Advice for FY1 night shifts
Hi everyone,
Does anyone have any advice for starting FY1, particularly for doing night shifts as an FY1?
I'm starting FY1 next month and I just found out I'm starting on nights, and I'm absolutely terrified that I'll be out of my depth and won't know what to do. Any advice at all would be appreciated. Thank you!
Does anyone have any advice for starting FY1, particularly for doing night shifts as an FY1?
I'm starting FY1 next month and I just found out I'm starting on nights, and I'm absolutely terrified that I'll be out of my depth and won't know what to do. Any advice at all would be appreciated. Thank you!
Scroll to see replies
It's a scary way to start an already scary job, but it's manageable.
I would strongly recommend speaking to as many FY1s as possible during your shadowing period to find out where you're expected to be and what your responsibilities are as it works differently in every hospital, and differently in surgery vs medicine.
For example, you need to find out whether you'll be clerking new admissions or covering the wards, or both. You need to find out where handover takes place (usually SAU/MAU doctors office). Get one of those cards with bleep numbers on it and make sure you know how to bleep. When it doubt, go through switchboard. Also, it will probably be your job to make a list of new admissions at the end of the night for the ward round. Your department may already have old lists saved on the computer that you can use as a template (just basics like demographics, bed number, presenting complaint. Surgery seems to like lists with blood results and imaging which is a ballache).
My second tip would be to make a jobs list and be organised. If you're covering the wards, arrange it by location so you can do things as you're in that place. If you're clerking, make a list with tickboxes for bloods, imaging, regular Rx, management, VTE assessment and fill them in as you go along.
Third, when in doubt, do an A to E assessment before anything else. And if you feel out of your depth or you get more than one sick patient at a time, call for help. Do the basics: IV access, bloods, gasses, ECG, CXR, fluids. Use the intranet for local policies and antibiotic prescribing.
Finally, look after yourself. Nobody will tell you to have a break, but there will be plenty of people who will ask you for one last "five minute" job. They don't care that you haven't had a drink in 7 hours, they just want you to prescribe whatever ********.
It will be a good year and a **** year but you will grow as a doctor. Stick together with the other FY1s and engage with mess events. Blowing off steam with your colleagues will keep you sane.
I would strongly recommend speaking to as many FY1s as possible during your shadowing period to find out where you're expected to be and what your responsibilities are as it works differently in every hospital, and differently in surgery vs medicine.
For example, you need to find out whether you'll be clerking new admissions or covering the wards, or both. You need to find out where handover takes place (usually SAU/MAU doctors office). Get one of those cards with bleep numbers on it and make sure you know how to bleep. When it doubt, go through switchboard. Also, it will probably be your job to make a list of new admissions at the end of the night for the ward round. Your department may already have old lists saved on the computer that you can use as a template (just basics like demographics, bed number, presenting complaint. Surgery seems to like lists with blood results and imaging which is a ballache).
My second tip would be to make a jobs list and be organised. If you're covering the wards, arrange it by location so you can do things as you're in that place. If you're clerking, make a list with tickboxes for bloods, imaging, regular Rx, management, VTE assessment and fill them in as you go along.
Third, when in doubt, do an A to E assessment before anything else. And if you feel out of your depth or you get more than one sick patient at a time, call for help. Do the basics: IV access, bloods, gasses, ECG, CXR, fluids. Use the intranet for local policies and antibiotic prescribing.
Finally, look after yourself. Nobody will tell you to have a break, but there will be plenty of people who will ask you for one last "five minute" job. They don't care that you haven't had a drink in 7 hours, they just want you to prescribe whatever ********.
It will be a good year and a **** year but you will grow as a doctor. Stick together with the other FY1s and engage with mess events. Blowing off steam with your colleagues will keep you sane.
(edited 7 years ago)
Starting on nights is pretty scary, but to be honest, in some ways it's possibly better than starting on days!
In terms of advice, simple things first - make sure all your computer passwords are working and you know how to request bloods and X-Rays; have lots of spare pens and paper for taking a handover; have a supply of continuation sheets, fluid charts, insulin charts etc. as there will inevitably be none on the wards when you need them (those clipboard file things are a great idea). Make sure you know who your senior point of contact is if you are having problems and don't be scared to contact them for advice. They will know you're only just starting and will fully expect you to ask for help, even with simple things!
