other clinics, but this is the first time that I had ever seen a patient wait 1 hour to be brought back after being on time for their appointment.

I sent an email asking my boss if the nurse lead in my Chicago clinic could come help out for 1 week to show the nurse and medical assistants here how to be more efficient and work together as a team. He was all for it. This is something I have seen a lot, one market supporting another market.

Once he forwarded it to the Kentucky leadership though, all hell broke loose. Apparently management was upset that I made them look bad. Because obviously if a patient is waiting an hour to be brought back, that means the medical assistants aren’t doing their job; the lead nurse isn’t doing his job; the clinic manager isn’t doing his job, nor is the front desk doing their job. Of course, I had mentioned this problem to all of the leaders at my clinic (medical director, lead nurse, and clinic manager) prior to sending the email, and they admitted it was an ongoing problem. In fact, they said they were happy an outsider noticed. But the moment that they “looked bad” they were upset that I said anything at all.

The email wasn’t even to complain about the clinic. It was really to offer a solution.

The clinic manager and lead nurse had a huddle with the medical assistants to talk about the incident. I noticed since then that they have been working more together and patients are being brought back much quicker. Since then, the clinic manager asked me how everything was, and I told him everything was good. He then asked if I could send a follow up email letting everyone know things are good and we no longer need help. I said no I would not be doing that, because I think the team would still benefit from having the Chicago nurse help them.

I was annoyed by that request because everyone only cares about saving face. And I was starting to think they didn’t like me for speaking up. My boss called me the same day and apologized for everything getting blow out of hand. He also said that the clinic manager told him I am requesting 40 min for follow up patients and trying to finish by 3:30pm (we finish at 4:30pm), which are both absurd. I only requested 40 min appointments for new patients to me (which is the norm) and I said I want my last patient scheduled at 3:30 pm because by the time I finish that 40 min appointment it will be 4:10pm, and I can complete my workflow with the remaining 20 minutes.

I told my boss I obviously have a target on me ever since I mentioned the above incident, and was wondering if I should even bother staying. He said not to worry that he will take care of it. I was a bit sad thinking about leaving because the physicians here truly are so great. They care enough to ask about my personal life and invite me out. They’ll even offer to see a walk-in that the medical assistant was asking me to see since I have the most flexible schedule.

Later that day, the entire Kentucky leadership team met with me to see how things are going. We revisited the above incident and they agreed that no patient should ever wait 1 hour to be brought back. They informed me I will be having the same medical assistant from now on to make sure there is a good flow, and if any issues arise, to inform the supervisor of the nurse/medical assistants.

I also brought up some scheduling issues and the clinic manager said he will make it his duty to make sure my schedule is correct on a daily basis.  Everyone was really positive and supportive. They kept mentioning that they are so glad I am here to help. And they would love for me to consider staying longer than the 3 months…..

Since then, things have run more smoothly, but I do still wish the medical assistants could work faster.

I want to end this post by saying I already know not to expect perfection in any place I work. But it is sometimes challenging being a locums nurse practitioner because I have often worked in “perfect” places before, so I know it is possible. Thus, if I can suggest a way to make things better, I will definitely speak up. It’s funny to think that working in the Chicago clinic was nearly perfect – minus the toxic physicians. On the other hand, the physicians in Kentucky are amazing but the clinic itself isn’t the most organized/well run.

My job had us all take a Happiness Survey prior to a “wellness” meeting. Some of the physicians took the survey and most of them got  a “C” or less. I took the survey and got an “A”. An “A” means I am very happy. The physicians joked that of course I am happy because I get to travel and work in different places for 3 months and move on.

The survey asked questions related to 3 topics to get our score. The first topic was about Purpose. It asked questions about your passions, sense of meaning and connection. Some questions included if you set goals for yourself and work towards them. If you feel your work is fulfilling etc.

The second topic focused on Pleasure. It asked questions related to your everyday positive emotions and experiences. The third topic was about pride. It asked questions to assess your level of satisfaction in the major areas of your life.

I thought about possible reasons the physicians scored so low. I think some reasons were because the survey asked how much time off do you take for vacation. I take 8 weeks or more off a year, and the physicians take off way less. It also asked if you meditate or do yoga. Most of the physicians are too busy for these kinds of things. I don’t necessary meditate or do yoga, but I do read a lot and I think it provides the same experience for me that mediation does – which is relaxation and reflection.

Other questions asked about how many friends can you call if you have an emergency, I was lucky to have at least a dozen friends for this. It asked about being fulfilled at work, which I definitely feel. The survey asked about volunteering which I have always been active in. It asked about level of physical activity, and I try to work out 5 days a week for 1 hour when I am not on vacation.

Furthermore, the survey asked about positivity and outlook on life. I am definitely not the most positive person in the world, but I have a sense of being grateful. So I don’t let the little things phase me and I tend to have a very calm persona.

The test asked some financial questions as well. For instance, one question asked if you can afford to take 1 year off from work financially, which I answered yes. Even though physicians make a lot of money, most of them have a lot of student loans to pay off and family to support. That may have contributed to their lower score.

You should take the test via the link below and let me know what grade you get!

https://apps.bluezones.com/en/happiness