Questions to ask the Site

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Agencies sometime see the interview process as a means for a job site to approve their recommended candidate. However, I believe the interview is just as important for locum tenens candidates as it is for the job site. This is perhaps the best way to get a feel for the facility and if it is the right match for you. I have put together a list of questions I recommend you ask the person that is interviewing you.

 

  • How many assistive personal staff will I have?
    It is good to know before you get to the site how many medical assistants and nurses you will have assisting you. If the patient volume is low, then 1 MA per provider is sufficient. If the patient volume is high, then 1 MA per provider will not make the cut.

 

  • How many patients per day will I be seeing?
    Most places will give you a range. For ex: a high volume may be 25-30 patients per day. Does this include walk in patients? If a patient is a no-show, are you required to see a walk-in patient instead? A lot of times, the no-show patients help balance out our busy schedules, but if you are required to see walk-ins in their stead, then it may be challenging.

 

  • How much training/orientation will I receive before I start seeing patients?
    Some places will give you 1 full day of orientation, whereas others will give 1 week. It just depends on you, the facility, and your level of comfort. If you have to learn a new EHR system, I recommend at least 1-2 days of EHR training alone. If you are a relatively new nurse practitioner, I recommend you ask for 1-2 days of shadowing another provider so you can see the workflow. Many sites will gradually increase the amount of patients you are seeing per day as part of the orientation phase. Be sure to ask what their orientation process is before you start your assignment so that there are no surprises!

 

  • Will I have any admin time?
    It is common to work locum tenens and not be provided with any admin time. Meanwhile, you see other providers with either several hours or an entire day each week for admin time. Admin time is useful because it gives you time to answer patient calls/messages, provide medication refills that are requested, review lab results as they come in, complete prior authorizations, and complete charting if necessary. It just depends if you often find yourself needing extra time for these miscellaneous tasks or if you are able to fit them in your schedule. I once saw a locum tenens physician request her last week at the assignment for admin time alone, because she was so behind in charting, reviewing labs, and billing. I usually find that 1 hour a week is more than enough admin time for locum tenens nurse practitioners.

 

  • Will I be the sole provider at the clinic?
    Sometimes without realizing it initially, you may be the sole provider working at the clinic. If you are uncomfortable with this, make sure to ask during the interview process. Personally, I do not mind being the sole provider at an office. However, there are many advantages of having other nurse practitioners, physicians, or physician assistants working with you. For instance, you can bounce off ideas from one-another; get a second opinion for a complex patient; or switch patients if you are not comfortable with a requested procedure etc.

 

Having these questions answered can help determine if the facility is the right fit for you. The closer the answers match your needs, the less likely you will be stressed and unhappy while working there. As always, feel free to message me if you have any questions.

 

Short-Term Locum Tenens Assignment

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Upon completing my assignment in Sacramento, I had a few weeks to spare before a planned vacation departing from Miami, FL. I thought it would be a good idea to pick up a short assignment as I made my way back to the east coast.

Luckily, I was able to find a 2 week assignment near San Diego, CA. The assignment made a lot of sense for me because it offered quick credentialing, provided me with housing and a break in between traveling to my previous and upcoming assignment, and fit the time frame I needed. Not to mention I was able to get round-trip mileage from Sacramento to San Diego, CA, which I could add to my travel fund.

I was a bit nervous on my first day because usually short-term assignments do not entail much of an orientation. Upon arrival to the site, I was given a 15 minute orientation on their EHR program. Fortunately, their EHR system was pretty straightforward and I was able to jump in and start seeing patients.

My first day went well because the staff was helpful and the patients were pleasant. The following day I was working in their ‘walk-in’ clinic. I found myself overwhelmed in the morning because the clinic was really busy and I ended up seeing 5 patients per hour! Although it was a walk-in clinic and patients often come in for basic things like earache or rash, I wasn’t thrilled about the patient to provider ratio.

After discussing the activities of the day with both the site and agency, I opted to stay for the remainder of my assignment. It turned out that the clinic I would be working in for the remainder of my assignment had a low patient volume (8-16 per day average). The walk-in clinic was just the anomaly. This ended up being the case and the rest of my assignment went smoothly.

Although the majority of locum tenens positions are 3 months long, there are plenty of short assignments ranging from a day to a few weeks. Each have there advantages and disadvantages. For short-term placements, make sure you are a quick learner and easily adaptable!

