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Last December I had shared an offer I received for a really great permanent traveling position. If you aren’t already aware, it was a “permanent traveling” position, because I would still be able to travel to multiple states but I would be working as a permanent employee to one employer. No more agencies.

As some of you may have noticed, I did not accept their incredible offer. Here are the main reasons why:

• I loved working for their clinics in Virginia. Yet, I hated working for some of their clinics in Florida. This showed me that all of their clinics are not equally enjoyable to work in.
• I am not ready for such a commitment. I am turning 30 years old at the end of this year and I don’t want any restraints on my vacation time. I am planning on many wonderful trips abroad and don’t think 6 weeks PTO (including holidays) is going to cut it.
• I do not want to give up my tax breaks. I have often highlighted the pros of working both 1099 and W2 as a locum tenens nurse practitioner. If I became a permanent W2 employee, the taxes I would be paying would almost double.
• I don’t want to become a slave to healthcare. Unfortunately, healthcare in the USA doesn’t allow providers with enough time with their patients, resulting in less than optimal outcomes for patients. It is a high demanding environment, leading to increased stress and work hours. No thank you.

As amazing as the opportunity was, I knew in my gut I had to turn it down. On the bright side, that opportunity will always be there, if I am ever ready for it.

After completing my assignment at the FQHC in Southern Florida, I was ecstatic because I finally had time to go on a trip! I hadn’t been abroad since last summer since Hurricane Irma had other plans for me.

After living in cold Virginia for one year, I lost all of my color. Thus, I knew my first trip of 2018 would need to be somewhere with plenty of sunshine!

I decided to go to Aruba because since it is close to the equator that meant it is warm year round. Even though it was February, I knew the water in Aruba would still be warm enough to swim in.

I went on the trip with my sister, who was also mentally exhausted from recently changing jobs. We definitely enjoyed our brief getaway, which allowed us to catch up on sleep, sunbathing, and relaxation.

We also enjoyed snorkeling and hanging out at the beach with these fun birds:

I was very interested in seeing the culture of Aruba. The natives spoke an Afro-Portugese creole language, called Papiamento. However, I was most impressed that the majority of them also spoke English, Dutch, Spanish, and even sometimes French. They were very friendly and we ended up being there during their “Carnival”. This is a dance party/parade that runs on main streets throughout the island, lasting days. I have to admit that the Haitian Carnival is way more chaotic ;).

Our last day in Aruba, I made sure to enjoy a Dutch Pancake, and it did not disappoint! It reminded me of a thicker version of a French crepe. I would recommend Aruba for a quick getaway (it was only a 3 hour flight from Miami) and the water was warm as expected.

To my fellow locums out there, I don’t know about you but each time I tackle a new assignment I feel like I have to “prove myself”. I have to prove that I am a good locum tenens provider. That I am a quick learner, that I can see a lot of patients, that I can be thorough – covering health maintenance and quality measures; and that I can document well – not missing any important codes.

The funny thing is often the site has low expectations. They just need someone that’s going to be able to jump in and provide coverage while they recruit someone permanent or their permanent provider returns. Most of the time they aren’t expecting superman or superwoman.

Working as a traveling nurse practitioner for almost 3 years now, I have come across several other locum tenens providers. It’s interesting to see the variety from the locum tenens pool. Many other locum tenens providers are fine doing the bare minimum. Some don’t pay attention during our meetings or read their emails to learn how they can improve their documentation or care for the patients at this particular site.

I think it is the overachiever in me that feels like I need to exceed expectations. I guess I should take the pressure off of myself. In fact, locum tenens means filling a temporary need. The site and staff are usually so happy to have us helping out that they don’t even bother judging us.

 

 

I am wondering if my “I don’t take bs” attitude translates into me being a diva. As demonstrated in my prior experiences, I often stand up for others and myself. I think since I have worked in so many different settings, I know what a GOOD work environment is. I know that it is absolutely possible to work somewhere that is pleasant and not overwhelming. I also know what a GOOD recruiter is and what a GOOD deal looks like, so I do not want to settle.

There are 2 main aspects of working locum tenens that sometimes irritates me and causes my “inner diva” to come out.

1. Being overwhelmed at work. Whether it is due to being scheduled with too many patients, lack of leadership in the office, no admin time, or lack of assistive staff.
2. When recruiters speak to me as a car salesman, acting like taking this job is equivalent to buying a car. They say things like: even though this job doesn’t pay well nor is it in an ideal location, at least you will have work.

