Accepting a Locum Tenens Nurse Practitioner Assignment

After your interview, your recruiter will want to speak with you about how the interview went. Then they will ask you “If this facility were to offer you a job, would you accept it?” This is an informal agreement to accepting the job. If you say yes, technically you do not HAVE to take the assignment, but it is expected that you will. Later that day or the following day, your recruiter will follow-up with you and will confirm the job offer. They will have to draw up the contract for you and the facility to sign.

Although salary was already discussed during your initial conversations with the recruiter, there is no better time to negotiate your salary than right before signing the contract. Perhaps you initially wanted $60/hour but then you realized that moving to California would increase your cost of living, so now you want $70/hour. This is a good time to ask for everything you need because you already know the facility likes and wants you, and that the agency will do anything necessary to have you work there.

In my personal case, I actually had two different offers from two separate agencies and facilities on the exact same day (1 hour apart). Both facilities seemed awesome and both locations were ideal for me. I decided to be honest with both of my recruiters to help me make a decision. One of my recruiters offered $10/hour more than I originally requested. When I informed the other recruiter, they agreed to match that offer. So now I was back to square one. Coming from Florida I didn’t have a DEA license. The application fee for this license is $700+…. Something I really didn’t want to pay for. The first agency had already offered to pay for my DEA. When the second agency matched my hourly rate, they were sure it was a done deal. However, I told them that the other agency was also paying for my DEA. After pulling a few more strings, my recruiter informed me that they will also be able to pay for my DEA.

Fortunately, I was able to negotiate my time in a way that I was able to confirm both assignments, in which I would do one before the other. Sometimes I just really hate saying no. The second agency was initially upset with me because I verbally confirmed I would accept the job if offered. Yet since no contract was submitted to me, I did have the right to back out. As soon as I confirmed the new benefits, they submitted a contract for me to sign.

I made sure that everything we discussed was listed in the contract. The contract clearly listed my hourly pay, my schedule to include 40 hours a week Monday – Friday, reimbursement for state licensing fees, DEA license cost coverage, travel costs (specifically flight, lodging, rental car), my start and end date, and my requested vacation days.

Looking back now there are some things that I should have requested but did not think of at the time. For example, my flight to the site was covered but my luggage was not. So I had to pay $25 per suitcase per flight. In addition, my site was about 2 hours from the airport, so the gas I used to drive 2 hours each way to/from the airport was not covered. It’s obviously a learning process and in the future I will make sure to negotiate these costs as well. I didn’t think it was the biggest deal since they did book me a day early in Seattle, which was much-needed after a long flight.

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Working in Washington State

My first week working with a community health center in Washington was amazing!  The facility had so many different departments including medical, dental, maternity, WIC, laboratory, imaging, and pharmacy. There are groups of people who are assigned different tasks to facilitate the medical process for both patients and providers. For example, there is a unit that works with referrals. So they establish appointments for patients with the specialty provider depending on their insurance and availability. In addition, after the appointment they follow-up to make sure the patient went to the consultation, and to obtain records from the visit. Then there is a unit that uploads all supplemental documents to the patients file on the electronic health record. They contact hospitals and other medical centers to obtain previous records, so when a patient comes in for a follow-up ER visit, you can know what was done in the ER.

Each provider has two medical assistants and one nurse assigned to them. The medical assistants bring the patients to the room, take their vital signs, and ask for the chief compliant. For well child exams, they do the hearing and vision tests as well. The nurse administers medications, does wound care, and will assess which vaccines are needed per visit and administer as necessary. This saves me time and energy from having to review which vaccines each child needs. Moreover, the medical assistants have established protocols in which they can do lab work if warranted. For instance, if a patient comes with a fever and sore throat, they can go ahead and perform the rapid strep test before I even see the patient. The same applies for urinary tract infections and possible pregnancies.

The facility is large and accommodates all of these departments. The best part would have to be all of my co-workers. They are all supportive, friendly, and encouraging. They always check in with me to see how I am doing. It is a good feeling to have a good relationship with other nurse practitioners, physicians, and physician assistants. Sometimes others in the medical field can be antagonizing, as I am sure many have experienced. It is a good feeling knowing I can ask any of them for help or a second opinion, as medicine is a constant learning process.

