Maintaining Multiple State Licenses

I currently have 5 active state licenses. Many of you have asked how I am able to manage having multiple licenses (for cost and time reasons). I usually work on obtaining about 2 new states licenses every 6 months.

I actually allow some state licenses to expire. There are state licenses that expire after one year (which can be annoying). Some people may think it’s a bad idea due to all the work that went into getting them in the first place. But the truth is, reactivating licenses is pretty easy.

I allowed my California licenses to expire. Yes, the same licenses that took more than 4 months to obtain. The fees are costly though, since you have to renew 3 licenses. I think having a California license is always a good idea because there are plenty of jobs there. I had one agency I worked with prior renew the licenses for me. It was a piece of cake. The agency’s licensing team did all of the work and paid for my renewal fees. I just had to sign a form agreeing to work with them initially with the new license.

In case I end up working with a different agency in California, I would just have them pay back the other agency for that license. It’s no big deal. Not to mention the renewal process only took 2 weeks!

I had also allowed my Texas licenses to expire. The same agency renewed the Texas licenses for me. It was nice having the licensing team work with me because they would call the board of nursing to follow up on my application. This process also only took 2 weeks!

I allowed my Washington state license to expire. Washington is really far from Miami, so I didn’t see myself going back there anytime soon.

Lastly, I always renew my Florida license because that’s my home state and initial license upon examination.

Some people may have more trouble managing their multiple licenses than me. I recommend having some agencies invest in applying for or renewing licenses for you. It facilitates the process and covers the costs upfront.

 

Back in the Game


After working at one assignment for the past year, I had to get back in the groove of working in locums again. I was used to working with the most amazing recruiter, which made me have high expectations for all other recruiters.

My priority for my next assignment was for it to be a 1099 job. I had worked most of the year with a W2 agency and had also paid tons of taxes to Uncle Sam. I needed to work with a 1099 agency to allow me to have more tax deductions at the end of the year. Unfortunately, this meant that I couldn’t continue working with my favorite recruiter for my next assignment.

My experiences so far have been a bit rocky. Prior to presenting me to an assignment, I felt like this one recruiter/account manager put me on the spot as if it was an official interview. He asked me “what is special about you, that would make me want to present you to my site”? I was appalled because I know I am great, but I didn’t feel as if I needed to explain to him the reasons why. Because the reality is that by me working with this site, I would be providing him with his income. This is a type of question I wouldn’t mind answering someone interviewing me from the site, but not the agency….

Another recruiter called me SEVEN times in one day! I kid you not. If this were a relationship I would have broken it off long ago! Another one of my pet peeves is when I am not scheduled for a phone interview with a site, but the site will just randomly call me. I think it is more professional when you provide your recruiter with good interview times, and then they confirm the time the site will be calling you. Instead, I had a site call me during the mid-afternoon while I was at work. Then we were playing phone tag for the rest of the week.

I decided to accept a brief assignment with a new agency I haven’t worked with before. The credentialing process hasn’t been the smoothest. For instance, I was told by my recruiter to go to a lab site and request a urine drug test (without an order). Usually the agency provides me with a confirmation form for the urine drug test and I just bring in that paper to my scheduled appointment. I called the lab site prior just in case and they told me I needed to register for the urine drug test prior. I informed my recruiter, and she gave me a number to register for the test. When I called, they said the place of employment had to register me. -_-

The issue was resolved but sometimes it boggles my mind because don’t these people deal with this on a regular basis?

Another credentialing contact person requested I sign the protocol with my supervising physician. She only sent me the last page to sign via email. I had to let her know that I would not sign a protocol without seeing the complete set. Also, the board of nursing requires the original protocol with original blue signatures. Typically the agency will fed-ex me the protocol to sign and send back to them via fed-ex. So just printing the protocol and scanning it back to them wouldn’t make it official.

Many of my readers have shared some of their frustrations when starting locum tenens, and unfortunately a lot of them are due to their recruiter/agency. I was so used to working with some great recruiters and agencies, I almost forgot how bad others could be. Alas, I had to continue working with this agency because the assignment they offered really matched my current needs. I was a bit disappointed that my recruiter didn’t ask me how everything went after my first day of the assignment. It was something I was used to when working with other recruiters, and I think it’s a nice gesture.

After writing this, I am going to send my favorite recruiter some flowers as a big Thank You for Being Awesome! This pretty much sums up why I often advise my readers to reach out to me personally, to recommend specific agencies and recruiters, because they are not all created equally.

Ending of a Yearlong Assignment

The end of my yearlong assignment in Virginia was bittersweet. When I finally accepted that I needed to move on, I was reminded of one of the best parts of locum tenens – looking forward to the end. The things that used to bother me before didn’t bother me anymore. If the medical assistants were short staffed and took forever to bring my patient back, I no longer cared. The demanding or pessimistic patient that normally frustrates me, no longer impacted me.

It was tough to say good-bye to my patients. For some reason the majority of them were in a good mood during my last visit with them. For example, one of them randomly said: “You are really great. I’ve never had anyone explain things to me the way that you do.” This made it hard to tell her I was leaving. During a follow up with another patient, he said: “Man, you are the best! You remember everything about me and follow up on things from last visit. You review notes from my specialist before I see you. You don’t just fix everything with a pill. You explain things thoroughly and find natural ways for me to improve.” After telling him that I was leaving, he nearly caused a scene.

Many of the patients were extremely disappointed, some even cried (both men and women). I re-focused them to realizing that most importantly their health had improved significantly over the past year, and they know what to do to continue on that path. I also reassured them that since I would be working in their Florida clinic, I would be able to check on them from time to time and perhaps even see them again in the future.

I think I became too attached to the patients, but with our healthcare model, it was hard not to. The patients came every month or even more frequently, some I spoke to via phone on a weekly basis. I knew their husbands and wives pretty well too. Our goal is to keep our patients out of the hospital, and the only way I knew how to do that was to develop trust and bond with them.

My last day was extremely sad. I had never cried so much in my life. Not only was I going to miss my patients but I was going to miss my co-workers too. Our clinic is big with about 50 employees, more than half of them I was really close to. Any time one of the physicians or medical assistants would mention they were sad I was leaving, I would break down and cry. I was even super close to the Medical Director, who honestly acted like my guardian angel while I was there. It was weird knowing I wouldn’t be seeing them on a daily basis anymore. On the bright side, the Medical Director promised to fly me up for their annual holiday party and we agreed I could always come back in the future to help out when I wanted to.

The clinic surprised me with a sweet party. Everyone went around in a circle and said some nice words about me. The Center Manager told me he was so glad that I came because I brought a new uplifting energy to the clinic and between the other PCPs. The clinic also surprised with me with this beautiful gift:

I never knew leaving a job would be this hard! Yet, I am so grateful for my experiences there over the past year, and will continue to cherish the relationships I have built. I am looking forward to my next adventure and will try not to stay at one place as long again.

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

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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.