Kon’nichiwa from Japan! – Vacation

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Since I was living on the West Coast, I thought it would be the best time for me to dip my feet into Asia. Japan sounded ideal because a flight from San Francisco is about 9 hours, which is the equivalent of going to Europe from Miami.

I ended up having an incredible time in Japan! I was blown away by the culture and sophistication of its people. Everywhere was so clean; everyone was so friendly; and all of the food was delicious.

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A few friends and I flew into Osaka so we could start our trip in Kyoto, Japan. Osaka is more of an industrial city. Kyoto is more of a traditional town, where we were able to see “Geishas”, temples, Buddha’s, and historic streets. Sushi is my favorite dish so I was ecstatic to eat sushi almost every day for very cheap! In the US, 2 pieces of nigiri/sashimi usually costs $5-7. In japan, it only costs $1. I took advantage and ate more plates of sushi than I probably should have :).

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We took the bullet train down south to a town called Fukoana. Riding the bullet train made me feel like I was in the movie Hunger Games – it was that fast! We mostly went to Fukoana to check out this beautiful lying Buddha:

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The site of it was breath taking. I also really enjoyed the temple it was located in. We then went to Tokyo to meet up with some friends that were backpacking around the world. As soon as we arrived into Tokyo, I was immediately overwhelmed. There were tons of people everywhere!! However, it was interesting to see how the trains were always so quite (you could hear a pin drop), and how easily people formed lines for exiting the station. I have never seen so many people in my life!

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That night I had the best ramen dish – something I wasn’t sure I would even like. Tokyo is so crazy. Think of time square in NYC but 100x that. There were adult arcades, adult fantasy bars, animal cafes, robot bars, casinos, karaoke bars, and other interesting places I cannot describe. It’s cool because no matter what time of day it is, there is always some action going on.

We also went on a trek to Mt Fuji; visited more temples and the imperial palace; and went up the Skytree Tower. Thank goodness for my good friend Sandy that navigated us around town because the metro system in Tokyo is no joke. Although not as many people spoke English as I expected, we still managed to get around okay.

I had so much fun on the trip and had gotten so accustomed to the Japanese people, that it was really strange returning home. I wouldn’t mind going back again!

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Is California a Curse?


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I originally planned on working in California for about 3 months but ended up being there for almost 7 months. California is so large that it’s impossible to explore the entire state in a short period of time. Also, since the process of getting a California license is so lengthy, job opportunities are always plentiful.

After working in 3 different facilities while in California, I started to wonder if being in California was a curse? Each clinic I worked at was progressively better than the last. However, it was obvious that with the affordable care act, there was a significant increase in patients that needed care, and now had “access” to care. Unfortunately, the majority of community health centers in California are unable to keep up with the demand. Whether it is not having enough providers, enough work space/patient rooms, or enough assistive personnel.

Each facility I worked with in California had very low employee satisfaction rates. As my last assignment in California came to an end, I knew one thing – and that was that I needed to get out of California!

I found myself suddenly become homesick. I had only really been home for a mere 4 days this entire year. I decided to take a few weeks off to hang out at home and spend time with family and friends. As I thought about my next assignment, I knew I wanted to be back on the East Coast. I wanted to be somewhere that I could easily go home for the weekend if I wanted to.

Sadly, I was quickly informed that licenses I thought would only take 1-4 weeks to obtain, would take 2-3 months long. The reason is because now that I have a California license, the board of nursing in other states will want to verify that license. California is known to take several months to endorse a license. Unfortunately for us nurses, they also take several months to verify a license. I could not grasp how this made sense until I saw that California is not part of the nursys network, which usually provides quick online licensure verification.

Luckily I have other state licenses I can use while my new licenses come through. Hopefully they will only need to verify my original license in Florida and not all of my active licenses. I will be sure to keep you informed!

In conclusion, while RN’s that come to California have certainly hit the jackpot, I can easily say that California is not the best place to practice as a nurse practitioner. The pay rates are NOT higher than other states, but the cost of living is much higher, and the outpatient healthcare facilities like to operate as factories. RN’s in California often make as much as nurse practitioners, if not more. This is due to their highly organized unions and variable work settings/shifts. Overall, California is a lovely state and the stressful work environment was balanced out by the beautiful scenery and perfect weather. Do I recommend locum tenens work in California? Yes! Do I recommend permanent nurse practitioner work in California? Only if you manage to find a clinic that allows you to see 18 or less patients a day. Good luck!

