In this article, Wendy Groves describes her journey from working in a practice to becoming a locum dental nurse

Having worked in a practice in my hometown of Ilminster for 26 years, I was settled and in a routine that was very comfortable; I knew all the patients—life was good. But I wanted more—a challenge. I confided in my boss David, letting him know that I wanted to move on. I handed in my six month's notice; this was before I established the idea of becoming a locum dental nurse.

My last day of working in the practice had arrived, I started to constantly look at the clock—at 11am, I had only two hours to go. My stomach started doing somersaults, and I wondered if I had made the right decision to go ahead and become a locum dental nurse. I was due to leave this steady, regular wage and secure position, and dip my toe into the wide unknown, with no guarantee of work, let alone an income, to start my own locum dental nurse service. I thought to myself, it would work, why would it not? There was not a locum dental nurse service in Somerset who could help us at the practice whenever we were short-staffed. It had to work—I kept repeating this to myself. But my stomach was still doing somersaults, and my heart was skipping beats.

My first locum nursing job

My first locum nursing job started in September 2009, which was just for the afternoon in Taunton, 12 miles away from where I lived. My friend Fiona, who is a hygienist, arranged the booking with her practice to set me in the right direction. Doubts were creeping in again—why did I agree? How did I think I would fit in such a demanding schedule? With traffic to battle, I attempted to stay calm and tried to be ready to deal with the unknown. I was so nervous that I could not eat any lunch, but I was also terrified of being late on my very first venture. I had the correct car park money ready and all I had to do was get there on time.

I arrived with 10 minutes to spare; I ran to the practice and was ready to start at 2 pm. The dentist was lovely, which calmed me down. I looked over the surgery, opened the unit drawers on his side to see how self-sufficient he was, and ran my eyes down the day list—thankfully there was nothing too demanding. The afternoon went well, with no issues. I had to constantly recall and memorise where items were located in the drawers and cupboards. I was enjoying being in a different surgery, having to think on my feet while trying to do a good job. At the end of our session the dentist thanked me for being cheerful and easy to work with. He said he would be in touch again if he was short-staffed. ‘Music to my ears’, I thought. I closed down the surgery with his help and left, exhausted but elated, back to my car.

Getting started

I officially started my business at the beginning of January in the year 2000. I made my own three-fold brochures on my home computer. They explained my rates and what my services would provide. It also included my photograph, a short biography, and contact details. I included an accompanying letter and sent a mailshot to all the practices throughout Somerset. I then had to be patient, and hope the telephone would ring.

The telephone rang periodically at first. With each booking that I took, I made sure that I was punctual, worked cheerfully and calmly, and always reassured nervous patients. I never turned down work—I was always reliable and available to help. I was thoroughly enjoying rising to the daily challenges, meeting new people, making new friends. I worked by myself in a self-employed capacity for just over a year. The phone was starting to ring more by the day for locum dental nurse cover and I was delighted to be more in demand. As pleased as I was to be in this busy situation, I started to get a little concerned because I was beginning to turn down more work as I was already booked out to cover other practices, and did not want to keep turning work away—which is not good for business—so I needed some extra help to be able to supply the demand.

While working in practices as a locum dental nurse I often got approached by the employed nurses at the practice I was working in, who would ask if I wanted more staff and ask about the job, how I got started and so on, as they found they would also like the challenge and would be interested too. I used to make a note of their name and telephone number and the practice to keep on file should I ever be in need of some extra help.

I never approached staff while I was covering for practices as I did not think that was ethical at all, but if I was approached and asked any questions I would willingly answer them. In a way, it was nice for me to work alongside the nurses who approached me in their working environment; I would know if they would be able to cope with locum work, how they handled themselves and their patients, and—just as important—how they handled their team, and how helpful they were over and above their own role within the practice.

When I decided I needed more help, I phoned Tracey, who I was working alongside at the time, who had approached me. She joined me on a self-employed basis, and I booked Tracey to cover practices as a locum dental nurse too. We started to get busier and the business was starting to grow, so I went through the same process and asked a further nurse to join me. At this point I was advised by my accountant that it was an agency and that I should employ the girls, which I did. There are now nine of us on the team and we are still going strong, with a view to expand still.

Locum dental nurse agency

At the time of writing this article (April 2015), I am still running my locum dental nurse agency, and I am proud to now have eight amazing locum nurses working on my team. We are all kept very busy, and I am hoping to expand shortly. All my nurses enjoy their challenges too, and have not looked back since becoming a locum dental nurse—we cannot imagine doing any other job.