In terms of assessing patients, don't panic and think ABC. This http://www.eastlancsdpe.nhs.uk/images/ATSP%20Book%202011.pdf is quite a good outline of the commoner things you will be asked to do as an FY1 on nights and how to approach them. But to be honest, you will probably want to run most things past someone more senior on your first set of nights, and it will definitely be expected!
Essentially, regardless of how much your prepare, your first few weeks of FY1 will be stressful and hard, and you have to prepare yourself for this. I found that people were incredibly supportive on my first job, both on nights and during the day job, and this has also been the experience of other FY1s I know. The worst thing is actually waiting for the job to start, but once you are there, you will get into fairly quickly and your confidence will begin to grow.
In terms of advice, simple things first - make sure all your computer passwords are working and you know how to request bloods and X-Rays; have lots of spare pens and paper for taking a handover; have a supply of continuation sheets, fluid charts, insulin charts etc. as there will inevitably be none on the wards when you need them (those clipboard file things are a great idea). Make sure you know who your senior point of contact is if you are having problems and don't be scared to contact them for advice. They will know you're only just starting and will fully expect you to ask for help, even with simple things!
In terms of assessing patients, don't panic and think ABC. This http://www.eastlancsdpe.nhs.uk/images/ATSP%20Book%202011.pdf is quite a good outline of the commoner things you will be asked to do as an FY1 on nights and how to approach them. But to be honest, you will probably want to run most things past someone more senior on your first set of nights, and it will definitely be expected!
Essentially, regardless of how much your prepare, your first few weeks of FY1 will be stressful and hard, and you have to prepare yourself for this. I found that people were incredibly supportive on my first job, both on nights and during the day job, and this has also been the experience of other FY1s I know. The worst thing is actually waiting for the job to start, but once you are there, you will get into fairly quickly and your confidence will begin to grow.
(edited 7 years ago)
Original post by Etomidate
Finally, look after yourself. Nobody will tell you to have a break, but there will be plenty of people who will ask you for one last "five minute" job. They don't care that you haven't had a drink in 7 hours, they just want you to prescribe whatever ********.
This is very true and definitely the most important skill to learn as an FY1. **
Original post by girl_in_black
This is very true and definitely the most important skill to learn as an FY1. **
I think I lost about 5kg in my first job as a house officer
Original post by Etomidate
I think I lost about 5kg in my first job as a house officer
I've yet to meet an FY1 who hasn't lost weight during their first job
I've enjoyed all my night shifts bar two which were just constant admissions and I lost the ability to speak properly or think clearly by the end. Believe it or not it might actually be easier to start on nights, though it seems a lot more scary, as there are fewer things to distract you, less people about to bother you, and you are not going to be harassed to write IDLs all night (and if they do you can tell them to go **** themselves).
Drink coffee at the start of the night, but be careful after 2-4am not to over do it or you won't sleep. Bring plenty of snacks, and a 'lunch' and breakfast/dinner to have. If you have to cover wards on your nights (rather than an admissions unit) its handy to have little snacks you can carry in your pockets while you roam.
Another tip is to have a full bladder for the drive home, keeps you awake. *Sometimes having a wee lie down and shut eye for a brief moment means that you can wake up and become a bit more efficient. If I can I will try and get atleast 15min during the night of 'quiet time'. My surgical nights have been amazing, I've even very lucky and usually managed to get an hours sleep on most night shifts (sometimes longer) curled up on some chairs or the floor. On medicine I tended just to lay my head on my desk and close my eyes for a few min before throwing myself back into the fray.
When you see someone sick the adrenaline kicks in (for me it does so more at night than in the day) so things become a bit more clear, and as everyone else says ABCDE and call for help.
Drink coffee at the start of the night, but be careful after 2-4am not to over do it or you won't sleep. Bring plenty of snacks, and a 'lunch' and breakfast/dinner to have. If you have to cover wards on your nights (rather than an admissions unit) its handy to have little snacks you can carry in your pockets while you roam.
