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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.

I have had some readers ask me what is the #1 travel credit card I would recommend. My answer is always the same, which is the Chase Sapphire Preferred Card. It has a $95 annual fee but the initial sign up bonus is 60,000 points after spending $4,000 within the first 3 months. The 60,000 points can be worth way over $1,000!

The reason this is my go to card is because it provides car rental insurance if you pay with this card. I also like the transfer partners this card has. For example, I can transfer points to Hyatt or Intercontinental, United or Southwest etc.

My favorite way to use these chase points are to transfer them to British Airways. British Airways is a partner of American Airlines. So, I am able to fly roundtrip from Miami to Haiti for 15,000 British Airways miles on American Airlines. This round trip flight typically costs $500-700 out of pocket, so using miles is a no-brainer.

I also like transferring chase points to stay at Hyatt hotels. In Hawaii, the hotels typically cost $400/night. By transferring 20,000 of my chase points to Hyatt, I am able to stay one night for free. For instance, if I used my 60,000 chase points to stay at a Hyatt hotel in Maui, I would be able to save $1200 of cash for the 3 nights. 

This card also provides trip cancellation insurance. If your trip is cancelled due to sickness or severe weather, you can be reimbursed for pre-paid nonrefundable expenses. In addition, if your baggage is delayed by 6 hours or more, you can be reimbursed up to $100 per day until your baggage is delivered to you. This $100 credit covers purchasing new clothes, toiletries, or other important items missing from your bag.

While on assignment, some agencies may provide an apartment for you to live in.

Before you move in, be sure to complete the check list of the condition of the place. I highly recommended taking pictures of the apartment upon move-in and when moving out. I have read many stories of apartment buildings trying to charge tenants for damages to the unit that were previously there. I never thought much of it until one of my friends had a similar experience.

My friend has a dog so she had to pay a pet deposit fee to the property she was living in. When she was moving out, her apartment was in perfect shape. However, a few months later she contacted the agency to find out if she would be given back the pet deposit fee. The agency housing representative told her that the apartment management kept the pet deposit fee due to the condition of the unit.

My friend was surprised and asked them to send her pictures of unit. Through the pictures she saw that there was some floor damage, wall scruff marks, and dents on the front door. These were damages made by the moving crew for the rental furniture!

Unfortunately, my friend was unable to provide pictures of the unit on the day she moved out which would have showed the apartment was in better condition. As a result, she lost her $400 pet deposit fee. The moral of the story is to always document everything!

I decided to extend my stay in Chicago because it’s an awesome city! Over the summer there has been a festival almost every week; for example we had a jazz festival, bar-b-q festival, international movies etc. I love going to the various parks for bike riding or long walks. Biking on the lake shore trail with a view of Lake Michigan is beautiful!

There are countless museums. The Art Institute of Chicago is a must. They have the famous “American Gothic” Painting, and many impressionist works of Van Gogh and Monet. I have also enjoyed the Field Museum, which has dinosaur skeletons and immersive cultural experiences.

The night life is great too. I have had tons of fun going to roof top bars and dancing. I also like the variety of food options here. I made it my mission to find the best deep dish pizza, and after trying 6 different places, I have decided my favorite is “Lou Malnati”. My other guilty pleasure is this Mexican ice cream shop called “La Michoacana”. My go-to is the home made mango ice cream, and you can find these shops all over Chicago.

It’s safe to say there is so much to do in Chicago and I highly recommend it as an option for your next travel adventures. I wouldn’t mind living here permanently if they didn’t have such brutal winters. 

This summer I am celebrating working over 4 years as a traveling nurse practitioner. So far I have worked at more than 20 different sites. If you follow my blog I am sure you are aware of all of the ups and downs throughout this journey. I thought it would be fun to share the top 5 reasons I still love working as a traveling nurse practitioner.

1. Flexibility – As a traveling nurse practitioner, I can choose to take a month off at a time if I feel like it. I don’t have to work holidays if I don’t want to. I can decide if I want to avoid working weekends or if I prefer a 12-hour schedule.
   
2. Traveling – Exploring the country has been a tremendous amount of fun. I also get to catch up with friends and relatives in numerous cities. Not to mention accumulating miles and points from traveling for work has allowed me to travel abroad on a regular basis for nearly free.
   
3. Increase in Income and Savings – Working in locum tenens I am paid higher than I would be working at a permanent job. I also do not have a car or house payment so my expenses are less than your average worker. As a result, I am able to save at a fast pace and who knows, maybe I will retire early.
   
4. Learning– The learning curve while being a traveling nurse practitioner is astounding. Between working in various types of facilities to caring for different patient populations, I am always kept on my toes. For someone that loves to learn, being a locum tenens provider has taught me so much.
   
5. Freedom – There is no better feeling than working at a place you don’t “need” to be at. Knowing you can quickly find another job if you aren’t happy or appreciated at your current job unloads a burden that most employees have. In combination with having a bulk load of savings to fall back on, I always have the mentality that the site needs me more than I need them.

I went down to Miami to celebrate my grandfather’s 80^th birthday last month. We threw a party for him and he had a blast! While I was down there, I decided to spend a few days in the Bahamas. It’s less than an hour flight from Miami.

I went with one of my best friends and we stayed at the Atlantis Bahamas which was amazing! From our hotel room we could see the stingray pool and the floating river. The beaches were even better than I remembered (I have been to the Bahamas many times before). The water was so clear and various shades of blue.

