Traveling NP

A few years ago, I wrote “Conflict in the Workplace”. I decided it was time to touch upon this subject again. Sadly, I have noticed that sometimes when you are the “new” provider (new to the site), you sometimes have to go through a hazing process. This process consists of the older providers taking advantage of you. Forcing you to see all of the walk-ins and helping them if they are behind.

When I first start working somewhere, the first few weeks are a bit slow since my schedule isn’t fully open yet. I am more than open to helping the other providers with their workload. However, my pet peeve if being taken advantage of!

My current work setting consists of 4 female physicians and myself. 2 of them have been there the entire time the clinic has been open, and 1 of them is new. She started right after me. Unfortunately, the 2 physicians that have been there the longest don’t get along and it can be awkward at times. The 4^th physician has been on vacation for a few weeks, and she is the only one with the “yes I can” attitude. Therefore, we’ve had more walk-ins (patients without appointments) than usual.  

I am typically the most efficient one, so I offer to see walk-ins all of the time. One day, we all had equally busy schedules, yet for some reason only the new physician and myself were seeing the walk-ins. After my 5^th walk-in, I was asked to see another one and I said “no the other 2 physicians have to pitch in”. To be frank, it was starting to bother me that there is no team effort amongst the physicians.

The next day the assistant medical director approached me and said she heard that I had refused to see a walk-in patient yesterday with chest pain. I was in shock because 1. I had no idea the patient they had asked me about had chest pain. 2. How did this information reach her? 3. Really? The only person that offers to see walk-ins is going to get in trouble?

I clarified with her that I had no idea the walk-in had chest pain, no one had notified me. And that I was just frustrated because the senior physicians never help out. Her approach was nice and she even brought up the fact that I am new but actually have the busiest schedule and lowest no-show rate.

Afterwards, I learned that the clinic manager was the one that reported the event to her. I was disappointed because it seemed sneaky. Why not come talk to me first?

I immediately called the Chief Medical Officer. He is the physician that recruited me to come help out in Chicago and is my direct supervisor. In my mind I was thinking, I don’t want to be in a place where things are going to be thrown out of proportion.

I explained what happened and I was relieved when the Chief Medical Officer apologized! He agreed with my reasoning for deferring the walk-ins. He agreed that the real problem is the fact that the senior physicians never pitch in and it has been an ongoing problem there. He also agreed that the clinic manager should have spoken to me about it before sending an email up the chain. He told me not to worry and that he will have a meeting with everyone next week.

I felt better after our conversation but his last comment threw me off guard. He told me that the physicians told him that I leave at 4pm (our clinic closes at 5pm). But he responded to them “good for her that she is that efficient!”. To be clear, we all have the same amount of patients scheduled. The physicians have had the same patient panel for 5 years – these same patients come once a month. So, at this point they should know them really well! I have absolutely no idea why they are always behind.

The funny part is that they don’t seem to realize that I don’t HAVE to be here. That I am doing them a favor. If I wasn’t here, guess who would have to cover all of those patients? Them! Not to mention I often help them when they are behind or offer to see their walk-ins. But instead of being appreciative they are being HATERS!

As most of you know, I am very reluctant to extend an assignment for various reasons. The longer I stay in a place, the more burnt out I become; the more drama I witness or become a part of; And the more antsy I get remaining stagnant. The only time I have ever extended, I ended up staying at that site for an entire year! At the end, I was exhausted and too attached to my patients. I told myself I would never extend again.

Fast forward to now and I find myself extending in Chicago. I had visited Chicago before but I didn’t realize how awesome it would be to live here. There is so much to do, historical activities, festivals, night life, cultural diversity, and delicious food.

I also really enjoy my current job. My patients are mostly Hispanic so it reminds me a bit of home (Miami). My patient population is geriatric so I am able to form a relationship with them, as they come to the clinic on a monthly basis or sooner. Plus, I find the job rewarding because you can measure your outcomes as patients become healthier and avoid going to the hospital.

