Thailand and Dubai Trip

I recently returned from a 3-week trip to Thailand and the United Arab Emirates with my family. Since Thailand is so far, I was able to get a free stopover in Dubai for a few days. We flew Emirates for the first time, which is the most luxurious plane with the best service! Our plane was two stories and we had access to the bar. We really enjoyed our 14-hour flight from Fort Lauderdale, FL to Dubai.

It was our first time in the Middle East, and we actually come from a Lebanese background, so it was exciting to be in Dubai. The Middle Eastern food was delicious! The city was really clean and modern. Our favorite day was when we went on the desert safari excursion. We went sand dune riding in the desert and rode ATV wheelers. We also visited a camel farm and rode on some camels.

On the way back from Thailand we stopped in Abu Dhabi to break up the flight. We went to visit the Sheikh Zayed Mosque, which was absolutely stunning!

Bangkok was a pretty crazy city. Our first day there we rode on a tuk-tuk and it was the funniest experience. Our driver didn’t speak English so he would just bring us to all of these random places instead of where we needed to go

Thailand was incredibly cheap! We would get 1-2 hour massages for $8 almost every day. A 45 min taxi ride cost about $5-6. A family of four ate for about $20-40/dinner.

I have always been intrigued by the Buddhist religion and enjoyed visiting various Buddha temples. My favorite Buddha was the reclining Buddha!

We visited the old capital of Thailand, Ayutthaya. It was interesting to see the ruins of the city and learn how this Buddha head ended up in this tree:

It turns out that the Buddha head fell off the statue during an invasion of the city. As the Buddha head lay on the floor, birds pooped around it. Eventually a tree started to grow and the Buddha head grew with it.

My favorite food besides sushi is Thai food. We ate tons of good food during the trip! And I never thought I would say this, but by the end of the trip I was actually tired of Thai food.

As much as I loved seeing all of the Buddha’s, the best part of Thailand was going to Phuket and the Phi Phi Islands. We had an incredible time swimming in beautiful water, snorkeling with a variety of fish, and sailing on a speed boat. We literally felt like we were in paradise.

Time Off


Americans have a reputation of being “workaholics”. Some companies only allow 1-2 weeks of vacation each year. Luckily with locum tenens, our vacation time can be as long as we want it to be. I calculated that last year in 2016, I took a total of 12 weeks vacation time. Isn’t that amazing?!

Anyways, I had been at my current assignment for almost 6 months, with my last vacation being about 3 months ago. I started to feel antsy being in the same place. And I noticed my patience starting to dwindle down and slowly became more irritable.

Just in time, my 3-week vacation came in. I was able to relax and take some time away from the daily commotion of working in the medical field. After recharging my batteries, I came back to work an entirely new person.

I was no longer stressed. I had an abundance of patience and took my time with my work. No poor scheduling or acute complex visit was going to ruin my day. I felt like I had more energy to listen to my patients and provide them with even better care.

The reason I bring this up is because I do not think there is a medical provider out there that is not familiar with “physician burnout”. Medical workforce burnout is troublesome because it enables us to become cynical about medicine and exhausted both physically and emotionally.

There are many factors that impact this burnout. Some of these include the amount of patients seen per day; amount of time allotted per patient; working with a challenging patient population; lack of admin time; the need for thorough documentation to avoid malpractice claims; and too many bureaucratic demands.

The best way to prevent burnout in the workplace is to allow frequent periods of vacation or time off. Working in locum tenens allows this flexibility. Many locum tenens nurse practitioners choose to take time off between assignments, while others choose to only work a part-time schedule. Although I do not think I will be taking off 12 weeks again this year, it will still be more than the average medical provider.

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.

 

What are some challenges of finding that first assignment?

 

The first assignment may be a bit challenging to find because as new travelers we are expecting the perfect job. After time we start to realize that we have to be a bit more open minded of the location and practice setting we are looking for.

 Another challenge is having recruiters take you seriously. Many nurse practitioners are curious about locum tenens and will talk to a recruiter about locum tenens options without being completely serious about it. Thus, recruiters do not like “wasting” their time with new travelers that may never accept a locum tenens position. I find that recruiters take you more seriously after completing your first assignment. I recommend networking with other travelers so they can refer you to their recruiter, as referrals are taken more seriously. I am always more than happy to get you in touch with some of my recruiters. 

