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I probably undergo about 20 interviews a year. When I am searching for an assignment, I hardly go with the first place I am presented to. Not to mention I am often presented to several jobs at a time. I recently had a phone interview that within the first 2 minutes, I already knew I didn’t want to move forward with that position.

The interviewer kept using the word ‘mid-level’ when she referred to me as a nurse practitioner. Strike 1. Then she told me that there wouldn’t be much of an orientation since their previous provider is leaving and I would be expected to dive right in. Um no thanks. Even 1-2 days of orientation/training is better than none. Then I found out that they use Meditech EHR, which is definitely my least favorite EHR. At this point, it already didn’t seem like a place I wanted to work at.

I briefly answered her questions and was hoping to end the call sooner rather than later. Before we hung up she asked me how housing is usually set up for me as a locums. She told me in the past her locum tenens physicians have been housed in the hospital. She made is seem like it was such a great idea – “free food” and all. I was rather appalled. There was no way I was going to live in a hospital room, considering the amount of infectious processes that reside there.

I thought it would be fun to share this phone interview experience to let you all know that you’re not alone! There are sometimes whacky interviews and it’s just a warning sign to stay away!

 

For this summer I was interested in working/traveling somewhere that is normally cold but would be warm during those summer months. I then realized I would need to obtain some new licenses but was almost repulsed when looking at the requirements.

I hadn’t really applied for a new license in almost 2 years. This was because I had stayed in Virginia for an entire year, worked some time in Florida, and then still had 2 other state licenses I hadn’t used (Texas and North Carolina).

Now that I needed to apply for a new license again, I was a bit discouraged. I naively forgot how much work it is – to complete fingerprints/background check, provide a passport like picture (some states require this), request official transcripts, take a state board of nursing law exam (some states require this), obtain verification from the ANCC, send proof of 24 hours of pharmacology CEUs or verification from my MSN program university….the list goes on.

Yet, at the end of the day, this is just busy work and you can really complete your end of the application and requirements in one day.

Indeed, the worse part had to be recalling that with each new license application, I had to request license verification from all my other nursing state licenses. This means that if I am applying for a license in Wisconsin, I would need to have the board of nursing in California, Washington, Florida, Virginia, North Carolina, and Texas, each fill out a form verifying that my license is in good standing and without disciplinary action.

First of all, the costs of these verifications can add up. I think California alone charges $100. Secondly, these verifications can take a long time to obtain. Once again California can take several MONTHS to submit this verification!

I was disappointed because I realized that by the time I received any of those new licenses, summer would be over and I would be stuck worrying about staying warm for winter.

I went ahead and had two of my favorite agencies proactively license me. I usually recommend traveling nurse practitioners obtain their own licenses, but really only initially. By going through an agency, I saved so much time and upfront expenses. It was such a smooth process to complete the pre-filled applications and have the agency representative do all the tedious work. For instance, they obtained verification from my previous state licenses, ordered my school transcripts, ordered my ANCC certification verification etc. Not to mention that they paid for every single thing saving me hundreds of dollars (even though I could have gotten reimbursed).

Fortunately, one of the states I chose to obtain a license in (Maine) did not need to verify ALL of my previous nursing state licenses. They only needed to verify my initial license which was in the state of Florida and has a good turnaround time. Maine is also part of the eNLC (nurse license compact) so I was able to use my Florida multistate RN license. This meant I didn’t have to waste time obtaining fingerprints/background check. Nor did I have to waste time completing the RN application and waiting for it to be processed.

On the other hand, Maine did have some annoying requirements for the nurse practitioner application. I had to have a supervising physician submit a letter to them stating that he supervised me for at least 24 months previously. I also had to have a previous employer notify the Maine board of nursing that I prescribed medications over the most recent 2 years.

Luckily, I had my supervising physician from my permanent job in Florida write the letter. I had been at that job for about 3 years so it sufficed. I then wondered about obtaining proof that I prescribed over the past 2 years. That would have to be a total of 6 or more employers writing a verification letter, which is time consuming. I was lucky again though, because once the Maine board of nursing received my application they emailed me and let me know that the physician who wrote my letter of supervision, just needed to email them and let them know I prescribed medications during my time working with him.