As much as I was open to extending, it would be a big sacrifice for me to extend. Especially since it will be summer and I would be giving up the opportunity to go to other states that are finally warm. So, when I was approached by my recruiter about extending, I told her I was interested, but couldn’t extend for free. Since the site had already increased my hourly rate at the start of the assignment, I knew they would be reluctant to pay anymore.

However, I told them that the last time I extended was with their same company in Virginia, and they had given me an extension bonus. The site was quick to say they couldn’t cover any more costs, as I expected. My recruiter let them know I was not interested in extending in that case.

I was not concerned during the negotiations because I knew the site needed me.

They had no Spanish speaking provider available to cover the 250 patients I had accumulated. They needed me way more than I needed them.

I was not surprised when my recruiter eventually told me that they had agreed to my extension bonus after all. But they wanted to squeeze every last minute out of me. If I request any time off during the extension, I will have to make up for it at the end.

I am happy to spend more time in Chicago, but I really hope I won’t regret it!

1. Pack light. Bring necessary clothes and accessories, as well as personal items. Try to buy toiletries when you arrive to the site. Bed linen, towels, and sometimes kitchenware are provided depending on where you are staying throughout your assignment. 
   
2. Join loyalty programs. Create an account with most rewards programs including airlines and hotels to accumulate miles and points when traveling. You can use these points during your time off to travel for leisure for free.  
   
3. Keep documents accessible. Put a copy of all your licenses, vaccine records and other documents in a Google doc so that you can send them easily regardless of where you are. Also, try to keep your CAQH profile up to date with recent work history and copies of malpractice insurance. This will facilitate current and future credentialing. 
   
4. Establish rapport with your recruiter. Communicate your needs to your recruiter. They are your best ally but they cannot help you if they do not know what you need. If you have an issue, be sure to be upfront about it right away. 
   
5. Be flexible. The more open minded you are about the site location and type of practice, the more successful you will be. Try to be flexible with scheduling and the needs of the site as well.
   
6. Ask questions. You will get a quick orientation and EHR training, so no need to worry about the adjustment. However, don’t forget to ask questions instead of assuming. Everyone is always more than willing to help.
   
7. Be aware of state practice laws. Unfortunately, each state has different practice standards for nurse practitioners. Familiarize yourself with the new state you will be working in. Do you need a collaborative agreement with a physician? Are you only able to prescribe a limited supply of narcotics?
   
8. Practice work-life balance. Being a traveler is the perfect time to start taking care of yourself both physically and emotionally. Take advantage of the new location to go out on hikes or to the beach. You can meet new people through multiple apps such as “MeetUp”, with common interests in your area.
   
9. Keep track of expenses. In order to take advantage of tax benefits, keep meticulous records of all your expenses on the road. This includes meals, laundry, mileage, car expenses, and cell phone bill etc.
   
10. Keep a positive attitude. It’s easy to get overwhelmed in a new environment. But honestly, the staff and patients are so happy to have you there, they would be willing to work with you to make things work. As long as you treat everyone with respect and carry a ‘can do’ attitude.

I gave up my personal vehicle over 6 months ago and have been obtaining rental cars during each work assignment (provided by mom job/agency). I recently shared my living arrangement in Chicago, IL. I mentioned that my job pays for me to have a parking spot, which is in a garage next to my apartment building.

As I am only human, unfortunately one day I was absentmindedly backing out of my parking spot when I accidentally hit the huge metal pole next to my car. There was a big dent on my front side bumper. I immediately felt dumb but then I looked around and noticed a lot of people’s cars had a similar yellow dent (the metal pole is yellow). Clearly, I am not the only one that has been careless.

 As per the damage, I was relieved because I knew my current assignment with Comp Health, always takes car rental insurance when booking me a reservation. In fact, when I returned my car, they just verified that I had car rental insurance (which I did), and no extra charges were made.

I felt lucky that it wasn’t my personal car, so I didn’t have to pay for the repairs, nor did I have to go through the process of getting it fixed.

Some agencies don’t provide car rental insurance. If that had been the case, I would have either had to pay for the repairs out of pocket or used my personal car insurance to cover the charges. Although I no longer have a personal vehicle, I still carry low cost car insurance. Thus, I have coverage when driving a car rental or even someone else’s car.