I feel spoiled with all of the support I have here because I can focus on my patient and their health. In places I have worked in Miami, I was often the sole provider. In addition, a lot of the assistive personnel were computer illiterate, so I had to input vital signs in the computer myself. A lot of them were not properly trained, so they could not help with assistive tasks such as notifying patients of their lab results. Nor did I ever have a nurse to administer medications, call in prescriptions for me, or provide patient teaching on insulin use. I was pretty much a jack of all trades. I definitely will not take for granted my experience with this community health center!

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They are always looking for locums and permanent providers. So if you are interested in working in Washington with a community health center, I would love to refer you to them!

I am a Traveling Nurse Practitioner!

I have wanted to go to Seattle since I was in high school. Maybe the fact that it was on the opposite side of the continental U.S. from Miami, is what appealed to me. I never had the chance to go, probably because the flights from Miami were just as long as going to Europe (non-direct flights).

I finally made my dream come true when I accepted my first traveling Nurse Practitioner job in Washington State. I had been looking forward to getting out of Miami, that I didn’t realize what I would be leaving behind until the day of my departure.
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As I was packing up my last items, it dawned upon me that I wouldn’t be seeing my family practically every day as I had grown accustomed to. I was leaving behind close friends, patients and staff I had known well, and my favorite spots around town. I couldn’t help myself from crying almost that entire day. I thought to myself that you do not know what you have until it’s gone. However, I knew this was my chance to pursue a career in traveling and I couldn’t give it up.

Luckily, upon arriving in Seattle I was instantly impressed by its scenery and diverse population. It was different from anywhere else I had been before. The tall “Christmas trees” were amazing and of course they reminded me of the movie Twilight. There were multiple waterfront sites, such as the ocean and various lakes. Coming from Florida, I love being close to the water.

Everyone was extremely friendly! Wherever I went people were talking to me and asking me questions. At first I was confused to why they were talking to me. I was in culture shock! I travel frequently and I was perfectly aware of how unfriendly people in Miami could be, but I had no idea to what capacity.

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My first stop was to the space needle. It was spectacular seeing it for the first time – something I used to see on a poster in my room during college. It didn’t appear to be as tall as I thought. The previous year my sister and I had visited the CNN tower in Toronto and that seemed to be much taller. I decided to wait to go up to the observatory until my family visited.

I then strolled around town and ended up at Pike’s Place Market. It was an incredible fresh market with the most beautiful flowers I have ever seen, for such a cheap price. They also had all kinds of meat, fish, grains, and fruits at your disposal.

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A short walk from there was the original Starbucks. There was a long line to get inside, so I settled for the café down the road. I love how Seattle has an abundance of cafe’s and bookstores!

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Interview: Travel Nurse Practitioner

Upon finding a travel Nurse Practitioner assignment that interests you, the next step is for the agency to submit your resume. After reviewing your resume, if interested, the site will request a phone interview with you. The turnaround time between reviewing your resume and setting up a phone interview can range from a few hours to one week. The agency will ask you to provide them with hours of availability for the interview. Depending on the agency, there may be an agency representative on the phone, or it may just be you and the site representative.

Do not stress the phone interviews! They are not going to ask you doses of medications or to diagnose a rare elusive disorder. Examples of questions they may ask are:

Tell me about yourself.

What is your experience working as a nurse practitioner or provider?

How many patients do you see per day?

What type of patients do you see?

Why are you interested in working with my facility?

 

Sometimes you may be asked some clinical questions. They just want to make sure you have an idea of what you are doing. They are not expecting you to be experts in every area. Some examples of clinical questions are:

Which preventative measures would you take with a Diabetic client, including labs, screenings, and assessment?

How would you handle patients that are requesting opioids for their chronic pain?

If a patient comes to the clinic with elevated blood pressure, how would you respond to this?

 

Then the remainder of the conversation will be them talking about their facility and their need. They will usually end the conversation by asking if you have any questions for them. I highly recommend you have a list of questions prepared for them or it will appear that you are not really interested.

Some questions I suggest you ask them are the following:

Does the facility use EHR, if so which one?

What type of patients are seen at the clinic? (Including demographics and illnesses)

Will there be other providers present?

What type of supportive staff would I have?

What are the hours of the facility?

 

Depending on the facility, they may request another interview. The second interview may be with their medical director or CEO. It is usually just a formality but definitely a good sign!

Why I became a Travel Nurse Practitioner

Working in Miami, FL as a family nurse practitioner was exciting at first. During the first year, it was a learning process and figuring out what worked best for me as a provider. I have always loved being challenged and trying new things. So after 3 years of working in the same primary care office, I was ready for a change. I knew I did not want to stay in Miami because I was interested in working with a different population. My patient population in Miami was majority Hispanic and elderly.