I ended up getting the Maine license in only 2 weeks! Talk about a quick turnover and ideal for traveling nurse practitioners looking to obtain a new license quickly.

Of course, the licenses I applied for with the other agency are still pending. I clearly won’t be able to use them this summer, but at least they will be ready for next summer! I better start planning where I want to go for fall/winter to make sure I have the necessary licenses in time!

The moral of the story is do not wait too long to apply for a new license! I still recommend nurse practitioners that are just starting in locum tenens to obtain their own licenses. This way you can have more job options by working with different agencies and will be more attractive to the agency/site when a job opportunity becomes available.

However, once you start collecting a bunch of licenses (like me), feel free to have agencies start proactively licensing you. This will save you tons of time and upfront money. I also realized how awesome it is to have the Florida RN compact license. Florida just joined the eNLC January 2018, so it’s the first time I was able to utilize this perk.

 

These days there are tons of locum tenens agencies. When you google “locum tenens”, the larger agencies will appear first. Many of the smaller agencies aren’t initially findable on google. Some people are quick to rule out the smaller agencies, but personally I feel like sometimes they can be better to work for. Below I will list the pros and cons of working with larger vs smaller agencies.

 

Larger agencies:

Pros:

-More job options since they have been around longer

-Offer proactive licensing even without being accepted to a job

-Can help facilitate the licensing process by employees constantly contacting the board of nursing

 

Cons:
-Often less pay due to all the overhead that needs to take a cut

-Sometimes they submit you as one of a dozen candidates for one job, because the more the merrier in the eyes of the client

-Occasionally credentialing and housing details aren’t completed on time, likely due to too many worker bees

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Smaller agencies:

Pros:

-Pay is better since they are small and have less people on payroll

-Provide a more personable experience

-Credentialing and housing details are typically spot on

 

Cons:

-Fewer job options

-Less likely to offer proactive licensing before being accepted to a job

-Sometimes they do not offer travel or housing, although this is rare

 

As you see, there are both good and bad things about working with either a larger or smaller locum tenens company. I prefer to work with smaller agencies but the larger ones usually have more job options available. So, I would say I work with both types of agencies equally.

In my last post I illustrated my recent trip to Europe. The best part was that I barely spent any money on the airfare and hotel stays. This is because I used some of my miles and points that I collect. I am able to collect these from mainly two ways. First, as a traveling nurse practitioner, I sometimes opt to stay in a hotel of my choice over an apartment. This way I can acquire miles from those stays and also elite status. I also fly domestically a lot, whether it is to and from an assignment, or just going home in the middle of an assignment.

Secondly, I am able to collect miles and points through credit cards. When applying for a new credit card they will offer a large sign up bonus offer. Sometimes these can be enough for a round-trip international flight, saving you $500+. Just to be clear, I do not hold a balance on any of my credit cards. And even by applying for multiple cards and closing them when I do not want to pay the annual fee (usually 1 year after opening), my credit score has remained 800+.

I previously posted about “travel credit cards” and have a tab on my home page with some of my favorite cards. If you decide you want to move forward with one of those cards, be sure to use the link I provide to make sure you are getting the highest available bonus offer. Feel free to message me for guidance, especially if you have a specific trip in mind.

So how did I book my Europe trip? I used 30,000 Delta miles for an economy flight from Miami to Amsterdam. I then used 55,000 American Express points for a first class flight from Zurich to Miami. In taxes and fees I paid $75 total for both flights.

For my Hotel stays I mostly stayed at the Hilton (each night cost between 20,000-50,000 points) and the Sheraton (starwood preferred guest) (each night cost between 7,000 – 12,000 points). Keep in mind that Hilton points do not equal Sheraton points. So if you see that Hilton cards are offering more points in the opening offer, it’s because you need more points to redeem a free night.

