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Many traveling nurse practitioners I know have given up their homes for a life on the road. They put the majority of their things in storage and pack up their car with the essentials. When they go back home for the holidays or vacation, they will typically stay with relatives or rent a hotel.

My situation is a bit different, in which I still have my home in Miami. I own my home with my sister, so we split the mortgage. I prefer to have a place to stay in case I feel like taking a month off in between assignments. Plus, I am close to my family and like to visit every 2 months or less. I also like keeping my items in one place so I can easily switch them out when I am home. Our mortgage is small, my half is the equivalent of a car payment.

We recently moved to another house closer to my sisters work in Miami. And we rented out our first property. The new house is under both of our names, but I am the only one on the mortgage. To qualify for the mortgage, I had to work continuously before closing because the bank wanted to see proof of income.

Initially, the process of obtaining a mortgage was challenging. Most large banks didn’t want to consider both my 1099 and W2 income as a qualification for the mortgage. It was one or the other. I eventually found some smaller mortgage lenders that were able to consider both incomes or even considered my 6 months of W2 enough income for the year.

Unfortunately, the larger banks thought of me as a high risk. After the 2007 mortgage crisis, it is no secret that qualifying for a mortgage is tougher than it’s ever been. The fact that my income isn’t consistent – some years I work more as a 1099 contractor, other years more as a W2 employee; scares them. The fact that I can deduct so many expenses being a traveler, lowers my adjusted gross income. I realized that this benefits me during tax season, but not so much when trying to qualify for a house.

They didn’t care that I had $0 in debt, no expenses, nor that I could make enough money to pay my mortgage in 2 days of working per month.

In this scenario, I had to write a letter explaining why I decided to work as a 1099 contractor at times (better locations or higher pay). In addition, my broker made me write a letter explaining my career and the demand for it. It even helped that I had 6 months of upcoming contracts in place. I was able to show proof of longevity.

It definitely helped that we were able to put 25% down on the house as well.

Thus, if you are considering purchasing a property in the distant future, my advice is to:

1. Save enough money for a 20% down payment.
2. Try to be aware of how much you are deducting at tax time. If your income in $120,000 but after deductions becomes $80,000 that might not help you qualify for a decent house in the future.
3. Use Fairway Mortgage. I have recommended them before and luckily, they consider both W2 and 1099 income so save yourself the hassle of qualifying with someone else. They have programs specifically for nurse practitioners.

Note: It is easy to get pre-qualified by any bank, but once it’s time to approve you for the loan that’s when they become strict.

I was able to use Comp Health as my employer – they even verified I was their employee when I was in between assignments from them.  They were so sweet, they even sent me a house warming gift!

Anyways, I just wanted to share my experience obtaining a mortgage as a traveling nurse practitioner. If you need help with the process in the future, feel free to send me an email!

This is my 4th time working for the same geriatric practice. I was a bit reluctant to start this new assignment because I was more interested in taking a break. But I had agreed to start soon after my last assignment as a favor to the company.

So far I have had a really good experience. The first time I worked with this company, I loved it and ended up staying for a year (in Virginia). The second time, I hated it because management was awful and it led to plenty of chaos (in Florida). The third time I returned to Virginia but worked at a different clinic. My experience was ok but I didn’t like it as much as the first time. I think because the clinic I was in had about 20 walk-ins (patients without appointments) per day. And the other providers had jammed packed schedules so I ended up having to see the majority of the walk-ins in addition to my scheduled patients.

The clinic I am working from in Chicago is pretty laid back. They only have 1 walk-in per day, which is such a relief. I don’t think the providers here know how lucky they are! My first day, the center manager and physicians took me out for lunch which was nice. I am also being scheduled with 40 min appointments to all patients new to me. The clinic is well run and organized so everyone does their job and I don’t have to back track. 

The majority of my patients are Spanish speaking. Most of them are just really happy to have a Spanish speaking provider. There are friendly and I don’t even mind them dramatizing their complaints.

The medical director wants to meet with me each week to make sure everything is going well, which I really appreciate. Of course, he wants me to extend for another 3 months so I think they are trying to flatter me and avoid making me feel overwhelmed. I actually wouldn’t mind extending but I’ll decide next month, when I am working at full capacity. 

