Traveling NP

My name is Scott and I have been working as a locums nurse practitioner for about 6 months.  I was turned onto the idea of Locums by the popular traveling ARNP herself, Sophia.  I met Sophia on one of her rounds in Lakeland, Florida, my hometown.  After working in a permanent position for almost 2 years, I was feeling burned out and ready for a change. I was not ready to commit completely to a new job so I decided to pursue locums instead.

My first assignment was in Pasco, Washington, working for a FQHC, one of my favorite types of work.  I was about as far from Florida as I could get, besides Alaska. During my assignment, I was constantly searching for the next assignment, making things a bit hectic.  I was fielding multiple calls, daily emails and texts, all while working.  As a locums, you always have to be on the lookout for your next position. While on assignment, I found myself networking and trying to keep busy when I couldn’t hop on a plane back home to family and friends. 

I was fortunate enough to negotiate a flight back home each month, paid for by the agency.  By far, this was the smoothest process and company I had worked for.  I literally had all options at my fingertips.  I said when I wanted to work and not work. I got to pick my hotel, rental company, and airline of choice. When I was offered the option to extend, they agreed to increase my hourly rate as well.

The Locums opportunity allowed me to see places I never could have being tied to a permanent job.  I explored Washington, Oregon, California, and even made it to Alaska, British Colombia, and the Yukon Territory. This experience also taught me that there are more work opportunities as a family nurse practitioner than there are for those of us that specialized in adult health. So, I decided to enroll in a program that would allow me to become a family nurse practitioner after studying (and completing clinicals) for an additional 6 months.

Aside from the experiences, travel, and new sites, I found myself getting homesick. While in school, I am going to be moving back to Florida to start a new permanent position. I am so very thankful for Sophia’s guidance, and tips for travel/credit cards. 

Working as a traveling nurse practitioner was a nice “break” and helped me rekindle my love for medicine. I hope my experience helps those consider working in locums during a transitioning phase in your life or career. 

Each quarter 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.

“I am currently applying to nurse practitioner programs with an end goal of becoming a traveling nurse practitioner. Which specialty would you recommend pursuing in order to find locum tenens jobs easily?”

Great question! I have noticed there are way more traveling jobs for family nurse practitioners (FNP) than there are for adult nurse practitioners. As an FNP you can work in primary care, pediatrics, geriatrics, and women’s health. There are also tons of urgent care and ER positions that typically require FNP certification. I have seen my FNP peers find locum tenens jobs way more easily than my adult NPs. I also know some adult NPs that have gone back to school to become an FNP to open up their job options.

Another specialty in demand is psych NPs. If you have an interest in psychiatry I would recommend obtaining the extra certification. There is such a need and they pay well too.

Most people know I do not like to extend my assignment. I prefer new experiences and moving on. The longer I am at one job usually the more irritable I become.

Soon after I extended my time in Chicago, the Medical Director was already approaching me about staying longer. I told him I would let him know during the beginning of my last month whether or not I would extend. This is because I have no way of knowing how I will feel 2-3 months from now.

There will be a finite time of my extension because Chicago has harsh winters and there is no way I could survive that. There will be a new physician starting at the end of my original extension, so the site wants to make sure there is a warm hand off by me staying longer.

Although there have been a few nuances such as physicians calling off frequently or not wanting to share the patient walk-in load, I enjoy my job. The longer I stay at this site, the easier it gets because the better I know the patients.

I have already celebrated milestone birthdays (80 and 90 years old) with my patients. I have celebrated anniversaries and births of their grandchildren and great-grandchildren. I have been there for them during the death of a loved one or met with their family when it was time to go on hospice. I have already helped patients improve their diabetes, work on their anxiety/depression, and become physically stronger after surgery.

The patients already know me well and make jokes about when is my next vacation and how humid it must be in Miami right now. Even though I am one of the newest providers to the market, I actually have the best patient outcomes. This means I have the least amount of patients going to the hospital. For geriatric patients this is significant because it means less sick days and more healthy days with their family. I believe the reason my hospital sick days are low is because my patients trust me.

Thus, I feel like there is no reason for me not to extend. My only concern is that I do not want to get too attached to my patients the way I did when I was in Virginia the first time. But I think this time I will have less guilt about leaving because there will be a warm hand off with their new doctor. I have also learned to compartmentalize a bit better.

Have any of you extended beyond 6 months?

Over the past year I have obtained 3 new state licenses. Now that I am a seasoned travel nurse practitioner, I just ask various agencies to acquire new licenses for me upfront. This way they can help with the application process and cover the costs 100%.

I had one agency work with me to apply for a Colorado license. The process was fairly quick and painless. Since Colorado is a nurse compact state, I was able to use my Florida RN license to apply for the nurse practitioner license. This cut the application time in half, and it only took 1 month to become licensed.

