Traveling NP

If you are currently working in a state that does not allow nurse practitioners to apply and use a DEA certificate, you will need to apply for one before beginning locum tenens. The same applies for those of you that do not have one because your current job does not require it. Applying for a DEA can be tricky depending on the state you are from.

For example, if you are coming from Florida, you cannot apply for a DEA using your Florida license. This means that in order for you to apply for a DEA, you will need to obtain a nurse practitioner license in another state. I would not suggest just applying to just any state. In fact, the first license you apply for out of your home state should be carefully selected.

The reason for this is because you need this state license to help facilitate your DEA application. This means that you should probably choose a state with full practice authority for nurse practitioners. Some states with limited practice authority require physician supervision and a controlled substance permit. You are unable to apply for the controlled substance permit prior to having a supervisory physician. You are unable to apply for the DEA without the controlled substance permit.

This prolongs the process of acquiring a DEA. States to avoid applying for initial DEA certification include Texas, Pennsylvania, and California. I recommend obtaining licenses in states with a quick turnover period and full practice authority if you need to apply for an initial DEA. Some of these states include Washington, Connecticut, Vermont, and Nevada. These states have full practice authority and allow you to obtain free temporary RN/ARNP licenses. This will speed up the process of obtaining a DEA because you can apply for one even with a temporary license.

If you are in a state that allows you to obtain a DEA but you do not have one, I highly recommend going ahead and applying for one with your current position. When you are searching for a job assignment, you are more “attractive” if you already have the DEA certificate. Sites often require their providers to have them, even if you do not end up using it at their facility.

There are two challenging aspects about attaining a DEA. If you are coming from Florida, you already know you need another state license to apply for the DEA. In addition, you need a physical practicing address to include in your DEA application, which should be in the state you are applying for the DEA with.

This means you cannot apply for the DEA until you already have a job assignment. It can be tricky since a lot of sites want someone to start right away and do not want to wait 2-4 weeks for your DEA to come in. On the other hand, some sites are willing to allow you to start prior to obtaining the DEA, while others will wait. The credentialing process in some sites can take 30-60 days. So these places are usually able to wait for you to obtain a DEA, as long as you already have a temporary or permanent license in their state. It is important you quickly realize that your first assignment as a locum tenens nurse practitioner is the most difficult one to obtain. I believe being open-minded to the location and type of facility will help facilitate this process.

The second challenging aspect involving the DEA is getting an agency to pay or reimburse you for it. In my experience, if you ask the agency flat-out if they will pay for your DEA, few will say yes and most will say no. Nonetheless, when it comes down to the negotiating process (remember the best time is after a phone interview when the site confirms that they like you), you can often receive a different response.

For instance, one of the agencies I was speaking with told me they would not cover my DEA, while others said they would. Upon choosing my first assignment, I was leaning towards going with the agency that would not pay for my DEA. Once I told them that my only hesitation was not having my DEA covered, while other agencies would, they quickly agreed to pay for it. Some agencies will provide you with a monthly stipend or sign on bonus that can be used to accommodate the expense instead.

If you prefer a site with an agency that will not pay for your DEA and will not budge, I recommend you go with the agency that will pay for your DEA. You shouldn’t have to pay $731 for a certification their site is requiring you to have. Therefore, I believe it is important that you are honest with your recruiter about your expectations, and to never settle for a NO. Remember you will not get anything that you do not ask for.

Some nurse practitioners prefer obtaining a new state license once they find a job in that state. Often, agencies will apply and pay for your license upon accepting an assignment. However, it is common that sites want someone to start as quickly as possible, so you are more appealing if you already have the license. In this case, you can apply for the state license on your own and expect to be reimbursed for it.

After working with an agency, they may offer to apply for a license for you proactively. This means if you are hoping to work in Wisconsin for your next assignment, they will go ahead and apply (and pay) for your Wisconsin license, as long as you sign an agreement to work with them once the license is obtained. This limits your potential job options since you are limited to working with that one agency, but may be ideal to some travelers.

I personally prefer to apply for licenses in states I see large needs and am interested in traveling to. Then upon choosing my assignment I inquire about license reimburse. Agencies are more likely to reimburse you for your license if you commit to 3 or more months with them.

