Questions from Readers – September

Each month 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 have worked at a permanent job for over 10 years. I am now interested in trying out locum tenens, but I am a bit worried about the transition. You always seem so confident so was wondering if you had any tips for us newbies?

 

This is an example of a pretty common question I get from my readers. I think any major step in life can be a bit nerve wrecking; this includes buying a house or getting married. Nothing in life is guaranteed but if you want to start a new adventure, travel to new places, and build yourself professionally; working in locum tenens can be a great option!

Here are a few tips of I have for those of you initially starting a career as a locum tenens nurse practitioner:

-Stay open minded, especially with your first assignment. Your first assignment will be a learning curve, so don’t think you HAVE to go to the best place on earth. (I have seen a lot of you act on this advice, which is great).

-Work with multiple agencies. To increase your probability of finding the right assignment, you are going to have to work with more than one agency. Yes this means tedious paperwork, but it pays off in the end. You can also compare benefits and choose which one you prefer. (Example: working W2 vs 1099, living in a hotel vs having an apartment).

-Always look for your next assignment. After working the first month of your current assignment, you should already be thinking about where you are going next. Should you be working on obtaining another license? Start looking at states you are interested in to see if there are job options there that meet your needs. The last month at your current assignment is crucial, as that’s when most jobs will open up (last minute). You can easily have your next assignment secured 1 to 4 weeks in advance.

 

South America – Vacation

My most recent international trip was to South America. I went to Colombia, Argentina, and Chile. I was originally supposed to go to Brazil as well but my visa didn’t make it in time.


My first stop was in Buenos Aires, Argentina. The first day I was there, I witnessed the person next to me get his Iphone stolen from him right out of his hands. This was definitely eye opening since I thought Argentina would be the safest place in South America. My favorite part of Argentina was watching a tango show one evening.

After a few days I went to Santiago, Chile. Ironically, it had been the last place I was looking forward to going to but ended up liking it the most. I think the combination of being in a big city with snow capped mountains and awesome seafood did the trick! The weather was a bit cold but I enjoyed being outside with the awesome scenery.

To end the trip, I went to Cartagena, Colombia, which is a small town on the coast. The people were very friendly and hard workers. No one begged for money, but everyone was hustling and trying to sell you something. I had a lot of fun and enjoyed visiting Castillo San Felipe de Barajas, which is a super-fort built long ago by the Spanish.

This was my second time in South America (I had gone to Peru a few years ago). As always, I enjoyed learning about the local culture and trying new things. I hope to get back down there to visit Brazil once my visa comes through.

Powerball Winner Quits Job At Hospital – Here’s What Nurses Would Do

Check out this article from nurse.org about the recent Powerball Jackpot winner quitting her job at the hospital. I was asked to give my thoughts on what I would do if I won $750 million dollars, displayed in that article. Would you quit your job if you won $750 million dollars?

Locums Make Stronger Nurse Practitioners

There is a new nurse practitioner that was recently hired at my current site. Watching her find her place during her first year of working as a nurse practitioner, reminded me how working as a locum tenens nurse practitioner has made me a stronger health care provider.

Working in various clinical settings and with different populations, we are constantly learning something new. Something new that we can apply to our future practice. I have gained some skill sets such as doing incision and drainages, joint injections, and skin biopsies. With much experience, I have also improved my differential diagnoses, and prescribing methods. I can think outside the box and see my patient holistically.

Being one of the first nurse practitioners to work at my current site, I could see that the new nurse practitioner did not have the support system she needed, being a new grad. Sometimes she would see my patients as walk-ins. I noticed she would give solumedrol IM injection for acute pain. In another instance, she saw my patient as a hospital discharge and failed to document that a chest xray done in the hospital incidentally noted a lung mass, which needed surveillance in 6 months.

I used these examples as teachable moments. For example: avoid solumedrol unless the patient has respiratory symptoms, especially in my diabetic patients. Read hospital records thoroughly and as nurses we are usually more thorough with our documentation in comparison to our peers. And how overlooking a diagnostic finding could lead to malpractice.

I also addressed my concern with the Medical Director. Virginia is not a full practice authority state. Thus, the new NP has a supervising physician. Besides being a name on a piece of paper, I believe the new NP definitely needed closer supervision. Even as an experienced nurse practitioner, some states I travel to may require physicians to review 5% of my charts or the first few dozen notes. The Medical Director assured me that the new NP’s supervising physician will play a closer role.

Most importantly, it is important to promote an encouraging vibe in the workplace setting. Luckily, after discussing some of my patients and concerns with the new NP, she started to ask me questions she was unsure about instead of proceeding with a wrong decision. For instance, she had a diabetic patient that could not tolerate metformin due to chronic kidney disease stage 4, and was unsure if she should add glimepiride to the patient’s plane of care, whom was already on glipizide. I discussed with her that the patient should not be on both due to increased risk of hypoglycemia, but as the patient was on a low dose of glipizide, she can titrate up.