I have been working as a locum tenens nurse practitioner for 4 years now. I recently realized that I have become so comfortable with jumping in and out of jobs for 3 months or less. Perhaps a bit too comfortable. To the point that I stopped inquiring about the orientation process prior to starting an assignment.

When I started my recent job in Tallahassee, Florida, I automatically assumed that the first day would be orientation. I was exhausted from just finishing another assignment the week prior. I thought my first day would be chill and figured I would start seeing patients the following day.

I was completely wrong! I arrived to the site and met the office manager, my supervising physician, and supporting staff. They got me set up with the EHR (electronic health record) and a laptop. I then shadowed the physician for a couple of patients and he showed me a bit around the EHR system. I started at 8 am and soon learned that my first patient was scheduled at 10 am!

I was a bit annoyed because I barely had time to get adjusted. I hardly knew the EHR system by the time I was seeing the first patient (it wasn’t one I had used before). Luckily, I didn’t stress myself out. I figured the easiest way to learn the EHR system is by actually utilizing it.

I definitely had tons of questions with each patient I saw, such as how to place orders and the correct process of doing things. I ended up seeing 7 patients on my first day, which isn’t too bad. I was able to have at least 30 minutes with each of them to get in the swing of things.

Although I felt cheated from having a proper orientation, by the end of the day I was over it. To be honest, I am such a locum tenens veteran that I really don’t need much time at all to dive into things.

Fast forward to my upcoming assignment in Chicago. It is a facility I have worked for previously, so I am familiar with their method of practice. However, I have not specifically worked in any of their Chicago clinics before.

Prior to starting the assignment, I texted the office manager to let her know I will be bringing my own laptop (they had me keep a work laptop from before), and that I would be able to start seeing patients on my 2^nd day. Imagine my surprise when she tells me that patients have already been scheduled for my first day!

I was somewhat annoyed because in my past experiences (the 3 times I have worked with this facility before), my login access is never ready that first day. Nor am I able to prescribe/dispense medications (they use an onsite pharmacy). I also think it would be nice to get acquainted with the clinic setting and meet my fellow co-workers, prior to getting started. In addition, it has been 3 months since I worked for them last, so I would like to review their guidelines to make sure I haven’t forgotten anything.

Side note: this facility isn’t your standard private practice. It’s a clinic that focuses on geriatric patients and keeping them out of the hospital. That means frequent visits, working on polypharmacy and primary prevention screenings etc. Some specific guidelines for the practice include making sure you check PTH labs with anyone with chronic kidney disease; or doing a fall prevention questionnaire for each patient at every visit etc.

I proceeded by telling the center manager that I usually don’t see patients on my first day. In fact, when I returned to Virginia the second time, they still gave me a 1-week orientation. Not that I need 1 week, but geez can I get a day?? I then asked her what time my first patient was and how many patients were scheduled. I figured if I had the morning free, that would be fine. And if it was a light patient load then I would have time to get adjusted.

The office manager told me that my first patient was scheduled at 8 am (we start at 7:30 am) and I had a full schedule. She said she blocked my first patient so I could get acquainted. Wow, a whole 30 minutes to get settled in – how nice!

Anyways, I learned from my experience working with them in Florida. Which is although I have a relationship with them, it would be best to go through my recruiter for certain things/issues. Thus, I contacted my recruiter and let her know they had me scheduled with a full patient load on my first day which is ridiculous. So, they will need to fix that, and if that’s a sign of them abusing me in the future, I will be putting in my 30-day notice ASAP.  

Just a reminder to myself and all of you seasoned locum tenens providers, don’t forget to ask about orientation BEFORE accepting an assignment! I am sure we can figure things out during a limited time span, but the whole point of working as a traveler is not to be stressed out!

My assignment in Florida finished quickly. I had an amazing time catching up with my previous college professors, mentors, and friends. I also spent plenty of quality time with my brother.

I was planning on taking a nice break afterwards but ended up getting persuaded to take another assignment right after.

The geriatric practice that I have worked for in the past in both Virginia and Florida asked for some help at one of their clinics in Chicago.  They wanted me to start as soon as possible, and this was back in January. I told them I wouldn’t be available until April and they said they would wait for me.

Of course, I wouldn’t be able to live there during winter anyways. Since I wasn’t sold about starting another job right after the Florida one, I decided to ask for more pay than previously, sort of hoping it would deter them away from having me. I told them my rate goes up $5/h after each year with them, and they said that was fine. They agreed to the new rate.

