Locum Tenens for Nurse Practitioners (APNs) and Physician Assistants (PAs): How to Start, What to Expect, and How to Succeed
/Locum tenens—temporary clinical work that fills staffing gaps—has traditionally been associated with physicians, but it has rapidly become a meaningful and often lucrative option for advanced practice nurses (APNs/NPs) and physician assistants (PAs) as well. Whether you’re burned out from a permanent role, looking to increase income, relocating, or simply craving more schedule control, locums can be a powerful way to practice on your terms—if you start with the right foundation.
This guide walks through the first steps, the details that matter, and the real-world workflow of becoming a locum tenens advanced practitioner. Then you’ll find a FAQ addressing the common questions NPs and PAs ask before starting.
Quick note on terminology: “APN” can mean Advanced Practice Nurse (often used interchangeably with NP). “Advanced practitioner” here refers to NPs/APNs and PAs.
Part 1: First Steps Into Locum Tenens for APNs and PAs
Why locum tenens is different for advanced practitioners (and why that matters)
Locums for NPs/PAs isn’t just “physician locums but cheaper.” The most important difference is scope-of-practice and supervision structure. For advanced practitioners, locums success hinges on:
State laws (full practice authority vs collaborative/supervisory requirements)
Facility bylaws and credentialing rules (what they allow you to do)
Billing and privileging policies (what you can independently bill/perform)
Clinical support structure (is there a physician physically present? on call? accessible?)
Role clarity (inpatient rounding? first assist? clinic only? procedures? admissions?)
If you treat locums like generic “extra shifts,” you can walk into a situation where expectations exceed your legal scope, or where you’re set up to fail because staffing and oversight are weak.
Locums done right: you gain flexibility, better compensation, and a clearer start/stop point.
Locums done wrong: you get dumped into a high-risk environment with unclear coverage expectations.
Who locum tenens works best for (and who should be cautious)
Strong candidates for locums
Locums can be an excellent fit if you:
Want schedule control and predictable time off
Want to increase income without taking on permanent administrative roles
Are adaptable and confident learning new workflows
Have a solid baseline of clinical competence and decision-making in your specialty
Want to sample different practice settings (like a “working interview”)
Consider caution if you:
Are brand new (0–12 months) in practice with minimal supervision experience
Have a specialty that depends on a very specific supervising physician relationship
Struggle with change, new EHRs, and “figure it out” environments
Need benefits stability and can’t tolerate income gaps
None of these are disqualifiers—just factors to plan for. Many early-career NPs/PAs do locums successfully, but they should start with low-chaos assignments and high support.
Step 1: Decide your “Locums Profile” — the 7 decisions that control everything
Before you talk to recruiters, get clarity on seven items. This prevents you from being pitched jobs that don’t fit.
1) Specialty and comfort zone
Be specific. “Urgent care” is not the same as “rural solo urgent care with no CT.” “Hospital medicine” is not the same as “night cross-cover with 1 attending covering 60 beds.”
Write your “yes list”:
What patient populations you’re comfortable with
What acuity you can manage
What procedures you can do confidently
What you won’t do (hard boundaries)
2) Ideal schedule structure
Blocks (7-on/7-off, 14-on/14-off)
Weekdays only
Nights vs days
Call: yes/no, max frequency
3) Geographic constraints
Local only vs travel assignments
Max travel time
States you’re open to licensing in
4) Supervision/collaboration preferences (critical)
For PAs: how will the supervising relationship be structured?
For NPs: are you in a full practice authority state? If not, who is the collaborating physician and what is required?
5) Compensation goals
Define a minimum effective hourly rate:
Don’t forget travel burden, onboarding time, charting after hours, and risk.
6) Practice environment
Clinic vs hospital vs OR
Staffing: MAs, RNs, techs, scribes, APP colleagues
Support: physician availability, specialist backup, transfer ability
7) Risk tolerance
Some locums sites are smooth and supportive. Some are in crisis. Your goal at the beginning is not heroism—it’s learning the locums process safely.
Step 2: Understand licensing, credentialing, and privileging (where most beginners get stuck)
Credentialing is the least glamorous part of locums—and it’s where new locums clinicians lose time and patience.
Licensing basics for NPs/APNs
You need an RN license and an APRN/NP license (varies by state).
Some states are compact for RN but APRN compacts are more limited (and still not universal).
Prescriptive authority may require additional steps, controlled substance registration, and state-specific rules.
Licensing basics for PAs
You need a state PA license and often a supervising physician agreement.