In addition, since I stay at hotels often during work and leisure, I have acquired elite status with both Hilton and Sheraton (Starwood Preferred Guest). As a result, when I stayed at their hotels they provided me and my guests with free continental breakfast and free room upgrades. Some Hilton hotels even had an Executive Lounge, where I was able to go any time of the day and find appetizers, snacks, and refreshments.

One of the highlights of the trip was when I was upgraded (for free) to an executive suite at the Four Points Sheraton hotel in Zurich, Switzerland. If you’ve been to Europe before, you know that the hotel rooms are usually tiny. Imagine being upgraded to an apartment sized room. It consisted of 2 bathrooms, a large bedroom and walk-in closet, a dining area with a Nespresso machine, living room – and the main bathroom had a his and hers sink with a spa bath tub and separate shower.

Without points and miles, this 3 week trip in Europe would have cost me over $5000. Luckily, I only spent about ~$1000 on this trip. My main costs were food, short flights/trains between cities, museum entrance fees, transportation etc.

What are you waiting for? It’s time for you to start collecting your own miles and points!

I was fortunate to spend almost 3 weeks in Europe this past spring. I hadn’t gone to Europe at all the year prior, which is strange for me. I often prefer to focus on visiting one or two European countries at a time. This way I can absorb as much culture and history as possible. However, this time I decided to jump in and out of several countries in one trip.

We started out in Amsterdam. Honestly, I had high expectations for this place because people always tell me how much they love it. The canals were pretty cool, and I had the most fun riding a bike with all of the locals. I also enjoyed the Anne Frank Museum and the Van Gogh Museum. Seeing tulips in the Dutch country was a nice bonus as well.

 

 

 

 

 

 

 

 

Next, we went to Copenhagen, Denmark. Unfortunately, winter lasted forever this year so we ended up stuck in a snow blizzard while we were visiting. The food was quite on the pricey side, an average meal (without drinks) costing $30+.

I didn’t care for Copenhagen much; the people are pretty stoic and all look alike. It made me feel like I was in a fake world.

I was relieved when we arrived in Berlin, Germany. I ended up liking it much more than I expected. First of all, it is very diverse. There are tons of middle eastern and eastern Europeans there. It felt nice to interact with normal people. In addition, there was so much history there and I liked how the Germans made their history free and public through outdoor museums. I respected how they did not try to hide their history but encouraged the community and tourists to learn about their dark history, and factors that had caused it.

 

 

 

 

 

 

 

The fourth country on our list was Belgium. It was definitely a plus in my book since they spoke French and I felt like I could finally understand what everyone was saying (despite them being able to speak English in all of the other countries we visited). It was an amazing culinary experience. From chocolate, to mussels, to Belgium waffles. I think we were all in heaven.

 

 

 

 

 

 

 

 

Lastly, we ended the trip with Switzerland. Our first stop was Geneva and it was more beautiful than I could have ever imagined. The snowcapped swiss alps in the surrounding lakes of clear blue water was breath taking. Switzerland was by far the most expensive place I have ever been to. The average meal was $40 and a bottle of water cost $7. You could tell everyone there had money. They all dressed well, even better than Paris. Most of them had luxury cars such as porsche and ferrari’s.

Halfway during our stay, we participated in a chocolate factory tour for Nestle. It was interesting to learn about how it is manufactured and we were able to sample various types of chocolate. Afterwards we drove to Zurich and Lake Lucerne. They were also marvelous towns but seeing the swiss country on the way over there provided the best sights. In Geneva, the Swiss spoke French, whereas in Zurich they spoke German. I was told that in southern Switzerland they speak Italian. Pretty cool that the countries they border have some cultural influence on them.

I had a great time but was pretty exhausted by the end. I will make a follow up post to this, to show you how I saved a lot of money by booking my trip with miles and points.

 

 

A couple of months ago I posted a survey to assess how various locum tenens nurse practitioners are being paid and which states paid them the highest rate. I wanted to share the results with my readers to make sure you are requesting the correct rates.

