Traveling NP

As I consider which states I plan on obtaining new licenses in, I am thinking about only getting licenses in states that allow independent practice for nurse practitioners. Here are the reasons why:

1. Respect: No one is calling me a ‘mid-level’. In states where nurse practitioners can practice autonomously, we are seen equally to physicians. When we are seen at an equal playing field, no one is using that term (mid-level), I despise. When I worked in Washington State before, a state that supports full practice authority for nurse practitioners, I felt respected.

2. Licensing process is easier: States that require nurse practitioners to have protocols in place or a supervising physician make the licensing process more difficult. Sometimes I have to provide a protocol before they even grant me my nurse practitioner license, which is ridiculous. Other times I have to show proof that I prescribed medications at a previous job, or obtain a letter from my supervising physician.

3. Freedom: In independent practice states I’ll be able to order home health and sign orders for my patients in need. I’ll be able to prescribe all kinds of medications without the pharmacist requesting the name of the physician I work under. I’ll be able to spend less time wondering if that’s something I am authorized to do and assume it is.

4. Better pay: States that value nurse practitioners have already progressed to allowing full practice authority. As a result, these states will typically pay nurse practitioners well. This is because other states use the term ‘mid-level’ to explain why nurse practitioners aren’t paid as well as their peers (physicians), even when doing the same work.

Some states that are considered to be independent practice states for nurse practitioners may have different stipulations. For instance, working in Washington was the ideal full practice autonomy state to work in. On the other hand, although Maine is also an independent practice state, the licensing process was still a bit tedious. I had to have a previous supervising physician confirm that I was supervised over 2 years or more, prior to them giving me an independent license. In addition, some home health agencies do not allow nurse practitioners to authorize home health orders, which I find strange. So keep in mind that the 23 states with nurse practitioner practice autonomy are not all equal.

I am so glad I chose to spend the summer in Maine. I went on a coastal road trip with a friend that visited me up here. We stopped in several cute towns on the coast of Maine, and wandered to many lighthouses on the way.

My favorite town was Camden. It was so endearing with nice views of the harbor and boats. I was able to try a Maine delicacy: lobster roll. I can’t say I am a big fan.

I really enjoyed visiting all of the lighthouses. The Pemaquid Point lighthouse had stunning views and they even allow you to go inside, all the way to the top.

We also stopped by this famous lighthouse from the Forrest Gump movie. It was even nicer in real life.

My preferred lighthouse is in Portland, Maine. It is located in the Cape Elizabeth area at Fort Williams Park. It is beautiful and I liked how families gathered there to enjoy the weekend.

A highlight of my time in Maine would definitely have to be going to Acadia National Park. There were many hiking paths, awesome views from mountain peaks, and beaches. The day I went, it was a bit cool so the beach was covered in fog. It looked like what I always expected Cape Cod to look like.

Additionally, Jordan pound was spectacular at Acadia. You can even enjoy lunch or coffee at the Jordon Pond House restaurant while enjoying natural views.

On a side note, I love being in New England because you are so close to the other states. I was able to take weekend trips visiting a friend in Boston, and exploring New Hampshire and Vermont.

My only wish is that I could remain here for fall. However, since snow fall starts as early as November I will not be extending.

There is so much provider support at my current job in Maine. It just makes our lives easier. For instance, there is an RN that handles the medication refills as long as it meets protocol (recent labs, recent appointment etc.).  When requesting a controlled substance refill, the medical assistant will copy and paste the most recent PMP report on the phone message. PMP is what we use here to look up where and when the patient last filled a controlled substance prescription.  How convenient that this information is automatically provided for you instead of having to spend precious minutes signing in and looking up the patient yourself?!

Like many states, Maine has an issue with the opioid epidemic and even patients forging prescriptions. Thus, they use a system called ‘imprivata’, which all providers must enroll in. Controlled substance prescriptions must be submitted electronically. After submitting the prescription electronically, the imprivata system pops up in which the provider must sign into. After signing in, the provider must then check her imprivata phone app and approve the prescription from there. It may seem a bit tedious but it’s a pretty quick process and at least it ensures that you are the only one prescribing controlled substances. Patients are unable to forge or change a prescription, and no one in the office is able to refill a controlled substance without your permission.

