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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

My first week in Louisville, Kentucky I stayed in a hotel so I could check out some apartment options in person. I didn’t like the ones that were suggested to me through the agency because they were either really old, had wall a/c or heater units (which wont heat up the place well during winter), or were too far from work (too far being more than 20 minutes).

The physicians I work with had tons of suggestions, but most of the places they recommended did not offer short term rentals. Luckily, one of the places that was recommended to me offered 3 month leases and could furnish the place at a corporate rate. I ended up moving forward with this place because it’s on the river, so you have nice views and beautiful walking trails. It is also only 10 minutes from work.

The 1 bedroom/1 bath unit is also very spacious and modern. I liked the gym facilities and how the amenities room even has a piano. Most importantly the unit has a washer and dryer – something I have grown to appreciate the more I travel. And there is garage parking – which is something else I appreciate when living in cold weather because you wont have to shovel snow or scrape ice off your car.

Below are some pictures of my place. I always like to share my accommodations so other traveling nurse practitioners can know what to expect. Keep in mind even the towels, bed linen, silverware, TV etc are provided. 

One of the perks of being a traveling nurse practitioner is that I get to stay in hotels often. I don’t mind staying in hotels because I am able to accumulate hotel elite status and points. Hotel elite status comes with certain perks such as late check out, free breakfast, free upgrades etc.

I mostly use these benefits when I travel for leisure. In the past I have been upgraded to 2-bedroom suites; been provided with lounge access and continental breakfast; been able to check in as early as 6 am; and been able to check out as late at 4 pm.

My first week in Kentucky I stayed at the Residence Inn Marriott. I like staying at this type of hotel because they provide a kitchen. I typically stay at a hotel during my first week on an assignment while I check out rental properties in person.

I didn’t find an apartment I was interested in until the end of the week, so I wouldn’t be able to move in until the end of the following week. Thus, I needed to extend my hotel stay for an extra week. My agency told me that unfortunately, my hotel was sold out next week so I would have to move into another hotel.

Moving into 3 different places within 2 weeks isn’t ideal. I remembered that since I have the highest elite status with Marriott, which is Titanium status, that I was guaranteed a room as long as I booked 48 hours in advance. In this instance, it was more than 48 hours in advance.

So, I contacted the hotel and told them my case and they said as long as the hotel wasn’t overbooked I was correct. Luckily, they were able to find some space for me and I could even stay in the same hotel room. Having elite status with this hotel chain allowed me to secure a room even when they were “sold out” and prevented me from having to move again.

Do you have elite status with any hotel chains?

Since I needed to escape Chicago for winter, my current assignment offered me to work at some of their other locations. I ended up agreeing to work at one of their clinics in Kentucky because this is where they had the greatest need at the time. I wasn’t too excited about going to Kentucky, because what’s really there? I was mostly doing it as a favor to my job since they gave me several bonuses that I shouldn’t have qualified for since I am a contractor.

However, most of my friends that had visited Kentucky said it’s nicer than you’d expect. I also asked around and heard the physicians at the Kentucky clinics were more amiable compared to the ones in Chicago.

When I got to Kentucky, I immediately felt homesick. Somewhat for Miami, since I was there for a few weeks for the holidays. But mostly for Chicago. I felt weird thinking that I was going to be working in the exact same facility but with completely different people. I asked myself what I was doing here?!

Fortunately, my first day went well. My sources were correct, the PCPs in the Kentucky clinic were very friendly. The medical director even gave me a hug – she was so excited to see me! My schedule was empty so I offered to help the other PCPs with their patients but they all told me “no thank you”. And if they asked me to see a walk-in that belonged to the PCP that was no longer there, they asked me a hundred times if I was okay with it. They wanted to make sure I wasn’t overwhelmed, which was sweet. If only they knew how much I have previously put up with.

The best part is all of the PCPs seem to get along well. They make jokes together, talk about life, and even complain about patients together. I had gotten accustomed to the poor PCP relationships in Chicago, I forgot what it was like not to be in a toxic environment.

My boss from Chicago is currently also managing the Kentucky market. He passed by to see me on my first day which I really appreciated. He told me the clinic in Chicago I worked in is already going crazy without me, and he/they can’t wait for me to come back in Spring.

I am glad things turned out well in Kentucky because it’s too cold for me to return to Chicago at this time. I can handle the 50 degree weather in Kentucky, no wind, and the sun going down at 5:30 pm (the sun goes down by 4 pm in Chicago).

Over 3 years ago, I started working as a locums for a geriatric practice that only accepts Medicare advantage plans. This company has clinics throughout the USA and continues to grow. Since then I have worked with them on and off because I truly admire their mission, and I like being accountable for my patient care. My most recent experience with them was in Chicago. I thought I was only going there for 3 months but kept extending because I really enjoyed it.