Make sure to keep receipts of all license application fees if you expect to be reimbursed. Some agencies will reimburse you during your first paycheck. Others may spread it over 2-3 months to make sure you keep your end of the bargain (staying with that site for the requested timeline). Some agencies will say they do not reimburse for license fees, but can pay you $1-2 more hourly to balance out the overall expense. Other agencies may provide you with a monthly stipend instead of a set “license reimbursement”.

When searching for an assignment, be honest with your expectations. Tell your recruiter you are expecting your new license to be covered or reimbursed. Lastly, do not sign your contract until it explicitly states in your agreement how you will be reimbursed for the license. It should state that your license fees will be covered or that you will be given $100 per month worked etc. (whichever form of reimbursement you and the agency agreed upon). I highly recommend applying for licenses on your own before finding an assignment.

One of the most important aspects of being a traveling nurse practitioner is decent lodging. Occasionally it can be tougher than you think to find the right housing. Sometimes the ideal lodging does not fit in the budget. Other times the community is so rural that you are left without many options. And maybe you have pets that cannot be accommodated so easily.

I have stayed at hotels without a stove or oven which made it difficult to plan meals. This is common in rural areas where hotels with kitchenettes are at least 1 hour away. Unfortunately, I have stayed in extended stay hotels that smell like smoke and the lock on the door did not appear to be secure. This was due to the budget but I requested an alternative, and was accommodated within a few days.

I have traveled to an assignment and to the hotel I was provided with for lodging, just to learn that there was no reservation made. I called the emergency number I was provided with to get in contact with someone from the agency. When I placed my call that night at 11:00pm, I was told that no one could help me until normal business hours. I ended up booking that night at the hotel with my credit card. The following day I contacted my recruiter and they had someone call the hotel and change the booking information. My reservation was officially made and the first night I stayed there was charged to the company’s credit card instead of my own.

I know of others with housing disasters worse than mine. One locum tenens provider had his lodging switched 4 times over a course of 1 week. The first inn he was staying at apparently had meth dealers as the owners. The next hotel he stayed at was an hour drive to the site which the provider did not like. The third extended stay hotel was closer to the site, but also had several patients he recognized staying there too. The final fourth place was a cottage that the site he was working for found for him.

I know a locum tenens nurse practitioner that was provided with a private room in a family household. She was living with a random family during an assignment due to high costs of living in that area. I know of another nurse practitioner that was given a hotel for her and her dogs. However, the hotel called her when she was at work, telling her she could not leave the dogs alone in her room. Her agency did not help with the situation, but her site and coworkers found her a nice short-term lease apartment. I know another nurse practitioner that was provided a nice bungalow by her site in California. However, due to a fierce forest fire, the house was destroyed and she was temporarily placed in a trailer.

Locum tenens agencies sometimes allow nurse practitioners to search for their own housing, as long as it meets the budget. After providing your recommendations, they will book the lodging and provide a credit card for payment. Locum tenens agencies are also increasingly providing monthly housing stipends (similar to travel RNs), to give nurse practitioners more autonomy in selecting their lodging. Some agencies will house you in a hotel for the first few weeks, while they search for short-term apartments. They will allow you to check out the apartment options for you to make a final selection.

Lodging is such a significant part of being a traveling nurse practitioner. I think a lot of times we are confident that our agency will provide us with the ideal place to live. Yet, it is obvious that there are several barriers to great housing including: budget, location, family/pets, and natural/external factors. Before I accept an assignment and sign the contract, I always request some housing options to be sent to me. I would like to know before I accept an assignment if I will be commuting 1 hour for work every day or if my only other option is to live in a sketchy motel.

 

Travel	RN	ARNP
Housing	Given the option to take a housing stipend or a paid apartment	Typically an extended stay hotel
Car	Paid mileage	Provided rental car
Travel to site	Paid mileage	Paid flight or mileage
Length of Assignment	Minimum 13 weeks	Ranges from 1 day to 1 year
Licensing Fees	Paid or reimbursed	Paid or reimbursed
Licensing Process	1 RN license application	1 RN, 1 ARNP, and sometimes 1 prescriptive authority license application = 2-3 applications
DEA License	N/A	Some agencies will pay for it
Credentialing	Ranges from 1 week to 3 months	Ranges from 1 day to 3 months
Paycheck	Mostly W2	Mostly 1099 but some W2 options
Other	Often food expenses and sometimes phone expenses	Rarely sign on bonuses
Setting	Mostly hospital	Ranges from clinics, to urgent cares, to hospitals
Location	Sites have to be 50+ miles from home	Sites can be in home town

 

*Note: The above chart highlights the average details per subject. However, each subject can vary depending on the location and agency.