Sometimes we get comfortable working in the same environment. However, health care is constantly changing and I think the best thing we can do is work in different environments and with different patient populations, in order to gain a diverse set of experiences and skills.

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In addition, I was personally fed up with living in a large city; where there is constant traffic, rude people, and a high cost of living. I was aware that leaving my family and friends would be tough, but at least I knew I would only be gone temporarily. The great thing about locum tenens is that when your assignment ends, they always bring you back home (for free).

Another reason why I decided to become a travel nursing practitioner is because I have friends that live all over the USA. Since I graduated from Florida State University, most of my friends moved away for their jobs. I try to visit some of them each year, but they are all just so spread out. Thus, by doing travel work I am able to visit them all routinely, while I make an income.

I believe locum tenens work is actually easier to jump into opposed to travel nursing as an RN. The reason for this is because everything we need is in our brain. Compared to RN’s that have to learn an entire new floor and where they keep items.

Nonetheless, I am glad I decided to become a travel nurse practitioner. One of my mentors told me it may be difficult at first, but it will only make me stronger. And she was right!

The Search Process

Depending on your flexibility, the search process can take several weeks to months. If you are open to going anywhere then that increases your chance of finding an assignment quickly. Often medical facilities want you to begin ASAP, so if you do not hold a license in the state they are located, they are unwilling to wait. Therefore, your first locum tenens assignment is commonly the toughest one to find.

Since the agency has not worked with you previously, they do not know how serious you are about starting a travel nurse practitioner position. Unfortunately, finding the first assignment requires you to be an advocate for yourself. If you need assistance during the search process, feel free to contact me ,as I can help vouch for you with my recruiters.

My favorite locum tenens agencies were the ones that my recruiters were following up with me frequently. Even if they didn’t have something that matched my interest, I knew they were looking out for me.

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For my first travel nurse practitioner assignment, I initially wanted to go to the New England area. Some challenges I faced were the sites unwillingness to wait for me to obtain a license because they needed someone to start right away. When I did find places that were willing to wait for me to get a license, they wanted a long commitment that extended into winter. Coming from south Florida, I knew winters in New England would be too difficult for me. After 1-2 months without any luck, I decided to change my location interest.

I was interested in the pacific coast, although I knew California licenses can take several months to obtain. After discussing this with my recruiters, they informed me that there were a lot of opportunities in Washington State and Oregon. I had always wanted to go to Seattle but never had the chance, so I figured it would be the perfect time.

One week after agreeing to purse availabilities in the pacific west, I had an ideal offer. A site in Washington State was willing to wait for me to be licensed and were flexible in the length of my assignment. Most importantly, I was able to escape the cold winter.

 

 

Responses from my Recruiters

In my last post I suggested some questions for every new locum tenens Nurse Practitioner to ask their recruiter. In this post, I will share some responses I received from my recruiters based on those questions.

  • What type of lodging would I be provided with?
    As I mentioned in my last post, most agencies said they normally set up an extended stay hotel for their providers during assignments. They gave examples such as Holiday Inns, Best Westerns, or bed and breakfasts. I did have one agency ask me if I would be okay staying in a motel 8, in which I kindly declined. I was offered an assignment with an Indian Health Services facility, in which they would arrange a house for me to live in.
  • How will I get to my assignment?
    My recruiters stated that locum providers usually fly to their site and are provided with a rental car. This is different in comparison to RN travel because the majority of them drive their own car to the site. If they were to fly, they would not have a rental car paid for. They are usually reimbursed in the form of mileage, in comparison to nurse practitioners that have their travel paid for upfront. When I was interested in going to D.C. for one of my assignments, I asked if I could possibly bring my car with me via the Auto Train that runs from Florida to Virginia. They actually agreed to do it since it was the cheapest option (only cost $250). They are consistently opposed to shipping your car. However, if you manage to convince them that you will drive your car, you can use the mileage reimbursement to cover the shipping costs.
  • What is the pay rate for family nurse practitioners?
    Each time I asked this, they tried to ask me what I was expecting to make hourly. I deferred the question back to them asking for a range. Some agencies told me family nurse practitioners can make $40-50/h, which I thought was very low, especially for locum tenens work. My hourly rate back home was $60/h and I was comfortable making the same rate or more. So when I told these agencies my minimum was $60/h, they thought I was crazy. Meanwhile, other agencies told me family nurse practitioners can make anywhere form $60 to $90/h depending on the site, location, and experience. The rate depends on your experience, location of the site, and the agency.
  • How does the licensing process work?
    Coming from Florida, one of my main concerns was obtaining a DEA license. Florida doesn’t allow nurse practitioners to obtain one (boo I know), so I have never had one before doing locum tenens work. When looking up the cost of applying for a DEA, I noticed it was $700+. That’s a good sum of money I did not want to be responsible for. So when speaking with my recruiters, I inquired if they would cover the cost of a DEA. Many agencies said absolutely, while others said they could not. I am grateful that when the time came, my agency applied and paid for my DEA license.