It is not our duty to judge new nurse practitioners, as we all started somewhere. Even physicians can admit their first year working in medicine is challenging. Yet, many people are still unfamiliar with the role of a nurse practitioner. Which is why I believe it is crucial we make sure we provide competent care. This can be done by trying your foot in locum tenens to make you a stronger nurse practitioner, and to make sure we continue to mentor novice NP’s.

Appreciated

 

I just posted about my final extension at my current site. Moreover, I wanted to share some kind words that were said to me during the final weeks of my previous extension.

“You have changed the way I see locum tenens.” The Medical Director told me this when asking for my final extension. She said she was previously apprehensive about hiring locum tenens providers but now sees it can work with the right fit. They even hired 2 locum tenens physicians after I started to help with a maternity leave and walk-ins at some of the other clinics.

“In my eyes you are a physician. There are some nurse practitioners that work better than some physicians, and you are one of them.” The physician lead at my clinic mentioned this to me as her eyes filled with tears just thinking of the possibility of me leaving. I will always be a nurse at heart but it is nice to be appreciated by a physician and for them to recognize the benefits of having nurse practitioners at their clinics.

After telling my patient his Diabetic A1c improved from 17% to 8% in only 3 months he said: “That is thanks to you. I appreciate you looking out for me, going above and beyond and doing more things for me than most doctors.”

I sent one of my new patients, whom was completely healthy and on no medications for a routine colonoscopy. The colonoscopy was positive for colon cancer and imaging confirmed an additional renal cancer. Luckily he was able to undergo a partial colectomy and nephrectomy and recuperated really well. After seeing him post-op, he said to me: “Thank you! I wouldn’t be alive here today if it wasn’t for you!”

I thought it would be nice to shares these kind words. It is easy to get burnt out in medicine, but if you remember why you got into the healthcare field in the first place, it should keep you motivated. As a PCP we are constantly hearing ‘complaints’ all day. “My back hurts; I have difficulty breathing; I have no energy” etc. So hearing words of appreciation really makes our day J

Final Extension

Although I initially enjoyed my current assignment, after extending 3 times (for a total of 9 months), I knew it was time for a change. I needed a change in scenery both state-wise and job-wise.

The site asked if I was interested in another extension. I kindly declined and told them I was ready for a change. They hired a physician to take over my patient panel and would like for me to stay an extra 3 months to help transition my panel over to the new physician.

The Medical Director set up a meeting with me titled “What Can We Do to Keep You Longer?” She wanted to respect my wishes to move on but also to make me feel like I was appreciated. She offered me her first and second born children as a joke. She even offered me to house-sit while she went on vacation (she has a beautiful home on the lake with kayaks and jet skis etc.).

Although I knew I was ready to leave, I spent several weeks with an inner turmoil contemplating what I should do. There are normally 4 PCP’s in my clinic, one of them was approaching maternity leave, while another one was having surgery in the upcoming weeks. I felt guilty knowing 1 PCP would be all-alone in the clinic if I were to leave. When 1 PCP is out, it’s manageable. When 2 PCP’s are out it’s a disaster. Think about the walk-ins, phone messages, medication refills, reading of PT/INRs, and paperwork that needs to be completed.

I also thought about my patient panel. When I had taken over for their previous PCP, the patients had been pretty neglected for a few months since their previous PCP had gone on sick leave. I thought about the connections I had formed with these patients since they come to the clinic at least on a monthly basis. I thought about how far these patients had come after first meeting them. The uncontrolled hypertensions now well controlled, improved diabetic A1cs, resolved heart failures, controlled depression, weaning them off their opioid dependencies, and encouraging health screenings to help with early detection of newly diagnosed cancers.

My patience and level of contentment were starting to decline, as I became blasé with this routine lifestyle. The cure to this was to move onto another assignment. But for the reasons above I knew that I had to stay. Another 3 months wouldn’t kill anyone right?

In return for my final extension the site offered me a $5000 bonus. This is equivalent to an extra $10/h over 3 months. They also agreed that I did not have to continue seeing new patients, and can focus on my current patient panel since they are already very complex. The agency I work for offered me an extra round trip flight home and proactive licensing in other states.

The site is hoping when I am doing with this final extension, that I will help them open their new clinics in Florida.

Questions from Readers

Each month 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.

How does dating work as a locum tenens nurse practitioner?

