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In the spirit of Thanksgiving and the upcoming holidays, I wanted to reflect on how lucky I feel and how thankful I am for my life. Here are the top 10 things I am grateful for:

1. Travel – I love the opportunity I have to travel both for work and for leisure. My favorite part about traveling is learning new things and experiencing new adventures.
   
2. Family – I am fortunate to have such a large and loving family that I can return to in Miami any opportunity I get. Of course, they always ask me the same question: “when are you moving back to Miami for good?”
   
3. Friends – I am lucky to have a vast network of friends. Pretty much in every state I travel to for work, I already know at least one person there.
   
4. Being a Nurse Practitioner – What a challenging and fulfilling career. I am grateful for every step that led me to become a traveling nurse practitioner.
   
5. Health – Over the past few years I have made my health a priority and have managed to lose a significant amount of weight. I also make sure to stay physically active which helps tremendously with mental health as well.
   
6. Being an American – As corny as that may sound, freedom and liberty is priceless. I have had an opportunity to work in Saudi Arabia for a significant salary, but there is no price for freedom.
   
7. God – He always has my best interests at heart and continues to bless me on a daily basis.
   
8. Financial Stability – Being debt free, having little expenses, and plenty of savings is uplifting. This allows me to have a carefree attitude about life and allows me to feel like anything is possible.
   
9. Knowledge – I have read 25 books so far this year. I am thankful for knowledge that allows me to keep an open mind and see different perspectives.
   
10. Culture – I feel empowered being multilingual and having a cultural background to share with my peers.

What are you grateful for this year?

Nowadays, most people look up flights using google.com. You can find a one-way flight for half of the cost of roundtrip. Many years ago, it was cheaper to book a roundtrip flight than 2 one ways. Presently, you can find 2 one ways for the same price of a round trip flight.

We often automatically search for flights in economy, not realizing you can frequently find business/first class flights for the same price, cheaper, or only $20 more.

After negotiating my recent extension, I requested reimbursement for a roundtrip flight home for Thanksgiving. I knew the flights would be pricey since this is prime time for flying.

Looking for a one-way flight from Miami to Chicago on the Sunday after thanksgiving were pricing at $680 for economy. That’s pretty expensive considering I can fly roundtrip to Europe for $680 from Miami. Regular economy flights from Miami to Chicago are usually ~$150.

I watched the flight for several weeks with no change. Then one day I decided to check the business/first class flights instead. Surprisingly, I found one way flights from Miami to Chicago on the Sunday after thanksgiving for $650 in Business/First class! This was $30 cheaper than in economy.

I went ahead and booked the flight for business/first class. I submitted the receipt to my agency, and they reimbursed me the following week. Now I get to end an incredible Thanksgiving week flying in style!

Moral of the story: always double check prices in business/first class.

A couple of months ago, I shared my experience training one of the new nurse practitioners in the Chicago Market. We’ve kept in touch since then. She reaches out to me when she has a clinical question or just to say hi. Reminder: we do not work in the same clinic.

She voiced her frustration with the Assistant Medical Director (AMD) at her clinic, who is supposed to be her mentor. Instead, the new nurse practitioner feels bullied by the AMD. Apparently, the AMD told her she should consider quitting and working at CVS minute clinic instead because it would be much easier.

Fortunately, the Chief Medical Officer (in charge of all physicians and nurse practitioners, including the AMD) said he didn’t agree with this statement and the AMD had no right to say that. He met with the AMD and told her that it is her responsibility to make sure the new nurse practitioner is successful.

I was recently able to spend a day shadowing the new nurse practitioner and have noticed she has improved a lot. She has become more familiar with the electronic medical record system and is quite thorough with her patients. She has also gained more confidence in her medical knowledge, which is a result from her studying for hours each day after work.

We discussed ways she could improve such as trying alternative treatments prior to referring to a specialist for any little thing. She also needs to work on multitasking, such as typing and placing orders while patients are talking.

The most important thing I noticed was that her patients love her. Her patient panel is mostly Polish speaking patients since she is the only Polish speaking provider in the clinic. I think that’s enough reason in itself for the company to continue investing in molding her into a better provider.

I just wanted to give an update and let you know that the new nurse practitioner is doing just fine. A little reminder for you new providers out there – don’t give up and be sure to find a mentor!

Of course, I did! Minus the occasional work place drama between the other PCPs, I really like my job. I really enjoy taking care of my current patient panel. They are the nicest group of patients I’ve ever had! In fact, after my big trip, they were more interested in talking about my trip than their medical problems.