Questions for your Recruiter

Your recruiter will be your main contact person of the agency of your choosing. It is very important that you establish a good relationship with him or her. If you always have to call them and never receive a response, feel free to ask for a different recruiter.

Besides providing them with your location preference and start date, you should have a list of questions to ask them.

  • What type of lodging would I be provided with?
    For short-term assignments (less than 6 months), locum tenens providers are typically placed in extended stay hotels. Some sites may provide their own form of housing such as company owned houses or apartments. Unfortunately, some agencies will try to make the most out of the budget and place you in motels. I highly suggest avoiding these agencies or negotiating for better lodging. For long-term assignments (more than 6 months), apartments or condo’s are possible because of the longer commitment.
  • How will I get to my assignment?
    Agencies tend to prefer that you fly to your site and they will provide you with a rental car. If the site is not too far from your current location, they will allow you to drive and take your own car. You can negotiate what your preference is when the time comes. If you drive your own car they reimburse you 56 cents per mile. So driving from Miami to Los Angeles would be 2750 miles, and I would be reimbursed $1540 each way. Some people prefer to drive if they have pets, a significant other, or plenty of items to bring.
  • What is the pay rate for family nurse practitioners? (or your respected specialty)
    Most often your recruiter will deflect this question to you, trying to find out what is your minimum hourly rate. Try to ask them for an expected range of payment so they do not low ball you. For example, let’s say they asked you what your minimum hourly rate is, and you said $50/h. If you had asked for a typical hourly range, they may have said $45-60. Yet, now they know you will easily accept anything paying $50/h and they will not offer you more. Keep in mind that the agency needs a profit for themselves.
  • How does the licensing process work?
    By asking this question you first get a response about them being able to cover your new license cost or not. I know it is expected that they will, but there are cases where they will not cover the cost. Also, you want to find out if you are expected to pay for the costs and will be reimbursed in the future, or if they will pay upfront for the licensing fees. Sometimes you have the option to choose. If you pay the costs of the license yourself, the agency will commonly reimburse you after 30 days of working with them. If the agency pays for the licensing fees up front, they will occasionally have you sign an agreement preventing you from using that license with any other agency for up to 1 year.

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Searching for an Assignment

After deciding to become a travel Nurse Practitioner, the next step is finding the right assignment.

Below are some things you should do before searching:

-Updating your resume
-Gathering all of your supporting documents (CEU’s, CPR/BLS, Licenses, Certifications, Vaccination/Titer record, PPD/CXR record, Graduate/Undergraduate Diplomas, Driver’s License etc.)
Note: It may be best to have all of these scanned and uploaded to your computer so you can easily submit them to agencies when requested.
-Decide what location, setting, and time frame you are interested in traveling

Next, you should contact several locum tenens agencies and ask to speak to a recruiter for nurse practitioners.

Check out my Agencies tab on the home page for some of my favorite agencies. You can also email me for direct referrals to my recruiters. Please mention my name (Sophia Khawly) when getting in contact with agencies to help support this blog.

I suggest getting into contact with at least 5 different agencies. The application and paperwork may seem redundant, but the more agencies you are connected to, the more likely you will be matched with your dream assignment.

I recommend reading through their websites to get a feel of how they work. For instance, some of them may pay you via W2 in which they take out taxes and provide benefits such as health insurance. On the other hand, some may pay you as a sole proprietor via 1099, in which they do not take out taxes but you can deduct self-employment expenses at the end of the year. Different methods of pay may benefit different types of people, so discover what works best for you.

Most of the agencies keep an updated list of current job openings on their website. Look at this page to determine if they have availability in the state of your choice. The most recent the date, the better; as many job openings are quickly filled and no longer available. After providing a recruiter with your preferences, they will follow up with you on any openings. Yet, I strongly encourage you to look on their website every couple of days to see if there are any job availabilities that interest you. Recruiters are very busy and appreciate you being active in the search process.