 

Many traveling nurse practitioners I know travel with their spouse or significant other. The agencies will certainly accommodate your needs with lodging. Some partners have flexible jobs where they can work from home, making it easy for them to travel. Some partners will fore-go their current job and may pick up seasonal jobs in their new living area. I also know some couples that will just take turns visiting each other throughout the assignment.

For single locum tenens nurse practitioners, traveling actually helps with the dating process. People always ask me if it’s hard to date since I am always moving around. I tell them no, that in contrary it is actually easier to date since I am traveling. This is because I end up meeting way more people than I normally would. I am even able to meet different types of people too.

Miami isn’t known for having an intellectual atmosphere, which made dating pretty tough when I lived there. Being able to move to different cities, I am able to meet people that more closely fit my needs.

Some of my friends that are travel nurses, ended up dating someone while on an assignment. To figure out if things would work, they extended their assignment. If the relationship became serious they eventually just settled down in that city permanently.

In a couple of states that I traveled to, I ended up meeting and dating someone while I was there. By the near end of my assignments, I had to contemplate if staying was worth it. In one instance, I decided to move on. In another case, I decided to extend my assignment to see where things would go. It was nice to have that companionship while I was there, but I do not think I am at the stage where I am looking for something long-term.

Bad Interviews

For the majority of locum tenens positions, a phone interview is done prior to a site offering you a position. They are typically less nerve wrenching in comparison to in-person interviews. In fact, I don’t even think twice about them anymore.

They typically start the same way where the company summarizes how they work and why they have a need at this time. Then they want you to talk about yourself and your background. Sometimes they may ask a few clinical questions as well.

It’s always funny to hear about interviews that went wrong. One of my close friends recited a story to me about an odd interview she had for a locum tenens position. Apparently the interviewer kept talking down to her, making my friend feel like she was on trial. The interviewer made it seem like she was not interested in offering a position to my friend. Then 5 minutes later, she called back asking if it was true that my friend was fluent in Spanish. My friend said yes, and the interviewer said ‘you got the job!’ Of course my friend did not accept.

One of my readers shared her experience interviewing for a locum tenens position. The interviewer told her that when she sees the word “locum tenens on a CV” she thinks to herself “what’s wrong with them, why can’t they get a job?” This didn’t make any sense considering that site was looking for a locum tenens provider, so should be well aware of how locum tenens can fit the needs of a practice.

Fortunately, I’ve had only one bad interviewing experience. The interviewer asked me tons of insurance specific questions that I couldn’t answer. She made me feel like an idiot for not knowing those answers. I didn’t care since my job is to treat patients, not to know the specific details for different health insurance providers. At the end, she still offered me the position, in which I declined.

I think the most important aspect of the interview is to feel like the site will be welcoming, patient, and understanding with you. Considering I will be joining them to provide help, I wouldn’t want to work somewhere that does not give off a positive vibe.

Anyone want to share some weird interview experiences?

5 Signs You Need a Different Recruiter

Our experience with our recruiter will make or break a locum tenens assignment or even our search process. This is why I cannot stress enough how important it is to have a good relationship with your recruiter. If you do not like your current recruiter, you can always contact the agency and ask for a different one!

Here are 5 signs that you need to change your recruiter:

  1. Unresponsive – Recruiters are known to blow up our phones and email us constantly. If you are having a hard time reaching your recruiter or if they do not respond to your phone calls, you know something isn’t right. With full time jobs, we shouldn’t have to be the one to chase down our recruiter.

 

  1. Belittling – There are recruiters out there that may speak to you in a condescending tone. You may ask for a certain type of job or pay rate and they may tell you it’s not going to happen. A good recruiter will hear what you are saying and work with you to meet a medium ground, not speak to you as if you are crazy.

 

  1. Unable to answer questions – If a recruiter has no idea when your eligible start date will be or how long your license will take, they should be able to contact someone to obtain those answers. Never settle for a “I’m not sure.” I noticed some agencies are hiring a lot of newbies that don’t seem to know what they are doing.

 

  1. Pushy – It is safe to say that most traveling Nurse Practitioners hate when recruiters can be pushy. When they continuously try to force you to accept a position you do not want or sketchily have you sign an agreement trying to bind you to something you did not agree to. My favorite is: “maybe you can work at this site for the next 3 months until something opens up in your location of interest”. No thanks.

 

  1. Not your Advocate – If you start an assignment and absolutely hate it, you should be comfortable enough to confide in your recruiter. This has happened to me on multiple occasions. My favorite recruiter served as my advocate and made sure my concerns were addressed. On the other hand, I had a bad recruiter who continued to put the site first and nothing was ever changed for my benefit.

 

A great recruiter is always following up with you, even when you are on a current assignment. They will take your needs into consideration and let you know when a compromise may be needed. Most importantly, your recruiter should be your advocate and encourage you in your field.