The front desk staff also handles all of the referrals. They make the providers lives easy by proposing referrals for patients. This means if a patient called requesting a referral to an eye doctor, the front desk staff will put in the referral and diagnosis, then send the proposed order to us, in which we just have to sign off on.  The RN also handles triage, so providers aren’t bombarded with ‘tick bite’ visits or patients with cold symptoms that just started today.

The only negative interesting finding I have surveyed does not have to do with the clinic staff. It has to do with the patient population. It appears that developmental delays in pediatric patients here is very prominent. Most places I have worked, you will find a developmental delay in about 1 out of 100 children. Here it seems that every other child that comes in for a physical has a developmental delay. I am assuming it has to do with the low level of education here and high use of alcohol and drugs during pregnancy and infancy.

These are just some observations I thought would be interesting to share with you all.

“I have been searching for my first traveling position for months now but so far, no luck. Did it take you this long to find your first assignment?”

Yes, I always let my readers know that the first travel assignment is the trickiest to find. Imagine how many people reach out to recruiters on a daily basis with an interest to travel but without follow through. It is expected that you will reach out to your recruiter on a weekly basis to follow up on possible assignments. They prefer you call them to let them know how serious you are instead of just sending an email.

I always recommend that as a first time traveler to go ahead and apply for 2 states licenses to make yourself more accessible to sites. If you have been waiting around for 3-4 months without a job lead and have not applied for any new state licenses then that is problem #1.

If you do have other state licenses but still have been struggling to find something, the next questions to ask yourself is – am I in contact with enough agencies/recruiters? To open more job options I suggest you are credentialed with at least 5 agencies so that you can be presented to more jobs.

If you have been presented to several jobs but no sites have accepted you, consider reviewing your CV and making it more attractive. Also, prepare for the phone interview a bit more and ask the right questions to make it seem you are very interested.

Lastly, if the first three steps are taken care of then I suggest you become more open minded. Maybe you envisioned yourself taking your first assignment out on the beach. Realistically, these assignments go fast so you may have to be more willing to go where the jobs are. Let your recruiters know that you are open, and they will pass more jobs by you.

Realistically, some traveling nurse practitioners may be presented to a dozen sites before something matches up well. Do not be discouraged, as some assignments do fall through. Just be sure to work on yourself and make you more appealing to the sites.

 

Normally when I am going on an assignment, I will opt to receive mileage for travel and either drive or ship my car to the destination. This time I didn’t want to bring my car up because the lease will be ending mid-assignment. I am considering not getting another car once I return my current one, because it doesn’t make much sense to have one as a traveling nurse practitioner. As much as I love my current car and bringing as much stuff as can fit in the car, driving long distances seems less and less attractive to me.

So instead of asking for mileage, I had the site provide me with a flight and rental car. If I decide not to get another car after I return my current one, I will just continue to obtain rental cars for work. When I am home, I can always borrow my parents’ car since they live abroad, or even rent one if I will be there for a short period of time.

I realized taking a flight to Maine was going to limit how much of my belongings I could bring. I was a bit stressed during the packing phase because I hadn’t taken the flight option since my Washington assignment several years ago. It ended up working out, as I like to pretend I am a minimalist.

When I picked up my rental car, I was hoping I wouldn’t end up with a compact hatchback. Fortunately, the rental car agency upgraded me to a small sport SUV. Since I would be renting it for 3 months, they gave me the newest car they had so that it wouldn’t need any maintenance.

Prior to coming I looked at my housing options. Being 1 hour north of Portland, Maine, I didn’t see any apartment options. I began to be nervous when all I could find were cabins in the woods for rent. Being a city girl, this wasn’t going to work for me. I talked to my recruiter about it and she let me know that the site had actually rented out a house for me and sent me some pictures which seemed fine.