California Excursions

The main reason I wanted to work in Northern California was to experience some fun weekend excursions in the area.

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I was able to visit the Muir and Redwood forest, which is such a treasure. There are multiple trails you can choose to hike up. I also went to Napa and Sonoma valley to experience several wineries. My favorite one was Castello di Amorosa. It is a huge castle modeled after Tuscany in Italy. I only like sweet wine, thus I was happy to see they had plenty of sweet wine selections as part of their wine tasting. The wine was so good that I even bought some bottles to take home.

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The last site I was excited to visit was Lake Tahoe. I was waiting for it to get as warm as possible before spending the weekend there. The Lake was absolutely beautiful! We hiked through several trails, went to the beach, and I kayaked for the first time! Kayaking was such a blast. The water was freezing cold but that didn’t stop a lot of OTHER people from swimming in.

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These fun excursions were certainly worth working in Northern California to experience!

Is Locum Tenens for You? -revisit

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A few months ago, I posted an article that I had written called “Is Locum Tenens for you?” It was a popular article because many nurse practitioners are often dreaming about work and travel, but wondering if they are cut out for the lifestyle as a locum tenens provider. Feel free to click on the name of the article above (embedded link) to be directed to the original article.

Today I wanted to share a great read from Comp Health’s Blog about figuring out if you are cut out to be a locum tenens nurse practitioner. Please click on the link below to read further.

9 Questions to Ask Yourself before Trying Locum Tenens

 

Bienvenidos a Miami

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As my assignment in California draws to a close, I am looking forward to going back home to Miami for a few weeks! I have spent the past 6+ months in California and I am ready to head back to the East coast!

I cannot wait for:

  • The beach – and actually being able to swim in the ocean because the water temperature allows it (although it will likely rain every day).
  • Pastelitos – Cuban pastries for breakfast or as a random snack.
  • Dominican hair salons – if you have curly hair you get the drift.
  • Humidity – yes I said it! Humidity actually cools you off and doesn’t include hot air blowing in your face.
  • Florida roads – pothole free where you aren’t constantly worried about getting a flat tire any day now.
  • Good food– can’t wait to hit up all of my favorite restaurants!
  • Publix Supermarket – where shopping really is a pleasure. It should be illegal to not have a Publix in each state.
  • Family & friends – Duh!
  • Inside jokes – Being able to use words from “sh*t Miami people say”
  • The driving – people actually drive like they have somewhere to go…
  • Shopping!! – Having a dozen malls in one place certainly is convenient.

It’s those little things that you appreciate about home the longer you are away 🙂

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Agency as a Buffer

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When you start working at a new assignment, you can easily be overwhelmed at first. I think the first two weeks are usually the toughest. You are learning a new system, in a new environment, and with new people. After two weeks, you can start judging if the facility you are working with is fair or not.

Some issues I have come across while working as a locums include but are not limited to:

-High patient load with limited time (example: 30 patients a day where new patients are only 15 minute visits etc.)

-Only having 1 medical assistant to help you

-Having 1 patient room to work out of…

-Clinic Manager/Supervisor scrutinizing you

-EHR system that is not so user friendly

 

The list can go on and on. Of course no place is perfect, and I don’t typically expect them to be. However, when my license is on the line, I can get pretty frustrated if the site does not have a good flow. Make sure to express your frustrations to your agency liaison (whether it’s your recruiter or the account manager). They can often help improve your situation by reaching out to their site contact. Also, if you end up wanting to leave an assignment early, at least there will be no surprises.

In one instance, I had a fabulous recruiter in which I confided in her some issues I was having with the clinic manager at one of the sites I was working at. She agreed that the clinic manager had said some distasteful things to me and immediately reached out to her contact at the site. The next day, I already had the clinic manager sucking up to me! Not to mention, my recruiter sent me a $25 giftcard to starbucks to brighten up my day.

I ended up continuing with that assignment and completing my 3 month contract even though I had a confrontation with the clinic manager during my first 2-3 weeks. I was grateful for how my recruiter handled that situation.