Fortunately, I was able to work something out with the Florida job, in which I finished 1 week earlier than planned. This allowed me to take a mini vacation. I went to Curacao in the Caribbean and got some much-needed rest and relaxation. Not to mention I was overdue for a tan. It is less than a 3-hour flight from Miami, and the water was gorgeous and warm enough to swim in.

Let’s hope I am reinvigorated enough to start my next assignment in the windy city!

My favorite hotel credit card right now is the American Express Hilton Honors Card. The current sign up bonus is earning 100,000 Hilton points after spending $1,000 within the first 3 months of card membership. That is a pretty low spend requirement for such a large bonus. The best part is that this card had no annual fee! So you can even choose to keep this card long term.

One benefit of this credit card, is it gives you instant Silver elite status. As a Hilton elite member, when you use points to book 4 consecutive nights at one hotel, you get the 5^th night free. This is quite a bargain!

What can 100k Hilton points get you? You can get 3 free nights in Orlando, FL if you want to take your kids to Disney world. What a major cost savor since everyone knows Disney can quickly break the bank. Or you can choose to spend your bonus points on 2 free nights in Barcelona, Spain. Or you can splurge on one night in the Maldives, with room rates going for more than $1,000 per night!

If you really want to make your points as effective as possible you can choose to spend 10 nights in Cairo, Egypt. No joke – each night in Cairo is only 10k points per night. Or up to 2 weeks in Vietnam at 5k points per night.

I highly recommend this card! By having excellent credit and from spending $1,000 in 3 months (that you were going to spend anyway), you are able to earn a substantial amount of Hilton points. These points can help save you hundreds if not thousands of dollars on your next trip. If you haven’t been able to travel much in the past due to costs, I hope you can start using credit card points to help enable travel in the future.

If you are interested in getting this card please use the link below to apply. This will make sure you are receiving the highest sign up bonus and will allow me to receive a referral bonus as well:

https://americanexpress.com/en-us/referral/SOPHIK4JFm?XLINK=MYCP

Before accepting an assignment, I personally like to think things through. But if you are a locum tenens nurse practitioner, you already know how quick the process is. Completing a phone interview and being offered the position can happen in as quickly as a matter of minutes. And usually the agency would like an answer right away. If you take a day to think things through, this makes both the agency and site nervous. They want to lock you into that position as quick as possible!

There is always that fear that you may start an assignment and absolutely hate it. Fortunately, in your contract you can give a 30-day notice and leave earlier than planned. But what if the assignment is so bad that you are afraid to lose your license? In this case, you can go ahead and break your contract. The site and agency won’t like it, but after all, you must think of yourself and your license first.

I have personally broken a contract before and know many other locum tenens providers that have too. The main issue about breaking a contract is that you open the possibility of the site not honoring your contract as well. For instance, they may not want to cover your flight back home anymore or will hold you responsible for fees encountered from breaking an apartment lease etc.

So to answer my original question: are contracts that official? Contracts are nice to have as an agreement but they are by no means 100% binding. However, there are some risks you encounter by breaking them. That is why I often like to stay at a hotel for the first week of my assignment so I can feel it out before agreeing on an apartment. I also like to keep a plethora of airline miles on hand in case I need an “emergency” flight home.

Now looking at the other spectrum, how easily can a site break a contract with you? They only can if there is a causative agent; such as complaints from patients or failure to comply with expectations. I have never been afraid of a site breaking a contract because I believe myself to be a good worker and in the rare case they do end the contract early, I know I have tons of other job options waiting for me.

Moreover, I believe the more established you are with the agency, the more flexibility there is with the contract. If you have been working with the same agency over several years and you break a contract one time out of those 5 years, there will unlikely be any repercussions. This means if the site doesn’t want to pay for your flight back, the agency will step up and go ahead and pay for it instead. This is when you know you are working with a great agency because they have your back!

Working back in Florida is always an eye opener. I am working at a private family practice with my supervising physician, covering a maternity leave. At this clinic in particular, nurse practitioners and physician assistants are expected to forward their clinical notes to their supervising physician to sign off on at the end of each day. Supposedly its to get a higher reimbursement rate from the health insurance plans.

