Tuesday, January 26, 2010

Being a locum midwife

Last year I spent a month being a rural midwifery locum. Now that I am reflecting on this experience for my Midwifery Standards Review, I am left with a couple of thoughts.

What skills a locum midwife requires
If you want to be a locum, you MUST be adaptable, willing to think quickly on your feet, confident, a good communicator, self-organised and autonomous. I would also add "experienced" to that list because if you do not have a rounded midwifery experience, it can be difficult to adapt to the ever-changing situations you find yourself in as a locum. You need to be able to build rapport very quickly with the people you work with - it's no good feeling shy - you've got to be prepared to get stuck in very quickly.

What I learned from being a locum
There were four main things that struck me about being a locum.
  1. It is really important you know what to do when there is an emergency..who to call....where the emergency equipment is...what the emergency policies are. It didn't matter to me if I got a 'routine' thing wrong because that could be sorted another time. But it was vital that I could handle an emergency eg I knew how the resuscitation equipment worked and who to call in the secondary hospital if I needed medical advice or back-up.
  2. I practiced in a far more conservative way than I would if I was working with women I knew well. There were two particular cases when I noticed that about my behavior. The first instance was when I transferred a baby to the secondary hospital. If I had been on my own turf I would have monitored the baby overnight, but because I was new to the staff etc, I transferred the baby. The other example was when I drove a very long distance to check on a lady who couldn't get to me. I knew it was probably a waste of time, but I didn't want to take the chance that something was amiss. If I had known the woman, I am sure I would have told her to come and see me when she could in the next couple of days.
  3. The locum does not have the same relationship with a woman as her regular midwife. This was brought home to me because a woman complained that I did not write her notes in the same lovely personal way that her previous midwife had done. To be fair to me, it would have been difficult to write in the same way as a midwife who had known her for months. But it is something I have taken on board for next time - to be more friendly and less clinical in my writing.
  4. It is really important to have a detailed briefing session and get organized before you start work. This reduces the necessity for having to go back to people with questions very five minutes.
What I will do next time
  1. Have a pre-arranged list of questions so I am better prepared eg where policies are kept, emergency procedures, who to ask for help.....
  2. Take time to organize myself how I like to be organized before I start work eg take my own equipment that I am familiar with?
  3. Things are more likely to go awry because I am not so familiar with things, so will pay particular attention to documentation to ensure I have well and truly explained my actions and justification.
Have you ever been in a similar situation where you have worked as a locum or casual member of staff? What advice would you pass onto anyone thinking of working in a similar way?

Image: View from the antenatal clinic at Te Anau


Pam said...

I suppose it has been easier for me being a locum for midwives who I already know in an area I already know.
The advantage I find is that I am not overly emotionally involved with the women and they are surprised when I give similar advice to their LMC and they see that it is a consensus and they can't pull at my emotional strings to get induced when they are 'over it'.

Yes it is a disadvantage to try and establish a rapport quicker I often find the first p/n visits I do are very uniform, quick business like and conversation is difficult yet a week later I am struggling to bring the consultation to an end and to try and leave the house!

As for the A/N visits they are a lot shorter when I am locum often only taking 15mins rather than the 30, however the midwife I used partner with is very much a 'control' kind of midwife and she likes to make sure she covers things her way.
I do miss some of the autonomy as there is a tendency to need to do things as that midwife does it but that is probably because I know her well and I know how she likes things done.
As I blogged the other day I did manage quite quickly to develop a rapport with a woman being induced when I worked in Wellington but because I spent around 10yrs doing labour ward it is probably the environment I feel most secure in.
It is probably easier too, to give slightly more critical feedback about a midwife who has only seen them a short time rather than someone who has looked after them the whole way through.
My horror feedback came from a clinic I once did for my midwifery partner when I decided I would just use my pinards.
Plenty of them said they didn't want that 'weird' wayout hippy midwife again! I am so far from hippy it's not funny!

InfoMidwife said...

yes Sarah I can relate to several of your points.... I do think that when in a different enviroment your practice may be more to the conservative side, as I have found this when I have not had time to build a realationship with a women, and secondly the clinical format of documentation...certainly changes when you see the woman on multiple visits...

Sarah Stewart said...

Hi Pam and Infomidwife, I've just re-read this post and thought I'd probably qualify what I've written, especially as someone on Twitter intimated that I was probably being a tad judgmental and opinionated...and fair enough.

I write this in the context of working in an geographical area I was completely new to. I was well supported by the unit nurses and I knew I could always pick up the phone to talk to a midwife or doctor, but for a while, I was the only midwife in the area. The unit was a rural one, about an hour's drive to the secondary hospital.

I have no right to say how confident, experienced, shy or extrovert a midwife should be when working as a locum - of course, each of us is different & works in different ways. But I would say that if you're going to be a locum, especially a rural locum in an area you don't know, it helps to be some of those things I have listed. It also helps to be able to read a map!!