Another tip is to have a full bladder for the drive home, keeps you awake. *Sometimes having a wee lie down and shut eye for a brief moment means that you can wake up and become a bit more efficient. If I can I will try and get atleast 15min during the night of 'quiet time'. My surgical nights have been amazing, I've even very lucky and usually managed to get an hours sleep on most night shifts (sometimes longer) curled up on some chairs or the floor. On medicine I tended just to lay my head on my desk and close my eyes for a few min before throwing myself back into the fray.
When you see someone sick the adrenaline kicks in (for me it does so more at night than in the day) so things become a bit more clear, and as everyone else says ABCDE and call for help.
(edited 7 years ago)
Original post by girl_in_black
I've yet to meet an FY1 who hasn't lost weight during their first job
I didn't! But I did have a particularly cushy supernumerary first job with no nights or weekends and we had a baking rota and a fully stocked biscuit cupboard all to ourselves...
Original post by Hygeia
I didn't! But I did have a particularly cushy supernumerary first job with no nights or weekends and we had a baking rota and a fully stocked biscuit cupboard all to ourselves...
Wow, that sounds like heaven. Baking rota in particular. What was the job?
Original post by Ghotay
Wow, that sounds like heaven. Baking rota in particular. What was the job?
Paeds in a DGH. I was banded 1b from doing long day every other week but i didn't hold an on call bleep and was just there as an extra pair of hands really!
Original post by lyra1987
I must be the only person looking forward to my future FY1 post purely for the "you will lose weight without even trying" thing.
No, that's definitely one of the things I'm looking forward to! I'll probably actually end up gaining weight from stress eating though...
Original post by girl_in_black
I've yet to meet an FY1 who hasn't lost weight during their first job
I totally gained weight from all the snacking haha!
Posted from TSR Mobile
Original post by girl_in_black
I've yet to meet an FY1 who hasn't lost weight during their first job
*hand up* F1 has mostly left me with no time and/or motivation for my usual exercise! It screws with your meal times doing long days and so on - I can't hold out until 10pm to have dinner so end up snacking when I never used to snack on anything. And of course when I do eat, it's mostly rubbish that I have psychologically 'earnt' via working crappy hours haha. I've definitely put on a good few kilos this year, got to get rid of them somehow...
(edited 7 years ago)
I just found out I start on nights too and am genuinely so nervous! I keep worrying about me being the only F1 looking after hundreds of patients I have no idea about, don't know the wards, the doctors, the nurses, anyone. Don't know where the equipment is, how to order scans, what the consultant wants. I am really worried something is going to happen and feel so out of my depth. I know there are people to ask for sick patients, but I can't bleep my reg because I've never done a female cath or because I can't decide what fluids to prescribe... I just felt in the day there would be other people around, my level who can help without judging me!
I've never even done a night at medical school (terrible I know, but we didn't have to so latest I ever stayed was about 11) and have no idea really what I should be doing on nights. Do I cover wards or clerk new patients, no idea! I'm on general surgery if that makes any difference (and I hate surgery!) Just feel this has made my last week off so stressful and I have no idea what to do
I've never even done a night at medical school (terrible I know, but we didn't have to so latest I ever stayed was about 11) and have no idea really what I should be doing on nights. Do I cover wards or clerk new patients, no idea! I'm on general surgery if that makes any difference (and I hate surgery!) Just feel this has made my last week off so stressful and I have no idea what to do
Original post by Anonymous
I just found out I start on nights too and am genuinely so nervous! I keep worrying about me being the only F1 looking after hundreds of patients I have no idea about, don't know the wards, the doctors, the nurses, anyone. Don't know where the equipment is, how to order scans, what the consultant wants. I am really worried something is going to happen and feel so out of my depth. I know there are people to ask for sick patients, but I can't bleep my reg because I've never done a female cath or because I can't decide what fluids to prescribe... I just felt in the day there would be other people around, my level who can help without judging me!