This is definitely a first. I remember working in California (another state with restrictions for nurse practitioners), in which the practices there often required the supervising physician to review 25% of the nurse practitioners charts for the first month. I was fine with that because it seemed fair, being a new employee at the practice and all. However, having to send ALL of my charts to my supervising physician EVERYDAY is a bit ridiculous.

It feels weird having someone “monitor” my work. Fortunately, my supervising physician here is pretty great. He doesn’t criticize my work, considering every provider practices differently. Instead, he will give me an update on worrisome patients or a thumbs up when imaging matched my diagnosis (such as pneumonia or gallstones).

In addition to forwarding my clinical notes, the supervising physician is the only one that reviews lab results and imaging. Initially, I thought ‘great, less work for me’. But now I am finding it a bit of a nuissance because I don’t know what’s going on with the patients I am caring for. This practice isn’t what I am used to, where the physician has his own patients and the nurse practitioner has her own patients. Instead they just manage the same patient panel together. So technically the patients belong to the physician and the nurse practitioner is helping the physician care for his patients. That is why there is so much oversight here.

Of course, I am not a fan of this. Especially since I have worked in so many states with independent practice for nurse practitioners. I almost forgot what it felt like to be constrained like this.

As I said previously, luckily my supervising physician treats me as an equal. He will encourage teaching moments but will say “I am not sure if you already know this or not” without assuming I don’t. He also tells me almost everyday “you are doing a great job and I am glad you are here.” I prefer this generalization versus him telling me “good job with that case” because the latter implies that he is surprised or not expecting a nurse practitioner to give good care.

On the other hand, sometimes he disagrees with my follow up timeline or my choice of medication. I try not to get worked up about it because I know each clinician practices differently. And he doesn’t disagree in a “matter of fact” way but is more inquisitive as to what led to my decision based on my vast experience. I have also observed that he really cares a lot about his patients, so I don’t take it personally when he wants to change my plan of care. It’s a testament to his practice when patients travel from out of state to continue following up with him.

Initially, it really bothered me that I wasn’t practicing “independently”. That prior to completing a note I always second guessed myself to make sure my supervising physician wouldn’t have any feedback. I slowly became accustomed to it and I am fine with it since it’s only on a temporary basis. I have even started consulting my supervising physician a bit more since they are technically his patients.

This practice is interesting because it is my first time working in a private family practice where the majority of patients are part of the working population and are very well education. This means most of them have co-pays and rigid schedules. So if they come to you with cold symptoms and paid $20 for their copay, they aren’t happy when you tell them they don’t need an antibiotic. I feel like the demand for antibiotics here is the equivalent of the demand for opioids in low income populations. The patients are looking for a quick fix so they can get back to their jobs or practicing for the next marathon.

I remember a fellow traveler telling me she worked in a private family practice last summer and didn’t enjoy it as much as working with disadvantaged populations. I understand what she means now. This population isn’t as sick as what I am accustomed too. That means less of a challenge and therefore, less of an impact.

In general, I don’t have much to complain about, my day goes smoothly and the majority of the patients are pleasant. In fact, I typically finish an hour early and get paid for the full day. I just wanted to share some interesting observations as always.

Sometimes my friends and family will ask if it gets lonely traveling around the country by myself. I always tell them no. I also have tons of readers ask me if it’s easy to meet new people on assignment. I always tell them yes.

Fortunately, I have friends or relatives that live in almost every state. So typically, I will reach out to them when I take an assignment and we will meet up at some point. If we are in the same city, we will hang out quite often. Even though we don’t have the chance to talk on a regular basis, meeting up in person allows us to rekindle our friendship.

In addition, I am lucky because some of my friends or family from home (Miami) will go out of their way to visit me while I am on assignment. For example, my mom visited me in Washington, my sister visited me in California, my friends visited me in Maine, California, Texas, and Virginia.

Even if I didn’t already have so many friends and family, I would say it is quite easy to meet people while traveling. I have found my co-workers to be very welcoming and friendly. They invite me to their homes for holidays, on hiking trips, on their boat, or out for a simple lunch. I end up keeping in touch with a lot of my co-workers after I leave.

I wouldn’t say I am the most gregarious person but I effortlessly meet people outside of work too. I became really good friends with my landlord in San Diego. He was around my age and we hit it off right away. I have also had neighbors befriend me, strangers that approach me at the gym or when taking a class.