There are many obvious challenges while working as a locum tenens Nurse Practitioner. Some of these include: learning new electronic health record systems; always being on the move; living out of a suitcase; and having to constantly meet new people and patients.

Luckily, a lot of assignments will allow time for training to get accustomed to the new environment. This can vary from hours to weeks, depending on the length of the assignment. I know travel RN’s are often given the “cold shoulder” by their peers on the floor. Some say they know that the travel RN’s are getting paid more than them, so they should be able to figure out everything for themselves. On the other hand, in my experience as a locum tenens nurse practitioner, my co-workers have always been very friendly and supportive. They always offer to help or answer any questions I may have. They even check in routinely to make sure I am doing okay.

Most importantly, being in a new environment, we are unfamiliar with our community and patient population. For example, we may be unaware of what time the pharmacy closes or how much a medication costs there. We may not know that our pediatric population has a high influence of gang violence and drug abuse. Or we may not know that our patients are non-compliant because they cannot afford to pay for the gas necessary for them to drive to the pharmacy or clinic. We may not know that there is no orthopedic within a 3 hour distance and may have to become creative upon treating.

Depending on the geographic location we are used to, diseases may also be different. For instance, it is rare to see Rocky Mountain Fever in Florida or Dengue Fever in Oklahoma. Fortunately, we have support staff and our peers that we can ask or refer to for information. We can also begin to learn these variables throughout our time working in a new setting.

You will also have to learn the different scope of practices for nurse practitioners in each state. In some states you will have full authority, while in others you may need strict supervision. It is challenging keeping up with legislation, not to mention how challenging it is being okay with the limitations in some states and not others.

However, I think these minute challenges do not even compare to the limitless benefits of being a travel nurse practitioner.

Does anyone have any personal challenges during a locum tenens or travel assignment they would like to share?

 

When I think of locum tenens, I instantly think that it is an all expense trip to work as a Nurse Practitioner. While negotiating, choosing an assignment, and establishing a contract, it is normal to try to have every aspect covered. There are so many small details that you will not even think about until you start your assignment. I believe the reality is that working as a travel Nurse Practitioner often requires sacrifice.

Sometimes in rural locations, there may not be housing with a kitchen available. This means you have to be creative about your meals. This happened to me previously, but regardless, I am not much of a cook so it was not a deal breaker. On the bright side, extended stay hotels often have continental breakfast. This is nice because it is free and may help keep your budget intact. Extended stays also have maid services, which can be requested at your convenience, and saves you both stress and time.

Another sacrifice I have made before is paying for gas for travel to and from the airport to my site (which was over 2.5 hours each way). This is something I did not think about until I was doing the actual drive. I was making $10/hour more than I normally do, so I did not think a one-time cost of $50 was worth complaining about.

I know other travelers that have sacrificed while making a cross-country move. They paid out-of-pocket for some moving expenses because the mileage reimbursement did not cover their complete costs.

Some sites do not want to pay for license reimbursement because of the competitive market in their city or state. Locum tenen Nurse Practitioners need to contemplate if $300-$400 is a huge expense, when they are making more per hour than they typically would. Some sites prefer to pay a higher hourly rate instead of providing travel expenses and lodging. Usually you can ask for $15-20 more per hour to cover these costs. In this case, you can rent a house or an apartment from airbnb for low prices. I know travelers that do not mind this because they have more options and are used to paying over $1.5k per month for their rent.

Moreover, some travelers may wish to work in large cities in a specific state. Yet, there is usually more availability in smaller cities where there are greater needs. In this case, travelers often compromise by deciding to work in a smaller town that may be 1-2 hours driving distance from their preferred city.

