Philadelphia Trip

During one of holiday weekends, I went to Philadelphia to visit for the first time. It was a 5-hour drive but I opted for the 1 hour flight instead.

I had a fantastic time in Philly! It was pretty diverse and there was so much to do. I visited tons of museums, including looking at my favorite artists.

My visit also reminded me of why it is so great to be an American! I toured the independence hall and the liberty bell. It’s crazy to think that our forefathers had the courage to rebel against Great Britain, the most powerful country in the world at that time. It’s even more amazing to think that the 13 original colonies all united together to fight for their beliefs.

Questions from Readers

Each month 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.

How does dating work as a locum tenens nurse practitioner?

 

Many traveling nurse practitioners I know travel with their spouse or significant other. The agencies will certainly accommodate your needs with lodging. Some partners have flexible jobs where they can work from home, making it easy for them to travel. Some partners will fore-go their current job and may pick up seasonal jobs in their new living area. I also know some couples that will just take turns visiting each other throughout the assignment.

For single locum tenens nurse practitioners, traveling actually helps with the dating process. People always ask me if it’s hard to date since I am always moving around. I tell them no, that in contrary it is actually easier to date since I am traveling. This is because I end up meeting way more people than I normally would. I am even able to meet different types of people too.

Miami isn’t known for having an intellectual atmosphere, which made dating pretty tough when I lived there. Being able to move to different cities, I am able to meet people that more closely fit my needs.

Some of my friends that are travel nurses, ended up dating someone while on an assignment. To figure out if things would work, they extended their assignment. If the relationship became serious they eventually just settled down in that city permanently.

In a couple of states that I traveled to, I ended up meeting and dating someone while I was there. By the near end of my assignments, I had to contemplate if staying was worth it. In one instance, I decided to move on. In another case, I decided to extend my assignment to see where things would go. It was nice to have that companionship while I was there, but I do not think I am at the stage where I am looking for something long-term.

Frustrations of Starting in Locum Tenens

I have been working as a traveling nurse practitioner for a while now, that I forgot how frustrating it could be to initially work in locum tenens.

 

  • Tons of paperwork: Each time you accept a new assignment you have to be credentialed with the new site. This requires filling out tons of paperwork and providing copies of your licenses, vaccination records, certifications, references, etc. If you are also working with a new agency for the first time, expect your paperwork to double. In addition, you will have to do a drug test for both the agency and site.

 

  • Last minute: There will be times you won’t know your exact start date until 1 week out or less. There will be times you wont know where you will be living until the morning you leave. It may be scary at first, but part of working in locum tenens is being okay with the unknown. After a while, you get used to knowing things last minute.

 

  • Licensing issues: Is your license taking longer than you thought? Maybe you didn’t realize you also need a prescribing license, in addition to the RN and ARNP licenses in that state. Some agencies have really good licensing teams that can get in touch with the state board of nursing and expedite the processing of your licenses.

 

  • Recruiters: Not having a good relationship with your recruiter can make your locum tenens experience awful. Your recruiter should be your advocate. If they are putting you down and not being helpful, ask for a new recruiter!

 

I think the above four topics are probably the most frustrating aspects of starting a career in locum tenens. After a while, you get used to those things and realize the benefits of being a traveler outweigh the nuisances. Also, keep in mind that being a traveling nurse practitioner isn’t for everyone.

Questions to ask the Site

IMG_1541

Agencies sometime see the interview process as a means for a job site to approve their recommended candidate. However, I believe the interview is just as important for locum tenens candidates as it is for the job site. This is perhaps the best way to get a feel for the facility and if it is the right match for you. I have put together a list of questions I recommend you ask the person that is interviewing you.

 

  • How many assistive personal staff will I have?
    It is good to know before you get to the site how many medical assistants and nurses you will have assisting you. If the patient volume is low, then 1 MA per provider is sufficient. If the patient volume is high, then 1 MA per provider will not make the cut.

 

  • How many patients per day will I be seeing?
    Most places will give you a range. For ex: a high volume may be 25-30 patients per day. Does this include walk in patients? If a patient is a no-show, are you required to see a walk-in patient instead? A lot of times, the no-show patients help balance out our busy schedules, but if you are required to see walk-ins in their stead, then it may be challenging.

 

  • How much training/orientation will I receive before I start seeing patients?
    Some places will give you 1 full day of orientation, whereas others will give 1 week. It just depends on you, the facility, and your level of comfort. If you have to learn a new EHR system, I recommend at least 1-2 days of EHR training alone. If you are a relatively new nurse practitioner, I recommend you ask for 1-2 days of shadowing another provider so you can see the workflow. Many sites will gradually increase the amount of patients you are seeing per day as part of the orientation phase. Be sure to ask what their orientation process is before you start your assignment so that there are no surprises!