We have such a great relationship that they come to me for anything instead of going to the hospital. Prior to my trip, I even had 30 days of 0 patients in the hospital. This was a HUGE deal. Apparently, I was the only PCP in the market that had ever accomplished this.

Just a reminder all of our patients are 65+ years old with many co-morbidities, so out of a patient panel of 300-400 patients, there is usually at least one patient in the hospital at any given time. The fact that my patients avoid the hospital and come to me instead for any urgent issues means they trust me.

In fact, as soon as I went on my trip a bunch of my patients went to the ER for any little thing. The moment I came back they stopped.  To the point that I was able to once again, have another 30 days of 0 patients in the hospital! And it’s not because I have the least sick patients. There is a scoring system we use, and my panel is the sickest panel in my clinic.

Leadership was impressed so they gave me an extra bonus (not conditional to me extending).

Once I came back from my trip and realized I actually missed my patients, I agreed to extend. Unfortunately, the extension is brief, only an extra 6 weeks. This is because I need to get out of Chicago before it starts snowing like crazy (Miami native here).

There is a new physician starting this month to take over my panel. By me extending I am providing a warm hand off. It will take her 3 months to accumulate my panel but at least the patients can be stable by the time they get to her; and I can give her some insight into the more complex ones.

Some of my patients know I am leaving. They found out when they tried to get their relatives to transfer to me and the front desk told them I would be leaving soon. I joked with the patients that I was going to Miami for winter, as some of them are going to Mexico for winter.

I told them a new doctor that is also Spanish speaking would be taking care of them when I am gone. They said that’s fine but asked when winter is over will I come back and can they transfer back to me? I kindly smiled and said “we will see.” Because honestly, you never know.

I took almost 3 weeks off from work to go down-under. On my way to Australia, I stopped in Fiji to relax a bit before the big journey. The people are so friendly and I loved watching the sunrise.

First stop in Australia was in Brisbane. We mostly went there so I could visit the Koala Lone Pine Sanctuary. My childhood dream came true when I got to hold a koala! It was definitely my favorite part of the trip. I was able to watch tons of koalas eat, sleep, cuddle, snore, pee, climb etc. for hours!

We were also able to hang out with the kangaroos and feed them. It felt like feeding a dog. Both the koalas and kangaroos were friendly contrary to what people believe.

Afterwards, we went to Sydney. Sydney was much bigger than Brisbane but I actually liked Brisbane more. Brisbane still had a city aspect to it but was much more beautified (lights and flowers everywhere, public pool and beach at the parks etc.).

Of course, we saw a show at the Sydney Opera house and went to both Manly and Bondi beach. I had heard Australia was expensive but it was quite similar to visiting/living in the USA.  

Next, we visited Bali, Indonesia. We stayed at a wonderful resort and never wanted to leave. With my Hilton status, I was upgraded to a huge suite that had a separate living room area. This was beneficial when we had the group over and needed some privacy. The Hilton also provided free continental breakfast to me and all of my guests. It was literally the best breakfast we ever had. There was a buffet assortment of cuisine from the USA, Japan, China, India, Vietnam, Indonesia, and Europe.

I liked Bali because the entire island was decorated with temple like gates so it had a zen vibe. People were very friendly and everything was really cheap. We hired a driver for an entire day for only $50. For some reason I expected the Balinese people to be poor just because the cost of living was low, but truthfully everyone seemed pretty comfortable. Although they greatly appreciated any tips they didn’t expect any.

The food was so good! We got a taste of the Balinese jungle life by swinging into the abyss and visiting some rice terraces. My friends loved the monkey forest but there was no comparison to the koalas for me :D. Bali also has a bunch of beach clubs in the evening which are quite fun.

It takes several hours to get anywhere in Bali because traffic is so bad. So, I recommend staying in different areas for a few days at a time if you plan on visiting there in the future.

We ended the trip with a few days in Singapore. If you’ve seen the movie “Crazy Rich Asians” you know why. It was 90 degrees but luckily our hotel had an infinity pool with gorgeous views.  

My favorite part of Singapore was the Super Grove Trees. These are electronic trees that have a music and light show at night time. Just incredible! I also really enjoyed the cloud forest nearby which reminded me of Avatar.

We went to the rooftop bar at Mandalay Bay hotel, which also had a light show at night. Singapore was cool but it had that Las Vegas/Dubai vibe – where you feel like it’s not a real place.

