What to expect from FY1 nights

So I’ve drawn the short straw and starting FY1 nights including covering the first weekend.

I’m guessing it will be standard ward cover/on-call?

Any tips/things to expect would be greatly appreciated!

Reply 1

nexttime

My first tip is to find out what speciality you are working in, and let us in on the secret when you work it out :wink:

Reply 2

Nearlyamedic

Thank you that’s really helpful, I’m hoping it is just a case of typical nerves kicking in! That’s really reassuring!

Reply 3

Nearlyamedic

Original post by nexttime

My first tip is to find out what speciality you are working in, and let us in on the secret when you work it out :wink:

General medicine cover at nights, not exactly narrowing it down sadly!

Reply 4

Hype en Ecosse

Your bleeps will mostly be about things like: re-write this prescription, come prescribe analgesia, come do IV fluids, come replace this person's venflon, this patient has spiked a temp, and this patient is generally unwell (with a problem that is already well-documented), and this patient is unwell (with a new, but very common problem).

To cover these respectively:

1. Just re-write the prescription - but you don't need to rush over to do this if you have other things! Give the staff a realistic timeline for you coming over. If you can pop in quickly on your way to do something else, that's probably an efficient use of your time and will help keep nurses on your side.
2. They can have whatever analgesia is written up prn. Don't be afraid to give them a little bit of oramorph or something like that as long as the patient isn't an opioid dependent chronic pain patient presenting with chronic pain. Ask the nurses what they would normally give and give that - if you're unsure about dose, I'd stick to the lower end at first. If they are still sore, you can always give more later if you need to.
3. Know your local IVF policy, know how to do a quick fluid status assessment, and then withhold fluids or give your institution's maintenance fluid as appropriate
4. Know the bleep numbers for your seniors and the rest of the H@N team. Hopefully your H@N team has some ANPs on it - they are gods at cannulae.
5. You don't need to rush in with antibiotics right away unless you think the patient is very unwell. You have time to pull off bloods, cultures, and get appropriate investigations and start initial management (fluids, paracetamol) as required. Once you're settled on a source, then you can give whatever antibiotics are recommended by your institution's policy. If you're unsure on a source still and think they might need antibiotics overnight, give your senior a phone to discuss it with them. They will probably tell you to treat for sepsis of unknown origin for now, or that they are probably okay without antibiotics for just now.
6. Follow the usual treatment plan from when they have previously had this problem.
7. You know in your head how to treat all the most common stuff - if you need a refresher, have a quick look at one of the FY1 guides like mind the bleep or ATSP to remind you. If still a bit unsure, discuss with senior.

(edited 3 years ago)

Reply 5

Starz678

Original post by Nearlyamedic

Do you have shadowing days? Use these to check all your IT login’s are working, your swipe card lets you in to all the places it should, you know how to use the pods for bloods, where to find protocols/policies on the intranet, is there a Trust app etc

Ask the outgoing F1’s the process for things at night (it may differ from the day) such as how to contact radiology for a portable, getting urgent bloods done, which wards you cover etc What role H@N do, a lot will do all the bloods,cannulas, cultures, catheters, early morning ABG’s etc If you’re asked to do these things by ward staff, if you’re really busy don’t be afraid to redirect them to contact H@N.

Don’t leave handover unless you’re sure you know how to contact seniors, who is your first point of call, is it reg or the SHO. I had one F1 job where I had to contact the reg directly with all questions as the F2s/CTs just did the take out of hours with no ward cover.

A lot of night teams have team breaks at certain times, ensure you know what room they normally meet it, usually H@N co-ordinator will bleep everyone for break.

Write down all the jobs you’re given to make sure nothing gets missed. Find a system that works for you. For example, I had an A4 page, with a different section for each ward I covered. Then I did all the jobs in one ward when I got there (assuming no one was sick elsewhere). Ask the nursing staff if they have anything else that needs to be done before Ieaving)

Plan something nice for your day off or even a nice breakfast out with friends the morning you finish nights so you have something to look forward too.

Reply 6

Etomidate

Write a list and never lose it.

Reply 7

Brachioradialis

Have a look at a couple of apps: Stetho-O-Cope (Android only), and Pocket Doctor. Really useful for on calls.

Reply 8

Ghotay

All of the above advice is good. I would say most important is know who your seniors are and who you can ask for advice. Get the phone numbers of the SHOs/regs/ANPs. Odds are they will all be happy to be contacted even about minor things. They all had a first day once, they know what it's like.

Also, remember that most nurses are really excellent and will help you help them. If you get a bleep to prescribe analgesia, tell the nurse "Hey I'd love to do that, I'm a new F1 starting today so can you please check if over and tell me if it looks right/tell me what you'd like prescribed/whatever". If you are upfront that it's your first day and just need a bit of extra support, 99.9% of people will be totally understanding of that and give you all the tips you need.

I started on nights as an F1 and I'll be honest, it was rough as hell. Not because of the work - I was in a very supportive team and working directly with them on medical receiving so never even out of line of sight of my seniors. But honestly because I was overtired. So be kind to yourself, prioritise sleeping well, and forgive yourself if you don't feel like you were doing a great job because it's never going to be a scenario where you feel like you're getting the best from yourself. It WILL get better

Reply 9

panda1093

Did you guys notice much of a difference between doing F1 nights and F2 nights...?

Reply 10

Starz678

Original post by panda1093

Did you guys notice much of a difference between doing F1 nights and F2 nights...?

F2 nights were a much more pleasant experience. You just don’t get the same volume of rubbish bleeps and you’re more confident in prioritising and saying no to things that don’t need done overnight.

Although have to admit, the first time an F1 called me for help I was scared, more so because I felt like I wouldn’t have much advice to offer and felt I didn’t actually know any more than them. Most of the time a team effort solved the problem.

(edited 3 years ago)

Reply 11

nexttime

Original post by panda1093

Did you guys notice much of a difference between doing F1 nights and F2 nights...?

Again: what speciality? Do you mean medical?

FY2 you can do nights a lot more independently so you can be the only person resident on call for e.g. psych, T&O, plastics, ID, neuro. A lot more responsibility, though you can always phone the (sleeping, non-resident) SpR.

For medicine they can sometimes give you broader roles too - in some places FY1s don't to take nights or cover AMU, whereas an FY2 you almost certainly can.

In medicine, overall you are more used to it though and it feels easier I found. In other specialities if you're alone it can be very scary but you get used to it.