I’ve been a nurse practitioner (NP) for a few years, and still, the hardest time in my career has been the transition into practice. From NP student to NP in practice. With experience and stumbling blindly along, I gained competence and confidence as all NPs do. Uncertainty and doubt started to fade away with experience and familiarity.
Fear of failure
Maybe it’s not talked about enough, but fear of failure can ebb and flow throughout one’s career. The more fear of failure is discussed, especially as nurse practitioners, the more validation, confidence, and support we will feel throughout our careers.
While things get better over time, there are still periods when doubt and uncertainty creep in. I was suddenly reminded of this when I decided to pursue a locum tenens opportunity for the first time.
What is locum tenens work?
Locum tenens means “to hold place of” in Latin, and it’s a job position where a provider temporarily fulfills another provider’s duties at an organization experiencing a staffing shortage for whatever reason.
With a few years of NP experience under my belt, I decided to take a locum tenens opportunity to expand my clinical experiences, challenge myself, and travel to new parts of the country.
Fears
I wasn’t expecting to feel the doubt and uncertainty that I had initially experienced as a brand-new NP. But I experienced several fears while beginning my work as a first-time locum worker. Some of my fears included:
- Worry that I would be unable to “fill the shoes” of the physician I was taking over for
- Fear that the patient acuity would be too high, and I wouldn’t have enough support
- Anxiety about being the sole provider at this practice setting, being The One and Only
- Worry about learning to navigate a new electronic health record in an efficient manner
- Concern about documenting as eloquently as the previous provider (mind you, this was a locum tenens physician with decades of experience I was taking over for)
- Worry about utilizing telehealth for the first time and being unable to concurrently document and establish therapeutic rapport
- Worry about being the only prescriber and not being around anyone who has a similar role and knows “what it’s like”
- Concern about difficulty interpreting new labs I’m not used to ordering that is typical at this practice site
- Fear about ‘leading’ weekly team meetings, which is something I had not done before
- Fear of coming across as incompetent and unsure (even though I’m not new at this)
- Worry that I would be taking over for a prescriber who was more liberal with prescribing controlled substances
- Worry about letting staff down if I decided to leave the position early before the agreed-upon assignment ends if I didn’t feel I was a good fit
I clearly worried about many things in this new type of setting as a locum tenens worker. Now, I must admit, I’m a Natural Born Worrier by nature, but I knew that many of my fears were warranted, and they all felt very real.
What I’ve learned from my first locums experience
My experience as a first-time locum tenens provider was very different from what I had originally expected it to be. It was much more challenging for me than I anticipated, and it pushed me quite far outside my comfort zone at times.
It’s neat reflecting on what I have learned along the way, though. I’m grateful to have kept a journal recording my experiences as I went. Following my locums assignment, I made a list of some of the things I learned while there, including:
- How to navigate a new and complex electronic health record
- How to concurrently document while doing telehealth with patients and establish therapeutic rapport simultaneously
- How to titrate a medication I was not previously familiar with
- How to multi-task with: prescribing (and administering) long-acting injectables, assess a patient, and document all within one visit (I was not used to being both the RN and the APRN simultaneously, which involved administering injections)
- How to work in an environment that I feel is uncertain and unpredictable*
- How to live in a new part of the country and make it feel like home
- Learned more about my preferences, such as the types of patients I enjoy seeing and the work environments I like
*Truly, the hardest part of doing this type of contract work was getting comfortable in a new, uncertain, and unpredictable environment. No one likes to feel uncertain and that the environment is unpredictable. The dislike of uncertainty is just human nature. We, humans, seek certainty and familiarity. Having to sit in the discomfort of the constant unknowns was really tough for me. There’s not really a way through it that is neat and easy.
How to deal with discomfort and uncertainty
Uncertainty will exist whether you’re a brand-new NP or an experienced NP entering a new setting or type of job. The uncertainty I felt was slightly different as a new grad than when I started doing locum tenens work, but it was still there.
Ways to handle this uncertainty vary greatly from provider to provider, but I did several things that helped me. I do want to note that I was still uncomfortable throughout my time as I navigated this new type of position, but there were things I did that made it easier, including:
- Ongoing meetings with my therapist to work through the challenges and changes I was experiencing (I believe that everyone could benefit from therapy, self-discovery, and self-improvement, which are lifelong activities)
- Daily morning meditation (I was using Headspace at the time)
- (Trying not to) chart on weekends and explore the city I had moved to for the locum tenens assignment
- Journaling about my experiences as they were occurring, including my frustrations and struggles
These activities helped me stay a bit more grounded as I adjusted to the busy, chaotic, and challenging environment at times. I was able to bring the best version of myself to work each day and work through the uncertainty and discomfort.
Nature of locum tenens work and who should consider doing it
Locums work is interesting because it brings forth the resilience in a provider. Often, places looking to hire locums workers have difficulty maintaining full-time, long-term workers for various reasons—a difficult patient population, high staff turnover, undesirable work location (i.e. very remote or cold, etc.), or anything else.
As a result of the difficulty holding onto staff, locums workers are often going into challenging settings with limited resources. These jobs are not often the least stressful in the world.
Now, it sounds like locum tenens positions are all negative, and you might be thinking, why would anyone ever do this sort of work?
I think the answer lies in both the personal and professional growth that occurs from doing it. I learned so incredibly much about myself during my first locum tenens position. I got better at adapting to new environments, handling uncertainty, honing my clinical skills with challenging patients, learning to fit into a new organization’s culture. I also got the chance to serve an under-served population, and I felt the gratitude from the staff I worked with that I was there. I felt appreciated.
I don’t think locums work is good for a new grad; there are already too many unknowns when you are new. But for an experienced NP with some years under their belts, I think it could be a wonderful experience to grow and learn more than you were initially expecting.
