Traveling NP

Instead of focusing on the covid pandemic, the American Medical Association (AMA) has been advocating for #StopScopeCreep. The AMA has been calling for limits on the autonomy of NPs and PAs, and for years has been working against legislation that allows NPs to practice independently. Their argument is that Nurse Practitioners do not have adequate training to work independently. They support this by saying Nurse Practitioners have less clinical hours during graduate school than physicians have during their training and residency.

I think the AMA forgets that most NPs have experience as nurses prior to practicing as an NP. Our first 1-2 years working as an NP is technically a residency as we adjust from being in the classroom to implementing what we have learned. In addition, most independent practice states only allow nurse practitioners to become autonomous providers once they have several years of experience under a supervising physician.

It is disappointing that the AMA is using this challenging time to blast social media with misinformation about other healthcare professionals. I am not sure why they are so threatened by nurse practitioners. Physicians will always be the expert in medicine, and nurse practitioners are filling in gaps in the healthcare system.

I was happy to see the American Academy of Nurse Practitioners (AANP) publicly defend nurse practitioners and asked the AMA to discontinue the #StopScopeCreep campaign. If you aren’t already, try to support the AANP by becoming a member. We need to unite as nurse practitioners to prevent the AMA from continuing to dispraise us.

For more information, click the link below to read the statement from the AANP in response to the #StopScopeCreep campaign.

Joint Statement on the Scope of Nurse Practitioners

Last year I had a couple of posts about a new nurse practitioner in Chicago that I was mentoring. I thought it would be nice to give an update on how she is doing since then.

In my previous posts I animated how the new nurse practitioner had a lot to learn and didn’t have much support from the physicians in her clinic. Since then she has registered in multiple boot camp courses to build upon her medical knowledge. She also studied for a few hours every day after work.

Besides asking me questions from afar, there were a couple of new physicians at her clinic that she was able to form good relationships with and go to them if she had any questions. As a result, her support network has improved.

She has been practicing at that clinic for over one year now and has come a long way. I am happy to report that she has excelled even beyond her fellow peers.

In her clinic of 4 providers, she has the top patient satisfaction scores and the top patient outcomes. This means she has been the most successful in keeping her patients out of the hospital and healthy.

I have also noticed her clinical knowledge has improved, along with her confidence. She doesn’t come to me as much with questions, and if she does, she typically already knows the correct answer.

I am proud to say she has graduated from her role as a novice nurse practitioner. I think it’s so important for new nurse practitioners to continue learning their first year working and find a mentor to guide them. 

It has been a while since I made a post based off a question from a reader. I had an interesting question from a reader the other day that I get quite often, so I figured it was time to share it.

Do you have consistent work as a traveling nurse practitioner?

It seems a lot of nurse practitioners are worried about having consistent employment prior to taking the plunge as a traveling nurse practitioner.

The answer to the above question is – yes. I have consistent work because I have formed relationships with recruiters in multiple agencies. When I am ready to start searching for my next assignment (usually 1 month prior to my current assignment ending), I will reach out to my recruiters. I let them know when I am available and what I am looking for. This allows them to keep me in mind when something opens up that meets my needs.

By having these relationships, the recruiters are constantly reaching out to me when they have new gigs. I try not to ignore them, and will let them know if I am currently not available or not interested.

I think the other important aspect is that I have at least 5 active state licenses at any given time. This makes me a good candidate for job prospects, as most clients aren’t willing to wait for you to become licensed.

As I stated above, I do have consistent work being a locum nurse practitioner. In fact, there are often many options from me to choose from at any given time. It also helps when you have been traveling for a while, because previous sites may often request you to come back. I like to use these as my back up options unless I am excited to return.

The reality is you have to be flexible. If you are only open to working in a certain city vs being open to working in the general state, then your options will be limited. In addition, sometimes the start date may be delayed a week due to credentialing or licensing so you should make sure you always have a financial buffer.

I have found that newbies are concerned about consistent work but once they start working as a traveling nurse practitioner, they realize their take home pay is more than their full-time job. As a result, they recognize that they actually don’t need to work 52 weeks out of the year. And enjoy taking time off to be with family/friends or travel abroad.

This year went by incredibly fast. I guess because most things that happen were halted by Covid such as traveling and celebrating holidays.

Finishing up my assignment in Florida, I interviewed for several assignments in California. I was looking for an assignment for November-January. Since it would be cold during those months, my options were limited. I had 3 offers from CA jobs that actually seemed great. However, I ended up turning them down because in the end I decided I just wanted to be home for the remainder of the year.

November is my birthday month and Thanksgiving. Even though I knew we wouldn’t have our usual 50-person thanksgiving dinner, I still wanted to be home to celebrate those occasions with family and friends. I had an incredible birthday, so I am glad I made the decision to be home for it.

