Starting FY1 is both exciting and daunting, and I felt the same way in the months leading up to August. This was rapidly replaced by a sense of dread when I received my rota and found out that my first ever shifts as a doctor would be night shifts. Statistically speaking, each rota will have one FY1 who will start on night shifts. If this is you, read on; if not, read on anyway. The information below will still apply to you.
An adequate induction is vital to a smooth transition into work, ideally paired with a period where there is always someone available to answer a question when you can’t figure out how to find something on the computer. Unfortunately, my nights meant I would be missing the departmental induction, so I took it upon myself to arrange one prior to my first shift, alongside a few hours of additional shadowing with the FY1 bleep holder.
It is difficult to understate how much of a difference this made for my first on-call shifts, as it meant I didn’t have to grapple (quite as much) with the new computer system, the bleep and the location of handover.
Getting the night shift set up right
My personal recommendations on how to survive your night shifts:
- Prepare meals and snacks in advance that you will enjoy eating
- Get your life sorted- fresh bedsheets, washed scrubs
- The bedroom: good blinds, an eye mask and some comfy earplugs if you live with others
- Decide on a sleep strategy, whatever it may be
- Make sure you’ve got time to unwind, but also something to look forward to once you finish nights
Handover
Reality hit when I arrived for work at my first handover meeting, as it was straight to business. Unwell patients were discussed, crash team roles assigned, and I had to introduce myself to the many new colleagues as the night FY1 doctor. Before I knew it, the handover had finished, and I was alone in a new hospital holding a very busy bleep, a long list of jobs to crack on with, and clinging onto my coffee cup for dear life.
Initially, I saw handover as the first step in the night shift process, but with time, I’ve learnt how to make the most of it:
- Arrive on time (secure the best seat)
- Bring a piece of paper for your jobs list
- Write down the names, bleep numbers and phone numbers of your on-call team
- Clarify with your colleagues how they prefer to be contacted (phone call or bleep)
A WhatsApp chat with your on-call team gives you the opportunity to ask for non-urgent advice or get a second pair of eyes for that funky ECG. Just keep patient identifiable information off the chat.
The Jobs List
As a ward cover FY1, you will spend the majority of your night shift working through what may feel like a never-ending, increasingly messy list of tasks. It can be very frustrating balancing the satisfaction of ticking easy things off, with the need to answer the bleep and start more long-winded jobs, especially if you can’t make head or tail of what you’ve scribbled on your jobs list.
How to Optimise Your Jobs List
- Start with a blank piece of paper
- Fold it in quarters, eighths, or whatever takes your fancy- I like to fold mine so that I have a section of paper for each ward
- For each job, write the patient’s initials and hospital number. If you write the bed number along,e it can get tricky if you work in a high turnover area where patients are frequently moved
- The sooner you answer the bleep, the more likely the person is to still be on the phone
- Get as much information as possible over the phone; this will help you accurately prioritise the urgency of the job
- Know when to say no- are you the right person for the job? Is this an urgent out-of-hours job, or can it wait until the daytime?
On the ward
It’s hard to know what to do first when you arrive on the ward. Suppose you’ve been asked to see a patient who has deteriorated, or ward staff are concerned. In that case, I can highly recommend walking past the bed space to eyeball the patient before you do anything else - that way, if they look horribly unwell, you can prioritise sorting the patient out prior to other jobs on your list.
In reality, when you are working on call on wards, your assessment of the patient, reading of their notes, documenting and answering your bleep will happen in a mixed (and possibly chaotic) order. Because of this, eyeballing the patient is especially useful.
- If you don’t know where to start, an A-E assessment will rarely fail you
- Form a problems list
- Escalate to your seniors early if you are concerned about a patient
- A basic, sensible plan is better than no plan
- Bookmark your most-used trust guidelines on the work system (antibiotics, electrolyte abnormalities, management of diabetes, chest pain) for quick access
- Be strategic about moving between wards- this can be very time consuming, so try to group jobs by location
Having done my first A-E assessment and documented it, I realised the crucial difference between being a shadowing medical student and a doctor on call- I had to document a plan that I’d come up with myself. The sudden realisation of the responsibility I now had felt almost paralysing, as I was so scared to miss something.
The important thing to remember in this situation is that, whilst it may feel like it, you are never truly alone, and the team is there to help you. You are there to cover the basics, your on-call team will help with the rest - nobody is expecting consultant-level plans from you.
It takes time to adjust to your new role as a doctor, and I’m only starting to feel now, eight months into FY1, that I’ve begun to really find my feet. Allow yourself that time, and be kind to yourself when you are feeling doubtful of your own abilities.
Your colleagues have a wealth of experience from which you can learn, especially your nursing colleagues on every ward. When things don’t go to plan, or if you feel you’ve made a mistake, be upfront about it, debrief with your colleagues, and learn from it. If it’s on your mind, it’s worth discussing with a colleague. I've found these discussions have not only improved my practice but also my bonds with these colleagues.
Whilst I wouldn’t have chosen to start my FY1 experience on nights, I learnt so much from the experience, and am a much better doctor for it. To be working at your best on night shifts, make sure you take your breaks and hydrate, maximise your sleep, reach out to your support network and approach some of the bizarre situations you will find yourself in with humour- all the rest will come with time. After those first few night shifts, everything else will feel much less daunting.
