Traveling NP

This year so far, I’ve worked in San Diego, CA and Virginia Beach, VA. These are two places I’ve worked in before. I knew for my next assignment I wanted to go somewhere new. The geriatric clinics I often work for had a need in Columbus, Ohio. I’ve never been to Ohio and thought it would be a nice idea to go there for the end of summer and fall.

I accepted an assignment with them in March, for a start date in August. I thought I would have plenty of time to get an OH license. Turns out, things happened more slowly because of covid. The Board of Nursing worked from home and it was almost impossible to get in touch with them. I tried both calling and emailing them without a response.

Luckily, I remembered I had a reader that was licensed in OH and I was curious about his experience. I reached out to him to see how long it took him to obtain his OH license. Since OH is not a compact license state, I needed both the RN and NP licenses. OH doesn’t allow you to apply for both licenses upon endorsement simultaneously. So, I needed to wait for the RN license to get approved before applying for the NP one.

After waiting 2 months for the RN approval – still nothing. That’s when I reached out to my reader and he told me that there are Facebook groups that have Board of Nursing contact information in each state to help facilitate license applications.

He gave me the contact information for the Ohio Board of Nursing President. I sent her an email saying I was still waiting on my RN license approval, in which everything was submitted 8 weeks ago. That same night (it was even a Saturday), I finally received notice that my RN license was approved!

I was thrilled that this tip worked. When it was getting close to August, I still hadn’t received my NP license. I decided to use the same email to inquire about my application. The following day, my NP application was approved!

Thanks to my reader’s tip, I was able to get my OH licenses just in time for my start date. I will be sure to look up Board of Nursing contact information on Facebook groups for future state license applications. 

I usually travel abroad several times a year. However, since covid, I haven’t travelled internationally. Once I got my covid vaccine and saw that covid rates were dropping, I decided it was time to plan my first trip abroad.

I chose the Dominican Republic because it’s only a few hours flight from Miami, and I was ready for a nice relaxing type of vacation.  

There’s an all-inclusive Hyatt resort in Punta Cana, Dominican Republic that I wanted to try out. It’s practically brand new and fortunately I had enough Hyatt points to cover the costs. The nightly rate is $550 for two people or 20k Hyatt points. Using points is such a good deal since it covers all of the foods, drinks, and amenities.

The resort ended up being amazing! The weather in the DR was surprisingly less humid and more breezy than in Miami. The ocean water was clear blue and cool. The service from the resort was impeccable. The people are extremely friendly and welcoming. Having the drinks and food included made our stay straightforward. Not to mention everything was delicious!

I also liked that the hotel wasn’t crowded. In many of the restaurants we were one of a few groups there.

When returning to the USA, you need a covid test prior to departure. The hotel made this easy by providing it free of charge on site. The results were ready within 1 hour.

Fortunately, no one on my trip tested positive for covid, so we were able to travel back home as scheduled. If you are looking for a relaxing an easy getaway, I highly recommended the Dominican Republic. I am still dreaming of the beach there!

Traveling internationally has made me more open minded and tolerant of other cultures. I recently realized how this has contributed to my role as a primary care provider. I love having patients from various ethnic backgrounds.  

In my most recent assignment I had patients from India, Puerto Rico, Mexico, Lebanon, Greece, Italy, Brazil, Philippines, Japan, etc.

Before I went into the room to meet the Lebanese patient, my medical assistant warned me that the patient was rather cold. I recognized a French last name so I asked her where she was from. When she said Lebanon, I let her know that my family has some Lebanese heritage as well. We bonded over our favorite Lebanese dishes and I noticed her relax and begin to open up. At the end of the visit, my medical assistant asked me what I did to get the patient to make a complete 360. I just told her I found a commonality between us.

The Hispanic patients are pretty easy because I speak Spanish so they are comfortable with someone understanding their native language. I am also from Miami so I have some form of knowledge of the majority of Latino cultures and behaviors. If I see these types of patient as a walk-in, they often request to change to me as their PCP. They told me that by me understanding their culture they feel more at ease coming to the doctor’s office.

I have traveled previously to Brazil, Greece, Italy, and Japan, so once I mentioned that to the patients from these countries, they were thrilled. We talked about their experience living there and why they chose to move to the USA. I think this brief dialogue made them feel calm and more connected.

Although I have never been to India or the Philippines, these patients have expressed being very relaxed when seeing me. They said it is because I approach them with an accepting mindset and explain things to them in a way they can understand. Whether it’s by speaking slowly or breaking down terms to a level that they can process. I think in having immigrant parents, I am aware of cultural barriers in healthcare.