Ideally it is nice to have all expenses covered AND to make a high hourly rate AND to have your preference of location and facility. Realistically, there may often be sacrifices if you are trying to work in a certain area or work during a certain time period. In the long run, you will truly make more as a locum tenens provider, than as a permanent employee, and will be enjoying your life way more as well! Please keep in mind that flexibility will always be the key to succeeding as a traveling Nurse Practitioner.

 

One of the most challenging aspects of being a traveling Nurse Practitioner is having to live out of a suitcase. Ironically, when traveling abroad I tend to pack light. In fact, I once “back-packed” through Costa Rica with some good friends from Florida State University! Yet, for some reason, whenever I travel in the USA I always seem to over pack. I think because being abroad, for the most part I will be wearing the same outfit the entire day. Compared to here, I typically need separate day and night outfits.

For my first assignment, I was pretty nervous about fitting everything I needed into one large suitcase. I downloaded an app called “Stylebook” on my iPad. This allowed me to gather all of my clothing and accessories into one app. Instead of having to go through my closet with tons of clothes, I could easily navigate my closet through this app. The first time using it is a bit tedious because you have to take pictures of all your clothes. It is definitely worth it though!

In Miami, Florida we only really have one season which is summer. The majority of my clothes are for warm temperature. Looking at the forecast in Washington, it seemed like some days were hot and other days cold. Therefore, I made sure to pack clothes for all types of weather. I ended up initially bringing 30 days worth of clothing and accessories. Between my large suitcase and my carry-on, my wrists were practically unusable by the time I made it to Washington. Both suitcases were as full as they could be, meaning they were also very heavy.

I did not think about it until I was lugging my carry-on throughout several airports and having to fit it into small overhead compartments. Then I had to carry both suitcases up and down stairs between the two different hotels I was staying in that first weekend. I knew I had done the rookie mistake, which was over pack! Of course my checked-in luggage was overweight by 4 lbs, but the kind airline attendant let it slip since I apparently was already emotional over leaving home.

I had to return home one month later for a bridal shower. I decided to leave essentials in my carry-on such as shampoo, conditioner, body wash, silver ware and dishware etc. (all of these I purchased when I arrived in Washington). I left my carry-on at the hotel since I would be returning after a few days. I left my laptop in my office at work. Somehow when I checked in, my luggage managed to weigh 60 lbs!

I hadn’t bought anything for myself while in Washington, but I suppose the bath and body items I purchased had taken too much space in the carry-on and I accommodated the original items in my large suitcase. At that point, I did not have many options because there was no way I was going to remove 10 lbs worth of items from my suitcase. The extra charge was going to be $100 for the overweight baggage. However, I noticed earlier that I had an option to upgrade to first class for $150 (first class baggage allowance is 70 lbs per luggage up to 2-3 pieces). Since my total time of flying was 8 hours, I chose to upgrade. It was definitely worth it, but I certainly learned my lesson about over packing.

What to pack (for a 1-3 month assignment):

• 2 weeks worth of  work clothing
• 2 weeks worth of undergarments (hotels usually have laundry service)
• 2 weekends worth of nice casual attire
• 1 set of pajamas
• 1 sweater or something you can layer
• 3-4 pairs of shoes at the most
• Electronics and cords
• Light jewelry
• 1-2 purses if you are a woman

The key thing to remember is to pack clothes you can easily layer for all types of weather. You can buy bath and body necessities and kitchenware once you arrive. Walmart sells light silverware and dishware for only $1 for a set. Hotels have TV and internet, towels and sheets, bar soap, iron, and hair dryer. So you won’t need to bring these.

On my return, I chose to bring a medium size suitcase instead. I brought back only half of the items I originally returned with. This time my suitcase only weighed 30 lbs –HALF of what it weighed last time. It was much easier to lug around as well. There is obviously more flexibility as far as packing, when you are driving your own car to the site.

Some tips I learned on the way:

• I am switching my laptop to a Mac book air. I never usually travel with my laptop but being gone from home for so long, I brought it with me to my assignment. It is pretty heavy to constantly carry around.
• My iPad air is a life saver- I can download movies to watch while I am on a long flight. Or I can watch Netflix while I am off on the weekends. I can also read books using the kindle app.