Traveling NP

I was fortunate that my next job didn’t have training available until the end of the following week. A lot of locum tenens nurses practitioners will take one to several weeks off in between assignments to recuperate. I usually just plan my vacations for the year ahead of time, not knowing what my schedule will look like. So I don’t take time off between assignments, since I already have scheduled vacation time during my assignments.

I had gone home to Miami, FL during the week of Easter because it was my brother’s birthday and my grandfather had just had back surgery. This was during my last few weeks in San Diego.

I was relieved I didn’t have to start working in the bay area the Monday after finishing my assignment in San Diego (which was a Friday). I slowly packed up my apartment during my last week of work. The following Saturday, I packed up my car with all of my belongings. I was surprised by how much I could fit in my car, especially knowing I had somehow accumulated a bunch of random things during my stay in San Diego.

I spent the weekend in Los Angeles with some friends. There are always new things to see in L.A. As we hung out by the beach and it was warm, I started wondering if I was making a mistake leaving southern California!

It was about a 6 hour drive from LA to San Francisco. I did not drive on the pacific highway because I had already explored it when I did an assignment in Monterey. I just wanted to get to San Francisco as quickly as possible. I am glad I never did an assignment in the Central Valley of California because it is pretty deserted. There were times I was afraid I wouldn’t be able to find a gas station. Other times it smelled like manure as I passed by farms with tons of cows – more cows I had ever seen in one place in my life!

Upon arrival to San Francisco, I thought to myself – wow it’s cold! I automatically started to miss San Diego a lot. I spent the next couple of days exploring San Francisco and Napa Valley with some friends. Seeing the Golden Gate Bridge again still gives me that breathless moment. The wine was incredibly good! I had a great time but found myself remembering why I always preferred Southern California to Northern California.

San Francisco was foggy for the first half of the day, and when the sun finally came out, it was accompanied with a lot of cold wind. Some nights I had trouble sleeping because I was so cold!

This assignment is 3 months long, but between all of my vacations, I will only really be working 2 months. I figured I could put up with anything at this point, but will really have to consider the location of my next assignment when the time comes. In the mean time, I am super excited about all of the cool places I will be exploring near by: the Redwood Forest, Lake Tahoe, Sacramento, Napa Valley, Silicone valley etc.

As usual, it didn’t hit me that I was actually leaving San Diego until my last day.

It was bittersweet because I was genuinely going to miss all of the great people I met, but was also looking forward to starting a new adventure.

The two main clinics I was at each through me a good-bye party. My main clinic made theirs a surprise and the charge nurse even sent me a beautiful bouquet of flowers. She is so thoughtful!

All of the providers hugged me good-bye, and asked if I really had to go. Yet, they were very excited for me to move on to the San Francisco Bay area.

Some patients said they wanted to make an appointment with me next week, or that they wanted to bring in their children to see me next month for a physical. I did not have the heart to tell them I wouldn’t be there. I also heard after I left that some patients came in expecting to see me, and when they learned I wasn’t there they caused a scene.

The tough part about doing locum tenens will always be leaving behind my peers, co-workers, and patients I have developed a bond with. It is good to know that I can always go back if I want to.

After San Diego, I wanted to make my way up to Northern/Central California. I wanted to be somewhere in the bay area or near Sacramento. I have previously visited San Francisco but have never been to Sacramento. I mostly wanted to situate myself close to Lake Tahoe, so I could easily drive there for a nice summer weekend.

I knew I didn’t want to overwhelm myself again as I did with my search in Southern California, by having over 20 options. I just stuck with 3 agencies this time to help with my search.

My main search criteria were:

-Working with an agency that pays 1099 (vs W2): the reason is because California already takes out a high amount of state income tax, and I had already done my due diligence in San Diego working with a W2 company. I needed to balance out my sole proprietor/self employed income with my employee/employed income for tax purposes.

-Location: I wasn’t too picky about the city; I just wanted to be within 1 hour from San Francisco or Sacramento (or both).

After interviewing with a handful of clinics, I decided to choose based on the clinic I preferred over location. Since I had a great location with my last assignment (San Diego) but did not enjoy the clinic itself, my main goal was to work with a clinic that was well-run and the medical assistant’s were very autonomous.