Besides Christmas and New Year’s Eve in December, my older sister got married and my younger sister had her first baby. Thus, I had a lot of (positive) family things going on, and didn’t think it was worth traveling back and forth from California at least 10 times within 2 months.

After finishing my Florida assignment, I wasn’t burned out so I actually wanted to continue working. But after talking it out with people I am close to, I realized that I want to retire early so I can spend time with the people I care about. So why wait until I retire to do those things?

I was worried I would get bored with 2 months off, but between all of the holidays and festivities I was pretty busy. I even picked up a few per diem shifts helping out the Ft. Lauderdale, FL clinic I worked at previously 1 or 2 years ago.

I had a great end of 2020 and am looking forward to what 2021 has to offer. Happy holidays everyone!

This law passed in 2019 and went into effect 1/1/20. It was originally created to allow gig workers for Uber and Lyft to earn benefits as employees of their company. As a result, it affected other independent contractors and requires companies to reclassify them as employees. There were some exceptions such as physicians, but of course nurse practitioners and physician assistants were left out of this list of exceptions.

Unfortunately, that means nurse practitioners can no longer practice in California as sole proprietors. We can only practice there as W2 employees. That means, even an agency that usually pays their travelers as a 1099 contractor, now has to pay their employees as W2 workers when they work in California.

This has created a lot of problems for nurse practitioners in California. Many providers prefer working as a contractor because you are able to deduct a lot of expenses on your taxes. Several agencies teamed up to advocate for nurse practitioners and have them added to the exemption list. So far this has been unsuccessful.

Since I was looking to work in California for the beginning of 2021, I was interested in working through an agency that pays us as 1099 contractors. For the reasons mentioned above, this won’t be the case.  And since the agency will have to pay me as an employee, that means less pay since they are required to offer benefits. It also means that they can no longer provide me with a housing stipend, but only a reimbursement.

For one assignment, I was originally being given a $3500/month housing stipend. I was planning on renting a place that cost $2500/month and pocketing the rest. This will no longer be possible since the agency is converting all contractors to employees by 1/1/21.

Hopefully nurse practitioners can be added to the exception list eventually because this is such a disappointment and will defer myself and other nurse practitioners from practicing there in the future.

I started this blog over 5 years ago when I first became a traveling nurse practitioner. At that time, I couldn’t find much information on how to become a traveling nurse practitioner and how it deferred from travel nursing as an RN.

I decided to start blogging to document my experiences working in different settings and to help other nurse practitioners get started in traveling. I have also used this blog to vent about my frustration working in modern day medicine. I have to admit – it has been quite therapeutic.

Some of my close friends and family read my blog which I appreciate. And of course, there are hundreds of fellow nurse practitioners that read it too. I love getting feedback from you, especially if you’ve had similar experiences to me. Sometimes it takes someone working in the same field to get it…

I love receiving emails from my readers with questions or recommendations to get started in this arena. I especially like getting follow up emails months later when you’ve started your journey.

I’ve had many readers offer to meet up with me while traveling close to them. I usually travel alone so I deeply appreciate this warm gesture. It’s been nice to form a bond with other nurse practitioners just from having a similar interest in travel.

Thank you for your support and I am looking forward to many more years of blogging! If there are any topics you would like me to cover and revisit, please let me know in the comments below.

I am writing this still on a high from my last day at the Bradenton clinic. I am just so grateful for my experience there. The patients were so sweet and the staff so friendly.

On my last day, dozens of patients passed by to give me gifts or just to say goodbye. They wrote the nicest things in their cards. It blew my mind that I made such an impact on them in the just the past 3 months or less. I felt myself trying to keep my distance from patients in this setting to prevent becoming attached to them. But as a nurse, caring for them is inevitable.

My care team surprised me with an edible arrangement. They were such a good team and I will keep in touch with them. The center manager provided the entire clinic lunch from a Japanese hibachi restaurant which was delicious. At the end of the day, we gathered together for a little party in the clinic.

My boss presented me with a gift and said a speech about how much they appreciated my help. The speech really touched me because he literally said “I don’t know how we would have survived these past few months without you. You did such an incredible job taking care of your patients, they trusted you in such a short amount of time.”

Afterwards, everyone had some wine and we did a little karaoke. It was hilarious. One of the doctor’s sung “The End is Near” as a representation of the mood. My boss asked what he should sing and I jokingly said Andrea Bocelli. The next thing I know he is singing Andrea Bocelli but in the most miraculous way. Turns out he sings really well!

At the end, no one wanted me to leave. They begged my boss to make me stay. He told them I already turned down his offer to become permanent. The doctors joked that they will make sure one of the new doctors gets pregnant quickly so I can return to cover the maternity leave.

