Dealing with First Day Anxiety as a Locum
This article was written by Amelia White, who is an F5 locum doctor and Messly’s Clinical Lead. In this article she discusses her personal experiences with feelings of anxiety related to working as a locum, and gives her top tips for managing these worries. If you're a junior doctor or considering options for your F3 year and want to discuss any particular issues mentioned in this article, email firstname.lastname@example.org.
Over the last few years I have had many ‘First Days’ as a Locum doctor.
First days in new Trusts, on new wards, with new teams. First days working in a new specialty, following new guidelines, or learning new computer systems.
Being a non-training locum doctor has many benefits:
👉 being able to choose my own work schedule
👉 having flexibility to go on holidays with my family and friends
👉 getting paid a rate that I feel reflects my value and experience better
👉 having more time for my hobbies and interests
However, none of that changes the fact that every ‘first day’ experience also gives me debilitating anxiety. Every time I book shifts to work somewhere new and unfamiliar I develop the same physical and psychological symptoms. Sleep disturbance, palpitations, chest pain, agitation, nausea, brain-fog, and paranoia. I’m convinced I’ll be useless, stupid, a burden to the team, a disappointment to the patients, and an unsafe practioner.
Over years of locuming, these fears have never really gone away. If anything, some of these feelings of self-doubt have intensified as I have progressed in my career - I fear that expectations of me are higher the longer I have been out of training, and I worry about my ability to meet those expectations.
However, I have managed to find ways of coping and addressing my stress to ensure that I can continue to live my life as a locum doctor in a way that is useful to my full-time colleagues, and safe for my patients.
In this article I will share my tips and tricks that have helped me deal with first day stress as a locum. If you have questions about my experience, or want to share your own first day tips, please don’t hesitate to get in touch with us at email@example.com.
I can roughly break down my anxieties (and tips) into three categories:
✅ Getting to work
✅ Being at work
✅ Doing the work
🏃️ Getting to work
Addressing my ‘getting to work’ stress makes a huge difference in helping me start my first day with a good mindset. Ensuring that my journey from Home to Handover™ is smooth on my first day means that I have more mental space and energy for the team and patients I am being employed to support.
Here are my tips for how I minimise the on-the-day stress of getting to work.
1. Get the lay of the land
Whenever I am booking shifts (through my Agency or through Staff Banks), I always request:
✅ A map of the grounds and buildings with particular reference to where I should park on the day and where I need to go to pick up my ID badge.
✅ A map of the hospital including the location of the ward I will be working on.
✅ The location of the handover room where I will be meeting the consultant or team member at the start of my shift.
My experience: I recently broke my own rule, and did not insist that the staff parking be highlighted on the hospital map prior to my first on-site visit. Instead, I accepted the instruction from the person running the virtual Hospital Induction to ‘just park in The Quarry and get a day permit from the parking attendants’.
When I did my dry run, I found myself lost and confused when I could see no signs for ‘The Quarry’ and the parking attendants had no idea what I was talking about. When I did eventually find the right place to park, I went to the parking attendants office and waited in a long queue to get my parking permit for the day. They eventually gave me a handwritten permit and told me to display it in the front window of my car. This meant I was walking back and forth from the car to the parking lot which wasted 30 minutes of my time.
If I had been working that morning, I would have been 30 minutes late for work and incredibly stressed. I probably would have risked having my car towed to ensure I made it to handover in time.
2. Dry Run
Personally, I’ve found that visiting the hospital in advance of my first shift has been the main treatment for my First Day anxieties. I try and do these mid-week in the afternoon so that I can catch the regular team at a time when they’re least likely to be busy.
I do the drive from my house to the hospital (or from where I am staying if I am working somewhere far from home), check out the parking situation (Do I need to pay in advance? Do I need a permit? Do I need to register my vehicle?), walk the distance from the car park to the ward (Do I need to arrive early? How bad is the traffic in the morning?), and locate the place I will be meeting my team in the morning for handover (Does my ID Badge give me access to the ward? Is there a code for the door?).
Practicing my the route from ‘Home to Handover’ has helped me answer these questions in advance which frees up brain-space for me on the morning of my first shift. The other benefit is that I usually end up meeting some of the doctors I will be working with, which leads onto my next point.