The hourly rate between family nurse practitioners and acute care nurse practitioners were pretty similar. However, there was such a vast range of pay rates for locum tenens nurse practitioners as a whole. Here is a summary of the survey results.

• Locum tenens family nurse practitioners have made as little as $50/h and as high as $95/h.
• Locum tenens acute care nurse practitioners have made as little as $60/h and as high as $100/h.
• The average nurse practitioner made $70/h while on assignment.
• Some of the highest paying states are Washington, California, Pennsylvania, Iowa, and Connecticut.
• Some of the lowest paying states are Florida, Georgia, Alabama, and Texas.

What does this mean?

Your hourly pay rate will depend on experience and location. If you have at least 1 year of experience as a nurse practitioner, please try not to accept less than $60/h.

If your goal is to be in a certain location or you are passionate about helping the native American population, then by all means you can take the temporary pay cut.

If you are driven to work in a state that pays well, see the above recommendations. Note that it is often rural areas that will pay the highest rate.

Just because someone noted they have been paid $85/h before doesn’t mean they will be paid this rate EVERYWHERE they go. They possibly worked in a rural area with a large need. Maybe on their next assignment they wanted to be in a big city in a different state and had to take a $5-$10 pay cut. I personally don’t mind a pay cut if it’s a prime location I want to be in or if the clinic is not that busy.

During nurse practitioner week, I remember reading somewhere “everyone wants a nurse practitioner but no one wants to pay for one.” That’s awesome that we are helping fill the primary care gap and especially in rural populations. But let’s remember that in order for us to be compensated appropriately, we’ll need to ask for fair pay and to work together. There should not be any nurse practitioner seeing ~30 patients per day (non-urgent care), nor should there be nurse practitioners being paid <$60/h.

Any thoughts?

I recently published an article on www.nurse.org called “Self-Licensing vs Agencies: What’s Best for Travel Nurses”. The article discusses when it is beneficial to obtain a license on your own and when it makes sense to get it through an agency. To read the entire article click here.

I also published another article on that site explaining to nurses how they  can upgrade their current nursing license to a compact license depending on their residential state. For more information you can find the article here.

Below is is a map of the eNLC (enhanced nurse license compact) states. The ones in green have already implemented the multistate licenses, while the ones in blue are pending approval.

I was able to adjust my schedule doing home assessments, where I could have 3-day weekends. I took advantage of this time do some weekend trips to other cities in Texas.

I mostly enjoyed visiting San Antonio due to its abundance of history. It houses the famous Alamo and multiple Missions, which are settlements where Spaniards and Natives inhabited.

Of course I ate some really great Mexican food and Bar-B-Q! I recommend La Fonda if you end up in San Antonio.

I was looking forward to going to the Riverwalk downtown and it exceeded my expectations. The San Antonio river is much longer than I thought. It’s incredible that you are able to walk along the river to end up in different parts of the city. You can have dinner on the river, go to the mall on the river, visit the Alamo on the river, or stay at a hotel on the river.

Another highlight was visiting Waco, Texas as a big fan of the show “Fixer Upper”. I felt like a child at Disney World! It was really cool to see everything in real life that I watched coming together on the show. Joanna’s cupcakes did not disappoint. I purchased a few items from the Magnolia store. I may have bought even more things but the two-story store was extremely busy and full with tons of people.

 

If you plan on visiting the Magnolia Market someday, make sure you get there early in the morning.

Honestly, I am not a big fan of doing home assessments. I prefer being in a traditional environment. On the other hand, I did enjoy the extra time it allotted me to connect with patients. I think I have a soft spot for geriatric patients specifically.

While I asked pertinent health related questions, performed a physical exam, and provided patient teaching, I was able to get to know the patient at a deeper level. They shared stories about their families and prior occupations. They elaborated on health care struggles and their appreciation for nurses. When I was done with the visit, I often lingered a little bit longer to hear more stories or if the patient insisted, on looking at pictures of their family or finished products of their current hobbies.

