My Worst Nightmare

After my assignment ended in Colorado, the following day I was driving to the airport to finally go home. While driving on the highway, it started to snow. It was the first snow of the season so it was very wet. The speed limit on the highway was 75 mph but since I was nervous about driving in snow I slowed down to 55 mph.

Suddenly, ahead of me, multiple cars had come to an abrupt stop. So, as I tried to hit the brakes, the car spun out of control on the snow/ice and I ended up in a ditch on the side of the road. Fortunately, there were no major trees nearby so I didn’t hit anything. I was completely fine, no injuries. I was also lucky that there were no cars or semi-trucks behind me when my car spun out of control. That would have been another story.

I was stuck in the ditch because it was too steep and icy for my car to drive up on. I called the car rental company for road side assistance and they sent a tow truck to help me. While waiting for the tow truck, a firetruck stopped nearby. Many other cars ended up in a similar situation in that same area near me. The firemen were checking to make sure there were no major injuries.

They said it was dangerous for me to remain in my car on the side of the road so they brought me to a nearby truck stop. They told the people that worked there what happened and everyone was really nice. The employees offered me coffee and asked if I needed anything. An elderly couple asked if I needed a ride anywhere. I was very touched.

Fortunately, the tow truck had been close by and were able to pull out my car from the ditch rather quickly. The car was still drivable – there had only be some damage to the front bumper. It was an hour later and I was still 30 minutes from the airport so I had missed my flight. But I was glad I was still able to drive the rental to the airport.

I think I was in shock during that first hour. Because as soon as I got back in the car and started driving to the airport, I started crying. And I cried for hours. During the few seconds the car spun out of control and I ended up in a ditch – I thought to myself “oh no, if I end up in the hospital my family will have no idea what happened to me”. By Gods good grace, nothing happened to me but I was still affected by all of the adrenaline and finally crashed.

I was a bit mad at myself for extending my assignment because this is exactly why I never want to live in snow. I am not accustomed to it nor do I want to be. And I had felt “trapped” when I was stuck in the ditch in snow, freezing, not sure how long I would be down there.

I am soo grateful it was not for long. And of course, that I walked out of there unscathed. I am also grateful for the rental company (National) for helping me promptly. I am grateful that my agency paid for car insurance so I didn’t have to pay for the car to be repaired nor for the tow truck.

Not to be dramatic but I have a little PTSD from the accident. I can drive perfectly fine. But anytime I am mildly cold even indoors, it brings me back to the accident. This was my worst nightmare but I am glad everything turned out well. I will definitely continue to avoid working in cold places and I won’t be persuaded to extend.

Is Pay Everything?

When searching for a locums assignment, there are various factors that can influence which job you choose to accept. Certainly, pay is very important and one of the main reasons nurse practitioners leave their permanent jobs to become a traveler. But is pay everything? Working as a locums nurse practitioner for the past 8 years, I have learned that depending on your season, is what you choose to prioritize.

Sometimes I choose to prioritize location. For example, last summer I chose to prioritize working in a new location that would be fun. This ended up being in Colorado. Although the pay wasn’t as high as I would like, I sacrificed the pay to be somewhere I wanted. I have done this several times by prioritizing to work in Florida or close to home.

Sometimes I choose to prioritize pay. This may be after taking a sabbatical or when wanting to quickly save up for something in particular, such as a down payment for a house. In this case, I am open to working in the locations that tend to pay more. These locations tend to be Northern California, Washington, New York, Maine, and Arizona.

Sometimes I choose to prioritize mental health. If I am feeling burn out but not ready to take a break, I will decide to select an assignment with a low patient volume. Typically, with a low patient volume, the pay will be lower. Versus if I am not burned out but looking for higher pay, I may be willing to seeing a higher patient volume.

Sometimes I choose to prioritize experience. For example, one time I had the opportunity to work in an employee health clinic for American Airlines. The pay was decent but I had other assignment options that would pay more. I ended up choosing to work with American Airlines because it would be a new experience and my first time working in employee health. I was curious to see what it would be like and build my skills working in a different setting.  

I decided to write this post because I get emails on a regular basis saying one of my readers found the perfect assignment except the pay isn’t as great as they would like. I always encourage negotiating, but I think you should choose the assignment based on your “season” at that time, and not always based on pay.