When I’ve worked far from home in places where I need to spend the night in hospital accomodation or a local hotel, I’ve done an adapted dry run were I head to the hospital the evening before my first shift to pick up my necessary ID badges and accomodation keys. If possible, I head into the hospital and scope out the ward prior to the end of the shift of the day team but if this isn’t possible, I at least try and find out where handover will take place the next day so I can get in early and check my logins all work. Then, I make note of the time it takes to get from the ward to wherever I am staying that night (very easy if it’s on site accommodation) so that I know how long I need to give myself in the morning.
3. Paperwork prep
One thing I find very helpful is speaking to medical staffing or the rota coordinator in advance of the first shift to find out how to submit my timesheets.
In some Trusts, I need to pre-print my timesheets and get them signed on the day by the Ward Manager or Consultant. At others, I need to edit a digital timesheet and they don’t need to be countersigned. Some Trusts use timesheets that are automatically submitted and don’t require me to do anything other than show up for work.
The key thing to establish is the Trust’s policy on working late. Some Trusts allow you to charge overtime and some don’t. Often as a locum, I am asked if I can stay late and knowing in advance whether or not I am permitted by the Trust to do that is important. It is about more than financial compensation - sometimes, your work is not insured outside of your scheduled and agreed hours, in which case you should politely refuse to continue working on routine tasks and should hand these over to the next team taking over care of your patient.
If there is an emergency, then of course you should ensure the safety of your patient before leaving work.
🏥 Being at work
Addressing the ‘being at work’ stress means making sure that I have the basic tools and knowledge needed to make the routine tasks of the day run smoothly.
Over the years, I’ve found much of the stress of locum work comes when I can’t get the routine stuff right. Things like printing the patient list, ordering routine bloods, knowing how to hand over scans and sick patients at the end of the day (especially on a Friday), and of course - how to write a discharge summary.
Being unable to do these basic tasks makes me feel more like a burden than an asset to the team.
Feeling confident that I am contributing to a team and providing value as a locum generally means shifts are much more enjoyable and I’m able to leave at the end of the day with fond memories and a positive attitude. It means I’m more likely to book shifts again in the future, and benefits my income in the long run as I have a positive working relationship with a new Trust or team.
Here are my tips for how I minimise the on-the-day stress of being at work.
1. Morning tasks
During your dry run, I like to speak to the regular team to know when I should be arriving for work and what I need to prepare first thing in the morning. If my shift is 8am - 6pm, but ward round starts abruptly at 8am, then I usually try and give myself at least an extra 30 mins in the morning of my first day. This is primarily to account for any traffic and printer difficulties.
If ward round starts at 8am, and the consultant expects the list to be printed, then you need to know how to access and print the list, and also need to account for printer connectivity issues on the day. You’d be surprised how often this happens.
If your first shift is on a team with other junior doctors then you will have someone around to help you address these issues as they crop up during the day. But if you are going to be working alone (which can happen in community hospitals and smaller district hospitals, or on evening or night shifts) then you need to get answers (and write them down) in advance of your first day.
My experience: I once gave myself an extra 45 minutes on the morning of my first day to try and ensure I wasn’t feeling rushed and to give myself time in the morning to pick up a coffee. After horrible traffic trying to get into the hospital grounds (which I later discovered is a daily issue) I only had 15 minutes before ward round and decided to head straight for the ward and skip the coffee.
It was lucky that I did because even though I had been taught how to access the patient list during my chat with the regular team a few days before, I had forgotten that I needed to add the printer to my printer list, and this took the full 15 minutes I had left before handover started.
I managed to get some patient lists printed in time for handover, but only because another staff member did it for me. It was a while before I managed to figure out how to connect a printer. This leads me onto my next point.
2. Work out the technical difficulties
During my dry run I always ask the team to show me which IT programs they are using and what they are using them for.
In order to do my job, I generally need to know how to:
👉 see the patient list
👉 document in the patient notes and review their medical documents/history
👉 check the patient’s observations, bloods, and imaging
👉 prescribe drugs, fluids, antibiotics, oxygen, and VTE prophylaxis and anticoagulants (i.e. warfarin charts)
Most of these things are done on a variety of computer programmes (through paper notes and drug charts are still prevalent) and require a unique login for each programme. I usually ask the ward doctors to show me how to do each of these things and I write down the processes and apps needed for each. I then find a ward computer and check that my logins for these programmes (which hopefully I have been given in advance) work, and that I am able to login to each system. If not, I ring IT and get it sorted that day.
