Traveling NP

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.

Some nurse practitioners I speak with think that finding a locum tenens position is a quick and easy process. They believe you can contact one agency and find the ideal position in a matter of a few days. This is definitely not the case. I believe it is important that every potential locum tenens nurse practitioner knows that he or she should develop a relationship with more than one agency.

Choosing an agency to work with starts off by determining your preference of compensation and benefits. If you are looking for a high hourly salary, then 1099 paying agencies are a good match. If you are more interested in having health insurance for your family, retirement benefits, and/or taxes easily removed from your paycheck, then W2 paying agencies should be your first choice.

Please see my Agencies page for a list of the most common national placing locum tenens agencies. Take the time to review their websites and analyze which agencies are paying W2 vs 1099. After determining which agencies compensation matches with your interests, establish a relationship with a recruiter from that agency. I highly recommended contacting at least 5 or 6 agencies.

If you think that your recruiter is always going to be searching for you and contact you if anything new comes up, you are wrong. Unfortunately, the first assignment is tricky because you have not technically “proven yourself”. Therefore, you must constantly follow-up with your recruiter to see if there is anything new out there.

It is okay to email your recruiter, but for a quick response time, I recommend calling your recruiter. It’s common that you may email your recruiters and they may not respond. For some reason, unbeknownst to me, recruiters are not that responsive via email. It may have to do with them being a ‘salesperson’, and believing in verbal conversation being more effective.

After the first couple of days or conversations, you will soon realize which recruiter and agency you like most. Your favorite recruiter may be very friendly, always keeping you in the loop, or looking out for your best interest.

If you have a recruiter that never returns your phone calls or emails, or discourages you from jobs telling you that you lack the experience, consider changing recruiters. One recruiter does not represent the entire agency, and I would hate for you to lose out on great opportunities because of a poor relationship with your recruiter.

As far as choosing an agency, it’s not as easy as choosing a meal. It is more similar to choosing the right car. You need to do some research, test drive the car, follow-up with the salesperson, and determine if it’s right for you.

Your preference of an agency should also be directly linked to job availability. If you have any questions as far as highly recommended agencies, feel free to email me at travelingnp.com@gmail.com or comment on this post.

After accepting your assignment, there a few things you need to do to prepare for it.

-Complete licensing application and supporting materials if needed. For more information see: Licensing as a Travel Nurse Practitioner

-Apply for credentialing. Most sites will need you to be credentialed prior to starting. They will have you complete paperwork to make sure they have all your necessary information for legal and billing purposes. The paperwork can be tedious, but luckily agencies usually have someone who will complete the paperwork for you. You will just need to review the information and sign a consent form allowing them to be your proxy.

-Some sites may have you do a drug test before you start.

-Confirm travel arrangements. Typically once credentialing is complete, your recruiter/account manager will have the travel team contact you to book your flight (if you are flying). Some agencies will have two separate people working on your travel/car rental and lodging. If you have a rewards number, you can provide it to them at this time, so they can include it in your reservation.

-Confirm lodging arrangements. Unfortunately, lodging can often be arranged last-minute. It’s not unlikely that you may not know your lodging until the day before arrival or upon arrival. Before your assignment, they will ask for any special requests such as kitchenette, accommodating pets, close to work facility etc.

-Packing: please see post on packing

There are two ways to go about obtaining a license. Some people prefer to wait until they have an assignment before applying for the state license. In this case, most agencies have a licensing team that will assist you in the process. You will most likely have to complete a standard form with your personal information, and they will use that data to complete the license applications for you.

Others will apply for a license in a state they are committed to working in, even before having an actual assignment. In this instance, they are more likely to apply on their own. Sometimes agencies will allow you to apply for a license proactively (before confirming an assignment), and in this case they will assist with the application.

It’s great when a state’s application is online and everything can be done electronically. For example, my application with Texas was all electronic and therefore the process was quick. On the other hand, some states only have paper applications in which you have to submit via mail. My application for the Washington state license took a little longer than expected due to this process. Apparently it can take about 2 weeks for mail to be received from the east coast to the west coast.

In each state you will need two licenses: RN and ARNP. Some states may even require an additional application for prescriptive authority. Typically this is just an extra fee or additional pharmacological CEUs. Some states will allow you to submit both the RN and ARNP application at the same time, while other states will only allow you to submit the ARNP application once you have been issued a temporary or permanent RN license.

• For the RN license, you will need to submit the following (depending on the state):
  -Application and fee
  -Nursys verification (tells the new state that you have a license through examination/schooling from your current state)
  -Fingerprints/Background check and fee
  -RN transcripts (depending on the state)

• For the ARNP license, you will need to submit the following (depending on the state):
  -Application and fee
  -Verification of education form (depending on state)
  -Graduate school transcripts
  -Certification verification by ANCC/AANP
  -Additional prescriptive fee or CEUs (depending on state)

The point is to notice that there are a lot of requirements and it can easily be overwhelming. I find it best to just read the application thoroughly and contact the board of nursing if I need to clarify anything. I keep a checklist for each state that I am applying to, to make sure I have everything covered. Keep in mind that you only need one set of fingerprints/background check per RN & ARNP applications.

Some states request miscellaneous things. For example: California requests passport photos for both applications; Washington requires a proof of current employment as an ARNP (can be a note from your employer or a pay stub), Texas requires you to take and pass a nursing jurisprudence exam etc.

• Benefits of applying for licenses on your own:
  -You are not restricted to a specific agency (but can be reimbursed after selecting agency/assignment)
  -Work is less redundant – you are not filling in a separate form for the agency, nor answering questions about your application for the agency representative
  -Even if the agency applied for you, you would still have to do a lot of the leg work yourself (fingerprints, requesting transcripts etc.)

• Benefits of applying for licenses through your agency:
  -Quick turnover (they overnight all mail)
  -There is someone checking up on the status of your application almost daily
  -Less stress for you if you are not organized
  -No upfront costs

Make sure to keep receipts of everything if you expect to be reimbursed. For applications sent via mail, I usually ask them to email me a receipt. Initially applying for a license appears to be a lot of work, but then you realize it’s nothing you haven’t done before.