Supervision language differs widely; some states require specific chart review percentages, onsite requirements, or named supervisors.
Privileging and scope
Even if state law allows something, a facility may not. Hospitals often privilege by:
Specialty-specific roles
Procedures (central lines, intubation, first assist, etc.)
Admission authority
Rounding vs consults
Your assignment must match what you’re privileged to do. Always ask, “Will I be privileged for X?” not just “Will I be doing X?”
Step 3: Build a “credentialing packet” (the single best move you can make)
A credentialing packet saves hours and reduces headaches. Create a secure folder with:
Identity and licensing
Driver’s license/passport
RN license (NPs)
APRN/NP license (NPs)
PA license
DEA certificate (if applicable)
State controlled substance registration (if applicable)
NPI number
BLS/ACLS/PALS/ATLS (as applicable)
Education and training
Diploma and transcripts (sometimes required)
National certification (AANP/ANCC for NPs; NCCPA for PAs)
CME logs (past 2 years)
Employment and references
Updated CV with month/year for all positions
Work history explanations for any gaps
2–3 peer references (supervising physician, lead APP, nursing leader)
Procedure/case logs (for surgical/procedural roles)
Compliance
Immunizations, titers, TB testing
Fit test (N95)
Background check and drug screen (if available)
Malpractice history / COI (certificate of insurance)
Claims history (if applicable)
Having this ready makes you fast—and in locums, speed increases opportunity.
Step 4: Decide whether to go through an agency, direct facility, or APP staffing group
Working with an agency (most common)
Pros
They find assignments
They coordinate travel/lodging
They help with credentialing
They can sometimes negotiate better terms
Cons
Quality varies massively by recruiter
You may feel like the “product” if they don’t understand APP scope
Some recruiters pitch mismatched roles
Working directly with a facility
Pros
Fewer middle layers
Sometimes clearer communication
May lead to permanent offers
Cons
Less support for credentialing/travel
Fewer options
Working with a specialized APP staffing group
Sometimes better for NPs/PAs because they understand scope, but still depends on quality.
Best practical strategy: start with 1–2 good recruiters who consistently bring you roles that match your profile.
Step 5: Choose the right first assignment (this is where you win or lose)
Your first assignment should be optimized for success, not maximum pay.
The “safe first assignment” checklist
Aim for:
Clear schedule (no “as needed” ambiguity)
Lower complexity and predictable workflows
Strong orientation and EHR training
Adequate staffing and physician backup
Reasonable patient volume
A specialty you already practice confidently
Avoid as your first:
Solo coverage in rural settings without backup
High-acuity nights with unclear escalation pathways
Roles with heavy procedures you haven’t done recently
Anything with vague job description (“help where needed”)
Examples of good first roles
Outpatient specialty clinic with stable staff
Hospital service rounding with clear attending support
Urgent care with defined patient caps and transfer protocols
Surgical first assist where the surgeon and team are stable
Step 6: Know what to ask before you say yes (APP-specific)
Before you accept, ask questions that protect your license and sanity:
Scope and supervision
Who is the supervising/collaborating physician?
How accessible are they (onsite, phone, overnight)?
Are there written protocols? What’s the escalation process?
Workload reality
How many patients per day? admissions per shift?
What’s the acuity and common diagnoses?
What procedures are expected?
Support and staffing
How many nurses/MAs/techs per clinician?
Is there a triage nurse?
Is there an APP lead or clinical champion?
Documentation and admin
What EHR is used?
Is there training time paid?
Are you expected to manage inbox/refills/portal messages?
Logistics
Travel/housing: who books? what are the limits?
Credentialing timeline and start date
What happens if the facility cancels?
Safety and escalation
What’s the transfer process?
Are specialists available? What’s the backup plan?
If they can’t answer these clearly, the assignment is higher risk.
Step 7: Contracts and malpractice for advanced practitioners
Many APPs assume “the agency handles it.” Sometimes yes—sometimes partially.
Malpractice basics
Confirm:
Is malpractice provided?
Is it occurrence or claims-made?
If claims-made, who pays tail coverage?
What are coverage limits?
Contract clauses that matter
Exact scope and location
Schedule details and overtime rules
Call expectations and callback pay
Cancellation policy
Payment terms and timesheets
Non-compete language (avoid overly restrictive clauses)
Expectations for extra admin time or floating
Step 8: Prepare clinically for a new site like a professional
The best locums clinicians have a repeatable “site onboarding method.”