On the property we were also able to see turtles, aquariums, and go on a water slide through a shark tank.

One of the days we took a jetboat to a private island where they have pigs on the beach. I was really excited to see the pigs. Although they were super cute and fun to feed, the reality was that they were pooping everywhere none stop. On this same excursion, we went snorkeling and were able to feed stingrays. Our guides caught some conch shells and made a fresh conch salad for us which was delicious.

It was a quick getaway to paradise but so worth it. The Bahamians are such nice and friendly people. If I lived in Miami permanently again, I would go back to the Bahamas once a month! Do you have any plans for the summer?

A few years ago, I wrote “Conflict in the Workplace”. I decided it was time to touch upon this subject again. Sadly, I have noticed that sometimes when you are the “new” provider (new to the site), you sometimes have to go through a hazing process. This process consists of the older providers taking advantage of you. Forcing you to see all of the walk-ins and helping them if they are behind.

When I first start working somewhere, the first few weeks are a bit slow since my schedule isn’t fully open yet. I am more than open to helping the other providers with their workload. However, my pet peeve if being taken advantage of!

My current work setting consists of 4 female physicians and myself. 2 of them have been there the entire time the clinic has been open, and 1 of them is new. She started right after me. Unfortunately, the 2 physicians that have been there the longest don’t get along and it can be awkward at times. The 4^th physician has been on vacation for a few weeks, and she is the only one with the “yes I can” attitude. Therefore, we’ve had more walk-ins (patients without appointments) than usual.  

I am typically the most efficient one, so I offer to see walk-ins all of the time. One day, we all had equally busy schedules, yet for some reason only the new physician and myself were seeing the walk-ins. After my 5^th walk-in, I was asked to see another one and I said “no the other 2 physicians have to pitch in”. To be frank, it was starting to bother me that there is no team effort amongst the physicians.

The next day the assistant medical director approached me and said she heard that I had refused to see a walk-in patient yesterday with chest pain. I was in shock because 1. I had no idea the patient they had asked me about had chest pain. 2. How did this information reach her? 3. Really? The only person that offers to see walk-ins is going to get in trouble?

I clarified with her that I had no idea the walk-in had chest pain, no one had notified me. And that I was just frustrated because the senior physicians never help out. Her approach was nice and she even brought up the fact that I am new but actually have the busiest schedule and lowest no-show rate.

Afterwards, I learned that the clinic manager was the one that reported the event to her. I was disappointed because it seemed sneaky. Why not come talk to me first?

I immediately called the Chief Medical Officer. He is the physician that recruited me to come help out in Chicago and is my direct supervisor. In my mind I was thinking, I don’t want to be in a place where things are going to be thrown out of proportion.

I explained what happened and I was relieved when the Chief Medical Officer apologized! He agreed with my reasoning for deferring the walk-ins. He agreed that the real problem is the fact that the senior physicians never pitch in and it has been an ongoing problem there. He also agreed that the clinic manager should have spoken to me about it before sending an email up the chain. He told me not to worry and that he will have a meeting with everyone next week.

I felt better after our conversation but his last comment threw me off guard. He told me that the physicians told him that I leave at 4pm (our clinic closes at 5pm). But he responded to them “good for her that she is that efficient!”. To be clear, we all have the same amount of patients scheduled. The physicians have had the same patient panel for 5 years – these same patients come once a month. So, at this point they should know them really well! I have absolutely no idea why they are always behind.

The funny part is that they don’t seem to realize that I don’t HAVE to be here. That I am doing them a favor. If I wasn’t here, guess who would have to cover all of those patients? Them! Not to mention I often help them when they are behind or offer to see their walk-ins. But instead of being appreciative they are being HATERS!

As most of you know, I am very reluctant to extend an assignment for various reasons. The longer I stay in a place, the more burnt out I become; the more drama I witness or become a part of; And the more antsy I get remaining stagnant. The only time I have ever extended, I ended up staying at that site for an entire year! At the end, I was exhausted and too attached to my patients. I told myself I would never extend again.

Fast forward to now and I find myself extending in Chicago. I had visited Chicago before but I didn’t realize how awesome it would be to live here. There is so much to do, historical activities, festivals, night life, cultural diversity, and delicious food.

I also really enjoy my current job. My patients are mostly Hispanic so it reminds me a bit of home (Miami). My patient population is geriatric so I am able to form a relationship with them, as they come to the clinic on a monthly basis or sooner. Plus, I find the job rewarding because you can measure your outcomes as patients become healthier and avoid going to the hospital.

As much as I was open to extending, it would be a big sacrifice for me to extend. Especially since it will be summer and I would be giving up the opportunity to go to other states that are finally warm. So, when I was approached by my recruiter about extending, I told her I was interested, but couldn’t extend for free. Since the site had already increased my hourly rate at the start of the assignment, I knew they would be reluctant to pay anymore.

However, I told them that the last time I extended was with their same company in Virginia, and they had given me an extension bonus. The site was quick to say they couldn’t cover any more costs, as I expected. My recruiter let them know I was not interested in extending in that case.

I was not concerned during the negotiations because I knew the site needed me.

They had no Spanish speaking provider available to cover the 250 patients I had accumulated. They needed me way more than I needed them.

I was not surprised when my recruiter eventually told me that they had agreed to my extension bonus after all. But they wanted to squeeze every last minute out of me. If I request any time off during the extension, I will have to make up for it at the end.

I am happy to spend more time in Chicago, but I really hope I won’t regret it!