The second license I wanted was between Wisconsin or Minnesota. I wanted to spend some warm months in the upper mid-west. Since Minnesota is not part of the nursing compact, I decided to move forward with the Wisconsin application instead. This license took a whopping 3 months to be issued. I also had to take a legal exam pertaining to the laws of the state. If you are interested in working in Wisconsin, give yourself ample amount of time to obtain a license.

The last license is the one I am currently using, which is Illinois. I had been offered a job here since January, with an April start date. Fortunately, with the agencies help I was able to get my license within 2 months, just in time for my start date. One thing I wasn’t a fan of during the application process was needing to have a supervising physician sign a separate controlled substance agreement. The form was titled “Application for Advanced Practice Nurse Mid-Level Practitioner Illinois Controlled Substance License.” Illinois is a reduced practice state but I feel like they could leave out the ‘mid-level’ part.

If you are new to locum tenens, I always recommend obtaining 2-3 state licenses on your own. Agencies are reluctant to license you without previous locums experience and you are more likely to get your first assignment if you are already licensed. Agencies will reimburse you for the cost of the license once you start working with them, so be sure to keep all receipts. Once you have worked your first 2-3 assignments, you can have agencies apply for licenses proactively.  

Almost half of my patients went on vacation during July, so my schedule was pretty open. I heard there was a new nurse practitioner at one of the other clinics that was struggling. I asked the medical director if I could help her out one day a week as long as my schedule allowed. Luckily, he thought it was a great idea. I was looking forward to helping a fellow nurse practitioner and having a change of scenery.

When I met the new nurse practitioner, she was ecstatic that I was there to help her. She confided in me that the other physician in the clinic was unapproachable and she felt alone. She struggled to find someone available to help her as needed. I understood her frustration and told her hopefully it would get better in the upcoming weeks when another physician returned from FMLA.

Fortunately, her schedule was still pretty light so we could take our time going through the motions. I shared some tips of approaching new patients (whether new to the clinic or new to her); considering I am constantly seeing new patients. For instance, I recommended she review all of her scheduled patients before the day started to have a plan in place. During this review, she can go ahead and order necessary INR tests, evaluate recent lab results, and consider any health screenings that are due.

Once the patient is made ready for her, I advised her to go ahead and start her note instead of waiting until she got in the room. This ended up being very beneficial for her because since English is her second language, I noticed she has a hard time typing on the electronic medical record while she speaks or listens to the patient.

Additionally, I taught her how to focus on the visits. Our patients come once a month and they are elderly. Thus, it is best not to change more than 2 things per visit or it may cause a lot of confusion for the patient. Hence instead of changing both blood pressure medication and depression medication during the same visit, just change one this time and plan to change the other at the following visit.

I observed that she had some gaps in medical knowledge. She has less than 1-year experience in a family practice environment, so I wasn’t surprised. She was used to seeing simple things such as cold symptoms and UTI. Versus a lot of our patients need treatment for co-existing chronic kidney disease, heart failure, diabetes, high blood pressure, coronary artery disease, osteoarthritis, depression, dementia – the list goes on.

I went through several scenarios with her in how to manage a patient properly. We discussed how to work up someone with chronic cough or acute abdominal pain etc. I reviewed pharmacology and initial treatment options. I recommended she do some reading after work and on weekends to review more chronic and complicated disorder.

Lastly, I mentioned to the medical director that she needs more mentorship so he said he will make one of the physicians at her clinic more available to her. She seemed overwhelmed initially but more comfortable by the end of the day with me. I told her she can reach out to me with any questions in the future. I’ll be sure to update you with her progress one month from now.

I have had some readers ask me what is the #1 travel credit card I would recommend. My answer is always the same, which is the Chase Sapphire Preferred Card. It has a $95 annual fee but the initial sign up bonus is 60,000 points after spending $4,000 within the first 3 months. The 60,000 points can be worth way over $1,000!

The reason this is my go to card is because it provides car rental insurance if you pay with this card. I also like the transfer partners this card has. For example, I can transfer points to Hyatt or Intercontinental, United or Southwest etc.

My favorite way to use these chase points are to transfer them to British Airways. British Airways is a partner of American Airlines. So, I am able to fly roundtrip from Miami to Haiti for 15,000 British Airways miles on American Airlines. This round trip flight typically costs $500-700 out of pocket, so using miles is a no-brainer.

I also like transferring chase points to stay at Hyatt hotels. In Hawaii, the hotels typically cost $400/night. By transferring 20,000 of my chase points to Hyatt, I am able to stay one night for free. For instance, if I used my 60,000 chase points to stay at a Hyatt hotel in Maui, I would be able to save $1200 of cash for the 3 nights. 