I am glad to see that the hourly rate and salary for nurse practitioners has increased significantly over the past 10 years. When I started working as a nurse practitioner in Florida 13 years ago, the average NP salary was closer to $90,000/year. Now, I know many nurse practitioners in Florida (with only a few years of experience) making $125,000/year.

The same goes for working as a locums nurse practitioner. When I started locums, the average hourly rate for a primary care nurse practitioner ranged from $55 to $70 per hour. Nowadays, I never see agencies offering that $55-65/hour range. These days, the average hourly rate for a locums primary care nurse practitioner ranges from $75 to $100 per hour. Of course, this varies by the state and practice setting. As stated above, Northern CA and NYC will pay closer to the $100/hour, whereas Southern states will pay closer to the $75/hour. Urgent care and ER settings will pay more than a primary care outpatient clinic.

Would love to hear your perspectives, feel free to comment below!

Extending in Colorado

So midway through my assignment in Colorado I was asked if I wanted to extend. This extension would be from October to December. I said no right away because I avoid places that snow (coming from Florida). They said they were open to me extending for as little as I wanted, even if it was just a few extra weeks. I asked around to see if it snows in October, and they said it may snow very lightly but usually melts right away. This is do-able for me so I decided to extend for an extra month.

My agency offered me an extra $5/hour for my extension. For one month, it’s just an extra $800, but I can’t complain. I like this assignment a lot so I didn’t mind extending for free. Especially because it would give me the opportunity to take November and December off like I like to do for the holidays.

Since school started, it has gotten a bit slower. I am only seeing about 8-10 patients per day now. I am enjoying fall, seeing the leaves change color. It’s cold in the morning and at night but pretty hot in the day time. No regrets.

Living in an Extended Stay Hotel

I have been living in a Holiday Inn Express during my Colorado assignment. The apartment provided by the site wasn’t available because they had another locums in it that kept extending his stay. I had a friend visiting from Florida one weekend, and I wanted to stay in Denver that weekend.

In the past, while staying at a hotel, I have the agency book me a different hotel (similar in cost) in a different town for the weekend, when wanting to explore. Pretty much, I would check out of my current hotel for the weekend and check in to another hotel in a different town. It usually isn’t a big deal since the agency/site are paying for a hotel anyways.

When I asked my agency if they could book me a hotel in Denver for the weekend, they said no because they have to send the hotel receipt to the site and they wouldn’t approve it if it’s in another city. I told them that was strange because I have done this before with another agency. They confirmed that it could not be done. I told them since I wasn’t able to move into the apartment like I was supposed to, could they at least do it as a courtesy.

The agency ended up agreeing to pay for one hotel night in Denver for that weekend. It worked out because I didn’t need to check out of my current hotel and could leave my things there.

After staying at the Holiday Inn for 6 weeks, I checked out for 1 week since I was going on vacation. When the hotel points hit my account I was surprised. I made 230k points in those 6 weeks alone! I already have plans to use these points for a trip in Asia next year. In Asia, I can easily book a hotel in that brand (such as the Intercontinental) for 10-20k points per night. So 230k points would give me at least 2 weeks worth of hotel nights abroad.

Living in a hotel without a full kitchen hasn’t been as bad as I thought. I can still cook up some meals on my hot plate and I am a queen of left overs. Earning a ridiculous amount of hotel points has been a bonus, and I am looking forward to earning more points during my stay. 

Top 6 Things to do Near Denver, CO

Colorado is an amazing state with all kinds of landscaping and scenery. Denver is a great city to work in because you have access to many outdoors activities within a 1 to 2-hour drive. These are my top 6 activities I enjoyed doing while working outside of Denver, Colorado, that I highly recommend!

  1. Garden of the Gods – This free park is located in Colorado Springs with 300 foot sandstone rock formations. There are multiple walking trails, wildlife, and even rock-climbing opportunities. Be sure to go in the morning so you can find parking. It is free to enter, but if you are interested in a tour you will have to pay and make reservations.

2. Red Rocks Park and Amphitheatre – Located in Denver, the naturally made amphitheater is a popular site for concerts and other events such as yoga. The red rocks park has 868 acres of geological marvels and wild life. There are opportunities for hiking and biking.