 

  • Will I have any admin time?
    It is common to work locum tenens and not be provided with any admin time. Meanwhile, you see other providers with either several hours or an entire day each week for admin time. Admin time is useful because it gives you time to answer patient calls/messages, provide medication refills that are requested, review lab results as they come in, complete prior authorizations, and complete charting if necessary. It just depends if you often find yourself needing extra time for these miscellaneous tasks or if you are able to fit them in your schedule. I once saw a locum tenens physician request her last week at the assignment for admin time alone, because she was so behind in charting, reviewing labs, and billing. I usually find that 1 hour a week is more than enough admin time for locum tenens nurse practitioners.

 

  • Will I be the sole provider at the clinic?
    Sometimes without realizing it initially, you may be the sole provider working at the clinic. If you are uncomfortable with this, make sure to ask during the interview process. Personally, I do not mind being the sole provider at an office. However, there are many advantages of having other nurse practitioners, physicians, or physician assistants working with you. For instance, you can bounce off ideas from one-another; get a second opinion for a complex patient; or switch patients if you are not comfortable with a requested procedure etc.

 

Having these questions answered can help determine if the facility is the right fit for you. The closer the answers match your needs, the less likely you will be stressed and unhappy while working there. As always, feel free to message me if you have any questions.

 

Don’t call me ‘midlevel’, ‘extender’, or ‘non-physician’

Working in California hasn’t been as enjoyable as I expected. Many warned me that this state didn’t have a good reputation for the way they treated their providers. I read a great article on Barton Associate’s Blog about nurse practitioner’s being called “midlevels”, something I have started to hear more and more of working in California. Below is the link for you all to read! In Washington (a full practice authority state for Nurse Practitioners), the MD’s, NP’s, and PA’s were all referred to as (equal) provider’s. This is something I plan on continuing to promote.

 

http://www.bartonassociates.com/2015/12/30/dont-call-me-midlevel-extender-or-non-physician/

Contracts

IMG_0565

Upon accepting an assignment, it will not be official until a contract has been created. Most agencies will send you a written contract for you to review and sign within a brief time frame after verbally accepting an assignment.

Some agencies use verbal contracts in which they review the terms of the contract and you will verbally agree to the terms. You may request to have a written copy submitted to you afterwards.

Sometimes an agency may review the terms of the contract with you over the phone, and then send you a contract that states no signature is needed because the receipt of the contract is binding.

I am sure like most people, I personally prefer written contracts I can sign. It gives me the chance to think about the assignment and the conditions agreed upon before having to sign the contract, and making it official.

However, as noted above, there are different methods of contract agreements. Be sure to ask your recruiter which type they use. I know many locum tenens nurse practitioners, including myself, that have found themselves “bound” to a contract they were not aware of.

Be straightforward with your recruiter that you will not consider the assignment official until you have a contract in place and have agreed to it after receiving it. In my case, I was emailed a contract that was binding upon receipt. Meanwhile, I didn’t think it was official since I had not signed it. When I was contacted by credentialing and their traveling team, I then realized that they assumed I was going forward with that assignment because they sent me a contract.

After a site determines that they want you, your recruiter may ask you if you want to accept the assignment. Sometimes we find ourselves saying yes before we are completely sure. Then a few days later you may change your mind and notify your recruiter. Often, they are upset by your new declination because now they have to inform the site. Technically, if they never sent you a contract or you had not yet signed it, you have the right to change your decision.

What should your contract include?

Everything agreed upon by you and your recruiter should be stated in the contract. This includes your hourly pay rate, overtime rate, exact time frame of assignment, and your general weekly schedule. The contract should state your travel and lodging will be covered, whether it is a rental car and flight, or providing you round trip mileage reimbursement. If your license costs are supposed to be covered, that should be in the contract. Other things that should be in the contract if indicated are sign-on bonuses, W2 benefits, DEA license fee reimbursement, and/or scheduled vacation days.

One of the most important things I look for in a contract is the “breaking of a contract” section. Most agencies will include the typical 30 days notice section, that states you must provide 30 days notice before leaving a site. Some contracts will state penalties for leaving before 30 days such as forfeit of pending paychecks and being responsible for your own travel back home. These things can be negotiable so make sure to read the contract closely before signing or agreeing to the terms.