On one of my locum assignments as an emergency medicine physician, a kid came in with an epidural hematoma with midline shift. For a moment, I froze. But not for the reason you’d think.
I wasn’t worried about the medicine. I’m a pediatric emergency physician. I’ve managed critically ill children hundreds of times. I knew exactly what this kid needed. What I didn’t know was how to activate the system at a hospital I’d never worked in before. And that moment taught me something that every locum physician needs to hear.
The Real Fear in Locum Tenens Isn’t Clinical
When physicians think about working locums, the fear that comes up most often is clinical competence:
“What if I get a case I can’t handle?”
“What if I’m not good enough?”
“What if something goes wrong and I’m the only one there?”
These fears almost never play out. You earned your medical degree. You completed residency. You’ve been practicing medicine. Your clinical skills travel with you to every facility you walk into. The medicine is the medicine, whether you’re in a Level 1 trauma center in a major city or a critical access hospital in a rural community.
The real fears with locums are logistical. Where is the crash cart? How do I activate the rapid response team? What’s the code for the medication dispensing system? Who do I call when I need a specialist consult at 2 AM? These are the questions that create anxiety on your first day at a new facility, and they have nothing to do with whether you’re a good doctor.
Managing a Critical Case on a New Locum Tenens Assignment
That kid with the epidural hematoma needed immediate intervention. In my home hospital, I would have hit a button, called a code, and had a full team at the bedside within minutes. I knew every nurse by name. I knew which neurosurgeon was on call. I knew the system like the back of my hand.
At this facility, I knew none of that. I had the clinical knowledge but not the institutional knowledge. For about thirty seconds, that gap felt terrifying.
So I did the only thing that made sense: I grabbed the charge nurse and said, “I have an emergency in this room. I need everyone here as fast as possible. What do I do?” She didn’t hesitate. “We’re upgrading this to a trauma. Trust me, everyone will come.”
Two minutes later, that kid had a full team. Neurosurgery was on the phone. The OR was being prepped. The kid did just fine.
Why Asking for Help Matters When Starting a Locum Tenens Assignment
The Culture of Self-Sufficiency in Medicine
Medicine trains us to be self-reliant. We’re taught that asking for help is a sign of inadequacy. Attending clinicians who call consults too freely get labeled as weak. Residents who ask too many questions worry about their evaluations. The entire culture reinforces the idea that competence means being fiercely independent and figuring it out on your own.
This culture is toxic in any clinical setting, but it’s especially dangerous for locum physicians walking into unfamiliar environments. You cannot know the institutional quirks of every hospital. You cannot memorize every EMR workflow before your first shift. You are not expected to. And pretending otherwise puts patients at risk.
What Nurses and Staff Actually Think About Locum Tenens Physicians
Here’s something I’ve learned after years of locums work: nurses and staff respect physicians who ask questions. They don’t think less of you for saying, “This is my first shift here. Can you walk me through how you activate your trauma team?” They think less of you when you pretend to know and fumble through it.
The charge nurse who helped me that night didn’t see a doctor who couldn’t handle the case. She saw a doctor who prioritized getting her patient the fastest possible care over protecting her own ego. That’s the kind of physician everyone wants to work with.
Practical Strategies for Your First Day at a New Facility
The First-Hour Checklist
Before you see your first patient, invest thirty minutes in orientation. Find the charge nurse and introduce yourself. Ask where the crash cart is. Ask how to activate the rapid response and trauma teams. Ask about the code system and any facility-specific protocols. Get the phone numbers you’ll need for consults, radiology, and pharmacy.
This isn’t embarrassing. It’s professional. Airline pilots run through checklists before every flight, even if they’ve flown the same route a thousand times. Physicians working at a new facility should do the same.
How to Build Relationships Quickly on a Locum Tenens Assignment
Learn names. Introduce yourself to the nursing staff, the techs, the unit secretary. Ask the nurses which attending was here before you and if there are any patients you should know about. These small interactions build trust quickly and create allies who will help you when you need it.
I’ve found that a genuine “I’m new here, and I want to make sure I do this right” goes further than any attempt to project confidence you don’t feel. People help people who are honest about what they need.
Why the Right Locums Agency Makes Your First Shift Easier
A good locums agency like Barton prepares you before you arrive. They should provide facility-specific orientation materials, EMR information, parking instructions, and key contact numbers. If your agency partner isn’t giving you this level of preparation, that’s a red flag.
I’ve worked with Barton Associates on assignments where they proactively connected me with the facility’s medical director before my first shift. That kind of preparation turns a potentially stressful first day into a smooth transition.
The Lesson That Applies Beyond Locums
Asking for help isn’t a locums skill. It’s a physician skill. It’s a human skill. But locums work forces you to practice it more frequently because you’re regularly walking into new environments where you genuinely don’t know the local systems.
That practice has made me a better physician everywhere I work. I’m faster to ask for help when I need it. I’m more comfortable saying “I don’t know how this works here.” I’m less attached to the fiction that competence means never needing assistance.
The fears that hold physicians back from locums are real, but they’re almost always about logistics, not clinical ability. And logistics fears have a simple solution: ask someone who knows. You’ll be surprised how fast help comes.