On day 1, the medical director was confident that he could convince me to become permanent. I laughed it off because that’s always the intention of sites, especially considering that his particular company has been trying to get me to go permanent with them for years now.

Surprisingly after my last extension, I was open to a discussion with him about going permanent with them. I was upfront about how I had previous offers from the company that didn’t match my needs. The medical director was also aware that it would be impossible for me to survive winter in Chicago.

Part of the offer was that I could spend 9 months out of the year in Chicago, and during winter months, I could work at one of their other markets in a warmer state. That seemed like a win-win to me.

There would definitely be a salary increase to make it worth it since my housing and car would no longer be paid for. I would also be eligible for quarterly bonuses since the particular clinic I work in is part of a shared savings plan. These bonuses can be up to $10k per quarter. In addition, if I made partner, which I easily could if I continued the way I have been practicing, I would qualify for an additional $5k bonus per quarter.

There is no time commitment, unless I want a sign on bonus. In that case I would have to commit to 1-2 years, which doesn’t seem like much.  

I was actually open to accepting the offer, considering the job only gets easier with time since you get to know your patients so well. And like I have said before, I have a special relationship with all of my patients here. However, once again it came down to PTO. When the chief medical officer of the company previously made me an offer (years ago), he would only provide 6 weeks PTO. I am used to taking 10 weeks off per year, so I could at most compromise to 8 weeks PTO.

The market president had a hard time fathoming how I would be able to provide great care to my patient panel if I am gone for 3 months (working in another market) and then gone for another 2 months (on PTO). I know it sounds ridiculous but in reality, I had already proved it can work. I accumulated my patient panel after winter (3 months of the year had passed). And throughout the 9 months I worked there I was gone for 8 weeks total for vacation.

I was still able to have the best patient outcomes in the market. I always had the least (if none) patients in the hospital. I had the highest Hedis score in the market. I was the first provider to have 80% and 90% of my patients flu vaccinated. I placed the least amount of referrals. And I was able to code high risk diseases well to get my overall risk panel significantly higher.

Since we couldn’t exactly come to an agreement, we decided to do a “trial period”. I was planning on ending my time in Chicago at the end of December due to winter. So I agreed to help them in one of their other markets for the next 3 months. The plan is for me to possibly return to Chicago in spring and pick up my patient panel there. This is a “trial” to see if we can actually make this permanent plan work.

This plan may seem a bit crazy but I honestly wouldn’t mind continuing to work in Chicago with my current patient panel. The medical director desperately wants to make it work since my clinic profited tons of money over the past 9 months thanks to me.

Stay tuned for where I am going next….

Sadly, my time in Chicago is coming to an end. Saying bye to my patients has been tough. We honestly treat each other like family. Some of them I have seen monthly or even weekly over the past 9 months of me working here.

My sister laughs whenever I talk about how sad I am to leave my patients. I think it’s difficult for an outsider to understand the bond I have with the patients. We clearly have a strong bond because I somehow made it to 80+ days without any patients in the hospital which is unheard of at our company.

My supervisors are trying to figure out a way to reward me for this but I feel like they don’t need to. It’s my job and something I enjoy doing. I ended up getting 90% of my patients flu vaccinated so my team gets an extra PTO day and $200/person. That’s a nice benefit J

Fortunately, the new physician started and we have slowly begun transferring my patients to her. She is very sweet and pretty quick, which is something my patients will appreciate. I told my patients I may come back in the spring so that has made saying goodbye a little bit easier.

I am looking forward to going home for the holidays so I can be in the sunshine state. Cold, windy, overcast weather gets old after a while. Stay tuned for what’s next.

Do you tend use the same one or two agencies to travel with?

I always recommend being in contact with at least 5 or 6 agencies at any given time. This will increase your job options. To date I have worked with 7 different agencies. I tend to use some more than the others. Ultimately, I just select which agency to work with depending on the job available at that time. It may be tedious to fill out all of the credentialing paperwork, but it will be worth it in the end. 

I am often asked what my favorite travel assignment was. After working in over 20 different settings, it’s hard to pinpoint just one. I think I can narrow it down to my top 3.

Washington State. This was my first locums assignment away from home. I had such a positive experience. I remember the clinic being well run, the medical assistants being industrious, and the fulfillment I felt for taking care of an underserved population. Had my first experience away from home been bad, who knows, I could have easily quit being a traveling nurse practitioner.

San Diego. To be honest, I did not like working at this site. However, living in San Diego was an amazing experience. It is probably the only city I would live in outside of Florida. I like that it is diverse, not too crowded, and there is so much to do outdoors. I would love to return there some day.

Virginia. This was the first assignment that I extended and ended up staying there for 1 year. I really enjoyed working at this geriatric practice that allowed me to be accountable for my patients outcomes. I especially loved forming relationships with my patients. I even briefly considered staying there permanently! I have continued to work for this site in different parts of the USA.

What has been your favorite assignment so far?