Traveling NP

Although working as a locum tenens nurse practitioner is often like being in a dream, there are some aspects of having a permanent job that I miss.

• Long-term follow-up with my patients – one of the reasons I decided to work in primary care is to establish relationships with my patients and provide them with a personal experience. In locum tenens, I am able to follow-up with a handful of patients, but they are often being scheduled with their primary care providers, and only scheduled with me when there is no space with their PCP. In a 3-month assignment, there are a few patients that I am able to follow-up with every couple of weeks. Sometimes they ask me to become their PCP, but I do not have the heart to tell them I am leaving in 2 weeks.

• Stabilization – working in locum tenens you are always on the move. You are constantly thinking about where you are going next, how you are getting there, and how much time off you need in between. You are constantly learning new electronic health systems and adjusting to the flow of the clinic. Sometimes I miss just being able to settle down and not live in a whirlwind of surprises. Fortunately, if this was a huge issue for me I could opt for a long-term locums assignment.

• Peer relationships – the most difficult part of leaving each locum tenens assignment is saying bye to my co-workers. The people you work with are always an important part of your life because you spend so much time at your job. I miss having the same friends at work I can joke with and confide in. I have been lucky to make friends at each travel assignment, but I am always sad to leave them behind.

• Possessions – living out of several suitcases limits the amount of clothing and personal items I can bring with me on each assignment. Sometimes I miss just having all of my things with me for easy access. I find myself not enjoying shopping that much anymore because I worry about where I can fit my new stuff. At the same time, I like this lifestyle because it inhibits me from being a part of the consumerist society that Americans love. Now I am able to only buy things I absolutely need, vs want, and can set aside that extra money towards my savings or retirement plans.

While in Miami visiting with family and friends, I was fortunate to find a locum tenens position 5 minutes away from where I lived. This is a big deal considering locum tenens positions in Florida are quickly filled (who doesn’t want to live in sunshine by the beach?), and because Miami is a large city so you can easily commute to work up to 1.5 hours each way.

The position turned out to be in a Pediatrics Office. The Pediatricians that own the clinic were planning a vacation for them and their children. They needed a nurse practitioner to cover ‘walk-in’ patients. They said they used to be able to just close the clinic whenever they left town, but due to insurance payment changes, they had to stay open to prevent their patients from utilizing the Emergency Room.

I was to be the sole provider while providing coverage. I was content that I did not have to do any wellness child exams, but my only apprehension was having to do newborn exams (as they cannot predict when they would come).

The Pediatricians requested to meet me before I started the assignment. I was able to pass by one morning since their office was so close to home. They were reassured by meeting me because they said that the last time they had a locum tenens provider, he looked like he was ready to retire, and the patients complained that he kept zoning out while talking to them. I was also reassured by meeting them, because they seemed laid back and even provided me with a cheat sheet on common medications and doses used in pediatrics.

My first day I thought was such a relief from working with adults. The visits were very basic, I literally had 10 patients in a row with a chief complaint of earache and that’s all! Also, the children of course were adorable and so much fun to be around. The only challenging thing for me was calculating dosages. I have always been good at math and used to be the drug math tutor when I was a faculty member in a nursing college. Yet, I realized I was spoiled by places I worked at previously which had a range of weight and proper dosing of medication already listed for you in the EHR.

At this clinic, I had to do all the dosing by hand. The more I did it though, the more I found myself memorizing dosing by weight.

Another plus at this clinic was that they have someone that inputs all of the notes in the EHR. I merely write the chief complaint, check the positives for the review of systems and physical exam, write the diagnosis, and medications I prescribed on a one-page form. Then someone inputs my findings in a more detailed note into the EHR, including billing. This makes the process of seeing patients way faster.

On a slow day I only saw about 20 patients. On a busy day I saw 40 patients. Surprisingly, I never felt overwhelmed. I had a good time working with this site. The site also appreciated my help and requested that I cover a few days the following week when they go to a medical conference.

My locum tenens assignments ended right in time for a planned vacation to Puerto Rico. I was able to use miles on southwest airline that I earned from travel as a Nurse Practitioner. So my out of pocket cost for my flight was $11. I stayed at a beautiful Hilton resort on the beach. Since I am a Diamond elite member due to all of my stays in Hilton hotels as a traveling nurse practitioner, I was granted free continental breakfast and a room upgrade. These are some extra perks when working in locum tenens!

Puerto Rico was actually different than I imagined it to be. The forts throughout the coast were really interesting to explore and provided some historic flavor. Puerto Rico also has an expansive rain forest with outdoor activities. Of course I enjoyed swimming in refreshing water that was not ice cold (sorry California). The food was good too – my favorite being the ‘mofongo’, which is a dish made out of plantains. Only 2.5 hours from Miami, Puerto was a nice mini-getaway!

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!

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.

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 :).

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:

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!

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!

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

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.

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.

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