I love traveling internationally, and I know it has made me a better person. It’s nice to see that it has also contributed to my skills as a primary care practitioner. 

During my recent assignment in Virginia Beach, I found myself getting busier and busier. My patient panel exceeded my typical panel size, and I was seeing 20 complex geriatric patients per day. This exceeded the 16 patients max per day I was supposed to be seeing according to my contract. Due to my previous experience with the company, I know what my limits are.

With this company, I often work up to 45 hours a week – 5 hours being overtime. However, in Virginia Beach, due to the reasons stated above, I was working 50-55 hours per week (10-15 hours of overtime which is ridiculous). I tried telling both leadership and my recruiter that I was working too much, taking too much work home, and feeling overwhelmed. This wasn’t the work-home life balance I have come to appreciate being a locum tenens nurse practitioner.

No one seemed to care so I decided to just suck it up for my remaining few weeks. I figured the extra income I was making in overtime would cover the 3 weeks of unpaid time off I was planning on taking after the assignment ended.

Then one day I was notified by my recruiter that the site was contesting some of the over time I had recorded. I had billed them for 54 hours but they suggested I had only worked 52 hours. Fortunately, the agency told me that even if the site contested part of the overtime, they would still pay me for the full hours worked (or that I billed for). Although I was pleased with that surprise benefit, I was disappointed with the work site.

It’s definitely about the principal of the matter. I had already made it clear to them that I didn’t even WANT to work overtime but they did nothing to ease up my load. And I am confidently very efficient as a provider so I knew there wasn’t anything I could do to finish my work more quickly.

Seeing 20 complex all-risk geriatric patients per day leaves me with little to no time after completing my notes – to complete refill requests, review phone messages and call patients back, review lab results and consult notes, and review patients in the hospital and call hospitalists to inquire about patient status.

Not to mention I have worked with this company on and off over the past 5 years and NEVER have had an issue with my hours billed or being paid overtime. I am sure there is a way they can see what time I log off from my work laptop, which is way after the clinic is closed. I think they are oblivious to the fact that their full-time salary providers work close to 60 hours per week.

To be honest, I think it is their way to get back at me for not wanting to extend my assignment. It was only after I declined the extension that they started to decline some of my overtime. Had they not taken advantage of me and overworked me I would have been more than glad to continue helping. Let’s just say I won’t be returning to this market unless there is a change in leadership.

One of my readers sent me a nice email and told me how they planned on become a traveling nurse practitioner this year once they start semi-retirement. For those unfamiliar with the concept, semi-retirement means that you work just enough to cover your expenses minus was you are getting from passive income. In this case, you wouldn’t need to save any of your income. There is no need to make more than your expenses because you have saved enough in retirement accounts etc., and just need more time for compound interest to grow your net worth.

For instance, someone may have $1000 a month coming from their real estate rental income. They need $2000 per month to cover all of their expenses. Therefore, they only need to work enough shifts per month to cover the remaining $1000/month for their expenses.

After she mentioned this to me, I reflected to see if this would be a good option for me as well – instead of just completely retiring early. I think it would be quite difficult to give up my identity as a nurse practitioner. If I went years without practicing I would lose my skills and wouldn’t be able to return to work competently.

I still like the medical aspect of my job – figuring out what patients have and providing appropriate treatment – such as a puzzle. I like the teaching aspect too. I enjoy forming relationships with patients and seeing their health improve. Of course, there are some aspects of the job I wouldn’t miss such as demanding patients, or being overwhelmed by scheduling. It’s amazing how we can often let one rude patient ruin our day after having 20 other nice patients.

If I were to semi-retire, I could work a mere 3-6 months to cover my expenses. This would be great because I would still have at least 6 months to travel or do whatever it is I wanted. Plus, I would continue to have a sense of purpose through working and could allow my portfolio to compound even more.

When I take off an extended amount of time from work, I always go back refreshed and am even excited to see patients. If I worked 3 months on and 3 months off, my passion for medicine would continue to thrive. 

There is also an option for me to work part-time. In some cases, a part-time job would provide necessary benefits such as health insurance. Once I’ve had enough of travel, this may be a good choice for later on. I just have to make sure I won’t be working “full-time hours” with part-time pay.

Outside of clinic practice, I can potentially work in teaching. I have previously taught at both the RN and NP level when I was living in Miami, and really enjoyed it. I may even consider going back to school for my PhD. I know various Universities that provide free tuition in getting a PhD while working as a teaching assistant for them.

By working less than full-time, I would have the time and energy to become more involved in nurse practitioner advocacy through local and state organizations. I would also have the opportunity to volunteer and continue to mentor youth, which has always been one of my passions.