The house turned out to be pretty big for just me. It is 2 bedrooms and 1 bath with an entire basement downstairs, and an entire finished attic upstairs. It also has a big screened in front porch and a detached 2 car garage. The house came completely furnished, with all essentials, from bed linen to dishes. The best part of the house is it’s across the street from the clinic so I can actually walk to work!

An added bonus is that they allow employees to use their brand new cardiac rehab gym at the hospital (which is across the street from me) after hours. So I often have the gym to myself when I go after work.

As I mentioned previously, searching for my next assignment I wanted to go somewhere up North that is normally cold but would be pleasant over the summer. I also needed to go somewhere with a quick licensing turn around. Thus, I ended up in Maine!

Originally it seemed like a random place to go, but after researching activities to do, Maine appeared to be an ideal place. I wanted to be somewhere that I could be outdoors and enjoy both weather and nature. Maine is perfect for that, as there are tons of hiking trails. It is a nice mixture of coastal beach town meets mountain life.

I have been here for a few weeks so far and I feel like I have reincarnated into Henry David Thoreau (who is from Maine by the way). I feel peaceful and harmonious with myself, work, and all of life.

I am working for a clinic owned by a local hospital, covering a maternity leave. It has been a truly positive experience. Everyone is so laid back here – the supervisors, the medical assistants, nurses, physicians, and even the patients. It’s nice working somewhere where patients don’t feel entitled and staff is extremely friendly.

My patient volume per day is light. I see between 8-14 patients per day. The majority of the patients are pediatrics so I do a ton of well child exams. These are pretty easy since the nurses handle the immunization schedules and I just verify the accuracy. I do have some adult patients but they are straightforward. Even the patients that my medical assistant warns me are “complex” or “nuts” are pretty basic. Sometimes I reminisce about my complex geriatric patients in Virginia. I miss them and the challenge. Yet, this zen life is too good to give up!

Each of the physicians and nurse practitioners have one day off a week for admin time. To be fair, the clinic is giving me one half day off a week, paid! I obviously don’t have any admin work to do, so I just get paid to go home at lunch time and spend the remainder of the day lounging around. Some days I use my free time to go on a nice hike…while getting paid. Yes people, these jobs exist.

The only issue in the work setting is the EHR. They use Cerner which most nurses would know belongs in an in-patient environment. It’s not user friendly, is redundant, and complex. All of the other providers and staff loathe it. It’s not as bad as Meditech but it’s a close call. Had I been seeing a patient every 15 minutes, I may have gone insane. But since my schedule is light, I have enough down time to maneuver the system.

Another great thing is that the coding here seems to be laid-back as well. I am used to having to change ‘well child exam’ to ‘well child exam with abnormal findings” (when there is something wrong) and linking diabetes to all other complications (neuropathies, chronic kidney disease, hyperlipidemia etc). Here, Cerner doesn’t give you all of those coding options so the coders have protocols to update the charts for us. This a big relief for us providers, considering how time consuming the billing/coding aspect of documentation can be.

I am so happy with my decision to come here, and I am looking forward to exploring the region!

I probably undergo about 20 interviews a year. When I am searching for an assignment, I hardly go with the first place I am presented to. Not to mention I am often presented to several jobs at a time. I recently had a phone interview that within the first 2 minutes, I already knew I didn’t want to move forward with that position.

The interviewer kept using the word ‘mid-level’ when she referred to me as a nurse practitioner. Strike 1. Then she told me that there wouldn’t be much of an orientation since their previous provider is leaving and I would be expected to dive right in. Um no thanks. Even 1-2 days of orientation/training is better than none. Then I found out that they use Meditech EHR, which is definitely my least favorite EHR. At this point, it already didn’t seem like a place I wanted to work at.

I briefly answered her questions and was hoping to end the call sooner rather than later. Before we hung up she asked me how housing is usually set up for me as a locums. She told me in the past her locum tenens physicians have been housed in the hospital. She made is seem like it was such a great idea – “free food” and all. I was rather appalled. There was no way I was going to live in a hospital room, considering the amount of infectious processes that reside there.