The GroupMe app is a popular way to meet people with similar interests as you. You can meet up for group runs, dance classes, or even book clubs! I have some friends that use tinder to meet people in each city they travel to. Others I know will volunteer or join a local church and meet people that way.

So those of you that are afraid to start traveling ‘alone’, don’t let that hold you back. You can easily make friends wherever you go. Nowadays, there are so many different outlets to meet people.

I ending up moving forward with the job in Tallahassee, Florida. Sure the extra pay was sweet, but the main reason I selected this assignment was because of my brother.

He just graduated from Florida State University in December. He had studied computer science, but like most of us after graduation, was still figuring out what to do next. He applied for jobs, internships, and is considering graduate school as an option as well. He planned on staying in Tallahassee during spring while he figured out his next step.

1. What an opportunity to spend some quality time with my brother before he has to move away to who knows where and become a working robot.

2. I thought it would be nice to offer some support to him and guide him through the process of figuring out his next step.

And 3. I found a way to support him financially through my job!

Typically, as a traveling nurse practitioner, the agency will find a place for me to live. Prior to accepting this position, I asked if I could negotiate a housing stipend instead. Originally, I was told I would be given a housing stipend to that equal of a hotel stay for a month (so about $2000-$3000 per month). I knew that was too good to be true, especially in a cheap place like Tallahassee.

Apparently, it was the clinics first time using a locums and had a very tight budget. When it was time to sign the contract they tried offering me only $1000/month for housing. I was able to negotiate them up to $1500/month for housing. Even though it wasn’t as much as I had hoped for, it was still more than enough to support my plans.

My brother is currently renting out a 1 bed/1 bathroom apartment for $450/ month, utilities included (that college life). My plan is to move in with him and pay for his monthly rental. In addition, I would give him an extra $500/month for the inconvenience, and pocket the other $500 for myself (for the inconvenience).

Inconvenience meaning, I am used to living by myself but now I will have to share a place with someone else. But it may definitely be worth the extra $1500 profit. Inconvenience for my brother because I will be taking over his bedroom while he sleeps on a mattress in the living room.

It is definitely a win for my brother because he won’t have to focus on working enough to cover his rent (he works part time at a local supermarket, and my parents are no longer paying for his rent since he graduated). This will allow him ample time to continue applying for jobs and look into graduate school. It is also a win for him because he is profiting an extra $500/month from really doing nothing, which he can use to cover other living expenses or save for his future move.

I figured I would be happy no matter where I ended up in Florida. But at least this way I can help out someone close to me J The funny thing is I always thought of this as an option, for when my brother started the transitioning phase. How astonishing that everything actually fell into place!

After finishing in Virginia, I thought about where I wanted to go next. Unfortunately, winter was back already and I knew I needed to hibernate in my own way. This meant it was time for me to return to Florida.

Florida is a tough market for locum tenens because there is a saturation of nurse practitioners. I have been lucky to find an assignment in Florida for the past 2 winters though.

I originally had 2 options in Florida. The first option was in Port St. Lucie, FL, 2 hours north of Miami. I thought that was convenient because I could easily go home for the weekend whenever I felt like it. The site was a clinic I had worked at previously, so I knew what to expect. That was definitely a plus.

My second option was in Tallahassee, Florida. This is in Northern Florida and where I went for my BSN (Florida State University). My brother currently lives in Tallahassee, so I was interested in going back there to spend time with him – along with some of my previous professors/mentors and friends. TI would be covering a maternity leave for 3 months. The physician in charge was pretty friendly and the patient per day ratio was fair (14-16 per day).

Am I the only person that really hates making decisions? Especially when my options are both equally as good.

When I thought things through, I wondered realistically how often I would actually go down to Miami if I lived in Port St. Lucie. A 2-hour drive could easily turn into 3-4hours during rush hour. Which is realistically when I would head down; right after work.

The Tallahassee position was initially paying $5/hour more than the Port St. Lucie job. I didn’t think that was a deal breaker, because after 12 weeks that only ends up being an extra ~$2000. Yet, once I mentioned I had another offer, the Tallahassee job increased their offer. So now they were offering me an extra $10/hour more than the Port St. Lucie job. After 3 months that’s an extra ~$5000.

Are you wondering which position I ended up choosing? I’ll explain which job I choose and the main reason I selected them in my next post.