Anyways, the possibilities are endless and that’s always exciting! Have you thought about what you will be doing when you choose to semi-retire, retire, or just want to change positions?

Check out an article I wrote for Barton Associate’s Blog on all that a DEA license entails:

https://www.bartonassociates.com/blog/what-is-a-dea-license

I’ve spent the past 5 months evaluating my job and trying to figure out the parts I like and the parts I dislike.

I like being able to figure things out medically– sort of like a puzzle. I also like offering patients natural treatment options for their ailments such as probiotics or exercise. I like helping patients and providing accessible care. And I love having the power to prescribe.

I thought my main dislike would be being overscheduled or forced to see walk-in patients without appointments. But I realized these nuisances weren’t often and they were fleeting. Even when I did have extra time to spend with patients, I found myself rushing to end the visit.

There is a reason why I am always exhausted after each shift, and need weekends to recharge. The answer is because I am an introvert. An introvert has a limited battery life to interact with other people, and once that battery is empty, they need alone time to recharge.

Although I like helping people, spending all day every day talking to tons of people is mentally exhausting for me, as an introvert.

This is why when I take 1-2 months off from work, I am mentally recharged and excited to get back to work. That is … until I am depleted again 4-6 weeks later.

I never thought about how being an introvert could accelerate my risk for burnout until I read a similar perspective on a financial forum. The person posting was actually a physical therapist. He said that as much as he loved his job, he wanted to become financially independent so he could work less. He stated that since he is an introvert, talking to different people all day long was overwhelming for him. When I read his post – I was like yessss! I completely identified with that.

I think next year I am going to make some changes professionally and I wanted to evaluate what those changes should be. As an introvert, it may make more sense for me to work part time. That way I am not spending 40+ hours a week giving away all of my energy to other people. I may also consider continuing locums but trying to work shorter assignments or taking a mandatory 1-2 month break in between gigs. That way when I am working, I can give the best version of me instead of a drained version of me.

I know it’s easy to ignore recruiters when they blow up our phones or emails with job options. But I try to send a quick response via text or email letting them know I am not interested or are currently on an assignment. This keeps my relationship with recruiters strong.

If I were to ignore them often and only reach out when I needed them, the recruiters would be less inclined to help. On the other hand, since we are often in close contact, I am one of the first providers they consider for any relative assignment.

I am often asked by peers if there are times that I do not have consistent work as a traveler. My answer is no, in fact I typically have multiple job options at any given time. One of the reasons for this is because I have established strong relationships with multiple recruiters.

In addition, I have built connections with previous work sites. So, when they have a new opportunity (they often do), they will contact me to come back. When I first started traveling as a nurse practitioner, I didn’t expect I would ever return to a previous assignment. My thought was I would only want to go somewhere new. Fast forward to 5-6 years later and my mind has changed.

For example, my options are limited in winter so I don’t mind going back to a previous job in California or Florida. I have also formed relationships with staff and the local community, so I enjoy returning for brief periods to catch up with my new friends.

Even though I only work at each place for 3 months (initially), I always put my best foot forward to give them a good impression of me. This way, I’ll always have a job to return to if needed or can help in their clinics in other places (like I do now for the geriatric company).

If you see locum tenens in your near future or want to work in this field long term, be sure to network and work on your professional relationships. 

When staying at a hotel while working at an assignment, I try to stay at a Marriott hotel. Their Residence Inn chains have a kitchen which I like to have. I like Marriott because they have a large footprint especially since they bought the Starwood preferred group chain (think Sheraton). So whether I am traveling domestically or abroad, I can typically find a Marriott hotel to book. Since I am a Titanium member (their highest elite status), I can request late checkout up to 4pm. This is convenient if I have a late flight or want to store my things before moving into my apartment.

When traveling for leisure I love to stay at Hilton hotels. Since I am a Diamond member (their highest elite status), they often treat me as royalty. Think room upgrades, free breakfast for my guests and me, and lounge access. I especially love staying at Hilton hotels abroad because they are usually very luxurious. When I went to Bali in 2019, they upgraded me (for free) to a huge suite. Instead of just a standard bedroom, I had a dining room and living room too. They also gave me free breakfast at their expansive buffet, and allowed my 3 guests to dine with me for free as well.

Since I stay at Hilton and Marriott chains frequently, I definitely have a credit card of each brand. This allows me to accumulate points to stay there for free. If you are interested in getting either of these cards, check out my referral links below.

Hilton Card

Marriott Card

Check out an article I wrote on Barton Associates blog about beginning your career as a locum tenens provider:

https://www.bartonassociates.com/blog/top-5-questions-for-your-locum-tenens-recruiter