I thought it would be fun to share this phone interview experience to let you all know that you’re not alone! There are sometimes whacky interviews and it’s just a warning sign to stay away!

 

For this summer I was interested in working/traveling somewhere that is normally cold but would be warm during those summer months. I then realized I would need to obtain some new licenses but was almost repulsed when looking at the requirements.

I hadn’t really applied for a new license in almost 2 years. This was because I had stayed in Virginia for an entire year, worked some time in Florida, and then still had 2 other state licenses I hadn’t used (Texas and North Carolina).

Now that I needed to apply for a new license again, I was a bit discouraged. I naively forgot how much work it is – to complete fingerprints/background check, provide a passport like picture (some states require this), request official transcripts, take a state board of nursing law exam (some states require this), obtain verification from the ANCC, send proof of 24 hours of pharmacology CEUs or verification from my MSN program university….the list goes on.

Yet, at the end of the day, this is just busy work and you can really complete your end of the application and requirements in one day.

Indeed, the worse part had to be recalling that with each new license application, I had to request license verification from all my other nursing state licenses. This means that if I am applying for a license in Wisconsin, I would need to have the board of nursing in California, Washington, Florida, Virginia, North Carolina, and Texas, each fill out a form verifying that my license is in good standing and without disciplinary action.

First of all, the costs of these verifications can add up. I think California alone charges $100. Secondly, these verifications can take a long time to obtain. Once again California can take several MONTHS to submit this verification!

I was disappointed because I realized that by the time I received any of those new licenses, summer would be over and I would be stuck worrying about staying warm for winter.

I went ahead and had two of my favorite agencies proactively license me. I usually recommend traveling nurse practitioners obtain their own licenses, but really only initially. By going through an agency, I saved so much time and upfront expenses. It was such a smooth process to complete the pre-filled applications and have the agency representative do all the tedious work. For instance, they obtained verification from my previous state licenses, ordered my school transcripts, ordered my ANCC certification verification etc. Not to mention that they paid for every single thing saving me hundreds of dollars (even though I could have gotten reimbursed).

Fortunately, one of the states I chose to obtain a license in (Maine) did not need to verify ALL of my previous nursing state licenses. They only needed to verify my initial license which was in the state of Florida and has a good turnaround time. Maine is also part of the eNLC (nurse license compact) so I was able to use my Florida multistate RN license. This meant I didn’t have to waste time obtaining fingerprints/background check. Nor did I have to waste time completing the RN application and waiting for it to be processed.

On the other hand, Maine did have some annoying requirements for the nurse practitioner application. I had to have a supervising physician submit a letter to them stating that he supervised me for at least 24 months previously. I also had to have a previous employer notify the Maine board of nursing that I prescribed medications over the most recent 2 years.

Luckily, I had my supervising physician from my permanent job in Florida write the letter. I had been at that job for about 3 years so it sufficed. I then wondered about obtaining proof that I prescribed over the past 2 years. That would have to be a total of 6 or more employers writing a verification letter, which is time consuming. I was lucky again though, because once the Maine board of nursing received my application they emailed me and let me know that the physician who wrote my letter of supervision, just needed to email them and let them know I prescribed medications during my time working with him.

I ended up getting the Maine license in only 2 weeks! Talk about a quick turnover and ideal for traveling nurse practitioners looking to obtain a new license quickly.

Of course, the licenses I applied for with the other agency are still pending. I clearly won’t be able to use them this summer, but at least they will be ready for next summer! I better start planning where I want to go for fall/winter to make sure I have the necessary licenses in time!

The moral of the story is do not wait too long to apply for a new license! I still recommend nurse practitioners that are just starting in locum tenens to obtain their own licenses. This way you can have more job options by working with different agencies and will be more attractive to the agency/site when a job opportunity becomes available.

However, once you start collecting a bunch of licenses (like me), feel free to have agencies start proactively licensing you. This will save you tons of time and upfront money. I also realized how awesome it is to have the Florida RN compact license. Florida just joined the eNLC January 2018, so it’s the first time I was able to utilize this perk.