Lastly, finding that first assignment is tricky if you do not already have the state license you are searching in. It is possible to work with an agency to obtain a license and then search for jobs. However, many sites do not want to hire you until your license comes through. I personally recommend you obtain the license yourself first, and then search for jobs with multiple agencies. This will increase the probability of you finding something that meets your needs. You can always be reimbursed for the license later on. I think new travelers have a misconception that the agency will do EVERYTHING for them, so applying for a license on their own isn’t ideal.

Losing a Patient

I write this post with humility.

After returning from a 3-week vacation, I was a bit nervous about how much work waited for me (lab/imaging results to review, medication refills, phone messages etc). Surprisingly, my first day back went pretty smoothly. My schedule wasn’t too crazy. My co-workers were ecstatic to see me, and my patients were relieved that I was back.

At the end of the day I was skimming through hundreds of work emails, deleting most, keeping the important ones. I came across some emails about one of my patients being in the hospital for a heart attack. I wrote down his name on my to-do list, so that I could give him a call and see how he was doing.

As I continued going over my emails, I was in disbelief when I read “patient expired. Sorry for your loss.” It turns out that the patient that had a heart attack in the hospital was discharged home a few days later in stable condition. The following day he passed away at home. It was a complex situation, as he had a history of severe coronary artery disease and other co-morbidities. Even though you know all that could have been done, was done for him, you still feel like it wasn’t enough.

I immediately started crying like crazy, as I had never cried before. He was actually one of my favorite patients, and one of the first patients I developed a relationship with at my clinic. A very pleasant man and compliant with all medical recommendations. During the 6 months of working at this clinic, I had seen him at least 10 times.

My co-workers tried to comfort me, explaining that all of our patients are much older and much more sick than the average person. They tried to reassure me that at least he is no longer in pain and was able to pass away in the comfort of his home.

It was so hard for me because I had seen him right before I went on my trip, not knowing it would be the last time. I had also wished I was here when he passed so that I could have at least attended his funeral.

The following day I was still grieving and wasn’t sure how I was going to face my other patients. I thought to myself, what is the point of all this? I had a busy day and it was actually a good thing. It distracted me and also reminded me that there were still other patients that needed me.

It has been so hard for me because I have never had anyone close to me pass away before. Although I also worked with a geriatric population in Miami for several years, none of my patients ever died while under my care. They didn’t seem to be as sick as my current patients. As a child I had distant relatives pass away, but death seemed so foreign as a kid.

The other providers told me that the first few patients they lost were really hard. But after a while, you have to learn to become less emotionally invested. I think the passing of my patient reminded me how near, death truly is. Death is inevitable. I realize I cannot promise my patients that they will never die. But I can help them to live a comfortable life and gain more time to spend with their loved ones.

May he rest in peace.

Continuing Education Reimbursement


I enjoy sharing benefits of working as a traveling nurse practitioners and any incentives provided by agencies with my readers.

I am currently working with Comp Health for my assignment in Virginia. I was contacted over the phone last month to go over my annual review. I have worked with Comp Health on and off over the past year.

When I was done with the review, I was notified that after working 500 hours with Comp Health, I am eligible to receive up to $500 in reimbursement for continuing education. Working one 3-month assignment with Comp Health automatically makes you qualify for the 500 hours minimum requirement. However, there is a stipulation where you will be reimbursed for your CEU’s as long as you are committed to your next assignment with Comp Health.

In my case, I met the 500 hours of working with Comp Health, and since I extended my current assignment, this qualified me to receive up to $500 in reimbursement for CEU’s. This can include conference registration fees, nursing membership organization fees, and all certification fees.

This year I am due to renew my Family Nurse Practitioner certificate through the ANCC. This comes with a hefty fee of $350. Luckily this certification is reimbursable through the $500 CEU credit.

This is definitely a nice little perk because permanent positions often cover CEU costs. So it is nice to have these benefits without having to commit to a full-time position.

Overtime

One of the benefits of working locum tenens is you are paid hourly. So if you have a busy day and end up staying an extra hour or two to catch up on documentation, you can bill for those hours. When those hours accumulate and exceed more than your 40 hour workweek, you get paid overtime (time and a half).

Most medical providers work beyond the 40 hour workweek. Unfortunately, those that are salary do not get paid for the extra hours they put in. Working during your lunch or for an extra half an hour after the clinic closes can easily add up.