Your first-week survival plan
Get the list of key contacts (charge nurse, attending lead, ED lead, OR coordinator)
Learn escalation pathways on day 1
Identify where supplies and equipment live
Create EHR templates early
Clarify consult norms and admission criteria
Ask “what usually goes wrong here?”—then plan for it
Charting strategy
A major locums pain point is charting time. Set a rule:
Close charts daily, or schedule a specific 30–60 minutes post-shift.
Don’t let charts eat your off time.
Step 9: Taxes, pay structure, and protecting your sanity (especially if 1099)
If you’re 1099:
You may need quarterly estimated taxes.
Track expenses, but don’t assume everything is deductible.
Consider a separate business bank account to simplify bookkeeping.
Consider retirement plans that fit contractors (Solo 401(k), SEP IRA) if appropriate.
Even if you don’t want to become a “finance person,” build a simple system. Financial chaos turns locums from freedom into stress.
Step 10: Build a sustainable locums career (avoid the “treadmill”)
Locums is supposed to give you more control. The treadmill happens when:
You book back-to-back assignments without recovery time
You chase higher pay in chaotic environments
You underestimate travel fatigue
You never say no to schedule creep
Sustainability rules that work
Maintain 1–2 “home base” sites if possible (repeat assignments reduce stress)
Cap high-intensity shifts per month
Schedule real off time
Choose organized systems over crisis sites whenever you can
Audit your wellbeing quarterly: sleep, irritability, dread, satisfaction
Step 11: Common locums pathways for advanced practitioners
Here are a few real-world pathways that work:
Pathway A: The “Test Drive” Locums Starter
1 short assignment in your existing specialty
Evaluate fit and workflow
Then repeat at the same site if it’s good
Pathway B: The “Transition Bridge”
Leave a permanent job
Use locums for income while searching for the right long-term role
Choose stability over maximum pay initially
Pathway C: The “Lifestyle Design”
Work 10–16 shifts/month
Travel only quarterly or do local locums
Protect off blocks for family/health
Pathway D: The “Geographic Explorer”
Use locums to test a new state/city
Build licensure and connections
Convert to permanent when the right fit appears
Part 2: FAQs: Locum Tenens for NPs/APNs and PAs
1) What is locum tenens for nurse practitioners and physician assistants?
Locum tenens for NPs and PAs is temporary clinical staffing where you take assignments to fill coverage needs at a facility. Assignments can be short-term or long-term, local or travel-based, and can include outpatient, inpatient, urgent care, or procedural roles depending on your training and privileges.
2) Is locum tenens a good idea for advanced practitioners?
It can be an excellent option if you want flexibility, improved earning potential, variety, or a break from administrative burden. It’s best when you choose assignments with clear scope, good support, and predictable scheduling.
3) How do I start doing locum tenens as an NP or PA?
The first steps are:
Define your specialty, boundaries, and schedule goals
Update your CV and collect references
Build a credentialing packet
Work with a reputable agency or facility
Choose a low-chaos first assignment with strong support
Confirm scope/privileges and malpractice coverage in writing
4) Do I need experience before I do locums?
Many facilities prefer at least 1–2 years of experience in the relevant specialty. Newer clinicians can do locums, but should choose supportive roles with clear supervision, strong onboarding, and lower complexity.
5) What are the best locum tenens jobs for NPs and PAs?
Popular roles include:
Urgent care (with good staffing and defined protocols)
Primary care
Hospital medicine rounding with attending support
Specialty clinics (derm, ortho, cardiology, urology, etc.)
Surgical first assist (for appropriately trained PAs/NPs)
The best job is one aligned with your experience and legal scope.
6) Do NPs have more independence in locums than PAs?
It depends on the state. In full practice authority states, NPs often have more autonomy. In restricted states, NPs may still need collaborative agreements. PAs typically require supervising physician relationships, though the strictness varies by state.
7) Do I need a supervising physician for locums as a PA?
In most states, yes—either a supervising physician or a defined collaboration structure is required. Confirm who it is, how available they are, and what the documentation/review expectations are.
8) What is credentialing and why does it take so long?
Credentialing is the process of verifying your licenses, training, work history, references, and qualifications to grant you privileges at a facility. It can take weeks to months depending on the hospital’s processes.
9) What documents do I need for locum tenens credentialing?
Typically:
Licenses, certifications, DEA (if applicable)
Updated CV with month/year
References
Immunizations and TB testing
Background check/drug screen
Malpractice history
CME documentation
Having a ready “packet” speeds everything up.