My experience: At a Trust I worked in recently, I was told by the IT department that they didn’t know which programmes I would need access to in order to do my job as a doctor on the ward. The medical HR and medical rota coordinators didn’t know either. My advice was to simply ‘find a doctor on the ward and ask them’. I usually do this anyway as part of my dry run, but it meant that I spent the majority of the rest of the day doing e-learning on the ward in order to get access to the programmes I needed in time for my start. The alternative however, was to not have access and to need to rely on others for everything (which I have also experienced as a locum. It’s very difficult to get anything done and it doesn’t really endear you to the team, or visa versa).
I know some people will feel that this is unpaid extra work is not worth their time, but I’ve found that having a 20 minute chat with the doctors already doing the job is invaluable, and helps me feel confident and competent going into a new role. Feeling confident that I am contributing to a team, and providing value as a locum generally means the shifts are much more enjoyable and I’m able to leave at the end of the day with fond memories and a positive attitude. It means I’m more likely to book shifts again in the future, and benefits my income in the long run as I have a positive working relationship with a new Trust or team.
✍️ Doing the work
The final stressor I need to tackle is the inherent stress of being a doctor and dealing with unwell and complex patients. Being in a new environment means I’m unfamiliar with the quirks and reputations of the regular staff at the Trust. Over the years, I have learned a couple of key lessons that have always served me well and protected myself and my patients.
1. Embrace your locum identity
When working at a new Trust or with a new team, I start the day by informing those I’ll be working with that it is my first day, and I ask for their patience and understanding while I adapt to the ward processes.
Often, it halts exasperated team members from lumping you in with the other junior doctors, and seeing you as an individual. This is particularly useful on wards where there is an inherent frustration between the nursing and medical staff (i.e. high turnover units where the junior doctors are run off their feet and the nurses are pressured to get patients discharged).
Similarly, if I need to ring a department to chase a scan or get advice, I pre-apologize if I have got a process wrong and mention that I am a locum and it is my first day. I’ve found that people are often more helpful and instead saying ‘you’ve rung the wrong department’ and hanging up on me, they make a bit of an effort to actually solve my query. I’ve found that sometimes this can be used as a tactful approach to getting my scans approved faster and getting quicker results or advice, and often hang up with the regular team in awe of the fact that I have got an echo agreed so quickly or a renal biopsy booked on the spot.
Maybe it’s the fact that I’m not familiar with ward processes, but sometimes having a fresh approach towards solving problems can actually prove your value to the team.
2. Escalating patients
I was once advised to use the phrase ‘I’m trying to prevent admission to (whatever department you’re speaking to)’ and I have to say it was some of the best advice I’ve received. This has been particularly true when I’ve worked in community hospitals and am speaking to ED consultants and medical registrars at the local DGH.
Ultimately, my greatest worry as a doctor (not just a locum) is that I will be confronted with a medical emergency that I cannot manage, and that I wont have the support around me to keep my patients safe. As a locum, I often ring for advice and I am careful to always document the name and grade of the person I have spoken to.
I’ve found that if I ring a department for advice and specifically state that I am looking to prevent admission then I am much more likely to get help when I need it. When I am working alone without consultant support, I find this a really helpful way of getting consultant input for cases I am concerned about, and for establishing criteria for escalating to ED or ITU (depending on where I am working). If the patient’s condition continues to worsen then I can usually skip the battle of getting my patient accepted to that specialty as they have already agreed the threshold for escalation.
3. Medicolegal Protection
One of the major things that gives me some sense of security and protection is ensuring that my medico-legal protection is up to date. If I ever significantly change my ‘role’ (i.e. move to a new Trust or Specialty or drastically change the amount of hours that I am regularly working) I inform my medical protection in writing. This is mostly for big changes - i.e. going from regular locum work in psychiatry to mainly ED working. If you move across medical wards you can tell your medial protection agency that you work across ‘general medicine, acute medicine, and elderly care’ to cover the range of specialties and work you will be doing. However, if you plan on going into Paeds, O+G, ED, ITU or Psychiatry (and maybe Oncology) then you might want to inform them that you will be in a niche specialty to ensure that you are covered.
You can read more about Medical Indemnity cover for locum doctors in our article that was written in collaboration with MDDUS. In the article you can also access your £50 Messly discount code if you decide to sign up with them.
In summary, the locum life has many positives but it can also come with additional stresses and anxieties if you are constantly adapting to unfamiliar work environments. There are ways to mitigate these worries so that you can be helpful, feel positive, and work safely as a locum doctor. For more tips on getting through your first day as a locum doctor, check out this article.
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