I've never even done a night at medical school (terrible I know, but we didn't have to so latest I ever stayed was about 11) and have no idea really what I should be doing on nights. Do I cover wards or clerk new patients, no idea! I'm on general surgery if that makes any difference (and I hate surgery!) Just feel this has made my last week off so stressful and I have no idea what to do
I've never even done a night at medical school (terrible I know, but we didn't have to so latest I ever stayed was about 11) and have no idea really what I should be doing on nights. Do I cover wards or clerk new patients, no idea! I'm on general surgery if that makes any difference (and I hate surgery!) Just feel this has made my last week off so stressful and I have no idea what to do
Breathe! You'll be fine.
It's a requirement to undertake a period of shadowing, during which you can ask about what your role is on a night shift.
If you're covering the wards, your priority is keeping people safe. Anything else can wait. When patients go off in surgery, it tends to be a simpler problem. The biggest part of your job will be prescribing antibiotics. You can use the hospital intranet to guide you.
With fluids, just know what you're aiming to do. Resuscitate or maintain? In a general ward population, crystalloids are crystalloids. 9 times out of 10, hartmanns will do fine or normal saline with a bit of maintenance potassium in it. It's good practice to check renal function before prescribing fluids.
When it doubt, 250mL boluses. You can always put more in, but taking it out is trickier.
The nurses will guide you and help you out. They've seen it all before.
If you are worried about a sick patient, call your SHO or registrar. But remember the basics: oxygen, IV access, bloods, fluids, blood gas, ECG, CBG, CXR/AXR etc.
You're not the first person to go through this. We all do, and we all make it through just fine!
Original post by Anonymous
I just found out I start on nights too and am genuinely so nervous! I keep worrying about me being the only F1 looking after hundreds of patients I have no idea about, don't know the wards, the doctors, the nurses, anyone. Don't know where the equipment is, how to order scans, what the consultant wants. I am really worried something is going to happen and feel so out of my depth. I know there are people to ask for sick patients, but I can't bleep my reg because I've never done a female cath or because I can't decide what fluids to prescribe... I just felt in the day there would be other people around, my level who can help without judging me!
I've never even done a night at medical school (terrible I know, but we didn't have to so latest I ever stayed was about 11) and have no idea really what I should be doing on nights. Do I cover wards or clerk new patients, no idea! I'm on general surgery if that makes any difference (and I hate surgery!) Just feel this has made my last week off so stressful and I have no idea what to do
I've never even done a night at medical school (terrible I know, but we didn't have to so latest I ever stayed was about 11) and have no idea really what I should be doing on nights. Do I cover wards or clerk new patients, no idea! I'm on general surgery if that makes any difference (and I hate surgery!) Just feel this has made my last week off so stressful and I have no idea what to do
Are you doing shadowing before you start? That should help you to learn some of the things you describe - how to order things, basic layout of wards, names of a few of the nurses, possibly even meet your consultant and get an idea of their basic preferences. You'll also be able to talk to the outgoing F1 who can tell you what's expected - probably mostly ward cover, but possibly also doing some clerking and assisting in theatres, though all of this varies between hospitals.
Don't forget you will also have an SHO to ask for help, so you don't have to escalate everything straight to your reg!
Original post by Etomidate
Breathe! You'll be fine.
It's a requirement to undertake a period of shadowing, during which you can ask about what your role is on a night shift.
If you're covering the wards, your priority is keeping people safe. Anything else can wait. When patients go off in surgery, it tends to be a simpler problem. The biggest part of your job will be prescribing antibiotics. You can use the hospital intranet to guide you.
With fluids, just know what you're aiming to do. Resuscitate or maintain? In a general ward population, crystalloids are crystalloids. 9 times out of 10, hartmanns will do fine or normal saline with a bit of maintenance potassium in it. It's good practice to check renal function before prescribing fluids.
When it doubt, 250mL boluses. You can always put more in, but taking it out is trickier.
The nurses will guide you and help you out. They've seen it all before.
If you are worried about a sick patient, call your SHO or registrar. But remember the basics: oxygen, IV access, bloods, fluids, blood gas, ECG, CBG, CXR/AXR etc.
You're not the first person to go through this. We all do, and we all make it through just fine!
It's a requirement to undertake a period of shadowing, during which you can ask about what your role is on a night shift.