My responses to these problems:

1. When asked to see certain patients (last minute) I will say NO just to make a point. I will request a change from either management or from my agency. If they are reluctant to change anything I will use the “it’s my license on the line” talk. In the back of my mind, I always consider just leaving if things do not improve.
2. “At least you will have work”. Hi, I am not desperate. I’ll just say NO if I don’t like something. For instance, sometimes a recruiter will try to get away with giving you poor housing options, such as staying at a motel 8 (ew). When you demand better options they will say “can you at least stay there for this week until we find something else?” The answer is NO. No, I will not travel all the way there for a “possibility”.

Do I overreact sometimes? Yes, I am human. But who else will speak up for myself if not me?

So am I a Diva? Perhaps at times 😛

 

One of the most common questions I receive is regarding the stability of being a locum tenens nurse practitioner. Is there consistent work? Are there periods or gaps with no jobs available? Looking back at the past year, 2017, one thing is clear. I worked way too much! More so, I worked more than I originally planned. I meant to spend most of 2017 traveling abroad but accidentally got caught up in work.

As soon as I finished my assignment in Virginia and needed to be home in Miami after Hurricane Irma, I was able to start working on another assignment. The only ‘gap’ was the 1 week road trip I purposely took on my way down to Florida. Once I completed my assignment in Miami, I had another assignment waiting for me, in which I started the following Monday.

To further illustrate the consistency and abundance of locum tenens job, is how quickly I was able to obtain an assignment after leaving the site in Tampa, Florida. I decided to leave that assignment early (I made this decision on a Wednesday). The following day, Thursday, I notified my recruiters that I would be available for another assignment. Friday was my last day in Tampa, FL, and during my lunch break I was already being interviewed for another job. By Friday afternoon, I had already been offered and accepted my next assignment. This new job started the following week. Luckily, it was right after new years so I had Monday off to recuperate.

My family and friends were impressed about how quickly I was able to get a new assignment. Personally, I wasn’t surprised because that’s just part of being a traveling nurse practitioner. I work with about a dozen recruiters at any given time to provide me with as many job prospects as possible. That’s why I always encourage my readers to credential with various agencies, and not limit yourselves to just one or two. There is a primary care provider shortage in America – someone is bound to have a job opening for us! J

As a quick summary, I spent the past year working in Virginia for a geriatric clinic that follows a preventative care model. I am currently working in Florida for the same clinic, as they have clinics in multiple states and continue to expand.

My previous post animated part of a discussion I had with the Chief Medical Officer of the company, in regards to nurse practitioners. The main purpose of the conversation though, was for the CMO to see what my goals were and if the company could hire me as their internal locums/traveler.

I alluded to having a similar conversation previously with their Chief Financial Officer. And how I told him that I wanted to continue with my current agency for now, until I had a better grasp of the various markets.

The CMO told me that he definitely sees the value in having an internal locums, especially as they continue to grow. He said he would love to invest in me to develop into a leadership role eventually. Meaning I would either oversee a larger traveling team in the future, or even manage all other nurse practitioners in the market. He said as a contractor it wouldn’t make sense for him to invest in me, so that is one of the main reasons he wants me to become directly employed with the company.

He asked me what I was currently being paid and told me he could increase that. (Side note, I already get paid significantly more than the permanent nurse practitioners, even those with 20 years of experience, since I am a traveler). He said he could also offer me a sign on bonus and yearly bonuses as well. The company would of course cover all of my travel, lodging and licensing fees. He said they would also provide me with a weekly dining stipend, and cover flights whenever I wanted to go home in the middle of an assignment.

In addition, I would have the same benefits as the other employees such as 401K, health insurance, CME allowance, and PTO. The company would also guarantee me with a yearly schedule where I am in a different location every 3 months or less.

After the CMO made all of these offers, I think he was surprised to hear me say “we’ll see”. Financially he was offering me a whole lot, but my priority has always been freedom and flexibility. Although I would continue being a traveler, I would be restricted to practicing in locations the company has clinics in. On the bright side, they are continuing to expand and are opening up new centers in several different states by mid next year.

At the end of our meeting, we agreed to allow me some time to feel out the new center I was in and to think things through. We set up an appointment to meet again next month.

I am extremely grateful for the offers he made me, and especially for the fact that he sees something in me that would make him want to invest in me as a leader. I would be honored to manage and help other travelers and nurse practitioners.

It honestly seems like an unbelievable opportunity for me to grow in an incredible company. My main hesitation is how much flexibility will I have? Will I still be able to take time off in between or during assignments to travel abroad? Perhaps I could negotiate this in my contract. The average PCP has about 4 weeks of PTO but I will definitely need more than that even if it’s unpaid. Will I still be able to leave an assignment early if I absolutely hate the place (whether it’s the people or location)? Maybe I can have them agree that if I don’t like a center I can give a 30-day notice the same way I do with my agency.