 

These days there are tons of locum tenens agencies. When you google “locum tenens”, the larger agencies will appear first. Many of the smaller agencies aren’t initially findable on google. Some people are quick to rule out the smaller agencies, but personally I feel like sometimes they can be better to work for. Below I will list the pros and cons of working with larger vs smaller agencies.

 

Larger agencies:

Pros:

-More job options since they have been around longer

-Offer proactive licensing even without being accepted to a job

-Can help facilitate the licensing process by employees constantly contacting the board of nursing

 

Cons:
-Often less pay due to all the overhead that needs to take a cut

-Sometimes they submit you as one of a dozen candidates for one job, because the more the merrier in the eyes of the client

-Occasionally credentialing and housing details aren’t completed on time, likely due to too many worker bees

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Smaller agencies:

Pros:

-Pay is better since they are small and have less people on payroll

-Provide a more personable experience

-Credentialing and housing details are typically spot on

 

Cons:

-Fewer job options

-Less likely to offer proactive licensing before being accepted to a job

-Sometimes they do not offer travel or housing, although this is rare

 

As you see, there are both good and bad things about working with either a larger or smaller locum tenens company. I prefer to work with smaller agencies but the larger ones usually have more job options available. So, I would say I work with both types of agencies equally.

In my last post I illustrated my recent trip to Europe. The best part was that I barely spent any money on the airfare and hotel stays. This is because I used some of my miles and points that I collect. I am able to collect these from mainly two ways. First, as a traveling nurse practitioner, I sometimes opt to stay in a hotel of my choice over an apartment. This way I can acquire miles from those stays and also elite status. I also fly domestically a lot, whether it is to and from an assignment, or just going home in the middle of an assignment.

Secondly, I am able to collect miles and points through credit cards. When applying for a new credit card they will offer a large sign up bonus offer. Sometimes these can be enough for a round-trip international flight, saving you $500+. Just to be clear, I do not hold a balance on any of my credit cards. And even by applying for multiple cards and closing them when I do not want to pay the annual fee (usually 1 year after opening), my credit score has remained 800+.

I previously posted about “travel credit cards” and have a tab on my home page with some of my favorite cards. If you decide you want to move forward with one of those cards, be sure to use the link I provide to make sure you are getting the highest available bonus offer. Feel free to message me for guidance, especially if you have a specific trip in mind.

So how did I book my Europe trip? I used 30,000 Delta miles for an economy flight from Miami to Amsterdam. I then used 55,000 American Express points for a first class flight from Zurich to Miami. In taxes and fees I paid $75 total for both flights.

For my Hotel stays I mostly stayed at the Hilton (each night cost between 20,000-50,000 points) and the Sheraton (starwood preferred guest) (each night cost between 7,000 – 12,000 points). Keep in mind that Hilton points do not equal Sheraton points. So if you see that Hilton cards are offering more points in the opening offer, it’s because you need more points to redeem a free night.

In addition, since I stay at hotels often during work and leisure, I have acquired elite status with both Hilton and Sheraton (Starwood Preferred Guest). As a result, when I stayed at their hotels they provided me and my guests with free continental breakfast and free room upgrades. Some Hilton hotels even had an Executive Lounge, where I was able to go any time of the day and find appetizers, snacks, and refreshments.

One of the highlights of the trip was when I was upgraded (for free) to an executive suite at the Four Points Sheraton hotel in Zurich, Switzerland. If you’ve been to Europe before, you know that the hotel rooms are usually tiny. Imagine being upgraded to an apartment sized room. It consisted of 2 bathrooms, a large bedroom and walk-in closet, a dining area with a Nespresso machine, living room – and the main bathroom had a his and hers sink with a spa bath tub and separate shower.

Without points and miles, this 3 week trip in Europe would have cost me over $5000. Luckily, I only spent about ~$1000 on this trip. My main costs were food, short flights/trains between cities, museum entrance fees, transportation etc.

What are you waiting for? It’s time for you to start collecting your own miles and points!