If you're covering the wards, your priority is keeping people safe. Anything else can wait. When patients go off in surgery, it tends to be a simpler problem. The biggest part of your job will be prescribing antibiotics. You can use the hospital intranet to guide you.
With fluids, just know what you're aiming to do. Resuscitate or maintain? In a general ward population, crystalloids are crystalloids. 9 times out of 10, hartmanns will do fine or normal saline with a bit of maintenance potassium in it. It's good practice to check renal function before prescribing fluids.
When it doubt, 250mL boluses. You can always put more in, but taking it out is trickier.
The nurses will guide you and help you out. They've seen it all before.
If you are worried about a sick patient, call your SHO or registrar. But remember the basics: oxygen, IV access, bloods, fluids, blood gas, ECG, CBG, CXR/AXR etc.
You're not the first person to go through this. We all do, and we all make it through just fine!
Thank you! Sorry, it all came out in a massive rush, I only just found out and had a panic attack. I think breathe is probably the best suggestion! It just wasn't at all what I expected or had prepared myself for so got myself into a bit of a state, but your advice really helped, I suppose I just needed someone to point it out, take a breath and do the basics and if I'm worried about a patients just ask
I totally forgot about shadowing! Of course that will help, I suppose I'm worried about someone dying because of me (ok maybe a bit OTT) and also that I'm going to mess up things for the day shift and automatically make my new consultant/reg think I'm terrible and my other F1s think I'm useless!Original post by Helenia
Are you doing shadowing before you start? That should help you to learn some of the things you describe - how to order things, basic layout of wards, names of a few of the nurses, possibly even meet your consultant and get an idea of their basic preferences. You'll also be able to talk to the outgoing F1 who can tell you what's expected - probably mostly ward cover, but possibly also doing some clerking and assisting in theatres, though all of this varies between hospitals.
Don't forget you will also have an SHO to ask for help, so you don't have to escalate everything straight to your reg!
Don't forget you will also have an SHO to ask for help, so you don't have to escalate everything straight to your reg!
Thank you Helenia, yes forgot about shadowing and SHOs! I don't even really know the system for nights so would there generally be an SHO and a reg around? Think I just felt really out of my depth and like there is no way I can do this or know enough to be looking after that many patients, but now I've calmed down a bit (!) I realise I'm not going to be all on my own and I won't be completely clueless! Thanks so much
Original post by Anonymous
Thank you! Sorry, it all came out in a massive rush, I only just found out and had a panic attack. I think breathe is probably the best suggestion! It just wasn't at all what I expected or had prepared myself for so got myself into a bit of a state, but your advice really helped, I suppose I just needed someone to point it out, take a breath and do the basics and if I'm worried about a patients just ask I totally forgot about shadowing! Of course that will help, I suppose I'm worried about someone dying because of me (ok maybe a bit OTT) and also that I'm going to mess up things for the day shift and automatically make my new consultant/reg think I'm terrible and my other F1s think I'm useless!
Thank you Helenia, yes forgot about shadowing and SHOs! I don't even really know the system for nights so would there generally be an SHO and a reg around? Think I just felt really out of my depth and like there is no way I can do this or know enough to be looking after that many patients, but now I've calmed down a bit (!) I realise I'm not going to be all on my own and I won't be completely clueless! Thanks so much
I totally forgot about shadowing! Of course that will help, I suppose I'm worried about someone dying because of me (ok maybe a bit OTT) and also that I'm going to mess up things for the day shift and automatically make my new consultant/reg think I'm terrible and my other F1s think I'm useless!Thank you Helenia, yes forgot about shadowing and SHOs! I don't even really know the system for nights so would there generally be an SHO and a reg around? Think I just felt really out of my depth and like there is no way I can do this or know enough to be looking after that many patients, but now I've calmed down a bit (!) I realise I'm not going to be all on my own and I won't be completely clueless! Thanks so much
Yes, there will almost certainly be an SHO and most places still have a resident reg as well (though do check your hospital's set up before calling them!) They may be busy clerking or in theatre but you can still call them. You'll usually meet at the start of the night to divide up tasks etc.
There are very few things you can do as an FY1 that will cause someone to die just because of you. The most risky thing is not calling for help if you're unsure.
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