Despite having car insurance, I would rather not use it because I would be responsible for the $500 deductible. So, if an agency doesn’t provide car rental insurance, I will ask to pay for the car rental myself and have them reimburse me. This way, I can use my chase sapphire preferred credit card to pay, and as a benefit of the card it provides car rental insurance for free. I also use this benefit when I travel for leisure. I know many people that have used this benefit and it has saved them thousands of dollars. This is one of the main reasons I recommend this credit card on the ‘finances’ section of my blog.

Anyways, I figured I would use my small accident as an opportunity to share 3 ways you can have peace of mind when driving a car rental. Best case scenario is the agency will provide car rental insurance. If not, you can choose to use your own personal car insurance or pay with your chase sapphire preferred card to make use of their free benefit.

Like usual, I had my agency give me a hotel for the first week of my assignment, while I checked out some apartment options in person.

I ended up moving forward with an apartment that is 5 minutes from downtown, and 15 minutes from my job. The picture above is the view of downtown from my unit! The clinic I am working at is in the suburbs. I didn’t want to live in the suburbs but I also didn’t want to have a long commute.

So, I really lucked out by getting this place. It is in a modern building that recently underwent renovations. It is located in the “medical district” of Chicago. This is where they have University of Chicago Illinois and RUSH medical center etc. I like that there is a main street within walking distance with plenty of restaurants and shops.

My agency booked this apartment through traveler’s haven. The rent is $2100/mo for a 1 bedroom/1 bath (city life for you). This does not include the cost of renting furniture and utilities. In addition, my job/agency pays $135/mo for a parking spot.

I love my downtown views and the upgrades in the unit! To be honest, I feel a bit spoiled living here but it may facilitate my decision to extend.

Many traveling nurse practitioners I know have given up their homes for a life on the road. They put the majority of their things in storage and pack up their car with the essentials. When they go back home for the holidays or vacation, they will typically stay with relatives or rent a hotel.

My situation is a bit different, in which I still have my home in Miami. I own my home with my sister, so we split the mortgage. I prefer to have a place to stay in case I feel like taking a month off in between assignments. Plus, I am close to my family and like to visit every 2 months or less. I also like keeping my items in one place so I can easily switch them out when I am home. Our mortgage is small, my half is the equivalent of a car payment.

We recently moved to another house closer to my sisters work in Miami. And we rented out our first property. The new house is under both of our names, but I am the only one on the mortgage. To qualify for the mortgage, I had to work continuously before closing because the bank wanted to see proof of income.

Initially, the process of obtaining a mortgage was challenging. Most large banks didn’t want to consider both my 1099 and W2 income as a qualification for the mortgage. It was one or the other. I eventually found some smaller mortgage lenders that were able to consider both incomes or even considered my 6 months of W2 enough income for the year.

Unfortunately, the larger banks thought of me as a high risk. After the 2007 mortgage crisis, it is no secret that qualifying for a mortgage is tougher than it’s ever been. The fact that my income isn’t consistent – some years I work more as a 1099 contractor, other years more as a W2 employee; scares them. The fact that I can deduct so many expenses being a traveler, lowers my adjusted gross income. I realized that this benefits me during tax season, but not so much when trying to qualify for a house.

They didn’t care that I had $0 in debt, no expenses, nor that I could make enough money to pay my mortgage in 2 days of working per month.

In this scenario, I had to write a letter explaining why I decided to work as a 1099 contractor at times (better locations or higher pay). In addition, my broker made me write a letter explaining my career and the demand for it. It even helped that I had 6 months of upcoming contracts in place. I was able to show proof of longevity.

It definitely helped that we were able to put 25% down on the house as well.

Thus, if you are considering purchasing a property in the distant future, my advice is to:

1. Save enough money for a 20% down payment.
2. Try to be aware of how much you are deducting at tax time. If your income in $120,000 but after deductions becomes $80,000 that might not help you qualify for a decent house in the future.
3. Use Fairway Mortgage. I have recommended them before and luckily, they consider both W2 and 1099 income so save yourself the hassle of qualifying with someone else. They have programs specifically for nurse practitioners.