After being in what felt like another life for the past 3 weeks, it was a bit tough returning back to the real world. Luckily, I gave myself a few extra days to recuperate from the jet lag. It took me a good 3 days to adjust back to our time zone. Just to put it in perspective, Australia is 16 hours ahead of East Coast USA.

What an amazing trip! I was so fortunate to fly the 20 hours from Chicago to Brisbane in business class using my miles. This is the only way I was able to sleep a good 8 hours on the way there. Let me know if you want to book a similar trip in the future and I can help you acquire the necessary miles!

My name is Scott and I have been working as a locums nurse practitioner for about 6 months.  I was turned onto the idea of Locums by the popular traveling ARNP herself, Sophia.  I met Sophia on one of her rounds in Lakeland, Florida, my hometown.  After working in a permanent position for almost 2 years, I was feeling burned out and ready for a change. I was not ready to commit completely to a new job so I decided to pursue locums instead.

My first assignment was in Pasco, Washington, working for a FQHC, one of my favorite types of work.  I was about as far from Florida as I could get, besides Alaska. During my assignment, I was constantly searching for the next assignment, making things a bit hectic.  I was fielding multiple calls, daily emails and texts, all while working.  As a locums, you always have to be on the lookout for your next position. While on assignment, I found myself networking and trying to keep busy when I couldn’t hop on a plane back home to family and friends. 

I was fortunate enough to negotiate a flight back home each month, paid for by the agency.  By far, this was the smoothest process and company I had worked for.  I literally had all options at my fingertips.  I said when I wanted to work and not work. I got to pick my hotel, rental company, and airline of choice. When I was offered the option to extend, they agreed to increase my hourly rate as well.

The Locums opportunity allowed me to see places I never could have being tied to a permanent job.  I explored Washington, Oregon, California, and even made it to Alaska, British Colombia, and the Yukon Territory. This experience also taught me that there are more work opportunities as a family nurse practitioner than there are for those of us that specialized in adult health. So, I decided to enroll in a program that would allow me to become a family nurse practitioner after studying (and completing clinicals) for an additional 6 months.

Aside from the experiences, travel, and new sites, I found myself getting homesick. While in school, I am going to be moving back to Florida to start a new permanent position. I am so very thankful for Sophia’s guidance, and tips for travel/credit cards. 

Working as a traveling nurse practitioner was a nice “break” and helped me rekindle my love for medicine. I hope my experience helps those consider working in locums during a transitioning phase in your life or career. 

Each quarter I will include a blog entry answering some of the most common questions I get from readers about locum tenens as a nurse practitioner. Feel free to comment any questions you have or email me at travelingNP.com@gmail.com.

“I am currently applying to nurse practitioner programs with an end goal of becoming a traveling nurse practitioner. Which specialty would you recommend pursuing in order to find locum tenens jobs easily?”

Great question! I have noticed there are way more traveling jobs for family nurse practitioners (FNP) than there are for adult nurse practitioners. As an FNP you can work in primary care, pediatrics, geriatrics, and women’s health. There are also tons of urgent care and ER positions that typically require FNP certification. I have seen my FNP peers find locum tenens jobs way more easily than my adult NPs. I also know some adult NPs that have gone back to school to become an FNP to open up their job options.

Another specialty in demand is psych NPs. If you have an interest in psychiatry I would recommend obtaining the extra certification. There is such a need and they pay well too.

Most people know I do not like to extend my assignment. I prefer new experiences and moving on. The longer I am at one job usually the more irritable I become.

Soon after I extended my time in Chicago, the Medical Director was already approaching me about staying longer. I told him I would let him know during the beginning of my last month whether or not I would extend. This is because I have no way of knowing how I will feel 2-3 months from now.

There will be a finite time of my extension because Chicago has harsh winters and there is no way I could survive that. There will be a new physician starting at the end of my original extension, so the site wants to make sure there is a warm hand off by me staying longer.

Although there have been a few nuances such as physicians calling off frequently or not wanting to share the patient walk-in load, I enjoy my job. The longer I stay at this site, the easier it gets because the better I know the patients.

I have already celebrated milestone birthdays (80 and 90 years old) with my patients. I have celebrated anniversaries and births of their grandchildren and great-grandchildren. I have been there for them during the death of a loved one or met with their family when it was time to go on hospice. I have already helped patients improve their diabetes, work on their anxiety/depression, and become physically stronger after surgery.

The patients already know me well and make jokes about when is my next vacation and how humid it must be in Miami right now. Even though I am one of the newest providers to the market, I actually have the best patient outcomes. This means I have the least amount of patients going to the hospital. For geriatric patients this is significant because it means less sick days and more healthy days with their family. I believe the reason my hospital sick days are low is because my patients trust me.