On the plus side, they will give me a schedule so I can actually plan where I will be in advance for once. Am I ready for a commitment? I guess worse comes to worse I can always quit and become a regular locum tenens nurse practitioner again J

I would love to know your thoughts! Should I go for it???

In between completing my assignment in Virginia and starting the one in Tampa, Florida (with the same company), I sent the CMO of the company a letter about my experiences working in Virginia. I had met him several times before and thought it would be a good way to share my experience at each clinic, both good and bad.

He was appreciative of my feedback and requested a meeting with me to see what my goals are and how the company could expand an internal traveling PCP program.

As our conversation began, I could tell how new the concept of having nurse practitioners was to the CMO. When he elaborated about the collaborative agreement between nurse practitioners and physicians, he also stated that there is a wide spectrum on preparation of nurse practitioners. He said that they have observed there can be some amazing, knowledgeable, and competent nurse practitioners; but on the other hand there can also be some inexperienced, insecure, and non-proficient nurse practitioners. Personally I agree, but it’s the same thing in any profession.

The CMO continued to ask me what was the perception of nurse practitioners from the patient’s point of view. He asked how my previous patients handled having a nurse practitioner as a PCP. I told him that the concept of nurse practitioners is something new to a lot of people, especially the elderly population. Many times they do not know what a nurse practitioner is, yet once they see that we practice similarly to physicians at a holistic level, they are fine with it. I told him that of course there are patients who automatically say they do not want to see a nurse practitioner and feel as if they need to be seen by a physician. He asked me, in my experience, what percentage of patients would I say did not want to see the nurse practitioner? I responded with 5% of patients or less. Perhaps other people’s experiences vary from mine.

I found his questions to be intriguing because like I said before, the concept of nurse practitioners is so new, even to a big shot CMO like him.

I updated the other nurse practitioners at my clinic on our conversation. I emphasized the fact that only WE can be our own advocates. That we have to speak up for ourselves when either management or patients try to suppress us. For instance, any time a recruiter or manager calls a nurse practitioner a “mid-level provider”, I make sure to correct them.

In addition, when a patient calls to be seen by their PCP the day of, the front desk will tell them “Your doctor doesn’t have an openings, but you can see the nurse practitioner.” I personally don’t like the way it is said, because it insinuates that the nurse practitioner is the next best thing, and not as good. So I am trying to encourage the front desk to say instead “We can accommodate you today but you will unlikely be seen by your PCP, and may have to be seen by another provider.”

Besides being our own advocate, I think as nurse practitioners, we need to have confidence. Sometimes I hear nurse practitioners turn down a job because they are afraid they are not well trained or competent enough for the position. Of course anything new is scary, but as long as you put in the effort and the time, I feel like you can excel in anything. Physicians will look up things they are not familiar with; we can do the same without being embarrassed by it.

In my next post I will elaborate on the second major part of my conversation with the CMO.

Remember I mentioned I couldn’t work with my favorite recruiter at the Occupational Health Clinic because I needed a 1099 job? Fortunately, going back to this geriatric clinic meant I could go back to my favorite recruiter as well!

As promised on my previous post, I sent her some flowers and she called me in tears! I think it is extremely important to make incredible people feel appreciated. J

When I asked for my new agreement with the Tampa clinic, I noticed that the pay rate was $2/h more than I was making previously. I honestly thought it was an accident because no one mentioned anything to me and I hadn’t even asked for a raise. I asked my recruiter and she said ‘I always try to get you the best rate, and even though it doesn’t always work, this time it did!”

I was really surprised and grateful! Sure $2/h doesn’t sound like much but over 3 months it’s an extra $1000.

Perhaps some of you are wondering why I didn’t ask for an incentive to work at another market for the same company. To be honest, the company has always treated me really well and I almost consider them to be family. For instance, they gave me a $5000 bonus just for extending another 3 months. When I worked 10 hours of overtime a week, they never questioned me about it. They house me in expensive hotels (such as the Westin) and don’t mind flying me home every 1-3 months. They even randomly give me gift cards occasionally for no reason (such as Starbucks and Walmart).

Although they need me more than I need them, it’s good for me to have an option in multiple states that I can consider at any time. They are also an amazing company that I would probably work for the day I decide to go permanent (if that day ever comes).

They also agreed to fly me up to Virginia for the annual holiday party, which is sweet and more for me than for them.