I ended up choosing a community health center in the Bay area, between San Francisco and Sacramento. Per my conversations with the directors of the clinics, each provider has two medical assistants, and they can be as autonomous as the provider wants them to be.

I am grateful that the facility has also pre-approved my requested vacation time for two trips I will be taking during the assignment. My assignment is 3 months long, but after deducting my vacations days, I will only really be working there for 2 months.

I was able to take 1 week off for a mini vacation with friends. We decided to go to Guatemala since it could be a quick fun trip. I had a good time, minus the fact that once again by baggage was delayed.

My friends and I joked that I should purchase some traditional Guatemalan clothing in the mean time. I didn’t get my luggage until the day before the trip ended. Funny thing is that my gut kept telling me to bring a carry-on, since I had a feeling my luggage would be delayed. However, since I already had my baggage delayed twice within the past 4 months, I thought I couldn’t possibly have such bad luck in which I would lose my baggage again. I guess since I travel more than the average person, my probability of having baggage delayed is higher than others.

I definitely learned my lesson and will bring a carryon to every trip in the future. I couldn’t even be upset about not having my things, as uncomfortable as it was, because the Guatemalan people barely have anything at all so I was fortunate I had “things” I could miss.

Guatemala was a mixture of Costa Rica and Peru. Although Costa Rica is more beautiful – landscape wise, Guatemala also had an abundance of volcanoes. It reminded me of Peru because the locals wore traditional clothing that was similar to the indigenous people. Guatemala is different because their ruins are from mayan influence.

Surprisingly the food in Guatemala was good too! I like that they pretty much use avocado/guacamole in plenty of their dishes. A strange thing is that they had a lot of café’s that served French crepes. It was a delightful surprise because crepes are my favorite!

Once again, thanks to being a traveling Nurse Practitioner, my schedule is flexible and I can easily make it on trips abroad.

Lake Atitlan with 4 out of 30+ volcanoes in Guatemala!

Antigua, Guatemala – small historic spanish town.

There are so many external factors that influence workflow for a locum tenens nurse practitioner. In some clinics I am able to see 25-30 patients without feeling stressed. In other clinics, I can barely see 18-20 patients without feeling overwhelmed.

What factors influence work flow?

• Clinic policy for late arrivals. One clinic I worked with had a 15 minute rule. Meaning, if a patient is scheduled to be seen at 4:00 pm, they have until 4:15 pm to show up for their appointment before they are marked as a no show. No shows then have to reschedule their appointments. This inspired patients to be on time for their appointments.

In another clinic, patients were scheduled 15 minutes before their actual appointment. So if they were scheduled for the 1:30 pm appointment, they had to check in by 1:15 pm or they were considered late. Once they were late, the provider was asked if the patient needed to be rescheduled or if they should wait for a “no show” and be placed as a walk –in appointment (replacing the “no show” appointment). Patients typically learn their lesson the first time they are late, because they will either not be seen or will have to wait a couple of hours to take a “no show” spot.

• Desktop vs Laptop for charting. I think it is ideal for providers to have a laptop for charting, in which they can bring with them to the patient’s room. On the other hand, a lot of clinics have their providers use desktop computers. There is a desktop computer in the provider’s office, and a different one in the patient’s room.

When using a laptop, you can easily start documenting before, during, and after seeing the patient (while staying logged in). You can quickly put in orders with the patient or while stepping out of the room. I find that having to log in and out of a computer upon each patient visit and upon each order can be tedious and time consuming when using desktop computers.

• Patient room locations. I have taken for granted having my own office and my patient rooms directly adjacent to it. In some clinics they have providers share a common work station/office. In this case, it is impossible to have provider rooms as close as possible to the office. Some days my patient rooms were easily a couple of hallways away from the office. This became time consuming, as I constantly had to walk back and forth between my office and the patient’s room. Some patients require care in which you need to step out of the room to look for something or call someone, thus you need to be in and out between their room and your office.

• Medical assistant level of autonomy. As I have mentioned previously, some clinics I have worked with have very independent MA’s. They gather past medical history; follow standard protocols to order and test for strep, flu, or UTIs; assess and order vaccinations per schedule; order screening exams as needed such as mammograms, colonoscopies, and diabetic retinal imaging exams; perform diabetic foot exams; have the patients undress for well woman exams or STD screenings; etc.