Some weeks I work 42 hours a week, other times I may work 50 hours that week. Although I do not like having to work more than my 8 hour shift, things come up. I am grateful I at least get paid for it in comparison to my co-workers. The extra pay does add up. I calculated that working an average of 2 extra hours per week of overtime all year, can accumulate to one month’s income. This makes up for unpaid time off we use for vacations.

Some sites may be stricter with paying overtime, while others are more lenient. In my experience, as long as your are straightforward and do not take advantage; the sites will pay the overtime hours worked, no questions asked. I think most medical facilities are aware that their employees work more than the 40 hour workweek.

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 long does it take to start your first assignment?

 

The answer to this question varies depending on if you are looking to work in your current state or accept a federal healthcare site position. In these cases, you can start your first assignment within 1 week.

If you are looking to travel to a new state working in the private sector, then starting your first assignment can take about 1-3 months from initiating your search.

After realizing you are interested in working as a traveling nurse practitioner, your first step would be to contact multiple agencies and become credentialed with them. Then you want to go ahead and apply for one or two licenses in another state. Check out my licensing page to see the average timeline for states licenses. Ideally for your first job you want to choose a state that will grant a license quickly such as Montana or Washington.

So that first month is really about establishing a relationship with agencies and recruiters, and obtaining licenses. In the mean time, you can search for locum tenens positions and your recruiter will present you to these sites while your licenses are pending. The timeframe between being presented to a job, interviewing, and then accepting an assignment can be 1-2 weeks. After accepting an assignment you will need to become credentialed, depending on the site this can take 1 week to 1 month.

To be on the safe side try to plan for at least 1-3 months before starting your first assignment. That means do not quit your current job until you have officially accepted an assignment. If your current lease is ending in the upcoming months, start your job search at least 3 months out.

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 do I know if a particular locum tenens job is right for me?

 

Upon searching for an assignment, you can easily become overwhelmed because there are so many jobs out there. I think you will need to first narrow down your job search to a particular state. Then consider what you value the most out of a job. Is it the type of facility (urgent care vs community health center)? Is it the hours worked (day shift vs night shift/ weekends vs weekdays)? Is it the length of an assignment (4 weeks vs 6 months)? Etc.

 Remember sites are looking for locum tenens nurse practitioners because we are supposed to be flexible. So if this new job is open on Saturdays, they will likely request you to work some Saturdays. If working on weekends is not an option for you, then do not accept the position. If you are a new nurse practitioner, you should definitely stay away from solo-practice settings. This means you are expected to work alone which isn’t ideal for a new grad, because you need mentors to ask questions to.

 Be sure to ask the right questions when you are being interviewed. See this past post for more details:

Interview: Travel Nurse Practitioner

 To answer this question, there may not always be the “perfect” assignment, but as long as it meets your needs, you should be fine. The more I work in locum tenens, the more I narrow down my job search to meet my maximum patients-per-day ratio. If a job is in my ideal city with a 30 patient per day schedule, I would rather choose the job with a 20 patient per day schedule in a city 1 or 2 hours further away. This way I know my work-life will be less stressful.

Extending My Assignment Part 2

In continuation of my last post, I wanted to animate more details about extending my current assignment – logistically speaking.

A lot of times, when a site wants you to extend your contract, they are willing to increase your hourly rate. Unfortunately, the site could not afford to increase my hourly rate. It didn’t matter to me because I am already paid at a high rate, and an extra $5/h is insignificant over the course of 3 months.

Instead, they offered an extra round-trip flight home of up to $450. I had received mileage reimbursement for getting to Virginia, and will again receive mileage reimbursement when I return home at the end of my assignment. So this airfare is primarily meant for me to use in between ending my original 3 months and beginning my next 3 months here. I probably won’t use it until I plan on going home prior to my next vacation in March, but it’s a nice bonus.

My recruiter asked me if I wanted to stay at my current apartment or move elsewhere. I am satisfied with my current housing so I opted to stay.

My only concern was about my requested time off. Usually when I accept an assignment, I provide the weeks I need off beforehand, so I am guaranteed those days before I start. To me, the best part of doing locum tenens is I can take off as much time as I want, since I like to travel abroad.

I discussed this with the medical director, and she guaranteed that my requested time off would all be approved as long as I give advance notice.

Of course a new contract was drafted and signed. All of this was done 2 weeks prior to the end of my current assignment. I am confident that I made the right decision, but lets hope that I do not get too antsy staying in the same place.