General practice nurses are a crucial part of the primary care team. So should a permanent member of staff become unavailable, locum practice nurses can be a huge asset to the practice to avoid great disruption of care.
If you’re between jobs or looking to top up existing hours, becoming a locum practice nurse could be a great option. But as with any type of work, there are pros and cons to the role. To start off, here are several questions to consider.
What are the financial implications of the role?
It is worth taking some time to plan and understand the financial implications of locum work. Nursing agencies provide locums and you can be added to their register of qualified staff, but this can be expensive for practices. However, agencies also deal with tax, national insurance and find the latest vacancies.
Alternatively, you may decide to do locum work while self-employed or even set up a limited company, but this will mean you have to deal with tax and national insurance payments yourself. You must ensure you have considered the hourly rate, any expenses you require and be prepared to deal with setting aside funds for your tax return at the end of the year. If you have an existing pension, you may also wish to make sure funds are set aside to pay into this.
As an NHS employee, you are automatically given indemnity cover through the employers’ vicarious liability (this also applies within general practice if you are a permanent employee) – but if you are self-employed, you must have indemnity insurance in place through an organisation such as the Royal College of Nursing.
What skills do you have to offer and what do you need to know?
Your means of contacting the practice to look for work can vary from direct contact or via the local LMC websites detailing your availability and contact details. But practice managers, GPs or lead nurses also need to know that they are taking on someone who is not only competent but accountable, reliable and professional. Have you completed the relevant updates for procedures such as cervical smear taking and immunisations?
Ideally, any prospective locum will visit the practice to satisfy mutual questions and concerns. Preparing an accurate and up-to-date CV will boost your chances of getting locum work. This should be clearly laid out and provide succinct information as to your experience, registration details, availability and skills. For example, you should outline the computer systems you are familiar with, such as Emis and System 1.
You also need to define what skills you are happy to undertake – remembering that you are accountable for your competencies and must adhere to the NMC Code. For example, if you agree to see COPD patients, can you operate the spirometer?
Now that everything tends to be linked to the computer, you need to know how to download the recordings of procedures such as spirometry, ECGs etc. There is nothing more infuriating than not being able to download the results to a patient’s notes because you have used the incorrect port. Patients are keen to know their results and GPs want to be able to access them.
Similarly, consider patients on depot neuroleptics, which may be an area outside your comfort zone. From my experience, some patients have certain quirks about how their injection is administered and prepared. Do they like to follow how the injection is prepared and mixed? Do they come with a support worker? Would you know if they were behaving ‘out of character’? This can be a very contentious area of primary care nursing so beware.
You should also check:
- What are the local laboratory protocols and requirements?
- Are you familiar with the blood sampling equipment?
- Do you have a code for taking cervical samples and are you aware of claiming procedure for injections given such as Zoladex/Prostap/Vitamin B12?
- Are you familiar with the Patient Group Directions for the locality and have you been able to sign them?
Pros and cons
As with any role, there are drawbacks to the locum position. For example, it can be isolating. You might find the feeling of not belonging to a team difficult, along with the lack of continuity. Likewise, when communicating with GPs, you might ask yourself whether you should send them an email or message them about any concerns, as there is an element of not wanting to ‘tred on the regular staff’s toes’.
The patients might also be a challenging in the sense of being wary that you are an ‘outsider’. They may want to play you off against the current staff in which case confidentiality comes into play. Some patients may treat you differently as you are ‘the locum’.
However, there are rewarding aspects of carrying out a locum position. If you find that you have an impact on a patient and see them more than once, it will give a huge sense of satisfaction.
You may also be able to give fresh eyes to a variety of situations. Take a long-term patient for frequent dressings as an example. You could ask yourself whether there are discrepancies in the care given and whether you would instigate further tests such as bloods or a doppler test. Likewise, you might see a patient with type 2 diabetes who is poorly controlled, and you might have suggestions to make about their future care. Examples like these could put you in a difficult situation but could also be in the patient’s best interest.
At the end of the day, you are a professional with expertise to offer. Becoming a locum will give you experience of different practices and patient demographics. While you must not feel coerced into doing something that you do not feel competent to do, you have skills that could be of huge satisfaction not only to the patient, but to the practice.
Becoming a locum also gives you far more flexibility and autonomy, as well as the ability to be selective with the role and pay. It might bring you fresh challenges, along with new contacts, colleagues and friendships. Or you may even find yourself liking the environment and deciding that you would like to apply for their latest vacancy!
Katrina Vos has four years’ experience as a locum nurse alongside permanent part-time work.