These little tasks can easily accumulate and become time consuming. By MA’s helping facilitate the process of gathering information and ordering recommended exams, it helps save us time and allows us to focus on other primary care needs.

I have worked in places before where the MA’s were not well trained. So when I went in to see a patient for a well woman exam, the patient was not undressed, nor were the pap smear materials ready for me to use. Once I had a patient that came in for wound care, but the previous dressing was not removed, nor were there wound care items easily accessible for me to use.

Unfortunately, those delays in the preparation of the patient cost me plenty of time. Anyone working in healthcare knows that time is precious, and any set back can push back the entire schedule.

As usual, time has flown by and I only have a few more weeks left in San Diego. It is bittersweet because I sincerely LOVE San Diego – but I am ready to work in a different facility.

I was asked to extend my current assignment by another 3-6 months. Unfortunately, the amazing weekends do not make up for the weekdays full of stress and anxiety. So I decided that I would just move on like usual.

I love that San Diego is so diverse. I love that it is a big city that is not overcrowded and there is not a crazy amount of traffic. I love the different coast lines; from the beaches to the cliffs to the bays. I love the food – my favorite restaurant is Chocolat! I enjoy the night time life at Gaslamp district. I absolutely love bike riding on the boardwalk where I live, with a nice cool breeze hitting me. I have also gotten used to seeing seals everywhere I go.

In a perfect world, I would take the community health center from Washington State and put it in San Diego, where I would be the happiest employee ever!

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Below is a picture of the sunset cliffs in Ocean Beach, SD (looks like Cabo, Mexico).

My sister came to visit and we had a blast bike riding:


Skyline view of San Diego at night time:

La Jolla Cove with tons of seals sunbathing:

My name is Kathy and I am a locum tenens nurse practitioner. Last year with my husband, I decided to leave Florida and start traveling. I was feeling burnt out at my previous job and wanted a change. My husband and I wanted to go to the West Coast and explore our beautiful country!

Originally we meant for Texas to be a half way point to our ultimate travel goal, California. We knew we wanted to visit either Austin or San Antonio, but didn’t know very much about them other than knowing they had good food and music. I took a job as a locum tenens provider working on Lackland Air Force Base in San Antonio.

San Antonio has been a blast! The people are friendly. The cost of living is cheaper than Florida. The food is AMAZING. If you love Mexican or BBQ, there will always be a great meal nearby. Our apartment is across the street from a farmers market, fantastic restaurants, and a culinary institute. There are a lot of outdoor activities- we love bike riding, running along the RiverWalk, and we have even hiked to see real dinosaur tracks! The museums have free admission once a week and many places have live bands.  Texas so far has been so much more than just working; we are experiencing a different culture and making new friends.

This past weekend we drove up to Waco to play disc golf, then spent the night in Austin and went to a brewery (named best in Texas, called Jester King) and a highly rated taco truck (called Veracruz). We also went to Ladybird Lake Park, famous for its running trail. On our way back we stopped at Bucees, the biggest gas station I have ever seen!

Regarding my current job, I am so happy this opportunity was available. Working with military service members is one of the most rewarding jobs you can have. Starting out can be difficult; you have to go through an extensive background check, lots of paperwork, and learn a lot about the military if you are not familiar with their customs and rules. Usually government contracts pay a little less than private clinics, they tend to ask for a longer commitment (my contract is 6 months, but could be up to a few years if I wanted), and the paperwork can be tedious.

For me, the positives outweigh the negatives. You don’t get burnt out here the way you do working in private practice or community health centers. I enjoy helping our military members get the care they need and deserve. At this job I have been able to help them in the process of retiring, doing physicals as they are leaving the military, and talk to them about their time in active duty. I have also gotten to learn about the different types of exams and health requirements for the service members. There is a great sense of teamwork with each department and if you need help someone is always willing to help you. In some cases you have the opportunity to fill in at other clinics and learn different skills. I have enjoyed it so much I plan to find my next assignment with the military or VA.

If you are thinking about taking a contract with the military, go for it! You will find that the patients are kind and appreciate your help. Management will not over work you, and everyone is a team player. I recommend traveling to San Antonio as well. Sometimes finding an assignment in bigger cities requires a little more patience, but it is worth it in the end to travel to a place you want to explore.