Thus, I feel like there is no reason for me not to extend. My only concern is that I do not want to get too attached to my patients the way I did when I was in Virginia the first time. But I think this time I will have less guilt about leaving because there will be a warm hand off with their new doctor. I have also learned to compartmentalize a bit better.

Have any of you extended beyond 6 months?

Over the past year I have obtained 3 new state licenses. Now that I am a seasoned travel nurse practitioner, I just ask various agencies to acquire new licenses for me upfront. This way they can help with the application process and cover the costs 100%.

I had one agency work with me to apply for a Colorado license. The process was fairly quick and painless. Since Colorado is a nurse compact state, I was able to use my Florida RN license to apply for the nurse practitioner license. This cut the application time in half, and it only took 1 month to become licensed.

The second license I wanted was between Wisconsin or Minnesota. I wanted to spend some warm months in the upper mid-west. Since Minnesota is not part of the nursing compact, I decided to move forward with the Wisconsin application instead. This license took a whopping 3 months to be issued. I also had to take a legal exam pertaining to the laws of the state. If you are interested in working in Wisconsin, give yourself ample amount of time to obtain a license.

The last license is the one I am currently using, which is Illinois. I had been offered a job here since January, with an April start date. Fortunately, with the agencies help I was able to get my license within 2 months, just in time for my start date. One thing I wasn’t a fan of during the application process was needing to have a supervising physician sign a separate controlled substance agreement. The form was titled “Application for Advanced Practice Nurse Mid-Level Practitioner Illinois Controlled Substance License.” Illinois is a reduced practice state but I feel like they could leave out the ‘mid-level’ part.

If you are new to locum tenens, I always recommend obtaining 2-3 state licenses on your own. Agencies are reluctant to license you without previous locums experience and you are more likely to get your first assignment if you are already licensed. Agencies will reimburse you for the cost of the license once you start working with them, so be sure to keep all receipts. Once you have worked your first 2-3 assignments, you can have agencies apply for licenses proactively.  

Almost half of my patients went on vacation during July, so my schedule was pretty open. I heard there was a new nurse practitioner at one of the other clinics that was struggling. I asked the medical director if I could help her out one day a week as long as my schedule allowed. Luckily, he thought it was a great idea. I was looking forward to helping a fellow nurse practitioner and having a change of scenery.

When I met the new nurse practitioner, she was ecstatic that I was there to help her. She confided in me that the other physician in the clinic was unapproachable and she felt alone. She struggled to find someone available to help her as needed. I understood her frustration and told her hopefully it would get better in the upcoming weeks when another physician returned from FMLA.

Fortunately, her schedule was still pretty light so we could take our time going through the motions. I shared some tips of approaching new patients (whether new to the clinic or new to her); considering I am constantly seeing new patients. For instance, I recommended she review all of her scheduled patients before the day started to have a plan in place. During this review, she can go ahead and order necessary INR tests, evaluate recent lab results, and consider any health screenings that are due.

Once the patient is made ready for her, I advised her to go ahead and start her note instead of waiting until she got in the room. This ended up being very beneficial for her because since English is her second language, I noticed she has a hard time typing on the electronic medical record while she speaks or listens to the patient.

Additionally, I taught her how to focus on the visits. Our patients come once a month and they are elderly. Thus, it is best not to change more than 2 things per visit or it may cause a lot of confusion for the patient. Hence instead of changing both blood pressure medication and depression medication during the same visit, just change one this time and plan to change the other at the following visit.

I observed that she had some gaps in medical knowledge. She has less than 1-year experience in a family practice environment, so I wasn’t surprised. She was used to seeing simple things such as cold symptoms and UTI. Versus a lot of our patients need treatment for co-existing chronic kidney disease, heart failure, diabetes, high blood pressure, coronary artery disease, osteoarthritis, depression, dementia – the list goes on.

I went through several scenarios with her in how to manage a patient properly. We discussed how to work up someone with chronic cough or acute abdominal pain etc. I reviewed pharmacology and initial treatment options. I recommended she do some reading after work and on weekends to review more chronic and complicated disorder.

Lastly, I mentioned to the medical director that she needs more mentorship so he said he will make one of the physicians at her clinic more available to her. She seemed overwhelmed initially but more comfortable by the end of the day with me. I told her she can reach out to me with any questions in the future. I’ll be sure to update you with her progress one month from now.