A typical day

In my mind, it really starts the night before. I make sure that the car has petrol, as this task would take extra time on the day. The aim is always to get to our destination as soon as possible, especially if we are on a call out day (where we are not booked in to a practice but are waiting for a telephone call from a practice who needs immediate help perhaps due to staff having been taken ill, and who need a locum nurse to cover straight away on the day). I get my tunic and uniform ready, and I prepare my lunch. The day starts by being up and ready by 7 am, but if my telephone rings before, my day will naturally start earlier. When I get a call, and I have gathered all the information I need, i.e. address, postcode, I always ask if they have their own car parking, as searching for a public car park or parking space would also take extra time. I am then ready to leave home and face the new demands for the day. Every booked venture is like starting a new job every day.

On arrival at the practice, I hand over copies of my General Dental Council papers, indemnity insurance, Criminal Records Bureau check, and details of vaccinations to the receptionist or practice manager for them to hold on file. Having changed into my uniform I then ask, if I have not been shown yet, which surgery is mine for the day. The challenge starts here—I relate it to trying to produce a perfect soufflé in someone else's kitchen, when you are not 100% sure what the drawers may contain and what may be hiding in the cupboards. I try very hard not to ask where things are to start with, by feeling my way around. I do find it best to look and search first, because most surgeries are run in the same way. I usually find that the filling materials are all together in the same drawer. The exception to this are usually root canal materials. It never takes long to get in the flow of a particular dentist's ways, having had the experience of many different methods while being a locum dental nurse. There are so many variations in simply passing across an amalgam carrier, for example. Would they like it handed over parallel to the floor, vertical, the nozzle pointing upwards for upper fillings, or the nozzle pointing downwards for the lower? Do I take the amalgam packer instrument from their hand? Do they keep it? Do I send over two carriers one after the other, or are they a one carrier at a time dentist? The dentists do not know this is all going on in my mind. When I passed over the amalgam carrier to a dentist on our first filling procedure together, I noted his placed hand, and passed it over in the position I thought he would want it. It was ever so slightly out. ‘Are there other ways then?’ he said with a smile. I smiled back, ‘A few’, I replied. We do have to adapt very quickly, to ‘their’ ways.

One of the things I like to achieve at the end of the day is to make sure I put everything back where I found it, as the regular nurse would not be too pleased if she/he could not find their materials and instruments where they thought they had left them. I did have an enormous compliment paid when a nurse said to me on a subsequent day I was covering at the practice: ‘I would never have known you had been in my surgery yesterday’. I smiled inwardly, and thanked her for the praise. I was very thrilled to know I had achieved what I set out to do.

The pros and cons

The cons

One of the cons of being a locum dental nurse is that it does give you the feeling of being constantly on call during the working week, but this is the nature of the job—not knowing where you will be working until the last minute.

Another con is longer hours, as all practices do not run the same hours. You may work a late shift one day, and then have an early start the following day. You have to be prepared to twist and turn and run with the hours that they ask you to cover, so locuming is certainly harder due to the fundamental hours, and of course we have to take in to consideration that there will also be variable travel times added to each day.

The pros

I believe that the positives truly outweigh the negatives. Some of the pros include:

• ? The flexibility of the role

• ? The hourly rate is higher

• ? You have the freedom with your holiday dates

• ? You meet new team members

• ? You learn different techniques

• ? You are not involved with any in-house politics

• ? There is no set routine to your week.

Another pro is helping a practice when they are most in need, which gets truly valued and appreciated. They have not had to cancel appointments, their patients are not inconvenienced, and this will keep their practice running smoothly. The very best pro for me is when a patient, who has never met me before, thanks me personally as they leave the surgery—that really makes my day.

Being a locum dental nurse gives me the insight into so many different ways of doing the same procedure. It takes a lot of skill, courage and competence to be a locum dental nurse, and you have to be able to fit right in with each practice. However, once you have tried it, I firmly believe you will love it.

Financial aspects

Being self-employed or employed with an agency are both fairly easy to organise. If you wish to become self-employed you just need to register online with HMRC. You will need to fill in a self-assessment form once a year to calculate how much tax and National Insurance you need to pay. You can either do this yourself or ask an accountancy firm to do this for you, although they will charge a fee. HMRC have a helpline if you have any questions.

If you have any doubts, I would recommend visting your local accountancy office. Ask them what you need to do to get started, letting them know you wish to become a self-employed locum dental nurse. They will guide you through what you need to do. Obtaining the correct information from the outset will help you for the future.

If you wish to work for an agency, the agency will assist you with your tax and paperwork by asking you for your details. You will need a P45 from your previous employment, which is a normal transition from employer to employer.

Final thoughts

I love my job, I love running my agency, I love my team. I have been a dental nurse for a total of 41 years; the last 15 of these I have been a locum dental nurse, running my own business. There have been some challenges, but I am so glad I became a locum dental nurse, and I have never, ever looked back.

Author: MA Healthcare