3. Rocky Mountain National Park – This national park is 1.5 hours north of Denver. It costs $30 per vehicle to enter, and during peak times such as the summer months, a reservation time permit is required. The mountain ranges are enormous and never ending. Plan to spend at least half a day at this park because it takes 3-5 hours just to drive through all the windy roads. There are some hiking trails but it can get difficult to breathe once you reach the summit. We saw some elk while we were there which was awesome. I recommend going at 6am because it is less crowded and you do not have to wait in line at the viewing points. I also recommend staying in Estes Park, CO before or after to make the drive more comfortable.

4. Glenwood Springs – This cute town is about a 2 hour drive west of Denver. They have a large natural hot springs pool that is enjoyable during colder months. The entry fee is a bit steep at $47 per adult, but is definitely worth it. You also have beautiful views of the mountains.

5. Day trip to Colorado Springs – Colorado Springs is a 1 hour drive south of Denver. I actually like it better than Denver because it has a gorgeous back drop of mountains and even red canyons randomly in the city. There is an opportunity to go on a hot air balloon there, and they have other tourist sites such as Caves of the Wind and Manitou Dwellings. Caves of the Wind is an underground cavern and Manitou Dwellings are Native American homes built into canyons. Check out Red Rock Canyon for more hiking.

6. Day trip to Boulder, CO – Boulder is about a 30 min drive north of Denver. Pearl Street area is a popular destination there. It’s an artsy area with shops and plenty of interesting dining options

Working in Colorado

I am working between two clinics. One of them is 1 minute from my hotel, and the other one is 15 minutes which is great. The clinic that is further out has a cafeteria which gives free lunch to providers. They have an amazing salad bar and the food is pretty good.

The town ended up being more rural than I thought. I have worked rural health before, but there is a helicopter at the clinic and a tiny hospital here with just a few beds. They consider themselves to be frontier rural since there isn’t a major hospital within 1 hour from here. A lot of the patients are ranchers and farmers.

On my first day, I was a bit nervous because I wasn’t sure if the patient population would be of higher acuity than I am used to. The physician that was orienting me mentioned they do a lot of casting and suturing, which is more like an urgent care. She also said I would be seeing things there that I have never seen before in my life.

My experience is more primary care and that is my comfort level. But they told me there will always be another provider with me at the clinic so if I don’t feel comfortable doing a procedure, I can just let them know.  The scheduling department asked me what procedures or types of patients I am not comfortable with so they can avoid putting them on my schedule.

They had me on a ramp up schedule seeing 1 patient per hour my first week, which was nice. It allowed me to figure out how the clinic is run. My orientation was only a couple of hours of introduction to the EHR. The patients are scheduled at 30-minute intervals. If they are a hospital follow up or an adult physical, they are scheduled at 60-minute intervals. That’s one thing I like about working in rural health, you get plenty of time with the patients. I am seeing about 14-18 patients per day. Even on a day when my schedule is full, I don’t feel overwhelmed.

The majority of the patients I see are with acute cold symptoms, workers compensation, sports physicals, well child checks, hospital follow ups, and other acute complaints like UTIs or back pain. They keep established patients following up for their routine visits with their PCP. I am enjoying having pediatric patients again.

Everyone here is really nice. The staff is friendly and helpful. The patients are very appreciative and are not the typical antibiotic or opioid seekers you may find in other areas. I have been seeing a lot of pediatric patients which I am happy about, since I needed that experience. Not to mention the kids have been super cute and easy patients. They are definitely less complex than the geriatric population I am used to seeing.

There are a few cons working here. One con is sometimes they accept patients that should really just go to the ER. I don’t think anyone is triaging these calls. For instance, I had a 6-week old baby with new onset seizures on my schedule (in the acute visit slot). I had to tell them to call the mom and bring the baby to the ER, as there isn’t much I could do for them in the clinic.

I also don’t like that the last patient is scheduled at 4:30pm, and we finish at 5pm. So, if the patient shows up a bit late, by the time they are roomed, it’s 4:45pm. I wish they gave the last 30 min as admin time to catch up on notes.

All in all, it’s been a great assignment so far and I am really enjoying my time here!