Note: It is easy to get pre-qualified by any bank, but once it’s time to approve you for the loan that’s when they become strict.

I was able to use Comp Health as my employer – they even verified I was their employee when I was in between assignments from them.  They were so sweet, they even sent me a house warming gift!

Anyways, I just wanted to share my experience obtaining a mortgage as a traveling nurse practitioner. If you need help with the process in the future, feel free to send me an email!

This is my 4th time working for the same geriatric practice. I was a bit reluctant to start this new assignment because I was more interested in taking a break. But I had agreed to start soon after my last assignment as a favor to the company.

So far I have had a really good experience. The first time I worked with this company, I loved it and ended up staying for a year (in Virginia). The second time, I hated it because management was awful and it led to plenty of chaos (in Florida). The third time I returned to Virginia but worked at a different clinic. My experience was ok but I didn’t like it as much as the first time. I think because the clinic I was in had about 20 walk-ins (patients without appointments) per day. And the other providers had jammed packed schedules so I ended up having to see the majority of the walk-ins in addition to my scheduled patients.

The clinic I am working from in Chicago is pretty laid back. They only have 1 walk-in per day, which is such a relief. I don’t think the providers here know how lucky they are! My first day, the center manager and physicians took me out for lunch which was nice. I am also being scheduled with 40 min appointments to all patients new to me. The clinic is well run and organized so everyone does their job and I don’t have to back track. 

The majority of my patients are Spanish speaking. Most of them are just really happy to have a Spanish speaking provider. There are friendly and I don’t even mind them dramatizing their complaints.

The medical director wants to meet with me each week to make sure everything is going well, which I really appreciate. Of course, he wants me to extend for another 3 months so I think they are trying to flatter me and avoid making me feel overwhelmed. I actually wouldn’t mind extending but I’ll decide next month, when I am working at full capacity. 

I have been working as a locum tenens nurse practitioner for 4 years now. I recently realized that I have become so comfortable with jumping in and out of jobs for 3 months or less. Perhaps a bit too comfortable. To the point that I stopped inquiring about the orientation process prior to starting an assignment.

When I started my recent job in Tallahassee, Florida, I automatically assumed that the first day would be orientation. I was exhausted from just finishing another assignment the week prior. I thought my first day would be chill and figured I would start seeing patients the following day.

I was completely wrong! I arrived to the site and met the office manager, my supervising physician, and supporting staff. They got me set up with the EHR (electronic health record) and a laptop. I then shadowed the physician for a couple of patients and he showed me a bit around the EHR system. I started at 8 am and soon learned that my first patient was scheduled at 10 am!

I was a bit annoyed because I barely had time to get adjusted. I hardly knew the EHR system by the time I was seeing the first patient (it wasn’t one I had used before). Luckily, I didn’t stress myself out. I figured the easiest way to learn the EHR system is by actually utilizing it.

I definitely had tons of questions with each patient I saw, such as how to place orders and the correct process of doing things. I ended up seeing 7 patients on my first day, which isn’t too bad. I was able to have at least 30 minutes with each of them to get in the swing of things.

Although I felt cheated from having a proper orientation, by the end of the day I was over it. To be honest, I am such a locum tenens veteran that I really don’t need much time at all to dive into things.

Fast forward to my upcoming assignment in Chicago. It is a facility I have worked for previously, so I am familiar with their method of practice. However, I have not specifically worked in any of their Chicago clinics before.

Prior to starting the assignment, I texted the office manager to let her know I will be bringing my own laptop (they had me keep a work laptop from before), and that I would be able to start seeing patients on my 2^nd day. Imagine my surprise when she tells me that patients have already been scheduled for my first day!

I was somewhat annoyed because in my past experiences (the 3 times I have worked with this facility before), my login access is never ready that first day. Nor am I able to prescribe/dispense medications (they use an onsite pharmacy). I also think it would be nice to get acquainted with the clinic setting and meet my fellow co-workers, prior to getting started. In addition, it has been 3 months since I worked for them last, so I would like to review their guidelines to make sure I haven’t forgotten anything.