After taking a brief break from the geriatric facility in Virginia, I agreed to help them out at some of their clinics in Tampa, Florida. Being in Florida during this time fall/winter is especially beautiful because it’s not too hot and not too cold. The drive up here from Miami was about 4 hours.

My first day at the new center was okay. I sort of knew what to expect since I had worked at their centers before. Upon arrival, everyone was gregarious and it was nice to see an LPN that I knew from Virginia. She had transferred to that market a few months prior.

I initially was a bit sad because it felt strange to work in a familiar setting with completely different people. The Medical Director was friendly but he didn’t nurture me the way the previous one did. The center manager was welcoming but wasn’t prepared with my laptop, new ID, and lab coats the way the previous one had been. I think I took for granted that the Virginia clinic treated us for lunch almost every day!

I thought I would jump in and start seeing patients, but I spent the majority of the morning on the phone with IT trying to set up my login and computer etc. I also called a few of my patients from Virginia to check in on them. They were extremely happy to hear from me and mentioned that they felt neglected from the clinic since I left.

Originally, the Tampa clinic wanted me to help out 3 months ago when they were short staffed. It seems like since then they have recruited A LOT of PCPs. So I sort of wondered why I was there and if I was even needed anymore. I felt like I should be at the clinic in Virginia, but knew I couldn’t go back there yet.

By the end of the day, I tried to keep a positive mindset. The clinic was new so it wasn’t nearly as busy as the ones in Virginia. Therefore, at least it was unlikely I would feel overwhelmed some days like I did in Virginia. In addition, I was mostly going to be helping with walk-ins and overflow for the PCPs. This meant I wasn’t going to have my own panel the way I did in Virginia. This was a good thing because I wouldn’t have as much responsibility or have to work overtime as I did before. The only bad thing is that I wouldn’t be able to develop relationships with the patients. But considering I spent a year in Virginia, I am glad it turned out this way because at least I can put in my 2-3 months and move on without feeling guilty.

As easy and stress free this job has been at the airport, of course it has its own set of problems.

When working for an occupational health clinic there can sometimes be some conflict between providers and the employer. The employer has this clinic to evaluate injured workers so that they can reduce costs by avoiding them from having to go to the ER or urgent care, and to have them be evaluated quickly so they can return to work. The goal is for them to get back to work as quickly as possible!

Thus, it is a big ‘no-no’ to recommend the patient go home without work. For instance, lets say a patient had a back injury from lifting heavy baggage, and shouldn’t continue to lift heavy baggage for the next few days. The employer would rather you provide the patient with work restrictions, including avoiding heavy lifting >10 lbs, walking and standing for up to 1 hour each shift etc. This way, the employee’s supervisor can find an alternative duty for that employee such as desk work or scanning bags etc. Of course they would rather have the patient at work doing something, than going home with partial pay for no work.

This is understandable, but as a nurse practitioner, my patient will always come first. There are times I do send my patients home unable to work. And a case manager from the employer would call me trying to find out why and insist I change my recommendations. These case managers are non-medical so I am rarely influenced by their comments.

Originally I didn’t think it was a big deal to receive their phone calls, but then they started to complain about the minutest things. In a world with so much chaos and injustice, I do not think these complaints are that serious. I would rather not waste 15 minutes of my day discussing these cases with the case managers.

There was one case where a worker twisted her back while moving a 70 lb bag, then accidentally fell and injured her back. She had trouble sitting during the exam but was comfortable with standing and walking. I put her on restrictions, which included no heavy lifting and “no sitting”. The case manager called me to ask why I put “no sitting”, just because the patient could not sit during the visit doesn’t mean I have to advise her NOT to sit. That didn’t make any sense. I kindly said I couldn’t advise someone to do something they are unable to do.

The case manager asked me if I thought the patient had not been sitting this entire time since being seen, like at home. I responded with: I am unsure as I have not seen the patient since the initial visit, but she is coming in tomorrow and I will surely re-evaluate her then. The case manager proceeded to tell me that I don’t seem to have a good understanding of restriction recommendations. I proceeded to tell her that she does not seem to have a good understanding of medical recommendations. She responded that she would escalate the request to the medical director.

My initial thinking was the patient is still able to work with restrictions, she is even able to stand and walk with no problem, which in my opinion is better than sitting for the employer. She was to follow up the next day, so unsure if changing the recommendations was a big deal for 1 day of work? Lastly, the case manager is non-medical so she doesn’t understand that some musculoskeletal injuries cause patients to find their “new” comfortable position. Whether it is sleeping in a sitting position or standing with a side bending position etc.

Too bad the dream job has its own share of headaches.
I do have a new founded respect for the fleet service crew. They often work every day and more than 8 hours per day, doing strenuous activities.