10) Do locum tenens NPs and PAs get malpractice insurance?
Many assignments include malpractice coverage, but you must confirm:
Occurrence vs claims-made
Tail coverage responsibility
Coverage limits
Never assume—always verify.
11) How do locum tenens NPs and PAs get paid?
Commonly by hourly, shift, or daily rates. Some roles include extra pay for call or call-back. Payment terms (weekly/biweekly/monthly) vary by contract.
12) Is locum tenens pay higher for NPs and PAs?
Sometimes. It often reflects the lack of benefits and the temporary nature of work. Compare pay based on your true hourly rate after taxes, travel burden, and benefits costs.
13) Who pays for travel and housing for locum tenens APPs?
Many contracts include travel and housing, especially for non-local assignments. Clarify what is covered, limits, and whether the agency books travel or reimburses you.
14) Can I do local locums without traveling?
Yes. Many clinicians do “local locums” or per diem-style locums. This is often the best balance for sustainability: higher flexibility without travel fatigue.
15) What are the biggest risks for advanced practitioners starting locums?
Top risks include:
Taking assignments beyond your scope
Poor supervision/access to physicians
Understaffed sites with unsafe workloads
Inadequate onboarding or EHR training
Documentation overload
The solution is careful job selection and clear written expectations.
16) What questions should I ask before accepting a locums job?
Ask:
Exact schedule, volume, acuity
Scope, procedures, privileges
Supervision structure and escalation pathway
Support staff levels
EHR system and training
Malpractice coverage type
Cancellation policy and pay terms
17) How do I avoid being overwhelmed at a new site?
Ask for orientation time
Get a list of key contacts
Clarify escalation rules early
Use templates and smart phrases
Close charts daily
Don’t accept scope creep
18) What is scope creep and how do I prevent it?
Scope creep is when “clinic coverage” slowly becomes “clinic + inpatient + procedures + call.” Prevent it by having scope defined in writing and politely declining duties outside the agreement.
19) Can locums help with burnout for NPs and PAs?
It can—because it increases control and reduces long-term admin obligations. But it can also introduce stressors like travel and repeated onboarding. Sustainable locums requires boundaries and recovery time.
20) How do I choose my first locums assignment wisely?
Choose the job that maximizes:
Support and onboarding
Clarity of schedule and responsibilities
Fit with your existing skill set
Don’t chase the highest pay for your first role.
21) Can I take time off between assignments?
Yes—this is one of the major advantages. Plan time off intentionally and treat it as non-negotiable, especially if you’re using locums for work-life balance.
22) Do I need my own LLC to do locums?
Not necessarily. Some clinicians use LLCs for administrative reasons, but many do locums as individuals. Consider professional advice for your situation; don’t assume an LLC is required.
23) Do locums APPs need their own health insurance?
If you’re 1099, often yes. Some agencies offer options, but many clinicians buy their own plan. This is part of the tradeoff for flexibility.
24) How do I handle taxes as a 1099 locums NP or PA?
You may need to:
Set aside money for quarterly taxes
Track income and expenses
Consider retirement planning options for contractors
A simple system prevents financial stress.
25) Can locum tenens lead to a permanent job?
Yes. Many clinicians treat assignments as “working interviews.” If the site is a good fit, it can convert into a permanent offer with better confidence and leverage.
26) What if I don’t like an assignment after I start?
It happens. Communicate early with your recruiter/clinical lead, document issues, and prioritize patient safety. Contract terms matter—know the exit and cancellation clauses.
27) How do I build a long-term locums career as an APP?
Find 1–2 good sites and repeat them
Keep your credentialing packet updated
Maintain licensure in strategic states
Protect time off and cap intense shifts
Build routines for travel assignments
28) What are the most common mistakes new locums NPs and PAs make?
Saying yes too quickly
Not clarifying scope and supervision
Ignoring staffing realities
Underestimating EHR/documentation burden
Not planning for taxes/benefits
Booking without recovery time
29) Do I need additional certifications to do locums?
Not always, but depending on role you may need:
ACLS/PALS
Procedural competencies
Specialty certificates
The facility’s requirements vary.
30) What’s the bottom line for starting locum tenens as an advanced practitioner?
Locum tenens can be a game-changer for NPs and PAs—but success depends on preparation, scope clarity, and choosing the right first assignment. Build your credentialing packet, pick a supportive role, define boundaries, and create systems for charting, taxes, and recovery time.