On the other hand, I worked at a site that did not follow through with their promises. 75% of the time I only had 1 medical assistant to help me, when I was originally promised 2 (and every other provider had 2). Every other day, I only had 1 patient room to work out of which was ridiculous when you have a full patient load.

I spoke to my agency liaison and she said she would address my concerns. I was once again promised by the agency and site that things would get better. They only got better about 25% of the time.

During my last month, the clinic suddenly wanted to add child wellness exams to my already busy schedule. I refused on the basis that their EHR system required using 11 different templates per each physical, and that California has a lengthy list of requirements for child physicals (including a fluoride application, TB screening, hemoglobin check etc). With me only having 15 minutes for new patients and for adult physical exams, I did not see it possible for me to add child wellness exams to my schedule as well.

At first the site said it was okay, but then they suddenly started putting these child physicals on my schedule. I once again complained about the child physicals, and the site pretty much told me I would have to see them. I contacted my agency and at that point they were more concerned about their relationship with the site than with me.

Since no compromise was reached, I opted to leave the site early, and thus my contract ended. I do not like to leave earlier than originally agreed upon because I understand how much help is needed. However, my priority will always be my patients and my license.

I truly wish my agency had stepped up to support me instead of prioritizing the clinic. Was I truly surprised? No. Yet, I showed you how much influence an agency has in the enjoyment of your assignment and on you completing it as contracted.

Feel free to reach out to me if you need suggestions on which agency to use!

Aloha Hawaii! Vacation

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Whenever I tell people I am a traveling Nurse Practitioner, they often suggest I do an assignment in Hawaii. Although I think it would be fun, I do not consider it as an option just because of the distance from home and the time difference. It is an 11 hour plane ride back to Miami, and 6 hours behind in time!

Regardless, I have always wanted to visit Hawaii and see what the hype was about. I decided to plan a vacation there while I am in California since the flights are only about 5 hours long. Luckily, my vacation time was approved prior to the start of my new assignment.

I spent 1.5 weeks in Hawaii visiting the island of Oahu and Maui with my family. We spent the first few weeks on Waikiki Beach in Honolulu. The water was beautiful and warm – similar to water in Florida. I was automatically intrigued by the culture of the island. Everyone was laid back and friendly. We went to a luau which was fun!

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I enjoyed Maui a bit more during the second half of the trip because it was quieter and different from Florida. There were huge waves that were pretty fun to swim in (when you weren’t drowning). There were beautiful views of volcanic mountains everywhere. On one of our last days we hiked and drove up to Haleakala, which is a volcano that makes up 75% of the island of Maui.

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The island type of food was tasty! We practically ordered coconut shrimp and calamari everywhere we went. We also shared Hawaiian shaved ice almost every day. My favorite flavor was coconut! Before going to Hawaii, people warned me that the food there was costly. I didn’t believe them until I saw that basic food such as a burger or tacos were easily $30.

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I really enjoyed my vacation in Hawaii. It was definitely relaxing and different. I still don’t think I would ever live there, but I do recommend everyone to visit at least once in their lifetime.

References

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In the medical field we often do not put much consideration into providing references. As a locum tenens nurse practitioner, the references you provide are in fact very important.

Most agencies and sites will need at least 3 references that are co-workers within the past year. These co-workers can be other nurse practitioners, physician assistants, and physicians. They usually request that at least one reference be a supervising physician if indicated.

Here are some tips about the references you provide:

  • Try to provide at least 5 or 6 references – Sometimes your references do not respond quickly and this holds up the credentialing process. Most places will not clear you to start your new position until they have heard from all 3 references.
  • Notify your peers that you will be using them as a reference – It’s always a good thing to have them be prepared and to clarify any information.
  • Switch up your reference list after a few assignments – By your third assignment, your references have already been contacted at least 4 times (once by the agency and once by the site). No one wants to give a reference a dozen times!
  • Obtain new references at each assignment – With so many different work experiences; we should also have a variety of references. Some agencies only want one reference per facility, meaning you cannot have all of your three references from the same job.

I know there are some people that have worked as the sole provider at their clinic for years. In this case, you may wonder whom you can use as a reference since no one has seen you work hands on. Usually agencies will be flexible with this situation. They may allow you to have a peer from school (that you have not worked with) or a supervisor (even if non-medical) act as a reference.

Be sure to keep in mind that the references you provide to an agency/site upon credentialing are actually really important!