I feel so blessed for these experiences! As always, leaving is bittersweet.

While I was working in Florida, I received a letter in the mail from the Board of Nursing (BON) in Kentucky. It stated my Kentucky license was under review because I failed to register for a Kasper account (controlled substance monitoring system) while holding a DEA license in KY.

When I first started working in KY, I began the process of registering for a Kasper account. However, I noticed that you had to get the application notarized. Since the lead LPN had Kasper access at the clinic, he would normally look up patients for the providers and print us the report. Thus, since I thought I would only be there for 3 months, I didn’t complete the Kasper application.

Apparently, it is a BON requirement to have a Kasper account while holding a DEA in KY. I had to submit a notarized letter stating I am no longer practicing in KY and my DEA license has been transferred to FL, with proof. I submitted this documentation as soon as I could.

In the meantime, my agency had to notify my current job about my license being under review. It was a bit embarrassing because it was the same site as in KY and such a trivial reason. Fortunately, it did not impact my current assignment.

While looking for my next assignment it has been a bit of a nuisance to have this over my head. For example, multiple agencies have done a search on my licenses and requested documentation to support the reasoning for the investigation on my KY license. In addition, when doing credentialing I had to select “Yes” when they ask “have any of your state licenses ever been under investigation.” This caused a red flag for my upcoming assignment because they are strict when it comes to those things, regardless of how trivial the reason is.

It took almost 2 months for the BON to review my documentation to resolve the review of my KY state license. They sent me another letter stating I need to pay a $250 fine for not following the BON rules. Once I paid the fine and signed the agreement, the investigation was resolved. They also stated in the letter that this wasn’t an official complaint so I do not need to report this to other states when applying for licensure or to future employers. This was great news since I no longer had to answer “Yes” when they ask “have any of your state licenses ever been under investigation.”

A reminder to myself and others is to always read the Board of Nursing rules and regulations thoroughly. Since I hold over a dozen state licenses, sometimes it’s difficult to stay on top of things, especially when you are transitioning from job to job (or from state to state) so quickly. I have to remember that each state is so different when it comes to nurse practitioner autonomy and regulations.

The majority of primary care offices had to convert to telemedicine visits once Covid became a pandemic. The geriatric clinic I worked for initially made 95% of appointments telehealth. As covid cases started to decrease, we increased the amount of in office appointments. Our patient population is high risk so we wanted to do this gradually.

I have not worked solely for a telemedicine company, but I did use telemedicine in my normal practice. It was an interesting experience since my patients were mostly 65 years old and older. We had to teach them how to use their smart phones and talk with us via facetime or apps. Eventually, we were able to create our own telemedicine software. This was pretty easy as we just sent the patient a link via text and once they clicked on the link we were able to communicate via video.

Some challenges included that some patients only had a landline or a flip cell phone. So they had no means to do a telemedicine consult. We did phone visits with them but these weren’t ideal because it was hard to tell if a patient was short of breath or in fluid overload without seeing them.

Now that we are doing a mixture of telehealth and office visits, sometimes it is difficult to stay on schedule. The office visits sometimes run longer than planned so we end up having to call the telehealth patient 30 minutes late. I also noticed that the medical assistants aren’t used to having patients in the office. They often don’t complete all of the vital signs (only blood pressure no weight, or glucose missing etc.), and I have to constantly be on top of them.

The positives are that thanks to covid, we will likely continue to incorporate telemedicine into our care. Some patients do not need to come in to discuss lab results or to follow up on their depression. The 20 min office visit can be replaced with a 5-10 minute telehealth video session. High risk or “needy” patients can be checked up on frequently via telemedicine visits too.

The “no-show” rate has declined as we are able to reach our patients more easily via phone. This is especially helpful for hospital discharges that are “too tired” to come into the office for a follow up.

What have your experiences with Telemedicine been like?

I was listening to a podcast the other day about a seasoned travel nurse. She said her favorite thing about travel nursing is the freedom to choose her work environment. I thought that was such a powerful statement.

As a traveler we can choose a job that allows us to see a fair amount of patients so that we do not become overwhelmed and can provide good care. We have the option to decline a job that requires us to see 30 or so patients per day.

As a traveler, we have the opportunity to decide if we want to work in home health temporarily or pick up some skills in urgent care. We can also choose to work at a site that has other providers if we are not comfortable working in a solo practice.

It’s crazy how people start working at a full-time job and are completely in the dark about work expectations. Being a locums allows us to test drive a job before signing on permanently. Since most assignments are 3 months or shorter, we can elect to stay longer if we enjoy the job. Or we can move on if we were not into the office politics.

Thus, I agree with the travel nurses’ above statement. Being a traveling nurse practitioner provides us with autonomy and the freedom to choose.