I appreciated the opportunity these home assessments allowed me to see life from a different perspective. There were times of sadness when I met a 90+ year old patient who lived alone and told me he did not have any living relatives or friends. There were occasions where I laughed hysterically as an elderly couple in their 80’s (in great health condition) made jokes about recovering from colon cancer, skin cancer, and even eye cancer. There were moments of joy to see a patient’s daughter or grandson be involved in their parents/grandparent’s care. There were flashes of worry when I realized many seniors live in trailer homes and wondered what would happen to them if another hurricane came along to the south of Texas.

My favorite part of this assignment were my interactions with the patients. They reminded me how to appreciate life on a daily basis and those close to me. I also thought about my geriatric patients in Virginia. That I wish I had done a home visit for each of them because you learn so much about them that way.  You discover what type of condition they live in and how much social support they truly have. Whether they need assistance at home or if they have an environment that will enable them to take their medications appropriately.

I think many healthcare professionals are reluctant to do home visits because patients may live in unsafe areas or live in unsanitary environments. But I believe it is essential to know our patients at this level in order to better understand them and provide them the best care.

At the end of some of my visits, the patients would say “I wish there was some way I would see you again.” That broke my heart, but also made me happy I was able to touch someone in such a brief encounter.

As I mentioned in my previous post, I have been working in Texas doing home risk assessments. Health insurances want these assessments done on their patients yearly, to identify gaps in their health care. Examples of these gaps include: poor medication compliance, home safety issues/increased risk of falls, and the need for specialty referrals.

Home assessments have their advantages but is isn’t for everyone. Here are some pros and cons for doing home risk assessments:

Pros:

-Flexibility: Your schedule can be what you make it. You can work weekends or 4 days of 10-hour shifts. You can even finish your shift early if you stay on task and go home hours early.

-Easy: the job itself is pretty easy as you are just asking a thorough history and screening questions, along with performing a physical exam. No treatment or prescribing needed. This job is pretty much stress free.

-Patients are happy: The patients are nice and welcoming. They usually are just grateful having someone to talk to and love that you are there.

-Mileage: You are getting paid to drive to the patients homes via mileage reimbursement. The scheduler will usually keep the distances short, and you can include mileage to and from your hotel. I usually profit $100 each week after gas expenses.

Cons:

-Atypical environment: Obviously you are working in other people’s homes. Unfortunately, not everyone is sanitary. Some bad experiences were being in a small apartment with a dozen cats and cat poop everywhere; feeling like you are in an episode of hoarders; smelling like smoke after you leave…

-Documentation: The assessment paperwork is extensive. Sometimes if the patient is a chatterbox or really sick, then you may have to bring paperwork home, and this can easily take an extra couple of hours of your time (unpaid).

-Equipment: You have to lug around an equipment bag to each visit. Inside is a laptop that requires about 5-10 min of setting up (extensive log-in process). You are also given a mobile wifi device. Many times the wifi device does not work (many patients do not have internet) so you will have to do all of the charting at home.

-Weather: Rain or shine you still have to do these home assessments. One day it was windy and raining tremendously. I got soaked arriving to a patient’s door, and they ended up not even being home!

 

My first day I knew home assessments wasn’t for me. The more days I worked though the more comfortable I became. Honestly, the patients were so kind that mostly stuck around for them. You can see I had more cons than pros.

Another aspect I want to mention is that you are paid per assessment, not hourly. So if you go to a patients house and they are not home, you will not get paid for the completed assessment. Instead you are paid for a “no show” which is a little less than half of what you would have been paid for a completed assessment. If a patient cancels prior to their appointment, this means no pay. If you are very financially dependent on this job, I wouldn’t recommend home assessments. Also, you have to make sure to finish the documentation thoroughly, if not the company will keep sending it back to you until all items are addressed.

If you are looking for something flexible and easy, home assessments may be for you. I personally think I am better suited for the clinic where I feel that my work is more impactful. With that being said, I may possibly me open to home assessments again in the future for a brief stint.