Side note: this facility isn’t your standard private practice. It’s a clinic that focuses on geriatric patients and keeping them out of the hospital. That means frequent visits, working on polypharmacy and primary prevention screenings etc. Some specific guidelines for the practice include making sure you check PTH labs with anyone with chronic kidney disease; or doing a fall prevention questionnaire for each patient at every visit etc.

I proceeded by telling the center manager that I usually don’t see patients on my first day. In fact, when I returned to Virginia the second time, they still gave me a 1-week orientation. Not that I need 1 week, but geez can I get a day?? I then asked her what time my first patient was and how many patients were scheduled. I figured if I had the morning free, that would be fine. And if it was a light patient load then I would have time to get adjusted.

The office manager told me that my first patient was scheduled at 8 am (we start at 7:30 am) and I had a full schedule. She said she blocked my first patient so I could get acquainted. Wow, a whole 30 minutes to get settled in – how nice!

Anyways, I learned from my experience working with them in Florida. Which is although I have a relationship with them, it would be best to go through my recruiter for certain things/issues. Thus, I contacted my recruiter and let her know they had me scheduled with a full patient load on my first day which is ridiculous. So, they will need to fix that, and if that’s a sign of them abusing me in the future, I will be putting in my 30-day notice ASAP.  

Just a reminder to myself and all of you seasoned locum tenens providers, don’t forget to ask about orientation BEFORE accepting an assignment! I am sure we can figure things out during a limited time span, but the whole point of working as a traveler is not to be stressed out!

My assignment in Florida finished quickly. I had an amazing time catching up with my previous college professors, mentors, and friends. I also spent plenty of quality time with my brother.

I was planning on taking a nice break afterwards but ended up getting persuaded to take another assignment right after.

The geriatric practice that I have worked for in the past in both Virginia and Florida asked for some help at one of their clinics in Chicago.  They wanted me to start as soon as possible, and this was back in January. I told them I wouldn’t be available until April and they said they would wait for me.

Of course, I wouldn’t be able to live there during winter anyways. Since I wasn’t sold about starting another job right after the Florida one, I decided to ask for more pay than previously, sort of hoping it would deter them away from having me. I told them my rate goes up $5/h after each year with them, and they said that was fine. They agreed to the new rate.

Fortunately, I was able to work something out with the Florida job, in which I finished 1 week earlier than planned. This allowed me to take a mini vacation. I went to Curacao in the Caribbean and got some much-needed rest and relaxation. Not to mention I was overdue for a tan. It is less than a 3-hour flight from Miami, and the water was gorgeous and warm enough to swim in.

Let’s hope I am reinvigorated enough to start my next assignment in the windy city!

My favorite hotel credit card right now is the American Express Hilton Honors Card. The current sign up bonus is earning 100,000 Hilton points after spending $1,000 within the first 3 months of card membership. That is a pretty low spend requirement for such a large bonus. The best part is that this card had no annual fee! So you can even choose to keep this card long term.

One benefit of this credit card, is it gives you instant Silver elite status. As a Hilton elite member, when you use points to book 4 consecutive nights at one hotel, you get the 5^th night free. This is quite a bargain!

What can 100k Hilton points get you? You can get 3 free nights in Orlando, FL if you want to take your kids to Disney world. What a major cost savor since everyone knows Disney can quickly break the bank. Or you can choose to spend your bonus points on 2 free nights in Barcelona, Spain. Or you can splurge on one night in the Maldives, with room rates going for more than $1,000 per night!

If you really want to make your points as effective as possible you can choose to spend 10 nights in Cairo, Egypt. No joke – each night in Cairo is only 10k points per night. Or up to 2 weeks in Vietnam at 5k points per night.

I highly recommend this card! By having excellent credit and from spending $1,000 in 3 months (that you were going to spend anyway), you are able to earn a substantial amount of Hilton points. These points can help save you hundreds if not thousands of dollars on your next trip. If you haven’t been able to travel much in the past due to costs, I hope you can start using credit card points to help enable travel in the future.

If you are interested in getting this card please use the link below to apply. This will make sure you are receiving the highest sign up bonus and will allow me to receive a referral bonus as well:

https://americanexpress.com/en-us/referral/SOPHIK4JFm?XLINK=MYCP