This card also provides trip cancellation insurance. If your trip is cancelled due to sickness or severe weather, you can be reimbursed for pre-paid nonrefundable expenses. In addition, if your baggage is delayed by 6 hours or more, you can be reimbursed up to $100 per day until your baggage is delivered to you. This $100 credit covers purchasing new clothes, toiletries, or other important items missing from your bag.

While on assignment, some agencies may provide an apartment for you to live in.

Before you move in, be sure to complete the check list of the condition of the place. I highly recommended taking pictures of the apartment upon move-in and when moving out. I have read many stories of apartment buildings trying to charge tenants for damages to the unit that were previously there. I never thought much of it until one of my friends had a similar experience.

My friend has a dog so she had to pay a pet deposit fee to the property she was living in. When she was moving out, her apartment was in perfect shape. However, a few months later she contacted the agency to find out if she would be given back the pet deposit fee. The agency housing representative told her that the apartment management kept the pet deposit fee due to the condition of the unit.

My friend was surprised and asked them to send her pictures of unit. Through the pictures she saw that there was some floor damage, wall scruff marks, and dents on the front door. These were damages made by the moving crew for the rental furniture!

Unfortunately, my friend was unable to provide pictures of the unit on the day she moved out which would have showed the apartment was in better condition. As a result, she lost her $400 pet deposit fee. The moral of the story is to always document everything!

I decided to extend my stay in Chicago because it’s an awesome city! Over the summer there has been a festival almost every week; for example we had a jazz festival, bar-b-q festival, international movies etc. I love going to the various parks for bike riding or long walks. Biking on the lake shore trail with a view of Lake Michigan is beautiful!

There are countless museums. The Art Institute of Chicago is a must. They have the famous “American Gothic” Painting, and many impressionist works of Van Gogh and Monet. I have also enjoyed the Field Museum, which has dinosaur skeletons and immersive cultural experiences.

The night life is great too. I have had tons of fun going to roof top bars and dancing. I also like the variety of food options here. I made it my mission to find the best deep dish pizza, and after trying 6 different places, I have decided my favorite is “Lou Malnati”. My other guilty pleasure is this Mexican ice cream shop called “La Michoacana”. My go-to is the home made mango ice cream, and you can find these shops all over Chicago.

It’s safe to say there is so much to do in Chicago and I highly recommend it as an option for your next travel adventures. I wouldn’t mind living here permanently if they didn’t have such brutal winters. 

This summer I am celebrating working over 4 years as a traveling nurse practitioner. So far I have worked at more than 20 different sites. If you follow my blog I am sure you are aware of all of the ups and downs throughout this journey. I thought it would be fun to share the top 5 reasons I still love working as a traveling nurse practitioner.

1. Flexibility – As a traveling nurse practitioner, I can choose to take a month off at a time if I feel like it. I don’t have to work holidays if I don’t want to. I can decide if I want to avoid working weekends or if I prefer a 12-hour schedule.
   
2. Traveling – Exploring the country has been a tremendous amount of fun. I also get to catch up with friends and relatives in numerous cities. Not to mention accumulating miles and points from traveling for work has allowed me to travel abroad on a regular basis for nearly free.
   
3. Increase in Income and Savings – Working in locum tenens I am paid higher than I would be working at a permanent job. I also do not have a car or house payment so my expenses are less than your average worker. As a result, I am able to save at a fast pace and who knows, maybe I will retire early.
   
4. Learning– The learning curve while being a traveling nurse practitioner is astounding. Between working in various types of facilities to caring for different patient populations, I am always kept on my toes. For someone that loves to learn, being a locum tenens provider has taught me so much.
   
5. Freedom – There is no better feeling than working at a place you don’t “need” to be at. Knowing you can quickly find another job if you aren’t happy or appreciated at your current job unloads a burden that most employees have. In combination with having a bulk load of savings to fall back on, I always have the mentality that the site needs me more than I need them.

I went down to Miami to celebrate my grandfather’s 80^th birthday last month. We threw a party for him and he had a blast! While I was down there, I decided to spend a few days in the Bahamas. It’s less than an hour flight from Miami.

I went with one of my best friends and we stayed at the Atlantis Bahamas which was amazing! From our hotel room we could see the stingray pool and the floating river. The beaches were even better than I remembered (I have been to the Bahamas many times before). The water was so clear and various shades of blue.

On the property we were also able to see turtles, aquariums, and go on a water slide through a shark tank.

One of the days we took a jetboat to a private island where they have pigs on the beach. I was really excited to see the pigs. Although they were super cute and fun to feed, the reality was that they were pooping everywhere none stop. On this same excursion, we went snorkeling and were able to feed stingrays. Our guides caught some conch shells and made a fresh conch salad for us which was delicious.

It was a quick getaway to paradise but so worth it. The Bahamians are such nice and friendly people. If I lived in Miami permanently again, I would go back to the Bahamas once a month! Do you have any plans for the summer?