Two things decide whether an urgent care locum shift is a good one for a nurse practitioner: what it pays, and what you're allowed to do when you get there. The first is set by the clinic. The second is set by the state the clinic is in.
This post covers what makes locum NP pay differ from shift to shift, how to check a state's scope of practice rules yourself, and what to ask the clinic before you accept.
What sets the rate on a locum NP shift
The clinic that posts a shift sets the rate. It picks a number it expects will fill that shift, so the rate reflects how hard the clinic thinks the shift is to cover. Two NP shifts in the same city can pay differently for reasons that have nothing to do with you.
These are the parts of a shift that change the rate, or change what the rate is worth:
- Day and time. Ask whether evenings, weekends and holidays pay differently from weekday shifts.
- Notice. A shift posted for tomorrow and a shift posted for next month are different problems for the clinic.
- Coverage. Being the only provider on site is a different job from working beside a second provider.
- Volume. The expected number of visits tells you how hard the hours will be.
- Services. A shift that includes occupational health visits or a wider age range asks more of you than a shift that doesn't.
- Location. A clinic far from where NPs live has fewer people to draw on.
On Rediworks, the rate shown on a listing is the most the clinic will pay for that shift. You name your own rate when you apply.
What changes the value of a locum NP rate
Two shifts with the same hourly rate can pay different amounts. Check these before you compare them.
Which hours are paid. If the clinic closes at 8 and you chart until 9, find out whether that hour is paid. A 10-hour shift with an unpaid eleventh hour pays less per hour than the listing says.
Cancellation terms. Ask how much notice the clinic gives when it cancels or shortens a shift, and what it pays if it gives less.
How the work is classified. Whether you're paid as an employee or as an independent contractor changes your taxes and who funds your benefits. Ask before you compare the rate with a salary. Our post on why urgent care NPs and PAs choose locum work has the steps for comparing an hourly rate with a full-time role, and it covers licensing in more than one state.
Malpractice coverage. Ask who carries the policy for the shift and whether anything is deducted from your pay for it. Our post on malpractice coverage gaps in locum work lists the questions to ask about a policy.
Travel. A higher rate an hour's drive away can pay less per hour of your day than a lower rate nearby.
How state scope of practice rules affect locum NPs
Scope of practice for NPs is set by state law. The rules that apply to a shift are the rules of the state where the clinic is, not the state where you first got your license. You also need that state's NP license before you can work there.
AANP sorts state NP practice laws into three groups: full practice, reduced practice and restricted practice. In a full practice state, the law lets an NP evaluate, diagnose, treat and prescribe under the licensing authority of the state board of nursing. In a reduced practice state, the law requires a collaborative agreement with another provider or limits at least one part of NP practice. In a restricted practice state, the law requires supervision, delegation or team management by another provider.
For a locum NP, the group a state falls in decides what has to be in place before your first shift. Where the law requires a collaborative or supervisory arrangement, the clinic needs a physician for that arrangement, and the paperwork has to be done on the state's terms. A clinic can only offer you the shift once that's true.
State laws change. Don't rely on what a colleague told you or on what the rules were the last time you worked there.
How to check a state's NP scope of practice rules
The state board that licenses NPs is the source. In most states that's the board of nursing, and NCSBN keeps a directory of every state board of nursing with a link to each one.
On the board's site, look for the nurse practice act and the board's rules for advanced practice nurses. Find the answers to these questions:
- Does the state require a collaborative or supervisory agreement with a physician?
- Does the agreement have to be filed with the board or approved before you start?
- What are the rules for prescribing, and are controlled substances handled separately?
- Does the state require a period of supervised practice before an NP can practice without an agreement, and does your experience count toward it?
- Does the board limit how many NPs one physician can collaborate with or supervise?
If the board's rules don't answer your question, contact the board. For a question about your own agreement or contract, ask an attorney who works with clinicians in that state. This post describes how the rules generally work and isn't legal advice.
What to ask the urgent care clinic before a locum NP shift
The clinic knows how it meets the state's rules for the NPs on its permanent staff. Ask how it meets them for a locum NP.
- Who is the collaborating or supervising physician, if the state requires one?
- Is the agreement signed and filed before the first shift, and who files it?
- How do you reach that physician during the shift?
- Will you be the only provider on site?
- Which ages does the clinic see, and which services are part of the shift?
- Who else is on the shift: medical assistants, an RN, a radiology tech?
If the clinic can't tell you who the physician is or whether the agreement is in place, wait until it can. Practicing without a required agreement is a risk to your license, not only to the clinic.
Get the answers in writing with the shift details. Questions to ask before signing a locum contract covers the rest of the terms.
Where to start as a locum NP
The simplest first locum shift is in the state where you already hold your NP license and already know the scope of practice rules. Add a second state when there are enough urgent care shifts there to justify the license fee and the wait.
Rediworks is a self-service marketplace for urgent care shifts. Every listing shows the rate, location, shift length and facility before you apply. Sign up to see shifts.